Is Pepto-Bismol Safe for Kids?

Home alternatives to pepto-bismol

Verywell / Gary Ferster 

Many adults will remember a time when Pepto-Bismol was the first thing you reached for whenever anyone in the family, including kids, had an upset stomach, nausea, or diarrhea. But Pepto-Bismol should only be used by adolescents and adults age 12 and over. Children's Pepto Antacid is available for children age 2 and older.

Neither product should be used by a child under 2 years old due to the risks of accumulation of bismuth, magnesium, or aluminum. Using the regular adult formula increases the risk of Reye's syndrome in children under age 12.

Reye's Syndrome

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% chance of death. Most of the cases seen in children involved the use of aspirin to treat such common illnesses as influenza and chickenpox. Symptoms can start with lethargy, nausea, and hyperventilation but quickly progress to vomiting, seizures, and even coma.

The association was recognized in 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.

Regular 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

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

Known as Pepto Kids Chewables, the formulation is offered as a chewable tablet in a bubblegum flavor and is approved for use in children over the age of 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.

Kaopectate and Oil of Wintergreen

In addition to regular 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 chickenpox 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

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 sip, 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, but they also 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 diarrhea, nausea, or vomiting is severe or is 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.

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Article Sources
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  1. National Institute of Neurological Disorders and Stroke. Reye's Syndrome Information Page.

  2. Merck Manual Professional Version. Reye Syndrome (Reye's Syndrome).

  3. Centers for Disease Control and Prevention. Surgeon General's Advisory on the Use of Salicylates and Reye Syndrome.

  4. U.S. Food and Drug Administration. How to Treat Diarrhea in Infants and Young Children.

  5. National Institute of Diabetes and Digestive and Kidney Diseases. Indigestion (Dyspepsia).

  6. Merck Manual Professional Version. Nausea and Vomiting in Infants and Children.

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