omeprazole dose for a baby

[duende]

Hi,
I have posted before about my DS. he's 21 weeks and has severe reflux. He has been on omeprazole for a couple of months. Initially, the improvement was incredible. His dose has been gradually increased from 5mg to 10mg a day. He has now started showing symptoms again -screaming in pain, arching his back, only comfortable if upright, etc.
he weighs 8kg, about 17.5 lbs.

if anyone has any experience with omperazole, can you please tell me what dose worked for your LOs?

thank you.

[alypaly]

duende..I am a pharmacy dispenser.the dose has been specifically tailored to the weight of your baby ...presumably by your paediatrician. Whatever dose has worked for other peoples babies is irrelevant, Im afraid. You should not alter the dose without consent from consultant unless he has said you can titrate it a little.But he is already on the top dose for his weight.
For the treatment of GERD and maintenance of healing of erosive esophagitis, the recommended daily dose for pediatric patients 1 to 16 years of age is as follows:

Patient Weight Omeprazole Daily Dose
5

[duende]

Alypaly, thank you for taking the time to answer my post. I would never change the dosage of any medication my DS is on based what other people's children may be taking. And I will of course speak to the paed again, but or next appointment is not until February. It is good however, to do your research before speaking to hcp's and mumsnet has proved invaluable in this respect before.
I've found this info on a few reflux websites:
Low dose range is 0.7 - 1.5mg per kilogram per day.
High dose range is 1.5 - 3.0mg per kilogram per day.
Very high dose range is up to 3.0 - 3.3mg per kilogram per day.

The paed also mentioned that if needed, the dose could be increased further. Poor DS's esophagus is in such bad state, there are sometimes bits of blood in his sick

[alypaly]

duende....i know from some of the patients....its really awful to deal with,watching little one in so much pain.does the consultant know he is bringing up blood.

the dosages that you found equate to virtually what your DS is on any way...low dose for 8kg baby works out at 5.6mg-12mg daily...high dose 12mg-24mg

sorry i misinterpreted your post if you have a read it looks as tho you were going to change his dose and i was a bit worried.
Hope he grows out of it. Has he got infant gaviscon to use for the night time feed.

[duende]

Alypaly, yes, the consultant knows about the blood. He said it was from the damage to the esophagus.

We don't use gaviscon, but we thicken his feeds with carobel.
Strangely, he is never sick at night and he sleeps quite well. (touch wood)
It's daytime when it's most difficult.
thanks again.

[alypaly]

how worrying for you because if he is bleeding ,it is damaging the oesophagus. Has doc looked down to see if its ulcerated.

Do you prop him up at night to help stop the reflux.
mad4myboys has the same problem with her LO

[duende]

I have read mad4myboys threads and I really feel sorry for her and her LOs.

My DS has been diagnosed with lactose intolerance and is now on LF milk. The consultant said at the time, that he may also be allergic to cow milk protein and in that case, should be put on nutramigen or neocate. Since his symptoms increased again, I'm really keen to investigate this.
I wish we didn't have to wait till February. Do you know if it could be possible for me to speak to the consultant on the phone..?
or his secretary?

they haven't done an endoscopy to see what damage has been done, which also worries me

[duende]

Alypaly, thanks for talking to me btw. We have already had an hour long screaming session this morning. Am feeling depressed and helpless

[alypaly]

neocate is very good...
if you have concerns about the blood i would speak to his secretary...its worth asking,she can always say no.
is the blood dark red or bright red and how much is there....poor little mite and poor you. I sympathise,i had a LO with projectile vomiting which was also frightening

[duende]

alypaly, can neocate be bought without prescription? and do you think it would be worth just giving it a trial?

when there's blood in his vomit, it is little bits which are sometimes brown and look like coffee, and sometimes dark red.

did your LO just grow out of projectile vomitting? or where they on meds for it?

[alypaly]

neocate can be bought over the counter ,but it is supposed to be used under consultants supervision.Has he had the tests for the lactose intolerance and dairy intolerance.
Your gp might prescribe it for you if you tell them how you feel.
Why are thickening the milk with carobel.how does that help.www.neocate.co.uk/aaa_neocate/2684-neocate-UK-home-page.html

occasionally some mums have bought it from the pharmacy when they have got frustrated with waiting for appointments.

Thankfully DS1 grew out of it at about 4 months. he was very prem and wasnt growing because he was throwing it all back.( he was only 4lb 4oz) Used to have bin bags all over the lounge floor to catch it. It frightened me to death to see twice as much milk come back like a hose pipe. they were going to operate on his sphincter if it carried on,but it stopped in time.

