Is Pepto-Bismol Safe for Kids?

Home alternatives to pepto-bismol

Verywell / Gary Ferster 

Many adults remember a time when Pepto-Bismol was the first thing they 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, a children's version of Pepto-Bismol is available for children age 2 and older, or you might try a more natural method to address their symptoms. Here's what you need to know about the dangers of Pepto-Bismol 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). The Food and Drug Administration (FDA) advises 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 medications containing ASA and Reye's syndrome, a rapidly progressing brain disorder that isn't fully understood. The condition typically develops in people recovering from a viral infection and, in children, is linked to the use of ASA.

Although Reye's syndrome is uncommon, it is a serious condition. If it's not diagnosed and treated effectively, death can occur within a few days. Most of the cases seen in children involved the use of aspirin to treat common illnesses such as influenza and chickenpox. Symptoms can start with lethargy, nausea, and hyperventilation but quickly progress to vomiting, seizures, and even coma.

Australian pathologist RDK Reye first recognized this syndrome in 1963, but national surveillance of the condition didn't begin in the U.S. until the early 1970s. Eventually, it led to strict warnings about aspirin use in children. 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 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-Bismol

If your child has indigestion, nausea, vomiting, or diarrhea, there are alternatives to Pepto-Bismol that may help. These options include a children's version of Pepto-Bismol 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 warning, the manufacturers of Pepto-Bismol created a children's 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 bananas, rice, applesauce, and toast. These 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 your child hydrated. Ensure that your child regularly sips water or an electrolyte replacement drink until their 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. 

If you want an alternative to an over-the-counter antacid, try mixing 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 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.

A Word From Verywell

Having an upset stomach is common in kids and can be particularly unsettling for parents. After all, no parent wants to see their child uncomfortable.

But instead of reaching for a bottle of adult Pepto-Bismol, which isn't safe for children under 12, try a more natural method of easing their discomfort first; and never hesitate to contact your doctor. Based on your child's age, the doctor can guide you in what you can do to relieve your little one's discomfort.

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Article Sources
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  1. U.S. Food and Drug Administration. How to treat diarrhea in infants and young children.

  2. National Institute of Neurological Disorders and Stroke. Reye's syndrome information page. Updated March 27, 2019.

  3. U.S. National Library of Medicine. Reye syndrome. Updated November 20, 2020.

  4. Centers for Disease Control and Prevention. Surgeon General's advisory on the use of salicylates and Reye syndrome.

  5. Kim-Jung L, Holquist C, Phillips J. FDA safety page: Kaopectate reformulation and upcoming labeling changes. Drug Topics. 2014:58-60.

  6. National Institute of Diabetes and Digestive and Kidney Diseases. Indigestion (dyspepsia).

  7. American Academy of Pediatrics. Treating vomiting. Updated August 1, 2017.