CMPA and reflux

[JadeFD]

Hi everyone!

just wanted some advice as I’m really struggling at the moment. My son is 6 weeks old and he is bringing up feeds almost every time, he has a rash on his face and chest and he is so unsettled all he does is cry.

been to the GP and they have prescribed him SMA althera and it seemed to improve his symptoms the first day! No rash and he seemed quite settled but now he’s even worse than he was before. Non stop crying, he’s bringing up his feeds and his rash is now returning.

I’m not sure what to do other than to back to the GP? He’s not sleeping properly and I also have a one year old so safe to say I’m definitely struggling!

Any advice would be much appreciated! Any advice on formula or whether I should keep him on the SMA?

Definitely go back to the GP. SMA Althera is a hydrolysed formula, meaning that the milk proteins are still there, they are just more broken down.

It could be that LO needs a completely DF formula if they could be reacting to one of the other Ingredients. I've got CMPA and also react badly to Rapeseed Oil. I know that if I was having it multiple times a day it t woukd really affect me.

Definitely sounds like he needs a completely dairy free formula. Push your GP to prescribe it because they seem to not care about baby being in pain. Really push for it

Definitely go back, it can often take a couple of trial and error changes before finding the one that works for your baby.

We found Neocate to be the one for us. What are you giving for reflux? We struggled with this, and also constipation.

Thank you for the advice everyone! I’m giving him gaviscon at the moment but it doesn’t seem to be doing anything but make him more constipated!
Will ring the GO tomorrow and push for a dairy free formula, honestly feel like they don’t listen to me or make me sound like I’m exaggerating the pain he’s in!

Have you tried filming him when he's screaming? My DS would be up for about 20 hours a day screaming, more sometimes. You could guarantee that if he was peacefully asleep, it would coincide with the Doctor's appointment.

Well spoke to GP this morning and he has advised me to stop the SMA and put him back on his original milk which was kendamil and he will refer to paediatrician. Discussed dairy free formula and he doesn’t think this is a good idea but to keep giving gaviscon.
complete waste of time.

Do you guys think this could be CMPA rash? Doctor has really made me doubt myself.

What did the GP say was causing the rash if he doesn't think it's CMPA?

I had to book in with another doctor at the surgery as I felt like I was just being dismissed completely. Just got back from the appt and they want me to now continue with the althera and gaviscon even though it’s making him miserable. Said to call back Friday if it’s not working. I can see myself calling back before then.

It might be worth reading the Nice guidelines and speaking to Allergy UK before you speak to the GP again.

What's really helped us in the past, when the GP appears not to be taking notice, is to take DH to the appointment with me. For some reason a lot of GPs seem to take you seriously if there's a man there.

I think I'd want a prescription for Omprazole and a referral to a Paediatric Dietician. If you want to go ask for everything, ask them for a referral to the Allergy Clinic too

Got a HV coming tomorrow who has said she’ll do a referral for me to the dietician so I’m hoping that’s going to help!

Give a few days and then go back again.
Push for omperazole.
The allergy formulas can often make reflux worse as they are thinner and if there was reflux anyway you might find it gets tricky
Cmpa often causes reflux but my daughter has reflux in addition to allergies. She needed an alfamino and gaviscon, omperazole and domperidone for the reflux. It took until 17 weeks to get proper treatment because our initial GP just kept repeating reflux is a washing problem, she's gaining weight there's nothing wrong with her ... she was screaming all day every day. My HV was about to step in and advocate for me when we saw a different GP and then a paediatrician for something else and we got put on higher dose reflux treatment and we went diary free..

Our magic combination was Neocate, Omeperazole and Movicol

Absolute game changer

Hi guys,

thank you all for the replies. Been told to keep him on Althera but to call GP back to ask for omeprazole as this might be why he’s not taking the milk as he should be.

not sure who to listen to at this point, I just know my son is in pain and I’m really trying to get through to the GP but it’s like talking to a brick wall!

Hi Everyone!

kept him on the Althera and GP is going to prescribe Omeprazole finally! However the rash has come back just wondered what people thought about the pics? I’m not sure whether to ring the GP back?

I ended up at the GPs 7 times in 8 weeks with DD until we finally found something that worked for her. Keep going back. I kept a diary of feeds and symptoms and just kept telling the same info and saying that my baby is not right so it needs sorting. It defiantly sounds like you need an amino-acid formula.
I also Googled the NICE guidelines on CMPA and told them to a GP too. Luckily I had a brand new, junior DR who listened and pushed our referral through.

How long have you been back on the althera?
I would be going back, if you have been on it less than a week I possibly would wait until you have been on it a week as I would expect you to be told to give it more than a few days.
I hope the omperazole helps. Just yo warn you, it might make it worse initially due to the acid battle where the body tries to reverse the effect of the meds

he's been on it nearly two weeks now and the rash keeps flaring up and going back down. Seems to be getting worse now though and he’s throwing up quite a bit. Have got another GP appointment later on today, they know me by name now!

Yep push for alfamino or neocate!
And dietician/paeds referrals

2 weeks is more than long enough.

They might suggest trying nutramigen first. There are two proteins in dairy, caesin and whey. You can be allergic to either or both. Some extensively hydrolyse caesin others whey so you might be asked to try and extensively hydrolysed formula with the other protein but I think I would ask to go straight to completely dairy free. A thickener might be required in addition to the omperazole as they are quite thin compared to regular formula

Is he exclusively formula fed? Asking as babies that are still getting some BM can react to things in your diet too.

A secondary lactose intolerance is possible, some formula that are suitable for CMPA still contain lactose.

This is why I just ended up buying my own soya formula and giving mine that because doctors just don't seem to care about babies in pain. Luckily for me mine isn't allergic to soya like some cmpa babies are and the difference in him was amazing. Is there a dairy free formula you can buy yourself so if you see a change and the rash goes you can then tell the doctor that. Honestly I understand how awful it is to watch little one in pain and not get anywhere with GP. Really hope you can get it sorted 🤞

Thanks everyone!

At my wits end with this and speaking to GP’s! He’s completely formula fed. I’ve been using a thickener in the althera as it just looks really watery! Not very hopeful for my appt later but I’m going to push for dairy free I think and see if it makes a difference. GP I spoke to a few days ago refused dairy free because it was too ‘expensive’.

If you search for cmpa and the name of your primary care trust you should find the prescribing tree.
Amino acid formulas are expensive and it is better to have some proteins in their diet if tolerated as it helps to keep the tolerance but 2 weeks and still sick, still coming up in a rash. It's time for a change.
If no luck, you could look at buying your own. You can find them online usually. I would personally go with alfamino or neocate over soya as half of babies are allergic to both dairy and soya. You might be lucky and in the none allergic group as @Devilsmommy was but you might be in which case you are looking at another few weeks symptomatic.

Been prescribed Alfamino and Omeprazole. Tried three pharmacies for the omeprazole and no luck apparently out of stock but managed to get the milk so fingers crossed there’s an improvement soon!

Is it the liquid you've been lucky enough to be prescribed?

Or the Losec Mups?