Silent reflux and side effects of medication

[irilys]

I am new to this site and am in need of advice.

My 9-week old DS has silent reflux. Usual symptoms include difficulties winding, cries after most feeds (BF almost exclusively so far), cannot be laid down flat on his back so he sleeps on my chest, has saliva bubbles, sounds congested etc.

One evening before we understood what was really happening we took him to A&E as he had been crying most of the day, which was unusual. The paediatric doctor there prescribed Gaviscon Infant and also Ranitidine in case Gaviscon did not help. We put him on Gaviscon Infant for 2 weeks, although on a slightly lower dosage than recommended as we were concerned about constipation - we did not want to make him worse than he was already. It helped very slightly as he did not cry as much as before but overall there was no change. We stopped for a few days and have decided to start again to ensure that the acid reflux does cause harm to the tissues around his oesophagus.

We are not keen to get him on Ranitidine because of what we have read of the side effects (allergies, neurological issues etc). But this is what I would like to hear from parents whose LO have suffered silent reflux in the past and have taken Ranitidine:

• Did Ranitidine stop silent reflux or improve it?
• How easy/difficult is it to give?
• How long would a baby be on Ranitidine for typically?
• Are there side effects that you noticed immediately?
• What about LONG TERM effects? Have some of you noticed any adverse effects on your LOs once they have grown out of silent reflux?
• Finally, I need all the hope I can get, when does it actually get better?

Many thanks in advance.

I was told by our GP that ranitidine is very unlikely to have any risky side effects (in comparison to eg omeprazole which can do). She is generally an excellent GP so I believed her!

It's very easy to give (small syringe full 3 or 4x a day iirc, our baby seemed to like the taste so no issues getting it down her). Much easier than Gaviscon for a BF baby. The main difficulty was that it is supposed to be given 20 mins before a feed - invariably DD was sleeping at that time and I didn't want to wake her so I ended up giving it more like 5 mins before a feed which probably made it a bit less effective.

Not sure about length of time. I think we took DD off it at about 4 months, or possibly before, because we discovered she was tongue tied - once we got the tongue tie snipped her reflux resolved itself (or maybe she never really had reflux and all her symptoms were down to the tongue tie).

We didn't notice any side effects either immediate or long term. However I have read on another thread of it giving tummy pain to another baby.

Hi Irilys. I'm sorry to hear your suffering - it has brought back memories from 11 years ago but here's my take, for what it's worth when my DD suffered from severe acid reflux from birth.

Gaviscon infant was the only recommended medication at the time, I would give her the dose after EVERY feed, as even missing a few made the symptoms worse. The crying was unbearable, angry and as if she was in constant pain. She didn't sleep at all during the day, arching her back if ever put down to sleep. Buggy pushing at an angle helped to catch 20 mins here and there. Night time, she'd sleep for around 4 hours and then start the cycle of crying. We resorted to a bean bag, as we could pop her in whilst getting ready for work, again, the almost sitting angle helped for short periods of time.

I know this all sounds negative - I think what kept me going was I knew what the issue was and that it would get better - for us that was when the weaning started, there was more for the stomach acid to work on and overnight, her personality changed. Weaning was a lot earlier then at 4 months vs the current 6 months, however, the improvements should start as your DS starts to sit up more.

I cannot comment on Ranitidine as this was not on offer at the time. We stopped Gaviscon at 4.5 months as solids eliminated the need, and from thereon she went from strength to strength. No long term side effects, now she is a very healthy 11.5 year old, never taken a day off sick in her whole school life!

Good luck.

Just for clarity irilys as my memory is poor - we used to mix the dose within her milk (I had stopped feeding by 8 weeks as part of the process of elimination as to what was wrong, my food, onions, garlic etc etc...)

I feel like we tried it all. Gaviscon did very little for dd. We used ranitidine which had some impact but was more effective in conjunction with domperidone. My dd wouldn't take omeprozole, as it really doesn't taste very nice, but got used to her doses of the other two very quickly. I was frustrated that we wasted time with gaviscon as it didn't work for her. Dd has a cows milk protein allergy, and this aggravated the silent reflux. Giving up dairy while bf seemed to have a strong impact too.

In terms of side effects, my understanding was that both ranitidine and domperidone are very safe for babies, but admittedly it's now over a year since I read up on this.

It improved DD1's silent reflux within 48 hours. It is very easy to administer by syringe. No side effects noted in short or long term. We weaned her off it gradually after 12 months. Symptoms did not reoccur. No ongoing issues regarding feeding. She eats and drinks normally. Sleeps 13-14 hours overnight.

