Gaviscon, then Enfamil Anti Reflux formula, now Domperidone and Ranitidine and commencing weaning at 18 weeks!

[nixrolz]

Hi there

DS has had a rather troublesome time over the last 4 months - in a nutshell (and to briefly capture all the threads I have posted over the last 4 months on mumsnet) -

1. He has been on Gaviscon, which the Paed told me to stop and "let him vomit".
2. He fussed so much on the boob that I had to stop breastfeeding as he didn't put on any weight for 4 weeks since stopping the Gaviscon.
3. I now have DS on Enfamil AR formula - which still doesn't help and he does HUUUUUUUUUUGE vomits still.
4. After to-ing and fro-ing from the Paed - I have now been advised to start weaning him (and he is only 18 weeks old) and have been prescribed Ranitidine and Domperidone.

My LATEST concern is that he is still puking every 10 mins - and I think it is MORE than what he used to vomit before going on to the latest medicines. He is having pureed carrot and/or baby rice with his lunch time bottle of formula (he loves it, and eats very well!)... but then for the rest of the day he is still just having formula at his feeds.

I am SERIOULSY at the end of my last nerve, I have been in tears all night when he was still vomiting up pureed carrot from his lunch time feed at 8pm last night (7 hours later!!!).

Has anyone else found that their baby vomits more on Domperidone and Renitidine? Also, has anyone else started weaning their LO's at 4 months?

I have left a message for the Paed to phone me back as this just seems really worse now...

nix, is your baby gaining weight and developing normally (smiling, rolling, socially responsive)?

Hi tiktok!

He is gaining weight now and is smiling and socially responsive. He isn't really rolling, and certainly doesn't like tummy time at all (makes him reflux more too).

I have literally just heard back from the Paed. He wants me to up the dosage of the Domperidone to 1.5mls 4 x a day, and the Paed is also going to book DS in for a scan next week (where they insert the dye and see where it goes I think).

you have to give the domperidone and ranitadine at least 7 days to see a difference

the weaning is IMO a red herring and won't help the reflux

i would honestly stick with the milk and the meds and see what the tests bring

reflux is horrid

Hi my 12 weeker has severe reflux. He tends to swallow the acid rather than vomit (silent acid reflux). He was diagnosed after a scary trip to A&E with choking/stopping breathing, he chokes badly several times a day and was irritable 24 hrs a day when awake. He used to sleep 30 mins a night so I know how hard it is and have sympathy. We stopped gaviscon as it just made the sick up thicker and he was uncomfortable on it with constipation. DS is now on Omeprozole and Domperidone. He definately improved on it (still choked etc but not the same irritability) but then went bad again and paed said he needed four times the dose. We were advised to stick to weaning at 6 months. I breastfeed as am scared it would get worse on formula. I am also cutting back on cows milk proteins and drink rice milk and avoid milk products. I hope you get it sorted. I also found it took about 3 weeks for the meds to work.

I wonder if one difficulty with the paed is that this is clearly a healthy baby with normal development - the sickness is a massive inconvenience and distressing (prob more to you - I am guessing it does not upset your baby to chuck up?), but as a clinical issue it's not really registering....hence his attempts at 'what else can we try?' with the weaning.

I can't comment on the meds, sorry, or the scan.

Weaning - you're already doing that, and finding it makes no difference.

Ask him what the rationale is for weaning - I expect it's because solids are a bit thicker, and of course that makes sense. It might be that thicker solids (thicker than rice and carrots) might work - ask him.

Milk is more suitable nutrition for him at 18 weeks, no doubt about it, but now you have already given solids, there's no reason to stop (unless of course they are making him worse). Some babies just are 'happy chuckers' and it's a real pain, but they do grow out of it.

hi nix,

I have 2 boys both have had reflux so i feel for you with the vomiting.

How much does your ds weigh as the dose of domperidone varies according to weight. my ds2 had to be 6kg before they put up the dose to 2ml 3x day - and this has worked wonders for him - he is now 21 weeks. you may need to keep upping the dose (under paeds guidance) until you get to the right dose. sadly, with ds1 i was persuaded to give up bf to try enfamil as its thicker and harder to throw up. it made no difference either and i am yet to find someone who has found it helped. it also can cause constipation. It may, and i only suggest may, be that there is some lactose intolerance there. DS2 is still bf (despite pressures to ff) and i avoid dairy as it seems to make his reflux and windiness (burps cause him to vomit more obviously) much worse. Maybe try lactose free formula - nutramigen on prescription, as its very expensive. Avoid soy formula as its not good for boys to take apparently due to risk to fertility but you can get goats milk formula on the net.

