Sarah Camp, February 2021
What is the “acid battle”?
An “acid battle” refers to the period of time for a baby’s body to adjust to being on a PPI, particularly a compound. For many, it looks a bit like a roller coaster. Things get a little worse at the beginning of this period, then markedly worse toward the middle/end as the “ride” gets higher, and then a sudden drop at the end which brings much-needed relief. These do not happen for every baby, but for those that do experience an acid battle it should resolve within 14 days.
What causes it?
There is a period where the body tries to increase acid production to overcome the acid that is being blocked. It won’t win in the end – but some people call this stage the “acid battle.” … The acid battle is mostly the buffer [in compounds] interacting with the acid in the stomach and making gas. Infants are not as good at passing burps as adults are and they tend to be laying down (which is not good if you want to expel the gas–and not the fluid that is in the stomach). So the buffer and acid combine to make CO2 (gas) and that causes some distention of the stomach which can increase acid production slightly.”
Increased gas (even without additional acid production) can be uncomfortable especially for very young babies. Their bodies do typically adjust to this within two weeks.
How can you get through it?
After you’ve been dealing with a baby in pain, the thought of your baby getting worse can be terrifying–even if there is a “light at the end of the tunnel.” Below are some ideas that we have seen success with for parents we’ve helped in the past. Please make sure to discuss all medications with an appropriate medical authority.
- Add in (or keep if you have already been giving) an H2 blocker like Pepcid (famotidine). You can wean from that medication once the acid battle period is over. H2 & PPI need to be spaced at least 3 hours apart, but 4 is better if you can. Click here for a more detailed explanation of the spacing of these two medications, as well as why it’s beneficial to continue with the H2 blocker until at least two full weeks on the PPI. [Note: that article was written prior to the recall of Zantac (ranitidine). Substitute “Pepcid” wherever you see “Zantac.”]
- Use CVS Cherry Supreme (MCS) or a home compounded antacid. Make sure it’s free of aluminum! Start with the lowest dose for baby’s age, as infrequently as possible. Work your way up to larger doses allowed/more frequently if baby is still in a great deal of discomfort.. Your goal should be giving as little as possible just to make it through this period. MCS is only a bandaid for a larger problem & should not be used regularly for a long-term period or in place of a properly dosed PPI. Too much of it can also cause loose stools. MCS *must* be spaced from PPI by 1-2 hours, but it *can* be given at the same time as H2. If you give with an H2 like Pepcid, then the H2 must now be spaced 4-5 hours from the PPI. [Note: some babies with sensitivities do not tolerate MCS well due to the inactive ingredients, which can be derived from triggers such as soy or corn (xanthan gum, citric acid, etc.).]
- Gas drops can be given as directed on the bottle to ease discomfort caused by extra gas. Again, please note that they do contain inactive ingredients such as xanthan gum and citric acid, which can be triggers for gerdlings.
- Gripe water is not something we typically recommend. If you are going to use it, make sure you are getting one WITHOUT sodium bicarbonate as part of the ingredients.
Sometimes the best thing to ease a worried parent’s mind and give hope are stories from other parents who have been in your shoes before and come out the other side better.
Kaley J. writes: Our acid battle was HORRIBLE. We tried home compound, felt it made her gassy, switched to Prevacid and we just couldn’t do the 30min before. She was 3 weeks old at the time of starting the first home compound. We decided about 5 weeks we was going to try the home compound again. She was super fussy, if not worse than before. We realized the gas drops were causing some discomfort. The worst days were day 7-13. Seriously, it last that long. But PUSH THROUGH it! Our girl just turned 8 weeks old and is so happy and smiley now. She sleeps all through the night. I am so glad we stuck it out. During the acid battle, we dosed Pepcid once a day and cherry supreme to help us get through the battle. We now only use the home compound with CC. She is 12lbs at 8 weeks old and breastfeeding beautifully! These ladies truly are a life saver in helping!
Becky B. writes: Our acid battle was horrendous ! To the point I was crying all the time because I just couldn’t settle my little boy . This group saved my sanity .. I was advised to add rennies to help neutralise the acid until the upped dose of lansoprazole was in his system . It took about 2 weeks and it was like a switch had been turned off .. he still brings up acid sometimes but he’s not in any pain anymore . He used to scream , you could hear the acid come up in to his throat and was burning him but now he doesn’t even know he’s doing it.
