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im not sure if my newborn dd2 has acid reflux

25 replies

jeanini · 01/07/2006 20:30

hi my dd2 is 5 wks old and recently hasnt wanted to go to sleep in her moses basket in the daytime. but she will go to sleep in a more upright position in her bouncy chair. also when i feed her she takes some ok then she will cry when i put the teat into her mouth as though it hurts her. so i take the teat out then she cries again as she does want the milk. i dont know if it is thrush in her mouth or what? the hv came and saw her a few days ago and checked her mouth and said she didnt have thrush. i dont know whether to take her to docs on mon to check it out anyway. she also seems really unsettled esp in the evening and want her dummy but keep spitting it out constantly. ive been putting dentinox colic drops in her milk to see if it helps as i think she does suffer esp thru the night she is straining and unsettled. any help/advice please. xxxx

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liquidclocks · 02/07/2006 12:29

Poor you! There's very little worse than a hungry baby won't eat, must be terribly difficult for you right now. My DS had thrush AND reflux so hopefully I can be of help.

Thrush -you can tell if they have this because their mouth will have little white dots in it that don'trub away when you smooth your finger over (milk residue would). Don't rub too hard if this is the case because the skin underneath is red raw andwould be painful. If there are white dots get your HV round again and get some meds. Also with thrush you need to sterilise with miltons or something like as a steam/microwave steriliser isn't good enough. Also make sure you wash your hands before and after each feed religiously as it can be passed between you.

Reflux - we could tell DS had reflux partly because he cried after his feeds and wouldn't eat properly, but also because he would throw most of it back up - reflux babies don't always throw up though, it can just be the 'heartburn' element of it. If DD is showing a preference for sleeping on an angle she might have learned it's more comfortable like that - try propping her basket/cot up on books/bricks rather than letting her sleep in the bouncy chair though as it's better for posture. Sickness with reflux follows a pattern too -they have one bout immediately after a feed and another bout 1 1/2 - 2 hrs after which is when the tummy pushes the milk into the intestine except with reflux it goes the wrong way.

2 schools of thought here. 1) feed them little and often - this is because after a short time the milk starts coming back with acid and can be painful but by feeding them only a bit they should keep most of it down. 2) feed them as much as possible and give them about 4 hrs between feeds, this works on the principle that no matter ow much/often you feed them it will hurt and they'll be sick so you might as well keep discomfort to a minimum.

Thankfully they do grow out of reflux but it's distressing for mum and dad too because they know baby's in pain. An effective treatment to try would be infant gaviscon (available from chemist or on prescription), this makes the milk thicken once it goes down so it doesn't come back as easily. If you try this and it works go to your GP and ask for a prescription of Enfamil milk which already has the thickening agent mixed in - it costs about the same for the GP to prescribe as gaviscon so there's no reason s/he should be against it. The other advantage of this is that gaviscon contains sodium as does formula so baby's getting a double dose, using enfamil cuts that out.

We ended up using the controversial gina ford routines for feeding but found they worked really well - this is the 'as much as poss 4hrs apart' method.

Newborns can sometimes find feeding upsetting because they have a blocked nose - have you listened to her breathing while she's feeding?

If there is projectile vomiting involved ask your GP about 'pyloric stenosis' or google it as sometimes discomfort following feeding can be more serious.

Sorry for the essay - just wanted to be of help as we were so lost with DS and it could have been much easier if I'd known about MN then!

CADS · 02/07/2006 12:42

Hi Jeanini

liquidclocks - has given you some very good advice. Also, does her breath/spit up smell acidic when she burps? I found this was a sure sign with my two and both had silent reflux.

We used rantitidine (zantac), I find it alot easier than messy around with thickening feeds but she will need to be diagonised first. I don't think you can get rantitidine over the counter. IMO thicken milks and gavison are more helpful if they are vomitting alot and not gaining weight suffienctly.

DD slept in her carseat for 4 mnths. Not ideal but even the raised cot/mose basket didn't help her and the doctors, chiropractic etc, weren't concerned about her back.

Hope you get better medical support than I did with my first.

jeanini · 03/07/2006 10:52

thankyou liquidclocks and cads-thanks esp for the essay liquidclocks. dd2 projectile vomited her morning feed so im taking her to the docs today. ive made a list of all her symptoms. she didnt settle at all last night in her cot i had an awful nights sleep. it doesnt help that she had slept almost all day yest in her bouncy chair. she gets hiccups an awful lot is this connected? when i lay her in her cot even though ive raised it up with 2 big books one end she waves her arms and legs about frantically for hours and i try and give her a dummy she settles for about 5 mins then pulls it out of her mouth and goes back to being unsettled. i think that i have smelt her breath once when she burped and it smelt a bit acidic. i will mention this to the doc. how do the docs test for acid reflux?