[alypaly]

Soy formulas are made with soy protein and are lactose free. Brands include Enfamil ProSobee, Similac Isomil, and Nestle Good Start Supreme Soy. They are good for children who don't tolerate lactose or milk proteins. ]

Elemental formulas are also lactose free and are made with hydrolysate proteins, which are easy to digest for infants with protein allergies. Types of elemental formulas include Nutramigen, Pregestamil and Alimentum.



Other infant formulas include Enfamil AR (added rice), which is supposed to be helpful for infants with reflux and premature formulas, such as Similac Special Care and Enfamil Premature.

is the doc using the carobel in a similar way to the Enfamil with rice....just as an aid to hopefully keeping it down.

ask doc for a tub of enfamil Ar and then you wont need to use the carobel

[duende]

Alypaly,

he was on enfamil AR and that reduced the spitting up a little bit, but when they tested his stool and it came back positive for sugars he was put on LF milk. (unfortunately there is no AR lactose free formula!)

he hasn't had any tests done for dairy intolerance yet.
carobel is meant to thicken the feed just like gaviscon does.

you must have been so scared when your DS was sick like that. I'm pleased he grew out of it and they didn't have to operate.

[MrsExton]

My son is 7 months and about 15lbs. He is on 20mgs of omeprazole a day, tried to reduce it recently and we went right back to square one. Reflux really is the pits. Hope things are improving for you. If you are still very worried about your son just keep going back to the GP or phoning Paeds consultant. Sometimes you have to be persistent to get the help you need!
We are awaiting appointment for allergy testing as DS has broken out in rash all over after trying formula and cows milk. Disappointing as I was hoping to give up breast feeding soon

[duende]

MrsExton, is your son no longer in pain when on this dose?
I am going to try and speak to the consultant tomorrow, we have had a horrendous day today. I feel devasted when it returnes with such a vengeance after he was doing brilliantly for a few weeks and I thought we had it all under control

sorry to hear about your DS's allergy. maybe he will be able to have one of those hypoallergenic formulas which alypaly mentioned? neocate or nutramigen?

[MrsExton]

He seems fine on the 20mg dose, it is the highest recommended for children. Hopefully he will grow out of it but it it feels like a long time coming!
Have been trying aptamil pepti, seems ok in that it doesnt upset his skin but it stinks! I wouldn't drink it if I had the choice

[duende]

MrsExton, can I ask, do you give him 20mg in one go, or do you split it? and is it losec mups you use?

I have heard that all the h-a formulae stink, luckily I can drink lovely smelling coffee ;)

[MrsExton]

We have losec mups, you half the tablet then mix it with tiny bit of water until it puffs up and starts to dissolve, then mix it in with some fruit puree. It is a lot easier to give in a puree than use a syringe, I found it kept
getting stuck in the syringe and blocking it up.
The pharmacist at hospital told me to make sure it is given as far away from a feed containing milk as possible. This is because the milk stops it being absorbed properly. This can be a bit of a pain but it does seem to make a difference

[duende]

he's not yet on solids, so can't mix it with puree. it is a bit of a pain to administer and we also found it was getting stuck in the syringe. we now dissolve it on a spoon, just like you do, and then squirt it into his mouth with water from a syringe.

[alypaly]

duende you can get the Gp to prescribe it as omeprazole solution. It gets made up at the specials lab for each individual prescription so you dont have to dissolve the tablets and it doesnt stick in the syringe. It can be made to the strenghth. you require

[alypaly]

not at work at the mo...but i think the strenght is 2mg/ml concentration and it takes about 2 days to get from specials lab. you keep it in the fridge and then just get a repeat prescription made up a few days before you run out.

[MrsExton]

The paeds doctor we saw told us that omeprazole solution is not suitable for infants because of the preservatives in it, and apparently it goes off quickly. Not sure if that is the pre-made stuff though, maybe if a pharmacy made it up as required it would be ok.

[alypaly]

there are no preservatives in it and it has to be kept in the fridge for the month and then disgarded as it goes out of date quickly.Ther is no premade omeprazole. It has to be made to order as it has such a short shelf life. The doc is probably naking excuse as it cost £280 a bottle for 100mls {shock]

[duende]

alypaly, I know about it, but also know about the cost and I would feel guilty knowing NHS had to pay this amount of ££ for it...especially seen as DS is likely to be on it for a while.

We couldn't speak to the consultant today as they are not back at work till next week.
We've been to our GP and she has decided to:
-try him on domperidone alongside omeprazole
-if no improvement - try nutramigen
-if no improvement - up omeprazole to 20mg.

fingers crossed something works, he's in so much pain at the moment

[alypaly]

oh poor LO and poor you....try to rest yourself,otherwise you will be shattered too.

[MrsExton]

Hope this works for you, I know it is really stressful when nothing seems to help x