REFLUX - can the effectiveness of no dairy and using gaviscon wear off? DS's puking has returned with a vengeance

[MadreInglese]

DS is 3 months old, exclusively breastfed, and from about 6 weeks I noticed a vast increase in his possetting, to the point where we had about 4 outfits, 12 bibs and countless muslins in a washing pile by the end of the day. I've given up bothering to chose nice clothes for me as I'm usually just covered in sick by the end of the day.

After doing a bit of research on here and other sites I initally cut out dairy as I was reluctant to give him medication if it could be avoided. We also kept him as still and upright as possible during and after feeds, shoved some books under the top feet of his cot and tried not to lay him down or jig him around too much, and tried to make sure he'd brought all his wind up. He feeds about every 3 hours for 20-30 mins so I also tried feeding him more frequently but for shorter bursts, thinking perhaps he was just over-guzzling. All of these things appeared to help in the short term but after a few days the sick increased again. So the next step (on GP advice) was gaviscon which worked pretty much immediately from the first time (two sachets with boiled water from a syringe straight after each feed).

But now the gaviscon seems to be not working any more and he is getting distressed - screaming his head off as I try to latch him on for a feed (he has tongue tie too which is an added struggle) and often having quite a grumble just before he is sick. He does not like lying down and arches his back with his arms out rigid to the side while making a sort of growly noise. I initally thought this may be just temper but I think perhaps he is in pain.

What do I do now? I'm still not eating any dairy and we're doing all of the above things, apart from the gaviscon as all it seemed to be doing in the end (after about 4 weeks of use) was making DS very constipated which was clearly painful for him. I have a GP appt on Thurs but she was quite "well babies do vomit you know ".

I can't take him anywhere or give him to anyone for a cuddle or even play with him properly as he's just sick ALL the time

Sorry for the essay, am having a little blub now

Any ideas much appreciated

[MadreInglese]

no-one?

[mawbroon]

I don't have experience of reflux in a baby, but was wondering if perhaps there could be an oversupply/forceful let down issue?

have a read here

[MadreInglese]

thanks mawbroon, I've had a look at that link and DS only has a couple of the symptoms so I don't think it's that

[buttonmoon78]

Ask for a referral (urgent) to a paed. Then ask for ranitidine. We lasted a whole weekend on gaviscon Poor ds was trying to poo playdough!

You have my sympathies.

[gallicgirl]

Don't bf but we found gaviscon stopped working after a while. Ask for paed referral and see if they'll prescribe ranitidine and domperidone. You'll go nuts if you try to cope without. Dd is so much better with meds and I'm a lot happier.

[buttonmoon78]

GP said he had to speak to paed dept to see if ranitidine is appropriate. Apparently not as ds is not losing weight. So it's ok to leave him in agony from acid reflux or constipated agony from gaviscon, just as long as he's not losing weight?! Sadistic buggers.

Also, they're not sure he's got reflux at all (from a second hand telephone examination, you understand). Apparently I'm overfeeding him. He's consistently getting through 33oz per day at the moment, which is 3oz over the recommended amount for a 2 month baby on the side of the box. Bearing in mind that 2 month baby is an average weight of 11lb and ds is 12lb (born on 91st c) I don't think +3oz a day constitutes overfeeding!

So I've rung back to ask exactly how much he should be drinking per day. I'll stick to that til Friday and when I'm proved right in that it is reflux I'll be going back to ask for an apology. And an immediate appointment up at the paed clinic.

Where do they get off? How come we have a culture where babies, mentally ill people, senile people, basically anyone who can't actually articulate their pain doesn't require medication for that pain? It's disgusting.

And breathe...

[gallicgirl]

That's a load of bollocks. My DD wasn't losing weight and was healthily climbing the centiles. Reflux babies will feed more because it soothes the acid. Paed had no hesitation in prescribing ranitidine.

Mind you, I had told the GP that if he didn't treat DD for reflux, he would be treating me for PND.