Monica S.D. writes: Several acid battles under our belts. Days 10-11 were usually the worst for us on the acid battle. It’s hard but worth it.
Zantac to PPI- Day 2 and it switched to happy at day 14.
Prevacid to Nexium- day 3 until day 10
Kid 2- no meds to PPI- day 3 until day 17.
1 dose increase and 1 Med switch- no acid battle that was noticeable, maybe a single fussy day.
Veronica M. writes: It took right around the 2 week mark for us to really start noticing the major improvements, but even before that, we did notice smaller things. And that was with us going through vaccinations and a PTT release! It’s so worth it. Give it the full 2 weeks and I think you’ll be amazed at the difference. Also, as has been pointed out, if you’ve been under-dosed with a PPI, it can get worse before it gets better thanks to the acid battle. So hang in there! So many mamas here have gone through the same thing.
Kelly G. writes: Day 9-12 were the worst for my son, then he was actually happy Proper dosing! Under-dosing will make things worse.
Jamie H. writes: Acid battle for my youngest (daughter) who has severe reflux. We started properly dosing 3 times a day around 4 months old after being on incorrect doses (under dosing) for months. Our acid battle was extremely extremely bad. My daughter has reflux to the point where she chokes, has laryngospasms, and breathing difficulties. During acid battle all these things got temporarily worse. I remember it hit at about day 3 she got way worse. It got slightly better around 11 days in and was over at 14/15 days proper dosing three times a day. She did not sleep for more than an hour at a time being held while I sat upright. She would have breathing episodes known as laryngospasms I would have to sit her up ever more for and help her resume breathing. Very scary. There was actually mucus in her nose and throat like she had her whole life but worse. I don’t think I slept for the majority of the acid battle time period to the point where I was actually clinically diagnosed with pneumonia right as her acid battle ended. I believe it’s pretty rare for acid battle to be this bad but acid battle is real and can happen, although does not happen to everyone. Do not let this scare you away. The benefits outweighs this temporary trial. We are doing much better since.
In response, Ashley S. wrote: Thank you for your story. We are currently going through a rough acid battle.. on day 9 …and today she had so much acid coming up her throat and out her nose that she couldn’t breathe and looked like she was having a seizure. I was about ready to give up Bc it was so scary! But after ready your story it made me feel better. I’m going to keep going Bc I’m desperate for this to work, and I hope I can write a success story as well. These poor babes deserve success stories!
[Ashley’s baby’s acid battle resolved shortly after that!]
Denise F.B. writes: 10-12 were the worst days.
Caileigh S.J. writes in her #success post: We also started her on lansoprazole(ppi) but only once a day. The first few days were awful. Screaming and crying and clawing me because her pain was so bad. The she improved a bit and was eating more and then again she was back to barely eating and projectiling. We discussed a NG tube and testing for Gastroparesis. I was at my wits end, severe depression was setting in and I didn’t know how to help my poor baby.
But I found this reflux group because of Brittney Z. you guys helped me to find the right information on proper dosing for reflux meds because babies metabolize them 3x faster than adults. 2 weeks into the group we went up to 3x a day ppi dosing. Immediately she was already eating more. Excited to eat and reaching for the bottle. She started spitting up more and we transitioned from breastmilk and nutramigen to Alimentum ready to feed(only corn lite milk protein sensitive formula) and then she upped her daily intake by 10oz a day! We stopped domperidone the gastric emptying med and still she was eating more every day. She started babbling and being more vocal! She stopped throwing herself back so much and started actually sit unassisted for a small period and starting to move while on her tummy. Something that was impossible before due to sandifers syndrome. A proper dosed ppi and proper diet has changed our life! We avoided an NG tube.
Hailley W. writes in her #success post: This time I pushed for a PPI and told my doctor I planned to MARCI dose. What a relief it was to get the ok! We home compounded omeprazole, and within 3 days, I had completely different babies. They actually smiled! Like really smiled! It was the most heartwarming thing I had ever seen.
Britney O.S. writes in her #success post: …at 4 months old i started dosing properly and using the alimentum RTF and within 3 days i had a completely different baby!!! no more spit up no more sleepless nights or napless days. It was a miracle.
