Bottle aversion, reflux or something else?

[ForPlumGuide]

Baby is 17 weeks. Breastfed exclusively for about six weeks, became distressed and fussy, switched to bottles but the problem has transferred. Feeling really stressed.

Baby feeds fine overnight and wakes every 1.5-2 hours wanting food, occasionally does a 3 or 4 hour stretch. Never is distressed feeding at night but often only takes small amounts.

He is on omeprazole for the past three weeks and haven't seen a difference. He also had tongue and lip lasered about two weeks ago and was worse for a few days, then went back to normal, until we went for check up and dentist stretched the area causing minor bleeding. Baby seems worse again since then (4 days ago).

Symptoms are

• Will almost always open mouth when offered bottle, but sometimes cries moments later, arches back

-Will usually only take 70ml in one go

• Confusingly in desperation one day I offered him a mini disposable kendamil and he gulped it but way too fast! I then bought similar ish teats (Dr brown's narrow) which seemed to help temporarily. Have tried size 0,1 and 2 in many different brands

-The last week didn't poo for four days which was unusual. Typically poos every two days and I've been a tiny bit of mucous maybe twice but otherwise seems normal

• No rashes

-Spits up a little after most feeds, doesn't seem upset when this happens

• Occasionally does drink normally when fully awake but usually is frantic, kicking legs etc

-Weight gain has always been ok but worried this might start to change

Any advice so very welcome! Feeling really overwhelmed and upset for baby.

Thank you!!

It sounds as though you may be unlucky enough to have two things going on, one is the Lip & Tonge Ties and the other may be CMPA.

Does LO have any of these symptoms?

Sounds like my daughter she fed only a night around 3-4 months due to feeding aversions which were worse during the day. She had moderate reflux but happy, severe silent reflux which made her very unhappy and multiple food allergies. Initially the GP was only treating the reflux and ignored signs of silent reflux. She had her on a low dose of omperazole which did help the reflux a bit but didn't touch the silent reflux and she quickly out grew each dose. For that she needed the highest dose of omperazole, as much gaviscon as I could get in her and me starting to remove her allergens from my diet.

He didn't have any rashes, he spits up but doesn't vomit, he sneezes a bit but don't think it's anything significant and definitely seems to have the general fussiness and refusal to feed (sometimes) which seems to be worse in the morning. He's been a bit backed up the last few weeks too but doesn't have diarrhea. Thanks for the suggestion, maybe I'll mention to GP but doesn't seem like a clear case to me :(

Thanks for replying, when did things resolve for your LO? We did up the dose of omeprazole but only a few days ago, so hopefully that helps although I don't think it's done much so far unfortunately!

My DD had awful colic. We changed to Comfort milk, gripe water/colief and used Mam bottles. Their teats are flatter. But in the end it was just a case of waiting for it to pass, you may be told to wean your LO early so that you can get a lot of milk into them via food.

Omeprozole can cause constipation in adults. I assume its the same for babies. Does it not interfer with his developing digestive system? Can you switch to goats milk based baby milk. What does the health visitor say?

just try to keep feeding system low stress, remember to breathe slow and deep and smile so baby doesnt pick up on your stress around feeding (spoken from experience, not trying to be rude or criticise) keep baby upright after feeding and try to grin and bare the crying. It will work itself out and pass, feels like it wont but it will. You need to cut the night feedings down to give yourself a break and some longer stretches of sleep. Hes old enough to be sleeping at least 4 hours overnight without a feed. It could be overfeeding him and not helping establish daytime hunger cues. Its ok to feed to a schedule as this will help make this predictable- his digestive juices will be ready for a 1pm feed for example, and wont be snacking or comfort sucking small amounts which can contribute to feeding problems like youve described.

also wanted to add that babies kick to develop their stomach muscles, which will help digestion so if hes not in distress when kicking hes fine and doing normal baby things. Hes gaining weight so youre doing well. Its time to prioritise your own need for rest before you get too anxious and it makes everything seem worse than it is. Youre doing really well x

