What steps to reduce silent reflux

[JMacks]

Hi,

Awaiting pediatric appointment for my 7 week old son who I'm certain is suffering significant pain from acid reflux. We've been given infant gaviscon, which made him worse, now doctors are prescribing him one colic remedy after another in an attempt to shut me up until he grows out of it. Unfortunately I can't wait that long, we're all falling apart a bit. I'm seriously worried about my sons health and his quality of life, my partner's mental health, and the effect of stress and sleep deprivation on my ability to look after my son. Thankfully my partner stepped in last night and stayed up with him so I could get some sleep, and I took over half way. Feeling a bit more up-and-at-em for getting some unbroken sleep. Am fed up of dreading feeding my son and can't continue to just wait it out for him to be prescribed something to help while syringing one sugary gloop after another down the poor child's throat. In the meantime I have to do something if even as a distraction for myself...

Changing my diet? I know some say not to unless an allergy is diagnosed, but it can't do any harm right? And as it takes a few weeks maybe if it's a factor he will improve with no need for pediatrician/medication. I've seen mention of cranial osteopathy to help with unsettled babies - does it just calm babies or can it actually help with physical symptoms? Are there any hidden breastfeeding issues that can exacerbate reflux that I could look at? All seems to be well, but I've never been scrutinised closely. Is there anything else? And in what order should I be looking at these factors, ie.which are most common causes or contributors to reflux? Massively grateful for any and all advice and suggestions.

Also meant to say, my son is a huge comfort feeder. He has never once turned down a feed, and we get into a horrible cycle of him getting distressed then feeding then getting distressed then feeding in an endless cycle that can make it difficult to so much as get an opportunity to change his nappy. Really. As much as I hear that milk is soothing and you can't overfeed etc., I really feel that this might be making it worse for him.

Will be watching this thread closely to see if there are any other suggestions cos this sounds like a fairly similar situation to my own.

My experience so far is this - they've given me lanzoprazole for my DD, which is an adult antacid just in a smaller dose. They've told me to wait at least a week to see if there's any improvement so I'm just waiting impatiently to see, I think it's helping a bit so that might be worth asking for.

Short of that Dairy seems to be the worst offender for digestive issues so try cutting that out, just be careful cos a lot of thingss you wouldn't expect contain milk and you'll need to boost your calcium levels

My ds is 11 weeks and since about 10 days old has been dreadfully unsettled. If he's awake he's either crying, just finished crying or about to start crying. It's so draining and like you I'm really concerned about his quality of life, it must be awful for him being so upset all the time but try as I might I can't work out what's wrong! We had terrible feeding issues at the beginning, lack of weight gain, tongue tie and he only really started gaining weight once I started topping him up with formula and expressed milk when I can pump enough. Every time he is unsettled I can't help but think he must be hungry and it's down to me being so desperate to breastfeed him above anything else.

Anyway, after all that babbling what I wanted to say was that I have taken him to see a cranial osteopath and there was a marked improvement about 48hours after the first session. Had the 2nd session this week and he visibly relaxed when she started touching him. I'm still not sure if it's a coincidence or not but I was so desperate that even if the improvement is him growing out of whatever the problem is at least I feel like I'm doing something proactive to help.

So take from that what you will, you have to give them so much info about pregnancy, labour and delivery that I felt it was a bit like telling a medium your life story then asking for a reading! Seems to be working but desperate times and all that!

I would take dairy and soya out of your diet immediately. As well anything acidic, like tomatoes, apple, orange, lemon, vinegar etc

At the same time as your GP to prescribe lansoparazole.

After 2 weeks of my DD being on lansoparazole she was a different baby altogether. Everyone could notice the difference. And after going dairy and other allergens free, she sleeps much better

It is such a tough tough time, it took a toll on our relationship too. I ended up taking her to A&E so the referral to peadetrician was speeded up (within 2 weeks)

For us, cranial osteopathy did nothing at all. I saw three different people, the last one was honest and told me osteopathy can't treat reflux and allergies etc. she told me it was a medical condition that needed sorting

Sorry to hijack but ShineSmile did you exhaust the gaviscon, ranitidine options before you moved on to the lansoparazole? We skipped gaviscon as had had constipation/lack of poo issues already so didnt want to make them worse. Ranitidine seemed to help at first but now it makes no difference, although if I dont give it he is no better and no worse really. GP has tested for lactose and CMPA and stool sample was normal. Am back there next week to discuss, wondering if its worth asking her to prescribe lansoparazole or asking for a paeds referral

The things that massively helped DS' silent reflux were:
Frequent breaks in feeding to wind. I'd use a soother so he didn't get too distressed from the break in feed before going back again

Holding him up/ letting him snooze upright on my shoulder for 20/30 mins after feeding. This is exhausting esp in the middle of the night but worth it

Using a sleep nest in his Moses basket and for naps. Made a HUGE difference

And the paediatrician prescribed omeprazole to neutralise the acid and domperidone to bring the milk through his stomach quickly which really helped.
The non medical things really helped, but within 4 days of being on the correct medicine he was a different child. I know how hard it is. Good luck xx

Mango, by the time we saw paediatrician, my DD was refusing feeds whilst awake and it was difficult to give her any medication. He prescribed lansoparazole, as it was just once a day, and didn't have to be before or after a feed. For us, after two weeks, we saw a different baby and two months later we weaned her off it.

Mango, which milk is your little one on?

Blood tests for CMPA aren't always accurate. I would try cutting out dairy and soya from ur diet

Thanks ShineSmile, we are nowhere near that point yet and as the ranitidine seems to make no difference I'm even unsure if it is silent reflux or not. He has a raft of the symptoms though.

