Infant reflux...how long for meds to work? (Domperidone and Omeprazole)

[jellybeans]

Hi 6 week old DS has silent reflux and the last few weeks have been horrendous. He has constant fluid coming up after feeds, violent hiccups, sick, and worst is gagging and choking, sometimes a couple hours after, have been to A and E twice he choked so bad, diagnosed with GORD. Tried gaviscon which didn't work, just made his poo bad. He started on the above meds 4 days ago but no sign of better days yet, could it take time? DS does not sleep AT ALL at night and we are exhaussted and desperate for DS to be happy, he is so miserable all the time poor thing. I am breastfeeding and often dread feeds as i feel guilty as i know whats coming and feel responsible

[TWezTheNightBeforeChristmas]

Omeprazole can take about 10 days to work

Poor DS you all have my sympathies.

hope you see an improvement soon

[TWezTheNightBeforeChristmas]

Little Refluxers is a great website/forum for parents of children suffering from reflux.

Offers lots of support and advice, I found it really useful when DS was little

[jellybeans]

Hi i have thought about it and cut out cows milk already, but i wouln't know where to start as everything seems to have milk proteins in! Any good websites to try? could i have DS tested for intolerance?

[mummypig]

hi I really know what you're going through as well. Ds2 had severe reflux and was on medications right up to his 2nd birthday. Give the meds a bit longer, you might have to wait up to 2 wks but they made a huge difference in our case.

Also agree about the cow's milk. It can be a huge pain reading labels, but if it makes your child better then it's going to improve your life no end. And if it doesn't help, two weeks avoiding milk isn't really so terrible for you to go through. If you can, make as much as possible from scratch at home. In my experience you really have to watch out for sliced meat, baked goods and ready made soups as they almost invariably contain milk in one form or another. So go 'back to basics' - roast a few joints of meat, cook veg with nothing added, make big batches of soup and bake your own bread for the fortnight. Substitute Pure margarine for butter (other margarines usually have some milk added), rice milk for cow's milk, eat rice cakes for a bit, have hoummous as a spread instead of soft cheese. I can't think of a specific website offhand but there should be lots of support and other suggestions on the mumsnet 'allergies' board.

Or it could be a different protein. The international Yahoo! group breastfeedingreflux has lots of helpful people on it and several have tried an exclusion diet with good results. I'm currently on one for ds3 who seems to react to oats and eggs. (Guess what my favourite breakfasts were prior to the exclusion diet?)

The NCT or LLL might be able to put you into contact with another mum who's been through it all too, and I've also used PAGER to do the same thing (just through e-mail, not phone, as their volunteers are based in the US). You can't underestimate the value of help from someone who really understands what you are going through. And take no notice of people who tell you to schedule feeds or leave a minimum length of time in between them. Refluxers do better on 'little and often' and I really had to rethink my approach to breastfeeding after having ds2.

Pollywogbaby is one of my favourite sites about infant reflux. I've not bought any of their products but the e-book is very helpful.

Thinking of you

[mummypig]

Also, to answer your last question, apart from coeliac disease I am not aware of any reliable tests for food intolerance. RAST and skin prick tests look for classical allergic responses which are not present if it's just an intolerance. 'Alternative' approaches like kinesiology just don't have evidence to back them up and the danger is that you would end up avoiding loads of food and potentially have nutritional deficiencies, for no good reason. Even tests which appear scientific e.g. YorkTest and ELISA which look for IgG are not based on good scientific research so please don't shell out money on them.

The best approach is just to cut out the food in question for a while, see if there is an improvement, and then see if the symptoms return after reintroducing the food. What makes it difficult is, as you've already noticed, the prevalence of cow's milk added in one form or another to many shop-bought foods.

Ideally you would do this with help from a good dietitian, but I haven't found any help from the NHS dietitians so far, and haven't been inclined to look for a private one. If you end up cutting out cow's milk for a long time you will probably want to watch out for calcium intake and I found the Vegan Society website had information on various non-animal sources of calcium.

