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Children's health

Baby reflux - when to medicate?

14 replies

PBobs · 17/08/2019 15:43

Hi all. I did a search and couldn't find quite what I was after. Our 10 week old has silent reflux. I can hear him bring up his feed and swallow it back. Rarely does he spit some out. If he does it's a teaspoon to a tablespoon at a time. Some days it will be after every feed. Other days it won't happen at all. Many days he'll scrunch up his face after a feed, stick his tongue out, chew his hands and do a bit of wriggling but doesn't cry or show other forms of distress. He has never had projectile vomit or any vomit.

He sleeps fantastically at night. Asleep at 9pm then we wake him during a final nappy change at 10-11pm and a final feed. Then he sleeps until 6-7am.

He doesn't fuss during feeds. Loves his food. He is overall very relaxed and unfussy. Nobody can believe how chilled out and easy going he is. He does have terrible wind and sometimes will cry or fuss until there's a fart or burp. He is a slow weight gainer but has put on 1.3kg since birth. Not ideal and has dropped to a lower percentile.

As a result a doctor put him on ranitidine for 3 weeks. He took it as instructed but I don't know how much difference it made. Spit up seemed to ease off but then came back a bit. Now a new doctor wants him on omeprazole. We have met her once.

I just don't know if it's necessary. Are his symptoms bad enough to warrant what feels like quite heavy duty meds? Please note that he's been seen by 3 prescribing doctors (+radiologists etc) in 10 weeks as we've been moving so nobody has a full recent picture of his health. The doctor who prescribed ranitidine did so at 7 weeks and hasn't seen him since.

I wondered if anyone could advise on their experience of how bad reflux was in their baby to warrant meds. Thanks very much.

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LatinforTelly · 17/08/2019 17:17

Has the new doctor said why she wants to change the meds over to omeprazole? Has he had a pH probe or endoscopy or is it on the basis of his symptoms or (lack of) weight gain?

My baby was put on omeprazole at 6 months but he was very small - around 5 kg at that age. I was told by his gastroenterologist that it is viewed as extremely safe for long term use in children, but am not a doctor so obviously can't verify that!

I'd be interested in understanding why the new doc thinks omeprazole is warranted. (I think re-reading your OP it is the weight gain?)

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PBobs · 17/08/2019 17:43

@LatinforTelly thanks for replying. It's good to have someone further along to talk to about it. New doctor is in a new country and says she doesn't usually prescribe ranitidine these days and prefers omeprazole. She says it's easier to give to him as it's once a day.

Interesting that you've been told it's tested and safe etc. We've been looking for relevant papers and studies and are still looking.

Not had an endoscope etc. Nobody has even suggested it although I would like one. It seems weird to me that they think symptoms are bad enough to medicate but not to do further tests.

Did they tell you why it might have affected your baby's weight? I can understand why it would if you have a baby who is frequently sick etc but a bit of spit up after every meal can't affect weight gain that much surely?

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PBobs · 17/08/2019 17:45

Just to add that yes, the slow weight gain (averaging 130g per week) is what is causing concern.

My understanding was that spit up after meals is ok and commonly expected as long as weight is being gained and child is happy etc. He is reaching all other milestones and is sticking to his curve for height and head circumference.

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PBobs · 17/08/2019 17:47

Can I ask what your baby's reflux symptoms were apart from weight being an issue?

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LatinforTelly · 17/08/2019 22:48

Hi @PBobs, would you mind if I pm-ed you? I'm happy to go into more detail but it's v identifying! In short he was put on omeprazole having been referred for failure to thrive. He was born small anyway, hated feeding (breast, bottle, whatever) was very fretful and then started missing milestones. His is quite an extreme case and reflux turned out only to be a part of it. Please dont worry - it doesn't sound like your son is the same! Will give more detail on pm if you want me to.

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PBobs · 17/08/2019 22:51

@Latin if you don't mind that would be helpful. I feel a bit at sea being overseas with no other mums to compare notes with. Thanks.

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LatinforTelly · 17/08/2019 23:03

Also wanted to add that it sounds appropriate they haven't done endoscopy or pH probe. Endoscopy would mean a ga on a baby and ph probe is not the nicest...small tube down nose with a sensor that tests the acid in the oesophagus for a period of time. My son didn't have either until he'd been on omeprazole for over a year and another medical procedure worsened the reflux.

It's probably a reflection of how safe they feel omeprazole is that they give it as a first resort before doing more invasive tests.

Btw it did help my son!

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LatinforTelly · 17/08/2019 23:06

Sorry cross post. Will pm from laptop. Am typing on phone, v slow!

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LatinforTelly · 17/08/2019 23:43

Have pm'ed you. It's long, sorry! Hope it helps a bit anyway.

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LatinforTelly · 17/08/2019 23:51

And despite the massively long pm, I don't think I specifically answered your question about why reflux inhibits weight gain if no vomiting. It's because the acid inflames their oesophagus and makes feeding uncomfortable. Also being full makes regurgitation into the oesphagus more likely, so they learn not to be full, or instinctively know to feed less. (The advice with refluxy babies is to feed little and often I think.) That was my understanding anyway. Right will shut up now!

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hazeyjane · 18/08/2019 00:06

My ds has reflux and has had since birth. His paediatrician said to us that with reflux it is often a case of trying medications (starting with gaviscon, then ranitidine, omeprazole etc) and if they are effective in addressing the symptoms of reflux/silent reflux, then that confirms the reflux, rather than diagnosing via endoscopy and ph probe (as Latin said, this is an invasive procedure done under GA and the ph probe can be very distressing). The majority of children 'grow out' of reflux, so if the medication can address the symptoms often further investigation isn't necessary. Ds has had ranitidine, omeprazole, domperidon and lansoprazole.

Ds is 9 and had an endoscopy and ph probe last year, as his reflux had got worse over the years, we were struggling to medicate and he had other gastro issues.

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PBobs · 18/08/2019 07:21

Thanks @Latin. Have tried to reply. Phone being a bit sticky today.

@Hazy thanks very much for the info on diagnosis etc.

Can anyone please give me tips on how to get 7.5ml of omeprazole into an EBF 10 week old? We struggled to get 0.6ml of ranitidine into him.

Thanks everyone for your help and support.

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LatinforTelly · 18/08/2019 17:14

Just replied @PBobs. Sorry I wasn't v helpful about the omeprazole - I don't really know how you'd do it other than by syringe to the back of the throat but obviously you don't want to introduce a choking risk. What did the doctor think, especially as she thought it would be easier than ranitidine!