Infant Gaviscon

[Slanted]

DS is three weeks old and has just been diagnosed with reflux. Our doctor prescribed Infant Gaviscon, saying we should start with that to see if it helps. I'm slightly confused about how to administer it, though, and would appreciate any help:

1. I am EBF. It says on the packet not to give more than six times a day, but DS feeds A LOT more than that. If I stick to only six times a day, does that mean that he will still suffer with the feeds where the dose is missed (assuming it even works when given), or is there some kind of build-up effect? Would it be better to give half a dose each time, to take it up to twelve times a day? Is it OK to "overdose", if it works, or does the sodium content make that dangerous?

1. The instructions say that if BF then it should be given with water and prepared just prior to use. GP advised that I could mix it with breast milk, though. Can I, then, prepare it in advance and store it in the fridge? Or should it still be prepared just prior to use? Does it need to be mixed with 15ml of breast milk (as per the instructions with water), or is it OK to mix it with less? (I'll be syringe-feeding DS the mixture.)

1. Unrelated to Gaviscon - I swore I would never use a dummy, but have read that it may help with reflux babies. Right now I'm prepared to try anything, as DS is utterly miserable and thus so are we. Does anyone know if a dummy really does would help to alleviate his pain? I don't want to introduce one if there's no evidence to suggest that it helps.

Thanks for reading - apologies if all this has been covered in other threads, but lack of sleep has rendered my search skills useless.

Poor you. Reflux is awful.

1. There is no build-up effect with gaviscon as such - It merely forms a raft over stomach contents and/ or thickens feed to keep it down . If your baby is having very many refluxing episodes a day then if the gaviscon works it could have a cumulative effect in the sense that it will lessen any further acid damage to the oesophagus. BF babies tend to take small volumes of feed more often so splitting the sachets and just giving half per feed might not be such a bad idea. I think once they get to 4 or 5 KG they can have more sachets per day - it says on the back of the packet I think. I think the sodium content might preclude massively overdosing otherwise, but I'm not at all sure on this.

1. I think you can give it whichever way you find best. If it's too thick I suspect that your baby may have trouble swallowing it or it may not mix properly with the milk in your baby's tum, but again not entirely sure - just theorising.

1. Go out and buy a dummy right away! With reflux it's very important to throw any preconcieved ideas about what you would and wouldn't do out of the window right away, and just do what you need to do to get by. Before we introduced my refluxy babe to one aged 4 weeks, we had hours - and I mean hours - of screaming every day. He would not comfort suck on the breast at all owing to the reflux. If however your DS will comfort suck on the breast, I would still encourage this as much as possible as it's important for your milk supply at this stage. However, sometimes you need a break with a refluxy baby and a dummy might achieve this.

Lastly, If he's miserable and the gaviscon hasn't worked after 4 days or so, go right back to the gp and ask for a stronger med. there's no point plugging on with gaviscon for weeks if he is in real discomfort as he'll likely need dsomething stronger. Options are ranitidine (zantac) or a PPI like omperazole.

Be warned - gaviscon can cause constipation but IME this is a lesser problem in BF than bottle fed babies.

You could also try temporarily cutting dairy and soy products out of your diet to see if that has any effect. Some babies are dairy/soy intolerant and it can cause unsettledness. However, you have to be really careful with your diet - don't want to be restricting food groups and calories without replacing the nutrients with something else.

omeprazole, not omperazole

Hi lunatic, ranitidine dose is calculated based on weight- there is a maximum dose per KG, but there is no lower age limit/ weight limit as far as I know. Likewise for PPI drugs, which stands for proton pump inhibitors. PPIs pretty much turn off acid production in the body. Ranitidine works in a different way and is considered less effective but may be tried before PPIs. It works well for some babies (and adults).

There is a product called Carobel Instant made by Cow and Gate and available on special order from chemists (its OTC, although you can get it on prescription if it works). Some parents find this constipates babies less than IG. You can give it in the same way. It's made from locust beans - used to be carob seed flour, hence the name, but they've changed the formulation.

