Reflux or CMPA

[SillyHam]

My baby is now 11 weeks. Since a few days after birth he has been throwing up his whole feeds or what looks like it.
Midwives on mat ward dismissed it.
Took him home had him on breast milk and aptamil advance. He had bad colic with this so moved onto comfort where he would be better but still vomit whole feed at least 1 time a day.
Dr prescribed carabol, which he threw up and choked on then gaviscon which made no difference.
Other than the projectile vomitting which has been coming out of his nose
He does have these red dots that appear on his face, hairline and torso after a feed and he will go really bloated, he also will cry for a feed then squirm at the bottle, moving around and jerking and crying when bottle in his mouth( about 1
or 2 times a day). He hasn't really been taking full feeds, maybe half the bottle and then will cry 40 mins later for the rest basically snack feeding all day. He will also go red and grunt, he always has boogies and sneezes and coughs ( I put this down to c section baby)
I tried him on pepti 1 and he's not thrown up since, only normal baby posetts. Its as if all symptons have gone

Is this a cmpa allergy then? If he's completely different, not squirming or throwing up on this pepti milk?
He dosnt have mucus or blood poop and he won't scream for hours which has kinda put me off thinking it is.

It very much could be. It could be both..my daughter has both reflux and allergies and if anything the reflux is harder on us than her allergies. She's nearly 4 and shows no signs of outgrowing either.

Pepti1 still contains milk just to be warned so you might need an amino acid formula such as neocate or alfamino especially if you think they were reacting to your breastmilk when breastfeed as they usually are babies that are more sensitive.

My daughter is allergic to carob which is the ingredient in carobel so she couldn't have that. Her reflux was controlled with high dose omperazole, gaviscon and later domperidone and I had to remove all of her allergens from my diet.

Hi @Superscientist I saw your post and wanted to reach out for your thoughts and experience
I have a 4 week old and we got a reflux disagnoses and also on a stool test he had calprotectin levels of 160. I haven't had dairy for 4 weeks, since delivery, he was given it in nicu ward as formula so perhaps that caused the calprotectin levels ti rise? The paediatric doctor said that the result shows my baby is allergic to dairy. We are already on nexium and don peridon for 9 days now. Things haven't much improved

Should I eliminate other allergens? I already cut out soy and eggs the last week
Any others ? I would love to avoid formula and continue to feed but it's tough he screams all day and night between feeds. The only "break" he gets is basically when feeding (most of the time) or 15-20 minutes after a feed
I'm otherwise eating bread, gluten, coffees (1-2 a day) dark chocolate, rice, the odd fizzy drink , loads of sweets for energy

His poo is v loose and today green -spinach colour (sorry tmi!)

Your best bet is to join the cmpa breastfeeding groups on Facebook. It can take 6 weeks for symptoms to die down so don't cut out too much too quickly. Keep a food and nappy diary instead of cuts if you've already excluded a fair amount. Watch out for hidden allergens, some breastfeeding vitamins contain soya for example.

also, I'm struggling to know what to do as advice is conflicting
Eg first paediatrician in hospital said cut soy and dairy
Second said nexium and donperidon and tested his poo for calprotectin
Then saw a paediatrician with reflux expertise said scrap donperidon it's old fashioned and pointless, it won't be an allergy (we didn't have results by this point) it will be structural and keep on nexium
When we heard from second doctor that it was a dairy allergy, he still said baked dairy eg croissant, and also butter, would be fine it's just to avoid glasses of milk or yoghurt
So it's hard to "commit" to cutting things when no one seems tor really convince me it's worth it (I know sounds ridiculous but I need to get prepared I'd food is a consideration-as I absolutely will give up any thing but without a strong guide, the breast feeding monster hunger kicks in and I think oh it's probably fine and eat eg bread/ fizzy drinks

@Kipperthedawg thank you will look for the group

Ime the medicines just mask the symptoms of allergy so don't solve the root cause. You have to be dairy free, all dairy, no croissants, no whey powders etc. Anything that has milk/butter listed in the ingredients has to be removed, so no biscuits, check every label. Bread is typically dairy free in the UK (it sounds like you're not in the UK?) fizzy drinks are fine in terms of allergy unless it's fizzy milk which sounds...wrong.