Amber G. writes in her #success post: So when I joined this group I was told about how the meds they prescribe are at way too low of a dosage and that there was this thing called Marci-kids and it explained how the dosing for infants needs to be higher due to them processing the meds through their bodies 3 times faster than adults, etc etc etc…. Well, I could not get my ped to prescribe any higher dosage so I felt stuck. Well, this group had told me about something called home compounding…and honestly I thought it was a little crazy and definitely didn’t think that I had the skills to do it. Lol. But eventually after researching and desperation I decided to try it. My mom and husband and everyone I told I was thinking about doing this thought I was crazy and told me not to. I did ask the ped about it and they said that they couldn’t recommend it but did assure me that it is not possible to overdose on ppi’s so that made me feel a lot more comfortable. (Because the dosage that she should have been having according to the marci dosing chart was 3 times more than what the ped prescribed.) So…I ordered the meds I needed and got to work and I kid you not, a week later I had a new and happy baby!!!
Saira H writes in her #success post: When I first saw how underdosed my son was i should have bumped him up to proper dosing..but I was scared. Surely the Dr knew what to give him right? Who was I to question it. I waited and waited..finally one day i decided I would try it. The dose the Dr had him on was less than 1/3 of what marci called for. My son was still in so much pain from acid fits. What did I have to lose. I had a new baby in about a week.
Ali B. writes in her #success post: I printed out all the research and took it with my notes to the GI. They did not agree to MARCI dosing, but they didn’t have a real leg to stand on either…I acknowledged their concerns and was able to argue every one of them! I went rogue, they had time to help and they didn’t, so it was MY turn! I did MARCI and home compounding and sought advice here along the way. I saw results within the first week, and by week 2 I had a whole new baby- the little girl that I KNEW in my heart was there…so happy!
Sarah S. writes in her #success post: I finally made the decision to start my twin on the Omeprazole, home compound. I was most fearful of the “acid battle”, I wasn’t sure my anxiety could handle seeing my girl in anymore pain. After we passed the 14 days on the MARCI dose she seemed to be doing 100% better. Her eating habits were improving, her poop was daily, she wasn’t having her screaming fits! We had our visit with the GI, whom didn’t support the MARCI dosing, he requested I give my baby 2 doses per day, vs. 3. So, I did. It was a huge mistake, she started projectile vomiting after feeds, we were standing in front of the tv again. I got into the group and started posting again, and was told to start giving her the 3 doses again and we could increase her dose. After a few days, she was thriving! We were finally feeling good about her intake, my anxiety had gone down, my husband was more comfortable feeding her.
Sarah C. writes: For us, I do not remember having a true acid battle. Honestly I’m not sure I would have recognized it unless I was physically on fire. My daughter was MISERABLE & in pain for the first 4.5 months of her life because she was on no medications, then the wrong medications & finally underdosed on a PPI. I remember her still being as unhappy & uncomfortable as ever for a few days after we started home compounding & proper dosing, but not more than she was before. It was difficult to get her to eat for those few days, but that was also at the same time that we quit thickening her bottles with cereal (HORRIBLE decision for us! Dangerous, does not work, can cause sooo many more problems, which it did for us. Don’t do it!!)
She is also insanely sensitive to corn, which didn’t really allow us to give her any MCS, gas drops, things like that. For anyone wondering, we figured this out because she was worse (fussier & gassier) when she was taking them vs. when she was not. Her symptoms also worsened after taking liquid medications.
Update: We have definitely experienced the acid battle now, a couple of times. We’ve had to take our daughter off of her meds for various tests and each time getting back on them is such a struggle. Terrible sleep, unhappy all the time, not eating hardly at all. I felt super foolish the first time it happened, because I could NOT for the life of me figure out what was going on! She stayed the same/maybe even got a little better for a few days to a week, then got suddenly much worse at like a week/week and a half back on meds. Um…hello?! I’ve been at this almost two years with my kiddo, and helping other moms with their babies for over a year. I should have realized! Anyway, solidarity with everyone going through this!
Laura H.B. writes: We had no acid battle. We noticed a turn to the positive on day 12 of proper dose & form of ppi.
Tiphaine C.-G. writes: My son never had an acid battle. We went hopped around with some different low dosed PPIs and then by day 3 of home compound Omeprazole properly dosed he was a new baby. Only thing is I tried twice a day dosing and he couldn’t make it 12 hours without being inconsolable. Went to three times a day and everything evened out.
Jaclyn D. writes: Here is the thing… not all babies experience battle… I didn’t with my DS.