That's a tricky one to answer as she's in the minority of children that don't out grow their reflux. She's 4 now and on 3 reflux meds

She was 4.5 months when we went to high dose omperazole and started cutting out allergens. We did notice a difference straight away but then in my diet changed in adjusting to be dairy and soya free and inadvertently introduced more of other foods she was allergic too. She maxed out her omperazole dose at 5 months as under 2 can't be on more than 20 mg so after this point it couldn't be adjusted for weight. She started on another medication at 8-9 months and it was around this point we had identified the most problematic allergens. She was 15 months when we got her on a diet free from her allergens. Her reflux went through a good period from 9-13 months but then returned full force again. Since then it's gone in and out of being in control usually needing medication adjustments once or twice a year.

It can take time for the omperazole to have an effect. The normal doses of omperazole range from 0.7 mg/kg to 3 mg/kg. My daughters GP kept us around 1-1.5 mg/kg which didn't do a great deal. If you times the babies weight in kg by 3 you will find the maximum dose they can have. I didn't find this out until later as I did have the capacity to do the reading even though it's close to my professional field so I didn't push for the dose to be increased and not just adjusted for weight when it wasn't helping. If you are having to have the weight adjusted for small changes in weight (less than 1kg) or after 2 weeks there's not positive changes I would then be going back to see if the dose can be increased.

Thank you! Sorry that you had this experience too!

I've been speaking with GP rather than health visitor but might check in with them. He has done a normal poo today after two days so maybe not constipated. I'd love to cut the night feeds but if he hasn't had enough during the day I feel too bad to deny him the milk. I do sometimes try to offer the dummy instead but he usually cries until he gets the bottle (although as I said will sometimes then only have a tiny amount). I was really hoping the tongue tie release would have helped by now but I think the recent stretch done by the dentist at the check up has made things worse :( thank you for the advice about trying to focus on my rest though, I do need to find a way to work on this. My partner is very helpful but I can feel myself wanting to be the one offering feeds.

Hmm I think his dose was actually very low so hopefully it going higher will help! Part of me worries that it's not reflux too though and that the medication could be causing side effects. I would have thought we might have seen some improvement even on lower dose. Sorry to hear your lo didn't grow out of it and hope they're managing well! Thank you :)

@ForPlumGuide we do ok. This time last year we were in a bad place but she's only needed one medication change since.

It is a difficult one, you don't want them to suffer but you don't want to over medicate either. My daughter gets practically no benefit from omperazole at less than 2 mg /kg!

She maxed out at 20 mg at 5 months and it then couldn't be increased until she turned 2! So her reflux was mostly managed with the domperidone. Then she turned 2 and her paediatrician could increase it again but only to 2 mg/kg. We were back at paeds every 3 months for weight adjustments. Her reflux generally gets worse when she grows upwards so some times it doesn't come with weight gain so the dose of the omperazole couldn't be increased so they upped the domperidone. Of the two medications its preferable to increase the omperazole first.
At 3 she had a bad flare up and actual damaged one of her teeth as a result of the acid reflux. She would spend the entire night refluxing and only slept in my arms. We were referred to a different paediatrician who put her on the maximum dose of omperazole for her age which is 40 mg total (20 twice a day) which was just under 3 mg/kg and that got her reflux back under control. In the summer we needed to increase the domperidone when her omperazole dipped to 2.6 mg/kg and so far that's doing the trick.

She is quite an extreme case but it's definitely possible to not have much benefit from low doses (0.7-1 mg/kg) but find moderate doses (1.4-2 mg/kg) make a huge difference.

When the dose was increased was it adjusted for weight gain or the dose put up? If it was just weight adjusted id go back and see if it could be put up. If it was put up you might need to give it a 1-2 weeks as you can get a bit of the acid battle again when doses are increased.

Gosh that sounds like it's been a journey! We went to GP yesterday and I was so upset to find out he's lost a little bit of weight (although we had weighed him at home with adult scales the previous time). Have a paeds referral now and dose has been upped to 10mg. He's 13 pounds.
Never had any weight concerns until now so this has really come as a blow:(