Dd 6 wks has reflux - questions about meds prescribed

[extremelychocolateymilkroll]

Dd had blood in her posset and poo at the weekend. Went to A+E who seem to think it's reflux which would fit in with her behaviour - very difficult to settle and arches her back quite a lot. However, she is putting on weight and healthy in every other respect. They have put her on Ranitidine, Domperidone and Gaviscon. Has anyone ever had this combination of drugs for their lo? Also, I'm breastfeeding and wondering when it's best to make up the Gaviscon - how long in advance can it be made up before being used? It takes forever to get the powder to dissolve so just wondering if anyone has any tips as to how to improve this. We're currently using a syringe but wondered if we could give it to her in a bottle? Also, ,how long before we should notice any improvement? TIA

Unusual that they've given all three - as usually you have to fight for any meds regarding reflux.

I've only had a baby on Gaviscon. We would make up one sachet in a sterilised glass container with warm water and give it to her in a sterilised syringe. We felt 15mls was to much for her so we gave her 7mls/feed but that led to her getting a bit consitpated so we dropped it down to 5mls/feed and that was fine. So a sachet would last three feeds. If the reflux had got worse we would have upped the mls again. Hope that helps we didn't get much guidance from the DR's and just sort of made it up.

My sincere sympathies - my dd had terrible reflux and is hell - yes, arching her back does sound very consistent.

I would give the meds about a week to really kick in. In addition, there are a number of "lifestyle" changes that will make a big difference - perhaps you are doing them already, but key is:

• do not lie her flat ever, prop up the head of the cot on telephone directories, and put a wedge under her cot mattress (my dd used to sleep on a mountain slope!). Also raise the head of her change mat.
• tummy time is excellent for reflux babies, also sleeping on the left hand side rather than on her back.
• minimal handling after a feed, don't jiggle or shake or wind too vigorously.
• keep her upright for 30 mins after a feed - this is terrible in the middle of the night but must be done. Get comfy in an armchair and let her fall asleep on your shoulder.
• give her smaller feeds, in all likelihood she will drive this herself as she may pull off the breast when feeding due to discomfort.

Something else to consider - blood in her poo can be a sign of a milk protein allergy in the milk (this is NOT lactose intolerance, which is a reaction to the sugar in the milk, but a reaction to the milk protein). And this allergy can trigger reflux. This was my situation, it took 7 months to get to the bottom of, but the root cause of the reflux was a protein allergy. It may be worth eliminating dairy from your own diet (do NOT replace with soya, as 50% of those with a milk protein allergy have the same reaction to soya). You could try replacing your milk with rice milk, its actually delicious.

If your baby does have a protein allergy, then you will eventually have to put her on a specialised formula which is completely hydrolysed, but you're not there yet so see if she improves first. Its worth doing some research online to better understand all this - good luck!

I FEEL YOUR PAIN!!

DS is now 11mo and whilst I don't want to add to your destress, he still has severe reflux. He's on 10mg of Omeprazole twice daily and 2 doses of Gavsicon per feed currently but has had Renitidine and Domperindone, niether of these worked. He is also allergic to cow's milk protien so is on Pepti Junior formula.

DS has other issues and is tube fed as he won't take anything orally. If he did take solids this would really help but he won't (long story). Nothing works for him, it's a "phase" apparently that he'll grow out of. Not sure when! I'm sure he is an extreme case and that his other complications don't help but at least you've caught it early and like most have said, you need to give the meds time to work. They all do different things but together are very effective.

Re the Gaviscon, not sure as DSs went down his tube in his milk. 1 dose (half a sachet) per 100ml.

Good luck and yes, do some research on the net. It'll anwers some of your questions if nothing else!

Thanks for all your replies. Started to give Gaviscon in EBM which worked well but constipated her so have stopped giving it. Hard to know what to do. Someone on another thread mentioned that her doctor said the body needs to learn how to cope with the acid and that the meds can cause more problems in the longer term.

Hello

My little girl is on the triple therapy. or rather, she was but I stopped the gaviscon...

when I gave it with every feed as instructed she became heartbreakingly constipated so I cut it down to just three feeds a day...but I struggled to get the full 15 mls into her so would make it up and only give half at a time.

after a while though she would just spit it out and it started to become a battle so I ditched it. She still pukes a lot either way so I didn't want to add to her misery.

she is still on ranitadine and domperidone. Sometimes I think she is improving and I cut back and at other times she seems to be worse so I up the doses again.

Reflux is hell but I am now 6 months in and from my experience it has definately got better. The horrible pain after every single feed started to go away when my daughter hit 3-4 months so life improved a lot then for both of us. She still vomits a lot and is on the bottom of the weight chart but I keep telling myself that she will eventually grow out of it.

Oh and i am surprised that a poster further up said that tummy time is good for reflux...we have had the opposite experience. Even if I wait for an hour or so after a feed she will still always always vomit just after tummy time and she doesn't enjoy it at all. Guess they are all different ey?

My DD is now 3yrs but was prescribed Gaviscon at around 6 wks after I finally got someone to take me seriously and that I wasn't being all pfb about her. At that stage our doc recommended that we gave smaller doses of the Gaviscon is ebm using a syringe - it was a bit trial and error to work out how much Gaviscon was enough for the reflux but not too much to cause constipation but we worked out a balance in the end and never looked back. She's now a healthy, happy 3 year old with no tummy problems.
Did lots of the things Rycie suggested especially raising her mattress as at night we could actually hear the acid gurgling up and she would let out this awful, painful scream but after raising the head end it made such a difference.
Good luck and let us know how it goes

I second what Rycie's said about investigating possible milk protein allergy as well. My DS is 8 months old and I am sooo pleased to say he has been meds free for 2 weeks after a few months of true acid reflux hell.
He still has cow milk protein intolerance and is on hydrolised formula and dairy free.
When he was on meds, the only thing that worked for him was losec (omeprazole).
To thicken his feeds we used Instant Carobel by Cow and Gate - better than Gaviscon as it doesn't constipate. Try it! And good luck.

The combination of meds prescribed is common- -they all do different jobs. The gaviscon increases the viscosity of the stomach contents, and also acts like a raft and sits on top of the stomach contents to try to stop things coming back up quite so easily. The ranitidine is there to help reduce the amount of acid that is produced. The domperidone stimulates gastric emptying and speeds up transit through the digestive tract. It also helps with the strength of the sphincter at the top of the stomach. Omeprazole tends to be the next step up if the others have not been effective. Try giving the ranitidine before the morning feed as acid production is stimulated by food. Thickening the milk can also help and may make the gaviscon unnecessary, but is not really possible in a breast fed baby unless you express every feed and then bottle feed
My ds was prescribed gaviscon by the hv but the paediatrician stopped it ( a faff to give as ebf) and put him on ranitidine, as it is the acid that is causing the pain and sore spots that the blood is coming from. He has grown out of the screaming and arching, but still throws up regularly. He only started to mprove when given solids as they stayed down better (but not totally) as they were thicker. If you want to persist with gaviscon it can be added to bottle of ebm ( i used to give a small amount at the beginning of the feed,before putting onto breast) or I used to give it with an infacol pippette. I found making it in boiling water and stirring vigerously just before the feed meant it had cooled enough to give after the feed. There was a really helpful websie that I discovered when ds was starting to improve and wished I had found sooner - www.babyreflux.co.uk/?gclid=CKqn1Jq98KACFY4U4wodm33Ijg it had some products that looked like they might have been really helpful. Hope things improve soon