Nexium: How to Mix and Give Nexium Powder Suspension to Children

Many infants suffer from a condition known as gastro-esophageal reflux disease, or GERD. Generally, this condition resolves itself by the time a child is about 18 months old, though it may require medical treatment during the time when the disease is active. GERD in infants can range from a benign condition to a very severe form of the disease requiring medication, surgery, or alternative feeding methods via a gastrostomy tube (g-tube). Less commonly, toddlers and preschool-aged children have persistent severe gastro-esophageal reflux disease, which can affect growth, nutrition, and development. Persistent severe GERD is sometimes, though not always, associated with other conditions including neuromuscular conditions.

For children who require medical therapy, the first step is typically an acid-blocker, such as Zantac (ranitidine), Tagamet (cimetidine), or Pepcid (famotidine). If the acid-blocker is unable to adequately control the GERD, a proton pump inhibitor (PPI) will be used. PPI medications include Prilosec (omeprazole), Nexium (esomaprazole), and Prevacid (lansoprazole). In some particularly severe cases, an acid-blocking medication and a PPI will be required to control the GERD. For children who fail medical therapy, a surgery called a fundoplication may be performed to stop the acid reflux.

Nexium is a common PPI prescribed to children. The recommended dosage for children ages 1-11 years is 10mg or 20mg once per day (based on body weight) for a period of 8 weeks. Children with extremely severe reflux disease may be prescribed an "off-label" dosage, being given the medication twice per day, at a higher dosage, or for a longer period of time. Older children may be prescribed Nexium delayed-release capsules, but infants and younger children will be prescribed the Nexium delayed-release powder, which is then mixed into a liquid suspension.

Problems with mixing the Nexium include clumping of the powder when water is added, not getting the full dose due to medication granules sticking to the mixing vessel, and a refusal of the child to take the medication. Instructions on the proper mixing of Nexium powder are detailed below.

Obtain all of the supplies required for mixing the Nexium. This will involve the Nexium powder packets, a glass to mix the Nexium and water together, a tablespoon to measure out the required amount of water, a mixing spoon, and a syringe.

Choose a round-bottom glass to make the mixing process easier, as the powder may stick to the corners of a flat-bottomed glass.

Add 1 tablespoon (approximately 15mL) of water to a round-bottomed glass. Open the Nexium packet, and gently shake the powder into the water. Immediately mix with a spoon: a silicone tipped baby spoon will prevent granules from sticking to the mixing device. Let the mixture sit for about 2-3 minutes to thicken, then stir again to evenly distribute the medication granules in the suspension.

The mixture must be given to the child within a 30 minute time frame, so make sure the Nexium does not sit for too long once it is mixed with water.

While the liquid Nexium suspension may be given straight from the cup it is mixed in, this is likely to leave some medication granules behind in the glass (even after a second "rinsing" with a small amount of water). The best way to dispense all of the Nexium medication is with a medication syringe. Draw up the medication into a medication syringe: it is best to find a syringe which can handle 20mL of liquid. These may be difficult to find at a pharmacy or store, but are readily available online through durable medical equipment companies.

After drawing the Nexium into the syringe, check the mixing cup to verify no stray medication granules are left. If there are, mix with a small amount of water and draw the Nexium medication granules into the syringe.

Initially, children may reject the taste of the Nexium medication. This resistance will generally reduce over time, but using a syringe makes giving the medication easier. The medication may be gently squirted alongside the child's cheek, bypassing many of the tastebuds on the tongue. Using a syringe reduces the chance of spilling the medication, and increases the chance that it will be swallowed rather than spat out.

As children become older and used to taking Nexium, let them handle the medication syringe. A child as young as three is able to hold the medication syringe and take his own medicine. Giving the child control over the medication syringe is one way to reduce power struggles associated with taking daily anti-reflux medication.

Ensure the child does not eat or drink anything for approximately 1 hour after taking the Nexium medication, as eating or drinking will significantly reduce the efficacy of the drug.

For children who absolutely refuse to take the Nexium liquid suspension, consider asking the prescribing physician for the capsule form. The delayed-release Nexium capsules may be opened and mixed with applesauce, which may ease the administration process.

Long-term use of proton-pump inhibitors has been shown to increase the likelihood of bone fractures. Ask the prescribing doctor if a child should be placed on calcium supplements if the medical therapy is expected to extend for a long period of time. In addition, PPI's may impair the absorption of iron salts, which may predispose children to iron-deficient anemia.