Reflux is very often caused (I understand up to 50% of the time) by cow's milk protein intolerance.

If you're EBF, dropping dairy COMPLETELY from your diet for 2 weeks will show big improvements if this is the problem. You need to totally scrutinise everything - milk powder is in loads of things - not even a drop of milk in tea - not a biscuit with milk powder in it - not a bit of butter, ice cream or chocolate. Sorry. Booja Booja chocolate is fab and dairy free!! Rice milk is a good alternative for many people. Don't even take goat's or sheep's milk or milk products. It takes up to 2 weeks for it to get out of your system but it can make a huge difference.

FF babies with dairy intolerance are in a much worse position but you can get dairy-free formulas on prescription, but I understand that they taste foul. In this case, if relactation is a possibility, it may be the best route.

DO NOT overdose on Infant Gaviscon as the salt content makes it dangerous. Interesting that the GP says mix IG with BM. In fact, it's been shown to work better with water, but then you're giving your baby quite a lot of water which isn't ideal. Either way mix it with as little as possible to get a good mix. You should really mix IG as close to giving it as possible, although you "can" store it for a few hours in the fridge.

Don't worry about giving a dummy but be aware that they can reduce your baby's ability to tell you he's hungry, so be aware that you don't miss any feeds. The other danger of dummies is that it can sometimes mean that they get nipple confusion, but it's less likely than the nipple confusion caused by giving bottles of milk. So you could choose to offer a dummy but just watch out for these things.

Slanted, I use water to mix it but I only use 5ml because it means I don't have to squirt in three syringe-loads of it. Works fine, so I think the same should go for EBM. DD fed a lot more than six times, too, but I found that she didn't need more than four doses in 24 hours to improve things. If Gaviscon works for your DS (and as narmada pointed out, it doesn't for all babies), take a few days to find out how many doses he needs for him to be painfree.

As for giving him a dummy, I would definitely do it. As you, I said I never wanted to use one but when DD was diagnosed with reflux at six weeks, I ditched that plan. Unfortunately DD doesn't take one, so I don't know if it would have made any difference. Reflux is awful, so anything that makes the LO better goes.

Lunatic, we used to give DD Gaviscon before feeds because she used to fall asleep while feeding every time. I found it's not quite as effective as giving it to her after a feed but it still made a big difference. The amount of milk she spat up decreased and more importantly, she wasn't in pain anymore. Now she's 17 weeks, she stays awake after feeds so I have time to give it to her then.

Very good advice from narmada. Reflux is miserable.

We mixed IG with the correct amount of water per sachet, but then only gave one 5 ml syringe with each feed. My EBF DS fed so little and often, I figured a little IG would help keep each feed down. The 'six times a day' thing only makes sense for a formula fed baby on a schedule (i.e not fed on demand).

Dummies have helped every refluxy baby I heard of.

We also found keeping Ds upright after feeds in a Baby Bjorn, facing us, helped keep feeds down and calmed him when he was distressed after being sick. Baby Bjorns have a bit of a bad reputation with sling mums, but I think that's to do with the facing out position - and frankly, as others have said, do whatever makes the baby happier.

Let burps come out gently - we just held DS upright, either over a shoulder or in a sitting position until some burps worked their own way up. Rubbing and rolling him around was the worst thing to do, as it turned out - all that sore acidic reflux just shot up into his throat. :(

DS also got badly constipated on IG - the BF friendly GP said to give him a teaspoon of freshly squeezed orange juice, and this did help. The HV said not to, EBF babies shouldn't have anything but boob milk etc - usual conflicting advice. We went with the GP. Don't be alarmed if you get a very green poo, that's a side effect of IG.

And I'm sure you are doing it already, but raise the back legs of your cot, if your baby sleeps in one - so their head is higher than their feet. You can use books or anything else stable. If they lay flat on their backs, the acid reflux tends to rush up their throats. DS was spluttering, choking and crying for weeks at night before I found out that's what was happening.

