Gastric acid-reducing medications (ARMs) such as proton pump inhibitors (PPIs) and histamine type 2 receptor blockers (H2 blockers) are crucial in pediatric care for treating various gastrointestinal conditions. These medications are frequently used to treat erosive esophagitis, peptic ulcer disease, and gastroesophageal reflux disease (GERD). ARMs are essential to the administration of eosinophilic esophagitis and Helicobacter pylori infection. Additionally, literature also supports its use in alleviating drug-induced dyspepsia, preventing stress-related mucosal damage, and lowering the risk of acid aspiration syndrome during anesthesia in critical care settings. Despite the widespread indications of ARMs, PPIs, the most potent acid suppressants, present concerns regarding safety and their inappropriate use in pediatrics. This paper aims to address these gaps by providing comprehensive, practical recommendations for ARM use in pediatric settings. The methodology involved a structured literature review and opinions from 24 pediatric specialists across India, including neonatologists, general pediatricians, pediatric gastroenterologists, a pediatric hepatologist, pediatric nephrologists, a pediatric pulmonologist, and a pediatric intensivist on the appropriate choice of ARM use in various clinical scenarios. They emphasized the benefits of H2 receptor antagonists (H2RAs) over PPIs, particularly in neonates and infants, where H2RAs offer a safer alternative due to their lower risk of adverse effects. The paper outlines the effective application of H2RAs in managing GERD, preventing stress ulcers, and treating drug-induced dyspepsia. It also provides guidelines for appropriate ARM use, stressing the need for careful patient evaluation to minimize the risk of unnecessary ARM use. Pediatricians also provided a view on the use of H2RAs beyond gastrointestinal indications, such as in urticaria, where they show promising clinical application when combined with H1-antihistamines. This paper offers valuable insights and recommendations for optimizing the use of ARM in pediatric practice. By highlighting the advantages of H2RAs and addressing the limitations and risks associated with PPIs, the paper aims to guide clinicians in making informed, evidence-based decisions. The goal is to improve clinical outcomes, promote the rational use of ARM, and enhance the quality of pediatric care.

Keywords: drug-induced dyspepsia; h2ras; on-demand use; ppis; ranitidine; stress ulcer prophylaxis; urticaria.

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降低胃酸药物（ARMs）如质子泵抑制剂（PPIs）和组胺H₂受体阻断剂（H2受体拮抗剂）在儿科护理中对于治疗各种胃肠疾病至关重要。这些药物常用于治疗食管炎、消化性溃疡病以及胃食管反流病（GERD）。ARMs 在治疗嗜酸性粒细胞食管炎和 Helicobacter pylori 感染方面也非常重要。文献还支持其在缓解药物引起的消化不良、预防应激相关的黏膜损伤以及降低麻醉期间吸入性酸综合征风险方面的应用。尽管 ARMs 的适应症广泛，但作为最有效的胃酸抑制剂的 PPIs 在儿科使用中存在安全性问题和不适当使用的担忧。本文旨在通过提供全面的实际建议来解决这些问题，以优化 ARM 在儿科环境中的使用。方法包括对文献进行了结构化回顾，并征求了印度24位儿科专家的意见，其中包括新生儿科医生、普通儿科医生、小儿胃肠病学家、儿科肝病学家、儿科肾病学家、儿科肺病学家和儿科重症监护医师在各种临床场景中合理选择 ARM 使用的意见。他们强调，在新生儿和婴儿中使用 H₂受体拮抗剂（H₂RAs）优于 PPIs，特别是在这些患者群体中，H₂RAs 提供了一个更安全的选择，因为它们的副作用风险较低。本文概述了有效应用 H₂RAs 管理 GERD、预防应激性溃疡和治疗药物引起的消化不良的方法，并提供了适当的 ARM 使用指南，强调需要仔细评估患者以尽量减少不必要的 ARM 使用的风险。儿科医生还就 H₂RAs 在胃肠疾病以外的应用（例如荨麻疹）提出了看法，在这种情况下，H₂RAs 与抗组胺药结合使用时表现出有前景的临床应用效果。本文为优化儿科实践中 ARM 的使用提供了宝贵的见解和建议。通过强调 H₂RAs 的优势并解决 PPIs 的局限性和风险问题，本文旨在指导临床医生做出基于证据的信息决策。目标是改善临床结果、促进 ARM 的合理使用，并提高儿科护理质量。

关键词：药物引起的消化不良；H₂RAs；按需使用；PPIs；雷尼替丁；应激性溃疡预防；荨麻疹。

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