@Kipperthedawg yes fizzy milk may turn my stomach ! I was just asking whether the calprotectin level could be raised from something else.eg wheat/ eggs (stoppped 10 days ago)
But ..: I have had some things like croissant/ ruch tea biscuits etc which could have dairy in

Yes I'm not in the uk

Thanks again

@Kipperthedawg the first step would be to keep a really detailed food and symptom diary. We found lots of subtle clues that started much earlier than the loose poos. It can take 3 days for symptoms to appear and weeks for them to improve. The more subtle indicators were really useful and we judged whether removing a food was helpful or not by comparing the number of good or bad days in the 5-7 days after removing a food. Absolutely all of a food needs to be removed once stable you can start the milk ladder to see if any dairy in your diet can be tolerated. We tried to see if I could introduce small amounts of tomato into my diet and she reacted to a barely visible smear of ketchup on a bacon sandwich. Directly she can tolerate meat from soya fed animals!

Domperidone is really a medication of last resort. It has some potentially nasty side effects and was found not to be effective in most cases of reflux which is why it's now only licenced for under 12 under paediatrician care. My daughter has been on it since 8 months but this was only after her still being symptomatic on the highest dose of omperazole and gaviscon. She reached the maximum omperazole at 5 months when she was on 20mg. She was 2 before it could be increased beyond 20 mgs and domperidone then was beneficial but we have to keep her on the lowest dose that is beneficial and her omperazole is always increased before the domperidone is.

What omperazole dose are they on. My daughter only gets the benefit of the omperazole when she is on the 3 mg/kg dose. If you divide the dose by their weight you will get the dose by weight which will be between 0.7 and 3. If it's is under 3 and you are still struggling with symptoms do speak to your doctor again as potentially there is scope to increase it but they will have to decide this based on the individual baby so it's far from a given that it will be increased just because it's theoretically possible. If it is at the maximum and there are still symptoms it's then that adding in a thickener or domperidone would be beneficial again dependent on the child.

I was told it was unlikely to be allergies too and it turned out to be 20! We struggled to complete the list when breastfeeding and it was only after she moved on to formula that we got her to symptom free. Once she started weaning it was very challenging to manage both of our diets to work out what she was reacting too. She thrived so much more on the formula and stayed on it until 2. When she started on formula at 10 months she hadn't put on any weight since 7 months.

Yes eggs can cause it but ultimately you have yet to rule out dairy. You need to do that first by cutting out everything with dairy in. Croissants do have dairy in. Rich tea typically don't but will depend on the brand, always check the label. In the UK we have amazing eu legislation that means all allergens are bolded in the list, v easy to spot. In the US it's more of a pain to check, you need to find a list of things that mean milk and check them against every label. They can include e numbers, whey powder, lactose and about 30 other terms that mean milk.

Poor love. Yes it sounds like CMPA, definitely.

Thank you
So you would recommend start with dairy elimination only for a few days? Then move to something else?
May I ask if you had positive results form domperidon and the side effects /risks you mention? We were prescribed 1 ml 3 x a day 20 mins. Before a feed
We are taking 5 ml of nexium 1 x a day but think baby needs more (weighs 4.4 kg atm)

No idea about the meds. But yes completely dairy free for 6 weeks is the usual protocol. You then challenge the allergy by consuming a large single dose, usually a yogurt. You wait three days for a reaction. If no reaction you then eat a yogurt every day for three days and again wait for a reaction. If after 3 days after the last yogurt there is no reaction then you have no allergy. Obviously if there is a reaction you have confirmed the allergy. You need to eat a large dose of dairy to ensure the reaction is obvious and you're not second guessing it.

Usually people cut out soya too because the proteins are recognised very similarly by the body. But you must only challenge one allergen at a time with several weeks apart on the challenges otherwise you won't have a clue what is causing what.

What is the strength of the omperazole (nexium) somewhere on the bottle it will say x.mg/ml. Multiple this value by the 5 ml to get the dose. At 4.4kg you would expect the number to be between 3 and 13 mg. If you are closer to 3 it's a low dose and if it's closer to 13 it's a high dose.

You should see some benefit within a week or two but it will be often 3-6 weeks to really see the difference. I would recommend removing high levels of soya alongside the dairy. Just meat and dairy replacements especially if you don't eat them already. If you switch dairy for soya based alternatives it can look as if there is no improvement as you have traded one allergen for another. Once you get to 3-4 weeks and you have seen an improvement you can test having soya dairy replacements. If you are at 3-4 weeks and you have seen no improvement I would then remove all soya. I would keep a food diary in the meantime detailing everything about their day.