Thank you very much to all of you for sharing your experiences. I feel a bit more at ease with this medicine if we come to administer it to our DS.

My DS has been on ranitidine since he was 11 weeks old... it changed our lives!!! He went from being in terrible pain and not being able to sleep for more than two hours at a time from discomfort to sleeping twelve hrs at night and being a much happier baby. We noticed an improvement within 3-4 days. He's 13 months now and we're gradually weaning him off. (But the nights of twelve hrs sleep are long gone... teething!!!)

Also, we administered the dose using old baby nurofen or calpol syringes as it was easier to get it in to him... although he never seemed to mind the taste of it. Haven't noticed any side effects.

Stargirl1701 - how old was your baby when you started the treatment?

Gooseygirl - your baby was receiving it for almost a year. What helped you determine when was the time to get off the medicine?

My DS who is now 9 had gaviscon, ranitidine and domperidone for his first 6 months of life for silent reflux. We just reduced it gradually at 6 months as he was on solids and cruising so upright. If it's any reassurance he is a very healthy 9 yo boy now. I hope that helps - I feel for you , it is incredibly hard living with reflux xxx

My twins were born at 31 weeks, diagnosed silent reflux at 33 weeks and medicated until they were 1. Domperidone, ranitidine and gaviscon. As they weaned we phased out the domperidone and gaviscon but they needed the ranitidine.

To be honest, side effects of the medication never crossed my mind. Theres was so severe that the side effects of the reflux would have been worse, FTT etc. we had issues with constipation from the gaviscon but they also had infacol which balanced it out somewhat.

Posted too soon - I your baby has been prescribed it it's because they need it. The ranitidine can ease symptoms in 24-48 hours. I can't really understand why you wouldn't?

We started at 10 weeks, I think.

Hi Irilys,
If you have time would you mind posting a link to the info re allergies and neurological problems? My DS had ranitidine when a few weeks old. Now a healthy 4yo but has multiple allergies and a question mark over whether he might have ASD (mild). Am now really worried it's all because of the medicine he had ...!
I hope you find something that helps your little DS feel better, and also that you find a way of getting a break too -- it's so exhausting for everyone!

There is absolutely no evidence linking ranitidine to ASD. None. Whatsoever.

There's some evidence it can cause rashes; no evidence it can cause allergies.

Dosage of all medicines are specific - altering the dose without the consultation of a specialist will contribute to the efficacy or otherwise of said medicine.

OP - my babies were on ranitidine for about 2 months to control their silent reflux. Symptoms eased within a week.

Thanks for further posts and answers.

nocarbsplease - I hesitate to give my DS medicine generally as I would rather look at natural/alternative solutions first. Reason being - he was admitted to hospital at 2 weeks of age because of Group B strep infection and was under IV antibiotics (penicillin) for 2 full weeks. That is a lot for such a small baby.

I continue Gaviscon Infant treatment for now because is not absorbed by the system. It does not stop reflux but seems to make it less painful for the little one. I have completely cut out caffeine (I was having a few cups of tea a day) and off obvious dairy ("obvious" meaning milk, cheese and yoghurt are out but I am still eating the odd pizza and the odd bit of feta cheese); that does not seem to have made a difference but I will persist because it's a cleaner diet anyway - note: I supplement with Pregnacare so vitamin deficiency is unlikely and I have a varied diet). Of course if things still do not improve then it's likely we will have to administer Ranitidine. I just wanted to hear what people's real life experiences had been rather than rely on the doctors advice.

cameorole if you look up "ranitidine side effects in babies" you will find some info. I know of one child who had reflux (not silent though) till she was 2. She was on Gaviscon, then Ranitidine then the next one up (not sure if Omeprazole or Domperidone) and has had nut allergy. But not her brother . So it may be unrelated; as other people have said in response to this thread, their children have not developed allergies. Therefore I do not want to worry you unnecessarily.

Again, many thanks to everyone for taking time to reply. I am grateful for your advice to guide me through this rather unpleasant experience for baby and parents.

Hi my ds (now almost. 3) had silent reflux. Dr prescribed the infant gaviscon which we used in every feed. By this stage he was on bottles full time as i thought it was the iron tablets i was on that affecting him and my milk dried up in the meantime). He was slightly constipated for the first few days until his wee system got use to it.

