8 week old - silent reflux. Started on infant gaviscon

[purpleviolet1]

Ds will be 8 weeks tomorrow and is a good weight of over 10lbs now. He was born at 37+5.

He is formula fed - cow and gait comfort (since 4 weeks) as we initially thought he had colic. He has had the following symptoms:

• distressed during feeding
• approx 1-1.5 hours after feeding he cries and cries. Very rigid body and very difficult to settle.
• gulping noises up until next feed followed by shrieking
• wheezing, clearing throat, grunting noises during sleep
• waking up mid nap clearly in discomfort. Not able to settle for more than 15-20 mins at a time
• sometimes bringing up milk , other times we have seen it in his mouth and then he has swallowed it
• burps regularly and passes LOTS of wind
• lots of hiccups
• congested nose (all the symptoms listed seemed to have started/ got worse after he had a cold)

On a side note he has very good head control and is very alert. Numerous people and HCP have commented on this since birth.

It appears to be more silent reflux than normal reflux. GP prescribed infant gaviscon yesterday and said to see how we get on.

So far the crying episodes are very slightly less. Don't think this medication is going to cut it but I understand it can take time so will give it until Monday unless there is further change. Only way he is settling is on his front on my chest if I'm lying down. He doesn't appear to be getting into a deep sleep at all.

If your LO had silent reflux do the above symptoms sound similar? What medications worked and how long until you saw an improvement? Any other tips?

We have got the wedge to raise mattress and keeping him upright after feeds (he is mostly in my arms now constantly anyway).

Fingers crossed for you guys going through this, it's awful and so hard seeing them in pain. Sympathies

Wrigley - I'd be pushing for a go appt asap with those symptoms. There's a condition where milk can leak into the windpipe - sorry to be vague, can't remember the name, a friends dad had it.

Oh really?!? .... I might have to book in then because everything seems to be getting worse not better.....it goes against all sleep advice but I have started putting her slightly on her side through fear of her chocking whenever she had to be laid down...this doesn't improve either after even an hour or more upright after feeds...

Thanks for the advice handhold!

Hlbug let me know how you get on. Good luck.

Cineraria did they offer you ranitidine or move you straight onto omeprazole after gaviscon? I understand omeprazole is the next line of treatment after ranitidine.

Wriggly mummy - handhold! It's terrible isn't it? To be honest I got so distressed one day when he hadn't slept from 7am until 11pm albeit 5 min catnaps totalling an hour at most that we took him to A&E. he had cried soo much all day and I was getting all anxious about the choking sounds. The chap there wasn't very helpful, and just said 'classic signs of reflux but he examines well'. He suggested raising the Moses basket but we had already done this the previous week as he was so congested. He then said ds doesn't need more than 24 oz and I had said he was having approx 27oz. So basically to cut the milk down and get on with it. I said I didn't think that would be enough to help as ds was in a really bad way (typically he fell asleep on the way to A&E).

So the next day I phoned my GP and she was much more understanding. She prescribed gaviscon over the phone (Tuesday). Spoke to her again yesterday as she called about my blood results and I told her there was no change. She asked me to arrange with reception to bring him in but there was no appts and a different GP phoned back. She wasn't ok-ish and said we could try ranitidine instead. We are booked in for a follow up a week today.

I dare say it but I think the ranitidine has helped slightly. But the situation is still pretty dire. He was very uncomfortable from 4am -7am wriggling and crying etc. Then he had his feed at 8am and didn't stop crying until 11.30am. Think he was also a little constipated. Then feed at 12 and has been a little better. Took from 1.30pm to 2pm to try settle him and he has managed to sleep the last 30 mins or so

Glad it's working for you ineed

Thanks sky. Why swirl oppose to shake a bottle? We are using comfort milk which doesn't come
In readymade and it's quite thick so I find it only mixes properly by shaking...

Thanks for that purpleviolet1....