I'm BF still at the moment and top up with no more than 150mls of aptimil (just the first stage ordinary one) probably every other day, sometimes a bit more often depending on how much I can express. He reacts no differently to the formula aside from being settled for slightly longer after a feed, no real significant difference.

Forgot to add, it was a stool sample rather than bloods

GP is really supportive, was helpful that she saw him full pelt crying for what she obviously thought was too long. I want to make sure though that the correct/reasonable course of action is taken at the next appt now nothing has been found in the stool.

Thank you all, this is really helpful.

Lots of mention of lansoparazole, which I hadn't heard of - same idea as ranitidine? Would be interested to hear how you get on with it Polly.

Shinesmile, great to hear that you got your little one sorted, it gives me hope. Did you get tested for allergies? Was it the sole cause of the problem, and have you continued dairy-free in place of the medication? If I could fix the problem by changing my diet that would be the ideal outcome.

I'm with you Mango - will try anything right now! Common sense tells me what shinesmile says, but thenI wonder if cranial osteopathy can help the digestive system relax then maybe has some merit, but don't know if it's just skeletal strains it can ease. It seems that ds got worse since his digestion slowed down, and a dirty nappy seems to ease his symptoms for a bit. I think that's why the gaviscon made him worse, it backed everything up causing more to come up the wrong direction. Makes sense seeing as takethestairs was prescribed drugs to make the milk pass through quicker.

Ds is upright pretty much constantly already. Can get him down in the cot for maybe 2hrs at the moment before he wakes, but hadn't heard of sleep nests, so will definitely have to look into those.

Thank you all!

My DD was around 12 weeks when the reflux was it's peak. She screamed and screamed and it was awful. She was EBF.

Based on mumsnet, I decided to go on a dairy and soya free diet for two weeks. During the period, I had a lot of apple based innocent juices to replace milk, and I still had egg and wheat (other allergies that we found about at 10 months).

After the two weeks I didn't see a difference in crying, and saw paediatrician, who gave lansoparazole reluctantly. Two weeks later she was a different baby, though still not 'completely settled'. She then used to wake up every hour at night until 11 months when we completely took out wheat, egg, dairy and soya out of her diet. Milk allergy was immediately noticeable when we weaned at 6 months.

If you don't want to go down the medical report and are brave enough, I would take the following out of your diet for 2 weeks minimum (and see if it makes a difference):

Dairy
Egg
Soya
Wheat
Fish
Nuts
Anything acidic - tomatoes, oranges, apples, vinegar etc

If you see a difference you'll know one of those or some of those are the culprit.

Alternatively you could put your LO on nutramigen/neocate for two weeks whilst you express to keep your supply, and see if that settles him.

(Above advice all based on the complete guide to allergies and intolerances by prof ... (Can't remember his name but fab book!))

Mango, are you sure your LO isn't reacting to the cows milk in the formula? Could be a culprit. Maybe try nutramigen?

Well J I have an update for you, we've had some tears and grizzling today but no screaming and if your LO struggles like mine you'll be able to appreciate how amazing that is. Nothing else has changed so I can only presume it's the lansoprazole

Polly, thank you for the update, that is great news! I hope that it continues to bring relief to you and your daughter. Will bear it in mind when meeting with pediatrician.

Shinesmile, thank you so much for taking the time to share your experience and advice. I had no idea there were so many potential problematic foods! I was thinking along the lines of dairy and caffeine. Cutting out all of those for two weeks is quite a daunting prospect, but I do like a challenge! I think I'll take a few days to research/draw up a potential food plan to see how feasible it will be, in the meantime cut out dairy and soya completely as they seem to be the most common triggers.

I really would like to avoid medication if possible. Can they test for all these allergies?

Ordered a copy of that book you recommended - Prof Jonathan somebody, I forget too, but sounds like it could be useful if I'm going to be messing around with my diet.

I would suggest:

• get checked for tongue tie, if you haven't already. IME tongue tie can cause episodes of silent reflux so it's worth ruling that out before setting off down the reflux path.

• ask for ranitidine. It's much more effective than gaviscon and I understand from my GP that it has very few dangers/side effects (whereas the stronger options omeprazole and lanzaprazole do have side effects and so usually need a paed to prescribe). You do need to make sure the dose increases as he grows though as it's very weight sensitive. You can also ask for a stronger dose (there are three levels and GPs often start with the lowest but can move up).

• cranial osteopathy is worth a try, but get the tongue tie check done first as a CO can't do much if there is a tie causing issues

• If you're going to cut out anything from your diet, start with dairy and soya as they are by far the most common issues. It will take 10 days/2 weeks for it to clear your system though, and another few days for it to clear the baby's. I assume you are EBF? I would be wary about cutting out lots of stuff at once - you won't know what's worked if anything does change, and it's hard to keep up your own nutrition levels/milk supply/energy if you are on a very restricted diet.

• the Cocoonababy was specifically designed for prem babies who often have reflux, it holds them in a tilted position and supports their legs too. I haven't tried it but wish we'd had it for DD (who did not have reflux "proper" but episodes of reflux due to tongue tie).

JMacks, I'm glad you've ordered a copy of the book, there's plenty of detailed advice in there.

Btw we also had DDs tongue and lip tie lasered at 2 months and it made no difference at all to her.

We had a tongue tie snip which made no difference too. I was devastated when it wasnt the fix I was expecting to the feeding issues.

Oh I certainly didn't mean to suggest tongue tie is at the root of all reflux - it certainly isn't. But since it's much easier to treat than "real" reflux, it makes sense to rule it out as a first step iyswim.

I think mine was unsettled mainly from me eating soya
But also maybe garlic and parsnip
She still reacts by spitting up about 4 hrs after eating soya foods herself (now at 2)
She does have a lip (and so probably a tongue tie) which hasnt been fixed
Hopefully removing the food from your diet will help