As an adult with heartburn, I have tried all of the natural remedies under the sun and nothing works. I'm not overweight btw. I take omeprazole every day to keep it under control.
I'm a mum of a DD who had reflux and getting meds made so much difference. No side affects that I can tell so far. I gave meds a go for her as I didn't want her to suffer the pain I do without omeprazol

Lindsay, apologies if you have already done this but has your doctor tested you for Helicobacter Pylori? If not, it may be worth trying and just requires you to breath into a tube. Simply cured if this is what you have.

Hi
Yes I have, unfortunately mine stems from a stomach ulcer years ago caused by taking ibuprofen!! It's inflammation that will always be there
However I did tend to suffer from bouts of heartburn before this. Apparently I was I major puker and screamed constantly as a baby so I'm assuming I must have suffered from reflux too! HV says it's hereditary so it all makes sense.
I took DD off omeprazol at 13months and she seems ok!

Have you ruled out tongue tie? Very similar symptoms.

Also if you give up dairy you need to do it properly. And soya - this caused quite bad issues for my DCs. I remember ds having green poo after I'd have a soya latte once so never again! He also got horrific rashes after having a soya yogurt at 6 months.

I was worried about ranitidine and took ds off of it at 9 months as his hair started falling about which, in my head, I'd linked to vitamin/mineral deficiency caused by ranitidine. My gp laughed at me when I asked about it....!

I started replying to this thead at 1am but my reply got lost by my browser. Grrrrr.....

Thanks for the additional replies.

iggly yes checked for tongue-tie. He isn't.

Re: dairy I talked to the doctor yesterday at DS'S 8-week checkup (delayed bcs of the surgery's backlog of appointments due to Xmas break) he told me not to eliminate it or else I would end up with calcuim deficiency. He said that based on my descriptions of symptoms it is pretty clear that DS has silent reflux and elimination would not help. Not sure what to think any more. I am tempted to have some milk again to see if there is a marked difference.
I have gone off citrus completely; I used to consume lots of it in juices (lemons, limes) to boost my immune system during pregnancy.

Doctor also would not prescribe Ranitidine. He does not want too much medicine in babies unless absolutely necessary. His opinion is that the effects of Ranitidine in infants are not well enough understood at this time. But he has prescribed more Gaviscon Infant and will refer me if I want to get DS on Ranitidine.

Also we have taken DS to the osteopath for treatment. He has had two sessions so far. The osteo said that his neck was a little tight and would not turn fully to one side. She is working on loosening up the nerves in the neck as they connect to the digestive system. So far I would not say it has resolved the problem but baby has not woken up bothered by it for a few days now - I hope I am not speaking too soon! Whether it is the sessions or how I give the Gaviscon (I used to give it via bottle mixed with water halfway during a feed, now mixed with a little formula half way through a feed) I cannot tell. But osteo treatment given by a specialised osteopath cannot be a bad attempt.

Another Q: is anyone consuming tea while breastfeeding? Does it matter for silent reflux? I have stopped drinking tea as well and drink only herbal.

So for now I will keep DS on Gaviscon for a bit longer to see if we can manage for a period of several months or if we need to switch.

I realise I went on and on quite a bit and my post is a bit patchy. Sorry! Just want to explain clearly (as best as my foggy head will allow) what I have been doing to help ths little one.

OP I think it's more likely that the antibiotics given at birth caused multiple allergies ... There is alot of anecdotal evidence showing evidence between a higher chance of allergies and antibiotics given just after birth.

If you really don't want to go down the ranitidine route, then I would recommend on going on a very strict dairy, egg, soya, all citrus (tomato/apple incl) and wheat free diet for two weeks. See if that makes a difference to your LO.

If you really don't want to do above, give your LO hypo allergic formula for two weeks (whilst you express) and see if it makes a difference.

Sorry forgot to say DD had silent reflux, medicated with lansoparazole at 3 months to 6.5 months, made huge difference. Weaned off it well.

At 6 months discovered multiple allergies. After removal of all allergies, that's when she really 'settled'.

My ds2 had exposure to antibiotics at birth ( second hand via BM) then developed silent reflux. He had Week 3 infant gaviscon, weeks 4-16 ranitidine at ever increasing doses, then Omeprazole months 4-16. we worked out he was cows milk protein and soya protein intolerant at 4 m old and I was dairy/soya free to bf for the next year. He outgrew the food intolerances aged two, and has had no short or long term side effects from the medication. If your son is in pain I would not hesitate to give the ranitidine, no adult would put up with heartburn. I know of babies who have had horrendous oesophageal acid damage and long term feeding issues due to uncontrolled reflux.
The site Little Refluxers and the book Colic Solved by Dr BryanVartebedian are invaluable in navigating a way through.