So has everything been prescribed over the phone? I had wondered as I'm not really sure what they'd be looking at if I took her along... as I say I had all of this with my little boy 3 years back but with double the spit up so I completely empathise with you and how stressful and worrying it is... I'd said to my husband all through my pregnancy this time the one thing I'd wish for is that baby isn't like Alfie was with feeds and milk... my little boy even bought up his first few months of solids too..I've always felt so guilty for not pushing it more for him back then....that said he's a very happy healthy 3.5 year old and as someone else has said on here...he did grow out of it but not until full solids were in place so around 9 months...

I shall call the gp Monday to see if they can either book me in or chat over the phone... it's certainly not normal to have all these symptoms and feeding our babies should be an enjoyable experience...this makes its very much not so for you and baby... I almost dread feeding her as I feel I'm adding to the problem!

I've tried normal milk and comfort and really make my mind up which is better for her as they both (aptamil) irritate her. I've spent a fortune on special bottles and drops to help her but nothing works and as I say the most worrying part for me now is the chocking issue... my mum's just taken both kiddies for an hour so I can get a break (my little boy isn't doing so well with the new arrival...loves her to bits but isn't a fan of having to wait for me to tend to her over his needs and like you I can't even get her to sleep soundly for even 20 mins the poor mite is waiting all day for mummy's attention.. so quite a stressful household right now!)

I've told my mum not to lie her on her back...keep an eye on her at all times in case she chokes....it's such a shame the man in a and e didn't seem bothered.... I feel like most professionals hear our concerns and think we're overwrought mothers. I'd be very interested to know in a week or two how the meds have worked for your little boy and I really hope they have a positive effect on him!

Let's hope I can get somewhere with the gp ...I've a few appointments coming up (I've been asked for the men b jab to be given seperatly to the routine jabs!) so I'll just keep trying if not... xx

Hi my daughter is now 13 weeks and was born at 36+5 days and struggled to feed at first but then got the hang of it, now I don't seem to be able to fill her she is on 5oz every 2 hours yet is always crying for more but then struggles cos there is too much in her little belly, I'm just wondering if anyone can help me do I give her some rusk or baby rice? Or is it too early??? Please help!!

You have my sympathies. I've had two with reflux, one silent the other not, and it was really, really hard. In both case for us, the reflux was triggered by CMPA (and in the case of dd various other allergies too). Once we identified her allergies and I excluded them from my diet (she was ebf) all the symptoms disappeared.

With my son we didn't work it out until much later, so he ended up on omeprazole and neonate which did work eventually.

Sounds like you're doing all the right things. I would definitely try a dairy free milk alternative for a good few weeks and see how you get on, I think it's really common for reflux and cmpa to go hand in hand, and your symptoms sound very familiar. Usually you start with a hydrolysed milk which means the proteins are broken down, and if that doesn't improve things, you move on to an amino acid based formula like neocate.

Best of luck to you, and remember it will pass.

They really should be checking it's not CMPA before starting meds; I'm pretty sure that's the trajectory advised by the NICE guidelines on childhood allergy (IIRC; not got them to hand).

We spent months treating DD with meds, all the way to omeprazole, before me coming off dairy and soya (BFing). In retrospect, it wasted so many of her first months with her in horrid discomfort, with the meds working for a bit and then not working. And you really, really don't want to be mucking about with stomach and gut chemistry if the cause is elsewhere. I strongly suggest you check the NICE guidelines and push for non allergenic formula as your next port of call. Good luck!

^^ ps Minky's advice on formulas is fab!

Yes both gaviscon and ranitidine were prescribed over the phone. Gp (a different one) saw ds at his 6 week check - that's the only time he has been in. I was so overwhelmed at the 6 week check I burst out crying and we talked a lot about me. I wanted to talk over this issue but time ran out and at the time I wasn't aware that all the symptoms were linked. I was feeling overwhelmed because I had a really tough year last year and with ds being my first I kept thinking how will I cope (I have my own health issues too). Now I know there is an actual issue it makes me feel more able to handle the situation if you know what I mean.

From everything I've read it's clear that some HCP don't really give it much focus so my attitude is that I have to keep pushing until it's more manageable. I was anxious about speaking to the GP but my mum was on hand and has been offering a lot of support. So yes defo push and if nothing else it'll be on the record that you contacted them x times. They've got to listen eventually ! Hopefully sooner than later ofcourse.

