Is Pepto-Bismol Safe for Kids?

Home alternatives to pepto-bismol

Verywell / Gary Ferster 

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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 today, Pepto-Bismol should only be used by adolescents and adults age 12 and older.

Instead, there is a children's version of Pepto-Bismal that is available for children age 2 and older as well as some more natural methods that can be used to address symptoms. Here's a closer look at what you need to know about the dangers of Pepto-Bismal use in kids.

The Dangers of Salicylates

Regular Pepto-Bismol is a concern for children because its main ingredient is bismuth subsalicylate, a derivative form of aspirin (acetylsalicylic acid or ASA). Since 2003, the U.S. Food and Drug Administration (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.

The primary reason for this warning is the connection between over-the-counter medications containing ASA and Reye's syndrome, 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 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 such 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 FDA issued warnings against the use of aspirin to treat fever-causing illnesses in anyone under 19.

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

Children and teenagers who have or are recovering from chickenpox or the flu should avoid Kaopectate. Meanwhile, 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.

Alternatives to Pepto Bismal for Kids

If your child has indigestion, nausea, vomiting, or diarrhea, there are alternatives to Pepto-Bismol that may help including a children's version of Pepto-Bismal as well as more natural remedies like changing your child's diet. Here's a closer look at what you can try instead.

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 2.

Those under 2 should not be given any medication containing bismuth, magnesium, or aluminum as these substances can rapidly accumulate and cause a potentially serious toxic response.

Dietary Changes

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.

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.

Hydration

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. Avoid home remedies like warm milk or rice water, which are not appropriate replacement fluids.

Natural Remedies

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.

Be sure to consult your doctor before using herbal remedies or over-the-counter supplements as most of these options are not regulated by the FDA and could be unsafe or harmful to young children.

When to Call a Doctor

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
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  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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