The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed an algorithm for prescribing PPIs in children (see below).  Included medicines are:
 

Omeprazole oral powder for suspension is BLUE (on recommendation of a specialist) 

• ONLY for children under 10kg and/or with enteral feeding tubes (less than 8Fr) in place.
• Consider using the higher strength preparation, 20mg/5ml as proportion of sodium,  potassium and preservatives per dose is less. 
• Switch to alternative PPI as per algorithm when enteral feeding tube is removed or larger gauge used

Omeprazole dispersible tablets are GREEN

• 1st line treatment option in children unable to swallow omeprazole capsules.
• Mezzopram® brand is preferred due to the smaller granule sizes. If Mezzopram® is out of stock or unavailable Losec Mups® should be used as an alternative.
• Disperse the tablets in water, then mix with orange/apple/ pineapple juice, apple sauce or yoghurt 

Omeprazole capsules are GREEN

• 1st line treatment option in children who are able to swallow capsules; OR
• For children who cannot swallow capsules, most capsules can be opened (licensed) and mixed with water or a slightly acidic fluid e.g. fruit juice, apple sauce

Lansoprazole capsules are GREEN 

• 2nd line treatment option in children who are able to swallow capsules
• For children who cannot swallow capsules, some capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice or sprinkled on soft food (e.g. yoghurt, apple puree)

Lansoprazole orodispersible tablets are GREEN

• 2nd line treatment option in children unable to swallow omeprazole or lansoprazole capsules.
• Oro-dispersible tablets disperse in the mouth to release gastro-resistant granules. Lansoprazole is NOT absorbed sublingually. The gastro-resistant granules must be swallowed for the medicine to be effective. The FasTabs® can also be administered in apple or orange juice.

Esomeprazole granules are GREEN 

• ONLY for children 10kg or more, with enteral feeding tubes (6Fr or larger) in place. 
• For children unable to swallow tablets,  omeprazole or lansprazole capsules or orodispersible tablets would be  preferred alternative options.

Aclomep® powder is RED

• Only for use by Ashford & St Peters NICU

All other unlicensed oral  PPI suspension preparations should be considered NON-Formulary