Omeprazole Pediatric Dose — Gastrointestinal (GERD/Acid Suppression)
Omeprazole is a proton pump inhibitor (PPI) that irreversibly inhibits the gastric H⁺/K⁺-ATPase enzyme, suppressing gastric acid secretion. It is used in pediatric patients for the management of gastroesophageal reflux disease (GERD), erosive esophagitis, and acid-related conditions. At CHKD, its use is restricted to children weighing less than 10 kg.
Pediatric Dosing
The following doses apply to children under 10 kg per institutional protocol at CHKD. Omeprazole is administered orally (PO).
- General pediatric dose (infants and children <10 kg): 0.5–1 mg/kg/dose PO, given daily or every 12 hours
- Pre-term infants: 0.7 mg/kg/day PO
Worked example — 8 kg infant: At 1 mg/kg/dose given every 12 hours: 8 × 1 mg/kg = 8 mg per dose, administered twice daily. At the pre-term infant dose of 0.7 mg/kg/day: 8 × 0.7 mg/kg = 5.6 mg once daily. Consult institutional protocol for maximum single dose and available formulations.
Indications and Clinical Context
Omeprazole is indicated in this weight-restricted population primarily for the treatment of GERD and acid-peptic disorders in infants and young children. Symptoms such as feeding intolerance, irritability, and poor weight gain secondary to pathologic acid reflux may prompt PPI therapy. The twice-daily dosing option may be considered for more refractory or symptomatic cases requiring greater acid suppression throughout the day.
Pre-term infants represent a distinct population with immature gastrointestinal physiology, and the reduced once-daily dose of 0.7 mg/kg/day reflects the altered drug metabolism and increased sensitivity in this group. Empiric PPI therapy should be weighed against evidence for benefit, as routine use in non-erosive reflux in infants is not universally supported by guidelines; diagnosis should guide prescribing decisions.
Administration and Monitoring
Omeprazole is administered orally (PO), ideally 30 minutes before a feed or meal to optimize efficacy. For infants unable to swallow capsules, compounded oral suspensions or granule preparations mixed with water or acidic liquid (per formulation instructions) may be used. Confirm availability and appropriate formulation with pharmacy, particularly for pre-term neonates.
- Administer 30 minutes prior to feeding when possible
- Monitor for adequate clinical response: improvement in feeding tolerance, weight gain, and reduction in regurgitation-related symptoms
- Adverse effects to monitor include diarrhea, headache, and — with prolonged use — hypomagnesemia and increased susceptibility to enteric infections
- Restricted to patients under 10 kg per CHKD institutional protocol; for children ≥10 kg, consult institutional protocol for appropriate agent and dosing
- Consult pharmacy for compounding requirements and dose rounding in pre-term infants
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.