Ranitidine will make no difference to the vomiting as its just an antacid to try asnd reduce the damage being done to his oesophagus when he vomits. Domperidone is the only drug i know that reduces vomiting - you just need to find the right dose. I'm sure you know all the other tips - keeping upright afterr feeds, avoid tummy time til after 6 months (i know hv want you to do this all the time but its no good for reflux babies) raising one end of the cot, etc

Scan -is he checking for pyloric stenosis?? Is the vomit projectile or effortless?? its is one big vomit or lots of little ones? is it always food or is it watery acid with little food in? I'm not sure what he's hoping to find but i guess he's covering all bases.

Also reflux peaks at 4 months and gradually gets better up til 6 months when the muscle at the top of the stomach finally strengthens enough to hold food down. YOu may have to tolerate this for a while longer but imo weaning makes no difference - its time thats needed. i know you want it to stop now and so do i but i was amazed at ds1 suddenly at 6 months, stopped throwing up!!

Hi Loulou33 and tiktok

Thank you so much for your emails!

The Paed wanted me to start weaning as the food would be thicker and "stay down" more! But am concerned that DS was still bringing up carrots 7 hours later!

DS now weighs 6.58kgs and is now on 1.5mls of Domperidone 4 x a day as of this morning. I fed him at 10am this morning (Enfamil) - and as I type this - he has just vomited twice. Generally his vomits are effortless and gush out... but sometimes the vomit is with a nice big burp.

I think the scan he is doing is the Barium scan - where they insert a dye and watch it on the xray to see what happens when he vomits it up.

I am literally counting down the days to him reaching 6 months old as I know he will hopefully grow out of it soon. I have delayed going back to work (was meant to go back at the beginning of March!). I am now only going back in Mid-June by which point DS would be completely weaned and hopefully vomit-free!!!

Ok - in the 7mins it took me to type this - DS has vomited 5 times in total - effortless and gushy ones!

nix, a 'happy chucker', for sure then....

This is indeed a Big Pain in the Bum, but fortunately, from what you say, medically insignificant, which does not help with your laundry or distress.

www.cryingoverspiltmilk.co.nz/MedicalTreatment/ManagingUncomplicatedReflux.htm

is a link I got when I searched on

babies happy chucker

The fact it is making you so tearful and unhappy makes me think you need a lot of support and sympathy - have you got that in real life?

my dd had silent reflux (wasn't sick but arching and screaming in pain during and after feeds and only gaining about 1oz per week on average) and careful weaning at 4 mths did help her. Breastfeeding was calmer after about a week and she started to gain weight after a couple of weeks. I have heard that in many cases it doesn't help though...

sounds like reflux rather than anything sinister - which is more of a laundry problem than anything else. I do wonder about dairy intolerance as there is an association between lactose and reflux so i wonder about asking your paed about this - can he test for lactose intolerance??

Sounds like the dose of domperidone is the lower end of the range. It starts at 1mg per kg per day - so 6mg/ml per day and i think it goes up to 2mg per kg so 12mg/ml but your paed would have to change the dose.

During those 7 mins, was he upright on your knee?? Even sitting in bouncy chair may be too 'slouchy' for him and put pressure on his tummy....i keep ds2 upright for 20 mins after a feed and have my hand under his chin so has soon as he burps, i push his chin upwards and keep his back really straight so his oesophagus is virutally vertical - some milk comes up but it tends to go back down again....do you use a sling?? I found when ds2 was at his worst, carrying him in chest to chest hold, so he's upright against me stopped him doing large possets hours after a feed. You may get covered in carrot though!!

Food can sit in your stomach for hours particularly solids in a young child so maybe that why there's still carrot in there after so long..hang in there

Oh Nix, how awful for you! My DD has reflux but it doesn't sound anywhere near as bad as your describing. She's been on gaviscon for 6 weeks now and while its helped, she's still vomiting particularly first thing and is constipated on it. We've just got a referral to a paedriatrician, we're going on Monday.

