Treatment of Gastritis in Children

Initial Management Approach

The American Academy of Pediatrics recommends lifestyle modifications, including dietary changes and feeding modifications, as the first-line treatment for gastritis in children 1
Dietary changes, such as avoiding trigger foods, and feeding modifications, like reducing meal size and increasing meal frequency, should be implemented as the first step in managing gastritis in children 1
For infants, a maternal elimination diet or hydrolyzed protein formula may be considered, and thickening feedings with rice cereal may help reduce symptoms 2

If symptoms persist after 2-4 weeks of lifestyle modifications, consider pharmacologic therapy, such as acid suppressants, including H2 Receptor Antagonists (H2RAs) and Proton Pump Inhibitors (PPIs) 1
The American Academy of Pediatrics recommends an initial trial of PPIs for 2 weeks, and if symptoms improve, continue for 8-12 weeks 4
Dosage examples for PPIs include omeprazole (0.7-3.3 mg/kg/day) and lansoprazole (0.7-3 mg/kg/day) 3

Evaluate response to therapy after 4-8 weeks, and if symptoms persist despite appropriate therapy, consider further evaluation with upper endoscopy and esophageal biopsy 1
Referral to pediatric gastroenterology may be necessary if symptoms persist despite appropriate therapy 4, 1

Avoid overtreatment with acid suppressants, particularly PPIs, due to potential risks including community-acquired pneumonia, gastroenteritis, and candidemia 1
In infants with uncomplicated regurgitation, avoid medications and focus on parental education and reassurance 4, 5
Weight loss is a crucial warning sign that should alter clinical management in infants 5
Be aware that many clinical conditions may mimic GERD symptoms, so careful follow-up of all treated patients is essential 5