Reflux in infants - advice Please

[midivydale]

Baby has now slept for 3 1/2 hours!!!! What?! Have wept tears of joy. Is it the gaviscone already? Consultanat said to pet him sleep in car seat for now (meeting strawbs tmrw to get wedges instead though). I mean 3 1/2 hours! I havent slept that long since february befor his birth.

His little face looks less strained as well. Is it a one off i wonder?

C.

[Strawbs]

The gaviscon can really help some babies! Two of my friends got t stoP at gaviscon and didn't need to Progress to meds so fingers crOssed!! Yay!! X

[Yellow Sardine]

Great news, I hope things continue to improve for you and your little boy. 3 1/2 hours sleep really can feel amazing when you've had a lot less!

[hellosailor]

How was the rest of the night midivydale? Hope it continued to go better? My fingers are crossed for you through the ether!x

[midivydale]

Hey all,

No sadly rest of night was rubbish- sigh. It does seem that he is in less distress though when feeding so that is an improvement, even got a gummy smile this morning which melted my heart.

Still cant put him down to sleep though but one step at a time i guess. Rentadine may take A cew days to work?

He does seem to take more milk and feeds every 3hrs rather than 2 so that is an improvement. Was told to feed him 5-6 times a day only and we are nowhere there yet. But progressing down from 10-12 or so it seems.

Cx

[Belle]

there's def a vicious circle at the start we found, where they get some temporary relief from feeding, and you end up feeding them really frequently, but then actually that aggravates the reflux, so once you graduate to every 3 hours that def does help.

[Yellow Sardine]

The feeding thing is so hard; I think the fluid helps ease the pain so they eat more, which causes more pain and so on. It really is a vicious circle. We found that a dummy helped a bit, not all babies will take one though but maybe worth a try. From memory the ranitidine kicked in pretty quickly for us so if you don't see an improvement within a few days it may be worth going back and asking to try a dairy free formula. Even though we saw a massive improvement with the ranitidine and dairy free diet it was a few months before we could put him down to sleep. Until then he slept on my chest.

[Yellow Sardine]

While eating my lunch, I remembered how ranitidine works: it neutralises the stomach acid, so it should kick in immediately. Stomach acid may have caused some (temporary) damage to the oesophagus prior to medication, however, so that can take a little while to heal.

[Belle]

Yes I think our GP suggested two weeks but when we saw Babu he said it shd be working inside a week (in our case it hadn't hence move to omeprazole)

[midivydale]

Another horrid night, it is just not working. I thoght it did at first but no.

Poo little man, and If i may- poor me!

Hoping app with babu tmrw can make things better. Also spending a fortune on this cranial ostheopath person...not entirely convinced but the things we do in desperation.

Sorry just had o get it out

[Strawbs]

When you go ask about omeprazole - it takes 2 weeks to work but it's so worth it x

[Yellow Sardine]

Arf! You poor things. Ask if you can try a dairy free formula too. Hope the appointment goes well x

[Saffron]

Ranitidine and similar drugs help inhibit stomach acid production by suppressing activity of H2 receptors, which partially control stomach acidity.

Omeprazole and similar drugs lead to more complete suppression of acid production by directly suppressing the activity of proton pumps, the tiny cellular components which are directly responsible for stomach acid production.

[midivydale]

Update and more advice please...

Saw consultant today and we are upping the meds, now on domperidone, and omeprazole. Anyone had that combination before? Also turns out ds was weighed incorrectly last time about a 2lbs out which means his doses have been to low. Worth upping exisiting meds before moving on? Comments?

Also dr vademalayan prescribed omeprazole in syrup form but warned as its dear most pharmacies dont sell it so hard to get hold of. Does Anyone use the syrup and if so would you Know where i can get it from? Just thought id ask before i run around london with screaming baby...

On a sidenote- there are a couple of ladies who have not replied here but have pm'd me re bf. Please could the breast feeding police kindly stop? This thread is a cry for help re reflux. Private pm's about bf and how me 'putting ds on formula is the cause of his reflux'is not helpful or productive. The decision to stop was taken by medical professionls for reasons that were medical - not that i should need to justify that on a forum... I can assure everyone that like every mother on here i am doing what is best for my son. Any further pm's along the lines of the above will be reported to the moderator.

To the res of you- i cant thank you enough for your kind replies and support. I hope that i will be able to return the favour one day.

C xx

[Strawbs]

Well done on your side note post, I'd be tempted to report them to the mod anyway so the breast feeding bullying can stop!