It really worries me that your paed seems to be clutching at straws, is he a gastro-paed or just a general paed? I;ve built my hopes up that he's gonna have a miracle cure for her, but from what you're saying that's highly unlikely.

I haven't really got any advice for you, I just wanted you to know you're not alone! All the best!

PS hi Loulou!!

Hi there everyone

He is a gastro-paed!!! That is why I am getting so annoyed, as you are right Honeymoonmummy - he is just clasping at straws!

I keep DS upright for 30 mins after a feed, and this still doesn't help! The poor chap gets so bored sitting on my lap all the time, bless - especially when there are lovely toys and things to explore .

Is anyone giving their baby water now as well? DS has been very constipated today, despite eating carrots, pear and apple now as well as having Enfamil (which makes babies constipated at the best of times, but the paed said that veg and fruit would help move his bowels)

x

enfamil is terrible for causing constipation and i don't think veggies will be enough to beat it on thier own imo. I had to get presription for lactulose for ds1 and it took several doses to sort it out. I changed him to nutramigen in the end as the enfamil was really bunging him up. i would suggest you keep a close eye on this as straining and constipation in one so young is not something you want to happen for long. it can cause long-term muscle problems in bowels which mean that constipation, impaction and over-flow (sorry if tmi)may occur more often as they get older. i don't want to worry you but please don't leave him too long if he's struggling...

quick one - sounds like could be an allergy to cows milk (quite diff to an intolerance).

Hi there Turniphead1
I saw a Cranio Osteo on Thursday, and she has also suggested that it could be an allergy to cows milk....

She has asked that I try DS on Goat's milk for a week and see how that goes. The concern I have is that the Department of Health strongly advises against that.... so what should I do? Anyone got any suggestions?

Hi,
I have a dd suffering with silent reflux, tht has bouts of vomiting. I feel like we have thrown everything and the kitchen sink at it, but the one thing I cannot find anywhere is anyone who has found a solution to this horrid problem.
My dd screams with pain,for at least half the day, most days.
Our problems started whilst i was breast feeding her for 8 hours a day until she was a month old, she seemed to be constantly colicky, we went through the infacol, dentinox, colief route (which was purgatory) especially as i didn't really have enough enough milk for her (not that a MW or HV would tell me that was the problem!)so expressing then getting coleif down her was a nightmare.
then someone reccomended Cow and Gate comfort, so we put her on to that. She still had tummy ache but it wasn't as bad as on breast milk. It gave her really thick foul smelling dark green poos, which she really struggled to shift. The HV saw her one day at nearly 6 weeks and said what the whole world told me was colic wasn't normal (despite everyone telling me she was just a colicy baby (I'd thought it wasn't normal but been persuaded I was a neurotic first time mother). At her 6 week check i spoke to GP about the screming and pain when she had a feed.
GP sympathetic and put her on Nutramigen on friday. By tuesday the reflux had started (I think becasue the nutramigen was thinner than the C&G) then another Dr prescribed Gaviscon, which I couldn't get down her - it just casued a milk aversion and she would scream the place down. after 2 days of trying this and diminshing wet nappies I took her back to GP, who refered me to Paed.
(Lack of wet nappies were the main driver not the reflux).
They put her on Domperidome. 1.4ml 4 times daily (she was 4.5kg) after 4 days she seemed worse if anything so they upped the dose to 1.4ml 5 times. After a week I took her back as still no improvement. The Paed prescribed Ranitidine 5ml 3 times daily, and told me to try again with the gaviscon. I still couldn't get gaviscon down her. After another 2 weeks of being at breaking point I have got some Carobel on prescription. We are now 3 weeks in to the Domperidone, 10 days in to the ranitadine and 3 days in to carobel.
Through all of this she contunues to scream with pain during feeds (and in between!) as the acid comes up, sometimes takes me 2 hours to get 4oz milk in to her and a lot of tears from us both.
She also Gulps the milk taking down air, which makes it even worse despite using avent anti colic bottles.
The carobel seems to have made the biggest difference, at full rate it stops the reflux totally, but it also stops the bowel movements meaning she takes up to 10 hours to get a poo out. I am trying to get water down her but she just throws it up.
GP says next step is lactulose.
I have found out some useful stuff along the way though, the most important being that keeping doses of domperidone and ranitidine apart makes them more effective. You can put Ranitidine in a bottle to get a large dose down them.
Gripe water has Bicarb in it which is about the only antacid you can give a baby.
I am still unsure if the Rinatadine and Domperidone are doing any good at all.
I am praying that she will improve at 12 weeks.
I have taken her to a Cranio osteopath who thinks she probably has a "floppy diaphram" which is congential and she will grow out of, but I am taking her back for one more session, becasue he thinks he can help shift the wind if nothing else.
I am at my wits end with seeing her in pain, and can only thank my lucky stars for supportive family and friends.
If anyone out there has had success with any of these treatments please do post something as I am on the point of stopping everything bar the Carobel and seeing what effect it has becasue I feel like i am pumping her with medicine for no good reason or improvement at the moment.
Also has anyone with a baby with severe reflux had real success with the DR Browns Bottles? I am reticent to invest in another "miracle cure" which only works for a "normal colicy" baby, i've been caught with other things.