[Poogles]

DS was diagnosed with reflux when he was 6 months old and started projectile vomiting. After being told 'all babies puke' etc we got domperidone & ranitidine prescribed. Vomiting got worse. At 13 months old we went private and were told DS had a hernia that he had been born with and the meds were making it worse! Maybe worth asking them to check that in case it's not reflux (although we had to lay DS down after a feed as he was never sick laying down - told GP this but they still said reflux!)

Trust your intincts! (and good luck x)

[narmada]

HI Madre,

My first advice would be to get the tongue tie ligated - there is a theory that tongue tie is linked to reflux, there was a great article on it somewhere but I can't lay my hands on it. The GP may try and tell you that tongue tie is insignificant if a baby is putting on weight but this is not necessarily the case. Babies who have tongue tie can appear to be doing well weight-wise until their mother's supply becomes more supply/ demand driven (and less hormonally so) at around the 3 month mark. Sometimes, if the baby is sub-optimally transferring milk owing to a tie, weight gain can slow down.

Are you cutting out all milk and dairy completely? E.g., whey powder in biscuits, caesin (in more things than you'd think). If so, and no joy, you could also try a week or so of eliminating soya as well as that's a common cross-allergen for babies with dairy sensitivity.

I think you need to get to the bottom of what's causing your DS to fuss at the breast and pull off. If it is reflux (and not related to tongue tie or dairy) then ongoing food refusal can become and issue and is something that IMHO needs to be treated by a specialist paedeatrician - I would really, really press for a referral.

Last idea - have you checked inside his mouth for thrush? It could be there's another, more straightforward cause of the pulling off.

And finally.... don't despair, if it does turn out to be reflux there are very effective medications for this, like omeprazole/ lansoprazole.

Un-mumsnet hug :)

[organiccarrotcake]

www.analyticalarmadillo.co.uk/2010/07/reflux.html

I think this is the article that narmada may be referring to. Have you had the TT snipped?

[narmada]

That's it.

Thanks ORganic.

[ThisIsYourSong]

Gaviscon (and comfort milks) are only good for mild cases. In more severe cases it makes things worse (in a hurry) as it thickens the milk and it sticks to the esophagus for longer and causes more damage. Just because he's not being outwardly sick doesn't mean its not happening - DS's spilling up mostly stopped on Gaviscon but it came up once and it was the consistency of toothpaste.

You need to stop the Gaviscon immediately, things will take time to settle down as the damage is done. You need to get a referral to a paediatrician, if your GP won't give you one see another GP. Take a support person with you if necessary and don't take no for an answer.

Otherwise, you are doing the best things for your baby.

This is a good website //www.cryingoverspiltmilk.co.nz

[buttonmoon78]

Apparently The ocrrect amount for a 2 month baby at 12lb is 24oz. Not 30oz as stated on ALL the cartons. The manufacturers have inflated that to get you to buy more.

There's a pig flying past my window.

[MadreInglese]

Thanks for all your replies

He is sleeping at the moment so I feel a little brighter, yesterday was just awful, my happy little chap is turning into a sombre little thing

Re the tongue tie - I didn't realise there was a connection between that and reflux, interesting! Apparently his TT is only mild and they said at birth that unless he had severe latch problems then it shouldn't be an issue. He does struggle to latch on and I became very very sore (almost to the point of giving up) but now we use nipple shields and they help to guide him on and to stop me hurting (he would slide off and just chomp on the end of my nipple while getting himself all upset and frustrated).

Interesting also in that article that reflux is linked to traumatic births - DS was an emergency C-Section as he was footling breech and tangled up in his cord.

Re the dairy - I have cut out all dairy and eggs and anything that is labelled as containing milk/cream/butter/cheese/etc. Might it be labelled as something else? What else would soya be in?

Re the crying/fussing/back arching at the breast - he only does this at the beginning of a feed (as if laying him down is unpleasant) and when he's being winded (as if burping is also unpleasant for him). Once he's actualy latched on he will guzzle away happily and doesn't pull off to cry.