Toby isn't on the combo med just the omeprazole and we give it to him in tablet form so I can't help on the syrup. My gp is always telling me that crystals pharmacy in nunhead are really good ( they want me to change from the one I use). Did they talk about dairy free formula at all?

X

[Yellow Sardine]

Yes, well done! Formula causes reflux? What a bunch of nonsense! Breastfed babies have reflux too.

When our local pharmacy hasn't had meds in they've been able to order them in for the next day, I would think most pharmacies do that (understand that you may not want to wait that long). Otherwise, I would've thought hospital pharmacies have most stuff in.

I don't have any advice on sticking with current meds or moving on. I guess if I were in your shoes I'd up the current meds to the correct dosage until I could get hold of the omeprazole and then give him that.

[Saffron]

Try telephoning your pharmacy first. See if they can order the liquid if not in stock. Personally, I think would move straight onto the omeprazole.

From a pharmacological point of view, omeprazole is the better drug. I'm not sure what prevents drs from prescribing it sooner for chronic reflux. I think it might not be licensed for infants and children. Age-rated licensing does not occur (or does not occur immediately) in the case of some drugs, but it doesn't mean that the drug isn't safe (in relative terms, obviously) and useful for a particular age group.

Omeprazole and similar drugs hit a very specific cellular target, ie the microscopic proton pumps in acid-producing stomach cells. By inhibiting proton pumps, they block the final step in acid production. Interestingly, digestion is able to proceed nonetheless. Indeed the bulk of digestion and absorption occurs in the intestines, not the stomach.

Domperidone is an antidopaminergic drug, ie it blocks/modulates the actvity of dopamine receptors. Because dopamine receptors are found throughout the body, it's more likely from a pharmacological point of view, to produce side-effects outside the target system. Domperidone's efficacy in treating infant reflux is thought to be through it's suppression of vomitting.

If you can get good resolution of symptoms with omeprazole alone, I would personally think that's best. But that's just my opinion. I'm sure your gp can discuss it further.

I'm a bit confused as to why people think formulated milk causes chronic reflux in infants?

Perhaps anyone who holds these views could start a new thread about it, so we can discuss it in a public arena?

To the best of my knowledge, formula could be linked to reflux if Baby were being overfed -- overfeeding causes acute reflux, though, not chronic reflux. So, if you're feeding formula, just don't overfeed. Little and often is how Baby should be fed, true for formula and b/f babies.

Formula might also be related to reflux if there is a specific element in the formula that Baby cannot digest (intolerance) or to which there is a true allergy. Indigestion causes excess stomach acid to be produced. Again, this is acute reflux, not chronic reflux. (Incidentally, my friend's daughter was allergic to her mother's breastmilk, and so she had to be ff. Weird, eh?!)

My understanding of chronic reflux in infants is that it is thought to be caused by cellular differences at the gastro-esophageal junction. I only read the abstract, but this journal article looked interesting...http://www.nature.com/ajg/journal/v101/n3/abs/ajg2006117a.html

If you're considering switching to non-dairy, have you thought of trying goat's milk formula first? There are good medical reasons not to give non-dairy formula if possible.

Babies need milk, even if it isn't human milk. The milk from other mammals still contains many of the compounds that are essential to growth, development, and digestive health. Mammalian babies are evolved to need and use these elements at a cellular level. Giving eg soya-based formula cannot replicate many of the essential features of mammalian milk. Many children who cannnot tolerate cow's milk can have goat's milk. Just food for thought -- no pun intended!! xx

[midivydale]

Hi all,

Wow i feel like i have my own online support network here- thank you all so much for everything. Read a very interesting thread on little refluxers website re association btw candida and reflux. Struck a cord with me and have sent hubby to healthmatters on lordship lane for infant probiotics.

Maybe that could help any of you guys too?

C xx

[EmmaG]

Both mine had very bad reflux and I do feel for you. Your GP will try Gaviscon first, then ranitidine and domperidone. If those don't work you need to see a consultant and get lansoprazole. Do bear in mind that the gullet will be damaged by the acid and therefore even if a medication "cures" the reflux, the inflammation can take several weeks to subside.

Things you should try include: keeping your baby upright or on a slope at all times (wedge in pram, cot, change table), dream feeding, creating a strong distraction to take their mind off the painful feed, introducing solids at 17 weeks, cutting out cow's milk from yours and your baby's diet and considering Neocate formula if your baby is formula-fed.

When my younger one was really suffering and nothing was working we gave her painkillers before feeds. The paeds said paracetomol was fine but to cut out long term use of ibuprofen.

I recommend Dr Edward Douek at the Portland or a referral to the paediatric gastroenterologist at the Chelsea and Westminster.

