Reflux, weight gain and meds

[ceefax]

Hi

I hope someone here can help just straighten out some thoughts and decisions we are trying to make.

We have an 8 week old girl who today just reach 4kg. She has been formula fed for the last 4 weeks. She has always been sickly during the day, vomiting, (not an incredible amount) a long time after feeds. Also a general feel of being uncomfy. But nothing projectile or endless hours of screaming. She exhibits most symptoms of reflux. But i feel its manageable in the usual ways.
She isn't refusing touch wood, some discomfort after feeding during the day, but nighttimes are pretty smooth.

Secondly. She was born just a little above the 25th centile, dropped about 7% then put it back on very slowly. The first four weeks were a bit of a nightmare breastfeeding. She gained either no weight per week, or gained 60g at most. She was flatlining through to the 2 centile. We then made a decision to formula feed. Over the next 2 weeks she gained 600g. The following week another 200g. Getting back to just under the 9th centile. And this is were the problems begin.

We had been keeping a sickness diary for the doctor as they were worried about reflux and weight gain. I think max she was throwing up was 10ml 4 times a day. Sometimes a little more, sometimes a little less. It was at this point (after gaining) that the doctor said this was reflux and she wants more weight gain. So prescribed gaviscon. 2 days ok, then the pattern of sickness shifted from daytime to evening. After the week (today) we went back and she had gained the same 200g, so was taken off gaviscon and prescribed ranitidine. The doctor was saying she would expect a 'healthy' child to put on 200g, but our baby needs to get back to the 25 centile so needs to put on more weight, like 500g per week.

I just don't feel i want to medicate and this seems a bit of a kneejerk reaction by the doctor. I feel if we need to stop vomiting ranitidine is not the drug to do that, and i don't want to go on domperidone as this appears to be under review by the MHRA.

I was thinking of just going onto anti reflux milk, as if i can stop the vomiting and weight gain is the same 200g it would rule out the loss of food as the issue, then it might lead the doctor down other avenues that could be causing the slow gain.

Or heaven for fend, there isn't a weight issue at all.

A bit long, but just your thoughts on whether this is normal, slightly weird, or i'm going insane would be appreciatedIs their a weight gain issue? should i just try the ranitidine.

I would say to try the ranitidine. We were in the same position with DS, and I wanted to avoid medication if possible. We tried everything you could imagine but it was the ranitidine that worked. He put on weight, became a much happier, less vomity baby, and generally easier all round. He only needed it for 8/10 weeks I think. If it doesn't work then at least you tried.

just out of interest, do you recall what he was gaining before going on it.

I thought ranitidine reduces acid in the stomach making the sickness less painful but not actually reducing the amount of sickness. That's how it seems to work in my DS, he's pretty much as sick as ever but the discomfort seems to be less most of the time but if pain isn't an issue for your DD then not sure how much ranitidine would help.

I would be tempted to try using a comfort or anti reflux formula or to thicken whatever she's on at the moment. I use carobel to thicken my sons feeds, the advantage of that is you can control the thickness of the feed and mess about until you find out how much works. You can have it prescribed but it doesn't need to be, I've bought it direct from my pharmacy, although they have to order it in. Might be worth a try if you are reluctant to use the ranitidine, but you can use them together too. My DS is still sick on it so not a miracle cure but he does seem better sickness wise.

My DS sickness definitely reduced on ranitidine. Gaviscon had no effect whatsoever. DS is now 17 weeks and still vomits sometimes but nowhere near the amount he used to. This is probably just down to him getting older but I couldn't cope without the ranitidine. I haven't tried anti-reflux milk but I guess it would be worth a try.
My DS was on 50th centile at birth, lost 12% by day 5 so we went back into hospital where I had to bottle feed him formula or expressed milk every three hours for 24hrs. Horrendous time and killed the breastfeeding confidence. I mix-fed until 12 weeks and now he's fully formula fed but still dropped down to the 9th centile. His weight gain is now good - he put on 10oz in two weeks but he's staying on the 9th centile. HV thinks he's just found his line now. At 17 weeks he's just over 6kg (I think).

Why does your baby need to get back to 25th centile?

DD was very similar, and it turned out she has cows milk protein allergy. As soon as she went on prescription formula (neocate) her weight went back up that might be worth looking into?