Further to this, (for anyone reading and wondering if I have found any answers) I have got some Dr Browns bottles and they have made a massive difference to my DD.
I think they were possibly the missing piece of the jigsaw.
I also took her back to the cranio osteopath 2 days after i started with them, 5 days on I have a different baby, she is 85% better.
In hindsight, I wish I tried Aptamil with Carobel in it to start with, then added in the cranio osteopath then the nutramigen.
My suspicion is that I would not have needed the Domperidone and Ranitidine had that been the case - hindsight - wonderful.
The other thing I have done which has helped is put an extra 1/4 ounce of water in to each 4oz bottle, which has helped her pooing massively. I am sure it is not what the medics would advise but it works for us.
DD is by no means cured, I took her for a walk in her push chair this avo on slighltly bumpy ground and regreted it ever since (got the old baby back) but I think that was my own fault. Best of luck to anyone out there struggling with reflux or silent reflux. xx

Further to this, (for anyone reading and wondering if I have found any answers) I have got some Dr Browns bottles and they have made a massive difference to my DD.
I think they were possibly the missing piece of the jigsaw.
I also took her back to the cranio osteopath 2 days after i started with them, 5 days on I have a different baby, she is 85% better.
In hindsight, I wish I tried Aptamil with Carobel in it to start with, then added in the cranio osteopath then the nutramigen.
My suspicion is that I would not have needed the Domperidone and Ranitidine had that been the case - hindsight - wonderful.
The other thing I have done which has helped is put an extra 1/4 ounce of water in to each 4oz bottle, which has helped her pooing massively. I am sure it is not what the medics would advise but it works for us.
DD is by no means cured, I took her for a walk in her push chair this avo on slighltly bumpy ground and regreted it ever since (got the old baby back) but I think that was my own fault. Best of luck to anyone out there struggling with reflux or silent reflux. xx

Hi everyone,

My ds has silent reflux and was on gaviscon since he was about 6 weeks old. This did stop some of the sickness ( although the sickness was never much anyway more just screaming during feeds arching his back and general discomfort). I still struggled to get more than 3 onuces down him so finally got an appointment with the pead on friday. He is now 16 weeks.
They gave him lansoprozole once a day and 2ml of domperidone 4* a day. Now his bouts of screaming are much worse than when he was just on the gaviscon and he has started been really sick all throughout the day??? Has anyone else had this.... could this be the domerpidone ????. Feel like we are right back at the beginning... so back to the docs tomorrow.
I really feel for all who go through the same as us.... very distressing. x

Hope the doctors give you some answers. In our experience you just go with trial and error until you find something which works for you. The drugs all work slightly differently (domperidone is an anti emetic and so is aimed at stopping sickness) we didn't think it did anything until we didn't give it to DS when we realised that actually it did help. We don't think it impacts on the silent reflux screaming one way or another for us although it does have wind as a side effect

If its silent reflux the antacids are more useful which is ranitidine for babies.

Lansoprozole is a proton pump inhibitor and is therefore again a different type of drug which may or may not be necessary.

For us gaviscon was a disaster so we stopped that quickly.

Have been back to the doctors and she changed us to ranitidine which so far (although am scared to say it outloud) seems to be helping.
Thank you for your information sometimes it seems more useful to have information from mums that know rather than the doctors.