Sorry you feel sad about Alfie. You did what you best could at the time. Don't feel bad now.

Tweedledumb and milky - thanks both. I've been writing that message for hours (for distracted) so missed yours.

I'm not sure how best to approach it with GP - to be fair they maybe just prescribed over the phone because I described the symptoms and said it was reflux.

When you try the non allergenic milk do you stop all medication? I agree I don't want to be messing with the gut and stomach for no real reason

You can actually buy nutramigen from the chemist. It's about £16 a tin. If you're feeling like GPS etc aren't listening / interested in prescribing it you could always buy a tin and do your own trial for a week or so and see if it makes any difference?

Thanks HL. I'm really stuck on what to do :

• try a normal formula (not comfort), different brand and keep on with ranitidine
• try a normal formula (different brand) and stop the ranitidine
• try anti reflux formula and stop ranitidine
• try a different brand comfort and keep on with the ranitidine
• try a different brand comfort and stop the ranitidine
• try the nutrimagen and stop ranitidine

Only started the ranitidine yesterday BTW.

I think it's very hard when your first born suffers with these issues ...at the end of the day they feed alot when so little and it's a big part of caring for your child so it can really make the experience extremely difficult. I remember having friends when my son was born who could feed and put baby straight down again ..no issue no discomfort no stress and thinking why can't I do that....and how nice it must be to not have that added worry to deal with so hold in there your doing a great job dealing with it all and you've done so well to get your little boy some medical help despite how you can be made to feel when you first raise these concerns with GPS or HVS...

I did tell myself I wouldn't be as stressy with my daughter as I'd been through it once and lived to tell the tale and I know deep down all will be well but I'm afraid it's not happened that way and I'm just as stressed as I was as a first time mummy re feeding and what to do for the best. For now my doing all the tricks I tried with Alfie which is the elevation during nappy changes and moses basket...keeping them upright after feeds for minimum of 30 mins... smaller feeds more frequently etc but can't say any massively help...though the elevation does stop the chocking issue being so severe...

I'm very interested in the allergy side of things... I've used comfort milk with both and whilst it doesn't stop the issue it isn't quite as bad as when on the normal formula...slight improvement and to be fair any is welcome...but the milk from the chemist might be worth a try.... my HV tried to say the erratic feeds we experience with the crying and pulling away from the bottle and straining etc is because she's more hungry at night on the comfort milk...I don't really believe that as she's going the same length of time between each round the clock which is 3 hours... to be fair the HV was a waste of time and I had to chase them for 2 weeks to have someone visit at all...they came on day 25! Not day 10 as the should.

Keep on as you are and stay strong... when I look back on Alfie as he is now it seems like a distant memory having all this going on but I know full well that during it feels like a life time before things get better - I'm back here again unfortunately! But that reminder helps me get through! Xx I'll deff look in to the dairy free milk !

Thanks for sharing wriggly, please keep me informed ! I think for now I'm going to carry on with comfort and ranitidine. Give it a few days. Got jabs on Tuesday as well.

From what you say it's definitely not worthwhile trying a normal formula. Technically normal formula will be much worse right. I just read a couple of forums where people said they moved from comfort to normal and it was a life changer. I'm just wondering whether we needed comfort formula at all ...

My GP opted to go straight for Omeprazole in preference to Ranitidine. I had visited the health visitor to explain how difficult I was finding it to give DS the Gaviscon and how I was worried he might get scared of breastfeeding because of needing to have the Gaviscon halfway through each feed. She told me to go back to the GP surgery and ask for a second opinion as she disagreed with the use of Gaviscon for breastfed babies, so we did and the Omeprazole was what the head of the practice prescribed.

Like others have said, a sling is really helpful too. My son pretty much lived in my woven wrap and as soon as he could sit unsupported (around 18 weeks), I booked a session to learn to put him up on my back, so I could get on with other stuff more easily whilst carrying him. That was life changing!

