Advice please - Eczema, Reflux and Nutramigen

[MelissaClaire]

My son is 5 months old. From birth he developed quite bad eczema and also opened his bowels very infrequently (once every 4 days until 8 weeks). At about 8 weeks he was diagnosed as probably allergic to the formula he was on (Aptamil) and put on Nutramigen. He was mix fed - part breast milk, part formula. We switched him to Nutramgen, and although he started pooing more regularly his eczema and cradle cap didn't improve at all, and he started displaying the symptons of quite bad reflux (sick all the time).

We went back to the doctor who said that yes, he did have reflux and probably had it before having nutramigen and that it was because nutramigen is so much thinner that it is easier to vomit up. Zantac was perscribed which didn't do much at all. We couldn't use gavisgon as it was likely to make him badly constipated again.

I still wasn't certain I agreed with the diagnosis, saw another specialist who agreed it was a cows milk allergy - purely because of the eczema and I just had to put up with the reflux.

I hate to admit, that against the doctors advice, I now mix aptamil with the nutramigen (3 scoops of aptamil, 5 of nutramigen) which helps with the sickness. The eczema has stayed constant and not got worst. Unfortunately I stopped breastfeeding at 4 months, so he is now only on forumla, but I have introduced solids (veg only) at the recommendation of the gastroenterologist. I also took him off the zantac as I thought it made his eczema worst, but infact it may be something totally different!

He gets really upset at nights (when flat, or propped up) and arches his back is a backwards C - typical reflex symptons. I thought his refulx would improve with solids, but it hasn't.

Has anyone else had a similar experience, or any tips!?

My first son had reflux (now 2) and DS2 is 3 months and has it too. We use Enfamil AR formula which helps a lot.

If your LO is still getting upset by it you need to go to see another GP or a paediatritian - there's plenty of treatment you could try including gaviscon and ranitidine.

Interms of whe things improve - we found a slight improvement at 6 moths but not the great leaps we'd been promised by the HV or GP. We found improvement actually became noticeable around 9/10 months and he was doing much better by 12 months. At 2 years he's still sick in his mouth quite a lot and sometimes it dribbles onto this t-shirt but nothing lke what it was when he was a baby - now it's only once or twice a day.

Before you put it all down to reflux though do try and find out if there's some sort of allergy going on as solving that may help you out - if you did end up with a different kind of fomula you can always add gaviscon to it to thicken it.

sorry to hear about your LO's problems - does your son have any other symptoms of intolerance eg very windy? My dd is on Neocate (having initially improved on Nutramigen but not 100%) which helped her wind/eczema wise but had no effect on the reflux.

You might be better off trying pure Nutramigen with a thickener instead of the aptamil - its what alot of reflux mums do. Its true that many find that the reflux initally looks worse because of the thinner consistency, unless you use a thickener. Carobel is the best known - it doesnt cause constipation and if anything it makes them a little loose. It didnt agree with DD (wind again!) but thats not that common (its just carob bean and maltodextrin). We ended up (after trial and error) using Nestargel (carob bean only) which you have to boil and its a bit of a faff, so prob best trying carobel. YOu can therefore make the milk as thick as you need. Both are available with or without prescription from the pharmacy (though you might have to ask them to order it in)

DD didnt come off thickener until 12 months and it was a lifesaver for us (as she didnt respond well to drugs tried).

As far as solids goes, it helps some and not others. I was advised by gastro paediatrician to try at 4 months. I waited til 6 and actually she refused pretty much everything til 8 months, and she is still iffy about both food and milk.

It may just be a waiting game i'm afriad, but liquidclocks is right - if you are not happy insist on another GP or a referral (though i would try thickener first) until you get the help your LO needs (which may be ranitidine or losec).

hth
alice

Thanks so much for the advice. I am going back to GP this week and will see what they suggest. In the meantime I will try with the Carobel.

I guess a main concern is whether the recommendation of Nutramigen was correct in the first place, and whether the eczema could be environmental (although I am not sure what causes it) rather than due to the milk, but two specialists thought it was a cows milk allergy, so I guess I should believe them!

I will let you know what the GP says.

Sorry, Alice - should have answered your question, no he doesn't have any other intolerance symptons other than being sick and very bad eczema and dry skin and cradle cap. He was nver sick until he went onto nutramigen. His poos are generally green, and were before nutramigen (as I know nutramigen results in green poo). He is not particularly windy.

melissa
how long has he been on the nutramigen? If i remember rightly it took a while for my DD's skin to improve (and we still had odd flare ups on her face from solids - though we could never work out what exactly). I dont know if you have found a cream that works for him but we had success with Aveeno baby range (only avail online as far as i can tell)
www.soft-skin.co.uk/estore/cgi-bin/cp-app.pl

My daughter saw an allergist at 8 months mainly because of the face rashes from solids. She was tested for milk allergy amongst others and it was negative. The tests are not that reliable but it does imply at worst she had a mild intolerance rather than an allergy. However we were still advised by dietician, paed and allergist to carry on with hypo milk and to do trials with cooked dairy after 1 year or so.

I am assuming the pain symtoms you describe ie back arching etc were there before the Nutramigen????

I think that Carobel or Nestargel would at the very least remove the problems you are having with nutramigen. You may need to do a couple of searches on reflux boards re amount of carobel to use - though its pretty much trial and error. But you will probably have more luck if you make it thicker than the aptamil and if necessary change teat (alot of people use fast teats with thickened milk). If he is still uncomfortable then you of course need to speak to the GP re medication (very few people seem to get very far with gaviscon).

Hi Alice,

I have put my son on pure nutramigen from today, and used Carobel as the thickener. He seems in less discomfort although he has been quite sick this afternoon, and has been a little more unsettled during his sleep this evening.

I have been using two scoops of carobel to a 8oz bottle of milk, perhaps I should increase the carobel tomorrow. He does seem to be a little constipated (no poo today) so will see how he does over the next few days. Can you remember how long it took before you saw an improvement in your daugthers skin?

Thanks for your help!

Melissa

Melissa

I would certainly give it a few days to see if the poos settle (carobel def isnt meant to cause constipation in the way that gaviscon does). As far as thickness goes - i think alot of people use 3 or 4 per 8oz so maybe try 3 and see (as i mentioned you may have to move to a faster teat)

If he seems unsettled after a few days i can only suggest Nestargel which is a bit more of a pain to use. As I mentioned, my lo didnt get on with Carobel (it made her grizzly and windy) but I know this is not common (i came across only 2 others in about 6 months on various boards with a similar problem - most find it helps alot)

It will take a few days for the apatamil (?) to get out her system anyway. Tbh i can't remember how soon her skin resolved but i think we are talking weeks not days. In the meantime the baby aveeno is def worth trying (though not the one with milk protein in it!)

fraid its all trial and error (it took me months to find the optimum solution and even then it wasnt a 'cure' - she still has reflux now at 15 months, but it all helped)>

hth
alice