We're using Zantac (ranitidine) and my son had totally settled. He climbed from 9th centile to just under 75th in 6 weeks and rarely brings anything back up. It was the same with my DD when she was a baby. Gaviscon didn't do anything apart from create poo which stuck to skin like wallpaper paste.

Regarding why get back to 25th centile .....

no idea...it is what the doctor is saying. She was born at that and needs to get back up to it, she says.

I said to her I thought ranitidine blocked acid, only stopping vomiting when the sphincter was healed by acid reduction, if that was a problem. She said where did you hear that I said the Internet...she laughed....I then said yeah...the but it was the nhs website.

My DS wasn't gaining much at all - he'd dropped from 25th to bottom of the 9th centile by the time he went onto ranitidine, and he just looked scrawny. He picked up really fast though.

Was he chucking up large amounts or small amounts...and did the ranitidine stopped the vomiting?

My DS has GORD. It is horrendous We tried ranitidine but it didn't work enough (for pain) so we moved to omeprazole which has changed our lives (from a pain perspective). Neither of those did anything for vomiting. We started domperidone when he picked up some sort of bug but was unable to stop vomiting/didn't recover from it and lost weight and that has made an enormous difference to the amount of vomiting. We're hoping to stop the domperidone asap. DS has various allergies including milk and once we stopped bf we moved to neocate. I don't really know why your dr is so worried about her being on the 25th centile I was always told that so long as they are gaining and have wet and dirty nappies and seem well. Have you asked another dr or your HV for a second opinion? You are right about what ranitidine does so I don't know why she laughed at you, that is incredibly rude of her anyway. I would want a second opinion personally.

Just a little bit of vomit but a long time after feeds, and several times.

My niece and a friends baby both have cows milk protein allergies and they both vomited a lot, and violently too, so I knew that reflux was the more likely problem.

I'd be curious about your gp's urgency to get back to 25th centile OP.

My DS was born on 50th, started to drop down at c8wks, eventually landed just below the 9th at c3-4months - and has stayed there ever since. He's now 21m. He did/does have reflux but the gp was of the opinion that so long as he didn't actually lose weight then she wasn't too worried. She's much happier that he's followed his new line pretty consistently for nearly a year than she is worried about that initial drop.

Can you get a second opinion?

Thanks for your posts. We are in process of getting a second opinion. I just think it's odd. The doctor has been very good so far but feel she is in a process of ticking boxes that she has tried things. She is the kids specialist at the surgery but I feel I do need another opinion.

The centile thing seems odd, her mum was on so much fluid and antibiotics during birth, I think that could have inflated the birth weight perhaps.dunno...

We changed to a reflux milk today and so far we have to sicks after her sleep that are the size of a 2p peice.

Just out of interest why is vomiting long after feeds worse than straight after. It seems this is why the doctor was worried about reflux...which is the bit I understand....but why would that affect nutrition or Weight gain differently.

When the baby vomits longer after feeds once the milk has started to be digested there is more acid so it's more painful and causes more problems. I can't imagine it affects nutrition but weight gain I guess if you're vomiting more often/for longer you're vomiting more overall so less milk is staying down? You could try carobel. It thickens the milk so less comes back up they say gaviscon does that but they must be lying ime. I don't think you can use it with reflux milk though but double check. Are they any signs of food intoleraces/allergies?

No rashes hives or ecsema. A bit cranky after feeding...some vomiting obviously or I wouldn't be here.

The only od thing is she does get zits which come and go in a day usually. She breathes through her mouth sometimes. Usually nodding off or excited. And I think she breathes heavily sometimes and I see her abdomen moving. I've read too much of the Internet im worried about everything

Sorry that was crampy not cranky although the two go hand in hand. I sometimes have to sit her upright in s burp position on my knee. Putting her long in my arms at 45 degrees makes her whinge

How are her nappies? Khaki coloured and/or explosive and frequent pop can be a sign on cmpa. That is quite common in babies with reflux.

Not frequent, not seen any khaki ones...explosive, not really, there has been some that are v heavy once she went onto bottles, but not wet, they seemed big but normal. She is farting quite a bit after feeding

Now i have said that….this happened today…2 days after we started reflux milk. We have a paed appointment on saturday.

But anyone else seen this with aptamil reflux milk …..its a poo photo…be warned

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