Is Pepto-Bismol Safe for Kids?

A popular antacid medication may pose harm to the young

A girl who cared by Grandma is sick in bed
Michael H / Getty Images

Many adults will remember a time when Pepto-Bismol was the first thing we reached for whenever anyone in the family, including kids, had an upset stomach, nausea, or diarrhea. It seems now that the familiar cure-all may, in fact, do more harm than good in children and teens, increasing the risk of a potentially deadly condition known as Reye's syndrome.

Reye's Syndrome and Pepto-Bismol

Reye's syndrome is a rapidly progressing brain disorder that we still don’t fully understand.

It typically develops in people recovering from a viral infection and, in children, is linked to the use of aspirin (acetylsalicylic acid, or ASA).

Reye's syndrome is uncommon, but, in those affected, it is associated with a more than 20 percent chance of death. Most of the cases seen in children involved the use of aspirin to treat such common illnesses as influenza and chicken pox. Symptoms can start with lethargy, nausea, and hyperventilation but quickly progress to vomiting, seizures, and even coma.

The association was recognized as far back as 1972. As a result, both the Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) issued warnings against the use of aspirin to treat fever-causing illnesses in anyone under 19.

Pepto-Bismol is a concern because its main ingredient is bismuth subsalicylate, a derivative form of ASA. Since 2003, the FDA has advised against the use of bismuth subsalicylate in children under 12.

The warning extends to any adult formulation of bismuth subsalicylate, including oral suspensions, chewable tablets, and caplets.

Children's Pepto, Kaopectate, and Oil of Wintergreen

In response to the FDA advisement, the manufacturers of Pepto-Bismol created a child formulation which replaced bismuth subsalicylate with calcium carbonate.

Christened Child Pepto Antacid, the formulation is offered as a chewable tablet in a bubblegum flavor and is approved for use in children over two. Those under two should not be given any medication containing bismuth, magnesium, or aluminum as these substances can rapidly accumulate and cause a potentially serious toxic response.

In addition to Pepto-Bismol, parents should be aware that Kaopectate (loperamide) and any product containing oil of wintergreen also contain salicylates found in aspirin. 

It is advised that children and teenagers who have or are recovering from chicken pox or the flu should avoid Kaopectate. By contrast, oil of wintergreen should be avoided in all children and teens as its central component (methyl salicylate) is not meant for ingestion, even in diluted preparations.

Home Alternatives to Pepto-Bismol

If your child has indigestion, nausea, vomiting, or diarrhea, there are alternatives to Pepto-Bismol that may help:

  • For symptoms of indigestion, focus on dietary changes to relieve the stomach of any irritation. Serve bland foods such as saltine crackers, dry toast, gelatin, and applesauce. Provide clear fluids to sips, avoiding sugary beverages or acidic juices. Cut out any greasy foods, chocolate, or heavy spices until the symptoms are fully resolved. Offer smaller meals more frequently rather three regular meals per day.
  • With nausea and vomiting, the main focus should be on keeping the child hydrated. Ensure that your child regularly sips water or an electrolyte replacement drink until the stomach settles, avoiding fruit juices and sodas. Flavored ice pops are also a nice way to encourage fluids. Gradually offer bland foods and clear broth once your child is able to eat.
  • For upset stomach and diarrhea, do what most pediatricians suggest and offer your child a BRAT diet consisting of banana, rice, applesauce, and toast. The foods are not only less challenging to the stomach, they have a binding effect that may help relieve diarrhea. Ensure that your child is well hydrated, and avoid home remedies like warm milk or rice water which are not appropriate replacement fluids.
  • There are also a number of natural remedies that many people swear by. Brewed teas made with ginger, peppermint, chamomile, fennel, or licorice may help relieve symptoms of an upset stomach. Instead of an over-the-counter antacid, mix a teaspoon of baking soda into a mug of warm water. Even a little warm water with lemon juice has been known to do the trick.

If any of these symptoms are severe or are accompanied by high fever, reduced urination, or lightheadedness, see a doctor immediately. Diarrhea or vomiting that lasts for more than 24 hours should always be considered serious and in need of urgent care.

Sources:

Kim-Jung, L.; Holquist, C.; and Phillips, J. "FDA Safety Page: Kaopectate reformulation and upcoming labeling changes." Drug Topics. 2014:58-60.

U.S. Food and Drug Administration (FDA). "How to Treat Diarrhea in Infants and Young Children." Silver Springs, Maryland; published October 31, 2011.

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