He has always disliked being even slightly reclined so car seats and pushchair were torture as far as he was concerned. Luckily we had been given a big old fashioned Silver Cross pram and in that he could sit bolt upright or leaning slightly forward, wearing reins clipped to the base so he couldn't climb out.

The other odd thing I remembered is that the acid in his digestive system used to give him bad nappy rash from around ten weeks and I wanted to give him some nappy free time but as he couldn't lie down due to the reflux it was tricky, so I got a little potty and sat him on it for ten minutes at nappy changes between my knees with my arms around him and read him a story or would spin his spinning top and not only did the rash clear up, he loved it! I think he found the position really comfortable for his digestion and as soon as he was on solids he started doing all his poo on the potty too, which was a great bonus!

It won't do any harm to carry on for a few more days as you are, but I really do recommend making sure that the healthcare professionals are trying to get to the bottom of what's causing this.

I've tracked down the NICE guidelines; they should be considering CMPA with these symptoms. Sorry, not sure I link on phone.... guidelines [[https://www.nice.org.uk/guidance/cg116/chapter/1-Guidance]]

Things will get easier

www.nice.org.uk/guidance/cg116/chapter/1-Guidance

Sorry; truly piss-poor linking!

Thanks so much tweedle. Do you think it's best to say to GP that I've read the NICE guidelines and I want to try the milk suitable for CMPA to rule it out? Any advice much appreciated

Maybe give the ranitidine a few days to see how it goes? Then try ranitidine and nutramigen if no better? If you see an improvement then you could speak to GP about stopping ranitidine and keeping on nutramigen to see if you still see improvement?

Although if you have injections next week that may affect feeding anyway. Sigh. Poor babies...

I'd say you understand that the symptoms may be indicative of CMPA, and you'd like to rule that out through different formula before going down the route of more meds. Bring in the NICE guidelines if you sense resistance 😁

The thing with the meds route is that they can work for a while on CMPA babies, but then stop working, so you get prescribed the next, etc, so it's a route that, IME, can cost you months, when actually the cause is quite simple. I'd def push for allergies rule-out first.

Unsure if anyone has tried aptamil lactose free? I've been looking online at lactose free milks as I'm looking to try one since reading these posts ...I have a week over before her 8 week check and jabs so could give it a whirl before hand.... boots apparently have this in stock where I live ...unsure if it's a chemist jobby or on the shelf... online it looks like you can just buy it... at least then if things did improve I could say I've trialed a lactose free milk on my own and see what they say...if it didn't help then I'll have one thing eliminated but just wondering if I'm ok to try it without GP advice....

I've been reading alot online too purpleviolet1 and again getting a gp to diagnose lactose intolerance can be a nightmare...a friend of mine has to go back 4 times demanding they re look at the symptoms her little girl was getting before she got a prescription and once she did her little girl was a different baby... I guess it's because the symptoms are so similar to reflux/silent reflux but it seems lactose intolerance and reflux can go hand in hand...

Only reason I mentioned the aptamil lactose free is its £5.99 from boots...400g so a lot smaller tub I think than the standard boxes.... not that cost matters when trying to help our babies! I've bought every gadget going belive me!

Any advice re trying this aptamil milk would be great... of anyone has any!

Also I follow point raise around jabs and feeding.... it can make them quite grumpy and off for a day or two...so try not to worry if feeds get more difficult just after. This is one reason I've requested the men b jab be given a couple of weeks later than with her routine immunisations... my little boy didn''t get the men b with his as it wasn't available then and to be fair was fine after his jabs but having read alot about the men b giving a temperature and the risk of this being massively increased when being co-administered I've gone with my gut and took it out of her 8 week appointment (totally personal choice! And may not even prevent her getting a fever either way but we do what we thinks right I guess!) - anyway slightly off subject there but was worth someone mentioning how immunisations - as important as they are- can effect babies feeding for a day or so! Xx

Thanks wriggler! I might be wrong but I think lactose intolerance is different to CMPA. Cows milk protein allergy is more common , I think lactose allergy is quite rare...

Ahh it came up in the hypoallergenic section.... maybe not then... it's so confusing