Weighed him last night (roughly on bathroom scales with DP) and he has not put any weight on the last 2 weeks - but he has always gained weight in fits and spurts since birth.

Hopefully the GP will listen to me and look into some other solutions for DS

Thanks all for your fab input

[buttonmoon78]

Oops - I posted that on the wrong thread!

I hope you get somewhere with your gp. Be prepared to be forceful. I was told yesterday that they won't go further than gaviscon as he's not losing weight. I said that was inhumane as leaving him in pain was unreasonable.

Fight your corner.

[MadreInglese]

Saw a lovely lovely GP this morning who was so nice and understanding I ended up blubbing

I just think after DP's mutterings of "well he doesn't really do it much when I'm home", my mother's eagerness for me to "get him on some baby rice" and MIL's helpful "he's just obviously a greedy baby and you're feeding him too much", it was sooo nice to have someone (other than MNers) really listen to me.

She has prescribed ranitidine for 2 weeks with instructions to go back and specifically see her for an update, and given me details of some local baby-clinic-type places where I can seek advice and support from professionals who are more specialised in bfing/tongue-tie/etc.

He's had one dose of the ranitidine and then fed with still a bit of sick but less fussing, and is in a deeper sleep now than I've seen him in for weeks.

Fingers crossed this will work!

[buttonmoon78]

Oh, I hope it works for you.

I totally get where you're coming from with other comments. DH doesn't understand why it gets me down so much. My mum thinks it's just something he'll grow out of if we just get on with it (which I know he will but at the expense of my sanity) and MiL is on holiday or she'd be saying something I'm sure!

[ThisIsYourSong]

That's great news, an informed and empathetic GP is what you need. re the tongue tie, do get it snipped, I'm sure it made feeding much more enjoyable for DS and it definitely did for me! Even if its mild it can make a big difference.

[MadreInglese]

Well another week on and the ranitidine seems to be having no effect at all, poor DS still puking all over the place and arching and screaming at feed times

Been and bought more bibs and muslins because we just didn't have enough and couldn't wash and dry them quick enough (I swear there will be smoke coming out of my washing machine any day now)

He's also gone from sleeping approx 9pm-5am to getting up 2-3 times a night now and won't settle for well over a hour each time so we're all knackered zzzzzzzzzzzzzz

Back at drs tomorrow so hopefully they can suggest something else

[buttonmoon78]

Wrong to feel this way but I'm glad it's not just us. The ranitidine is having no effect at all. True, we've only had it 2 days but it's just doing nothing.

I'm so fed up it's untrue. I've filled the washing machine twice today already.

[MadreInglese]

I really had my hopes up that it would work, thought perhaps it would take a couple of days but it's been a week and if anything he is worse

We'll just have it figured out and the little monkeys will grow out of it!

Have you another appt booked buttonmoon? (I loved that programme as a kid )

[MadreInglese]

out of interest what dose is your DS on?

weighing 13lbs DS is on 0.5 ml x 3 times a day, seems a tiny amount after the gallons of gaviscon but the dr assured me that was correct

[camdancer]

My DD2 is on ranitidine. She is on the maximum dose for her size. At 4kg (8ishlbs) she is on 0.75ml x 3 a day. Just as a comparison. It did take about 4 or 5 days for it to make a difference though.

[buttonmoon78]

Me too. DD1 was on gaviscon and ranitidine combined and that worked well for her. I've just spoken to the pharmacist though and she said that was only for 'desperate cases' . I never realised how bad she was - probably just as well.

She also said that the impact should be immediate or within 2-3 hours.

Ds is also 13lb (or was 12lb12 last Wednesday so they did it on that weight) and he's on 0.4ml x 3.

The paed is reviewing his referral this afternoon so I'm really hoping they won't just say that as he's not losing weight there's nothing they will do.

If she does say that then it won't just be him on medication. It'll be me too.