[susyp]

also worth bearing in mind that intolerances are very different to allergies (at least in my v ltd experience with my little one). She has a cows milk allergy - which is obvious as she comes out in hives/sick etc - but also i found out only when she was 2- she has a soya intolerance - that only manifested itself obviously after 2 weeks of soya yoghurts - before then was only having soya occasionally - but she didn't sleep properly until i cut soya out. So if you little one only has intolerances then an allergy test won't show it but it actualy seems to make them more uncomfortable as they don't throw it up/ get diarrohea. My daughter still on neocate at nearly 4. Loves it having had it from 5 months of age. She was also intolerant to beef - haven't tried her on that again yet. Have tried her recently on sheeps cheese but she got hives - was fine otherwise though - so even though she is still allergic (most children do seem to grow out of it by 1 year) - she is less highly allergic i assume.

You sound a lot more positive. Well done for everything you are doing (and for standing up to the breast feeding mafia). You sound like you are such a fantastic mum.

susypxx

[EmmaG]

Children with a cows milk protein intolerance are often intolerant to soya milk too. Neocate is the most hypoallergenic formula there is. It's very expensive so usually only prescribed as a last resort. We're in the process of converting from Neocate to Oatley now that bubba2 is a year old. We're also weaning off domperidone but still taking lansoprazole twice a day. The light at the end of the tunnel is hoving into view for us.

Let's hope you get some relief soon.

[Wanhope]

I'm so sorry to hear you're being harrassed by breastfeeding zealots! That's the last thing you need. If it's any consolation, I breastfed exclusively for eight months and this did NOTHING to prevent or lessen reflux. Even when I cut out all dairy and soya from my diet I never saw any dramatic reduction in reflux symptoms. When some type of food protein intolerance is sitting behind reflux (as is often the case), it's also quite difficult to identify the exact culprit. It's not always just dairy and soya and some paediatricians recommend also cutting out wheat and eggs -- a nightmare if you're breastfeeding, dealing with reflux (and so not sleeping or really relaxing) and still trying to feel like a normal, functioning human being. Given all that, it is kinder to both you and your baby to at least try a hypoallergenic formula if you can. Neocate worked for us in the end and seems to be fairly widely prescribed by paediatricians. I've also never had any difficulty obtaining repeat prescriptions for this from my GP (the DMC). Sorry, rant over! Just very bothered to hear that you're being attacked by some unpleasant lurkers.

Re your specific questions, we were prescribed both ranitidine and domperidone at one stage and actually never used the domperidone. My understanding is that it's an anti-emetic and as our baby had the so-called 'silent reflux' (ie, he wasn't really a possitter), we thought it was unnecessary and didn't want to over-medicate. Our paediatrician later agreed that domperidone is unlikely to have any impact if possitting isn't a problem.

As for omeprazole, we did find that there was generally a bit of a wait in obtaining this from pharmacists (we used a range, all based in ED) as the syrup needs to be specially prepared and can take up to three days from the time the prescription is first submitted. I don't think the expense was ever the problem. It also has a fairly short shelf-life (two weeks, I think), so prescriptions need to be renewed quite often. Again, though, we never had a problem getting repeat prescriptions from our GP when needed. You're also right re the dose needing to be very closely correlated to your baby's weight, so something to keep an eye on.

Hang in there -- it is hard, hard work! -- and please feel free to PM me if you need to chat.

[midivydale]

What if it never gets better? I know its early day but what if the meds will not work? The lack of sleep is killing me and My heart breaks for my poor baby who is in so much pain. How do you keep going with no sleep? Apart from coffee how do you get through? The 'sleep when the baby sleeps' advice makes me want to scream.

I dont know what else i can do.

Sorry for ranting im just so damn tired

[Fuschia]

Did you get the liquid? If that's losec mups the chemist by the library ordered it in for me, also the one in north cross rd though I had to

Leave my prescription with them because one little bottle costs ?40! Free luckily if nhs prescription

I had terrible reflux when

Pg with the twins so I sympathise with your poor baby

I know several

People whose small

Twins really suffer too - certainly seems to

Be an

Issue for many

Prem

Or small

Babies

Though there is a link with cows milk protein allergy in some instances, I

Presume the dr considered prescribing a special formula?

From what I hear, almost every baby does grow out of it as their bodies grow (and also once they start solids as it's milk that refluxes so easily)

You must be exhausted and at the end of your tether

Let's hope the changed meds start to have an effect

What help and support do you have? You need to eat, sleep, and get a break from time to

Time otherwise you will be I'll

X

[Fuschia]

Ill, even

Sorry, iPhone!