Sorry for the huge posts but I hope they help. As you can tell this area is close to my heart!

[beagle101]

Just to echo Hoochie and Mummypig - ds suffered terribly from reflux until he was 18 months - it was a nightmare all round so huge sympathy coming your way, it is a very difficult time. I was able to ditch the drugs and just use the occassional infant gaviscon after getting all the dairy out of my system - it made a huge difference (ds is now just 2 and bizarrely would drink a milk lake if you let him - so I am guessing it was not so much a milk allergy but an inteolerance that he can now cope with or something) but like the others I can say cutting out dairy made a big difference.

On a practical point (and I am sure you are probably doing this already) but slightly elevate head end of bed (we also additonally added on of those fitted triangle wedges to raise him up a bit more and it seemed to help) and I know you are breastfeeding but if you are expressing you might want to try one of those haberman medela feeders. They were designed for babies with cleft palette (sp?) but they work like breastfeeding and I found with ds they led to far less reflux than even breastfeeding so I used them mixed in with bf. They cost about £17 for one bottle which is enough to make you weep but certainly for us it made a HUGE HUGE difference and we use them to this day (ds still has a bedtime bottle!).

Good luck - it will get better but I think it just takes time and finding the right combination for you.

[nappyaddict]

Make sure you get him weighed every week and dosage adjusted accordingly. The dosage depends on weight and won't work properly if he isn't having the right dosage.

[jellybeans]

Thanks so much everyone Am going to try going dairy free. Does anyone know if I can have soya milk instead of normal milk?

Will also get DS weighed weekly. Anyone know Do I note his weight gain with my GP or the prescribing hospital?

Also any ideas to get DS to take the Omeprozole (disolvable) withour screaming, it is yukky by the look of it. The Domperidone seems to taste OK. He is getting bad wind not sure if related to the med.
Thanks again.

[jellybeans]

Thanks, will get some rice milk and study what I can eat! Are there any other signs of dairy intolerance in babies?

[jellybeans]

So stressed and worried, scared he will choke at any time and that he is really unhappy, I feel such a failure seeing him miserable, is this normal?

[bigbaubles]

This may be an obvious point but did the Dr tell you not to give Domperidone and Omeprazole within an hour of each other? Domperidone works by speeding up the rate at which the gut works, if you give the Omeprazole while the stomach is running at full pelt he will not get the full benefit of it. Domperidone works best 20-30 minutes before a feed and can take a few days to kick in properly. I do hope you both get some relief soon.

[jellybeans]

Hi no the doctor didn't tell me that, the doses both say 9am (with a further 2 for Domperidone) so we have been giving together. I think the Omeprozole says 30 min beore a feed also. Any idea how to best give it then? Thanks.

[bigbaubles]

I personally would give Omeprazole first, give it 10 mins or so to get into his system then the Domperidone 20mins before the feed. Omeprazole does not affect the absorption of domperidone but domperidone does affect omeprazole - it affects asborption of anything in fact hence the warnings on Calpol etc.
Omeprazole is also available in suspension form by the way, Drs don't advertise it as expensive but it's easier to take than the revolting dissolvable stuff.

BB (not a Dr but a seasoned reflux parent of 10yrs. You can imagine the state of my carpet!)

[jellybeans]

Thanks so much BB will try that from tomorrow and ask about the suspension. Poor DS hates the disolvable stuff, looks gross. Thanks again.

[nappyaddict]

I used to give Domperidone 30 mins before a feed and omeprazole 1 hour after I had given Domperidone. Is that not the correct way to do it?

[bigbaubles]

Nappyaddict - not sure any way is correct as such. I think it rather depends on the child. If reflux is only a problem an hour or so after a feed, then domperidone before the feed and Omeprazole an hour later is possible. My youngest DS suffers from reflux the moment anything hits his stomach, so we have to get all meds in before we even start feeding. If I gave the O after a feed it would be vomited right back at me along with everything else!
Omeprazole works by lessening the acid production so when it works best will depend on when your child is producing the excess acid. Trial and error has been the only way to get it right in this house anyway.