Good luck, it is miserable. (My DS improved at around 4 months, and all refluxy issues VANISHED overnight when he was started solid foods at 5 and a half months).

narmada - thanks a lot for that advice. I think we'll give it 'til Friday and if the IG hasn't worked then I'll go back to the GP. DH is not at all keen to let DS have anything stronger, though, so giving DS ranitidine, if needed, will require a bit of a battle.

oranganiccarrotcake - will definitely start eliminating dairy. I had no idea that it was responsible for that % of reflux, so it's worth a go.

gloyw - I've only just raised the back legs of the cot today. I couldn't get that much of an incline that way, especially since DS is still so tiny that at the bottom of the cot, where he is, there's not much incline at all. However, the raised legs shall remain. In addition, I've put a cushion under the mattress, so now the incline is at around 20%.

Only thing I'm worried about is that when he lies down on such an incline, isn't that going to make his chin too close to his chest, and risk obstructing the airway? It looks much closer than it does when he's lying flat on his back. (I'm very tired and stressed, and may well be being slightly ridiculous about this - I can no longer tell - but please humour me as it causing me some concern.) He does cough and splutter when lying flat on his back, and I'm worried about choking, so I'd like to keep him elevated; but is the chin to chest thing also dangerous?

Thanks everyone for replying. It's awful, isn't it? And such a shock after a relatively peaceful first week with DS. I can't stand to see him in so much pain at the beginning of his life, poor thing.

I do know what you mean about giving stronger meds, but if it is reflux, it really is best to get it treated sooner rather than later. Somtimes it resolves spontaneously at a relatively young age. Sometimes it doesn't. My DS is one of the unlucky ones for whom it evolves into a feeding refusal issue - and believe me, that is somewhere you really don't want to go!

We had the green poo on IG. Looked like rabbit droppings.

If you're BF and poo has always been green it may be worth just checking out the signs and symptoms of milk oversupply. This can cause excessive spit up and fussiness, and will either resolve in time as milk supply downregulates to meet the baby's demand, or can be addressed by block nursing.

Actuallym it nay be worth checking out oversupply even if the green poo's only been on IG. It would be great if it were something straightforward like that.

regarding the dummy, go for a 'cherry' one as they can help avoid nipple confusion. Boots do a 2 pack for £2.03

I am currently on the reflux/lactose intolerance train too. It is awful.

We are on ranitidine and carobel and nutramigen formula, had to stop BF for many factors.

Keep breastfeeding!
I had this problem, midwife spotted reflux at 2 days old. Got gaviscon. gave up two days later, impossible to give whilst EBF ! Well, nigh on impossible. Devils medicine!

ALso made my DD terribly constipated and this made the sicking up even worse as she strained to poo, she just threw up more.

At 6 weeks old, I knew something was terribly wrong as she lost her voice and I took her to A&E at 6 am as she had thrown up both boobs and kept screaming but this time with no voice!
They were lovely and admitted her and then the doctors got involved and they were HORRID, accused me of not coping with a screaming baby, told me to top up with formula immediately if she was hungry. Luckily, DH asked what their clinical reasoning was for such wild statements and funnily enough they all went away and the top dog himself appeared - Pead consultant!
Well they gave her ranitidene and my baby changed instantly - smiled, lay on her back and promptly fell asleep! This is antacid, same as given to adults but smaller dose! They also gave other stuff but ranitidine was the one that made all the difference. (She threw up until she walked but was never in pain anymore and you get used to being thrown up on all day every day!)

A GP isn't ( or wasnt three years ago) able to prescribe anything other than Gaviscon so hence this is what they have prescribed! You need to see consultant pead team at hospital.

Your GP should get you a priority appointment, also get your HV involved. Usually such referralls occur once baby is losing weight due to all the sicking up! Then there is the acid pain making them scream their little hearts out. Pester GP!

Sucking dummy definitely helps! Not sure if relevant but I never moved up the dummy sizes as my babies got older. There is a MAM one that says 0+ with no upper age limit so I stuck to this with a random thought as their mouth grew bigger, they wouldnt be so reliant. WTF?! I know!

good luck

Gosh, maydaychild, what a horrible experience.

GPs can prescribe ranitidie and even omeprazole if they're so minded - for off-license use though, so many won't as it's riskier for them. You may have a gem of a GP like ours who didn't make DS wait for months to be seen by a paed and prescribed good meds at 3 weeks old. Thank goodness for him, is all I can say. But I do agree with maydaychild that if your child's got significant reflux and is going to be on proper meds its best to have a paed involved. Press for a referral.

ooh, sorry, meant to say, I never gave full dose of gaviscon, always half was enough (because of constipation!)

It simply thickens the milk, it has no antacid effect at all and is fairly useful in bottle babies, but still not particularly effective in my opinion.

If you can pump off some milk and keep small amounts of 1 oz in freezer bags, then mix the gaviscon (half!) in to this and bottle feed to baby before putting on breast (giving bottle is also useful so baby is used to it - they are clever little babies and refuse bottles over mummy boob) or syringe this - sounds like this is what you are doing.

I know this sounds a faff, but we gave gaviscon three times a day - spread evenly so breakfast, late lunch and bedtime (7-8 pm) not six as the packet says.

This means baby in theory gets three good feeds a day which stay down hence weight loss should be minimised. As my DD gained weight, I eventually dropped gaviscon and took the sicking up as normal.

Once DD got ranitidene and domperidone added to gaviscon as well, I used to measure out her doses into syringes each morning then keep the syringes in the breast milk freezer bags (sterile!) in nappy bag, then I didnt have to carry two bottles and a mixing bowl around with me!

MayDayChild has reminded me, after the 1st few days on IG - reflux much better, but DS suddenly terribly constipated for the 1st time - we reduced the dosage. I think over the course of a day, we used 2 sachets in 5 mls doses, which is a lot less than recommended.

It took some fiddling around - too little and the reflux came back, too much and we got constipation.

LunaticFringe, I googled like a bastard when the green poo finally came out. It wasn't frothy green, which once in a blue moon DS got anyway (yes, probably oversupply) - but like green plasticine turf. Extraordinary. It should warn on the packet!

Re: cot legs raised - I think a small incline will still help - we used one of those back support cushions, the wedge shaped ones, under the mattress. It didn't lift him much, but it helped. I wish I could say something helpful about the chin to chest issue - I don't remembering noticing it with DS, so maybe I was too tired and ragged to spot it! If you are concerned, maybe try lessening the incline...? Sorry, not very scientific answer. A little incline will still help - the choking and coughing used to alarm me so much once I knew what it was.

OK lunatic that weight gain doesn't sound excessive, and if only occasional green poo then may be not oversupply. Please don't let them fob you off with the old 'oh, but he's putting on weight' line. Explain you think he's in serious discomfort nevertheless.

I had one of these wedge pillows for dd, it made a real difference.

lunatic DS is gaining weight well, but today the GP prescribed ranitidine without us even having to ask, as the Gaviscon isn't really working (although she suggested we continue with it, anyway, along with the ranitidine). She also said that DS shows no improvement by Monday then we should return and she will refer him on. So it's being taken seriously despite his healthy weight gain.

Hope it works out for you at your appointment today.

slanted that is good treatment from GP. hope the ranitidine works.

Seems you are blessed with a great GP. Nicely done

lunatic ranitidine tends to make them a bit loose on the poo front. Which will probably be welcome if he's bunged up from the IG. If you want to use some sort of thickener, I really do recommend carobel. Wonder stuff.

Your DS will likely vomit as much as before om ranitidine but it should be less acidic so won't hurt him as much. It may take a few days for any residual inflammation in the oesophagus to die down. Hope it works for him. We noticed DS's really, really noisy sleep improved after about 2 days on ranitidine in the sense that he quietened down...