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CADS · 03/07/2006 13:02

Hi jeanini

It sounds like reflux to me. They don't really test for reflux but go on mom's list of symptoms (unless very severe).

Some GPs insist on referring to paed (which is a pain) and others will be very helpful and go on your word. I found the most frustrating thing with both of mine is our GP insisted it couldn't be reflux because mine didn't/don't projectile vomit and thrive very well. However, it does not mean that they are not in pain. Unfortunately, we only got diagnosed when they were each in hospital for different reasons and the paed decided that they were in suffciect pain to justify reflux meds.

Yes, wet hiccups are very common with reflux. DD has never been a content baby after feeds and looked startled and would start flinging her arms about in pain anything up 1hr after feeds. Also, arching her back when screaming with pain.

Good luck

CADS · 03/07/2006 13:06

List of symptoms:

Persistent coughing or gagging
Irritability when feeding
Arching back when feeding
Refusing food or eating only small amounts
Frequent vomiting
Sudden or constant crying
Colic
Wet burps
Frequent hiccups
Blood in stool
Poor sleep habits
Slow growth
Difficulty swallowing
Weight loss
Spells of not breathing

She doesn't need to have all these symptoms and this is a list of chronic reflux, which hopefully she doesn't have.

jeanini · 03/07/2006 19:40

thanks cads 4 all your comments. the doc said yes it does sound like reflux and has prescribed gaviscon infant. does it start working straight away? ive given her one bottle with it in and she still had hiccups a little while after and still pulled a face when i put teat in her mouth at the middle of her feed. the doc said to bring her back in a weeks time and if gaviscon hasnt worked she will refer to a paed. when this happens do they do horrible tests like put a camera down her throat?

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CADS · 03/07/2006 21:01

hi jeanini

Glad your doctor was supportive and I hope the gaviscon works for your dd. Gaviscon is usually what doctors start off with. There are several drugs that they can prescribe and it's just a case of finding the one that works for your dd.

We only used gaviscon briefing with ds but unfortunately it didn't help him and made him very constipated. Not sure how long it takes to take effect but I assume fairly quickly. We were also told to review in a week but I don't think it takes that long.

There is also ranitidine (zantac), which suppresses the protection of acid in the stomach. They still spit up but because there isn't as much acid there it doesn't cause any/as much pain.

Domperidone is a motility drug, which speeds up the empty of the stomach so that the partially digested food doesn't come back up and cause pain. It is used in conjunction with one of the others.

Most infants are successfully treated with one or combination of these.

DD started on ranitidine at 6wks and then we added domperidone for a month. She is happy on just ranitidine now.

There is still another group of drugs called "Proton Pump Inhibitors" but I have no experience with these.

So my point is: No, they won't be doing tests just yet. There are many things to try before they go down that route and not until she is a lot older.

If the gaviscon doesn't work, speak to your doctor about ranitidine and see if you can use it until your paed appt comes through. You can use it with the gaviscon.

Oops, ESSAY

Ps ranitidine is the generic name for zantac

CADS · 03/07/2006 21:43

God, I really should read what I type

protection should actually be production

jeanini · 04/07/2006 15:24

hi cads-thanks again for your advice. i dont think the gaviscon is helping she still is getting hiccups and still pulls a face when i put the teat in her mouth when im feeding her. i let her sleep in her bouncy chair last night and i slept on the settee. she still was waving her arms and legs around. that said she has been awake for a bit longer today so she must of got some sleep last night. ive got doc appt for her on fri so i will mention zantac. thanks again i was feeling like i wasnt coping and i think with the sleepless nights i was starting to feel a bit depressed. but hopefully now help might be on the way. i just dont like to think of her being in pain/uncomfortable. xx

OP posts:
CADS · 04/07/2006 19:00

Hope you have better luck with ranitidine.

She might still be associating feeding with pain, hence the face pulling. Thankfully, neither of mine ever reached that stage and were the opposite. They both wanted to comfort eat all the time, which was difficult with ds because I didn't know about reflux then.

Yes, I know all about the 'not coping & depressed' feeling, it's exactly how I feel when I'm sleep deprived. It's amazing how you can cope with practically anything they throw at you, when you are well/fairly well rested.

Bye

liquidclocks · 05/07/2006 10:15

Hi jeanini - been off for a couple of days so just caught up. Glad your doctor agredd it's reflux, that can be half the battle. The gaviscon doesn't work straight away as in in won't take effect during the feed so DD may still be in pain for a short while. What it's supposed to do is once the feed's all in it should form a congealed thick layer on top of the milk which effectively plugs the top of the stomach so the acid can't come back up. This means it should prevent the second bout of vomiting and she should be more comfortable in between feeds if not during them. If it's not working by now it probably won't - we found the Enfamil much more effective at pain reduction but we never tried the other things CADS suggested.

DS's main symptom was obvious pain though so they were never really concerned with trying to keep the food down as he was always a good weight. If she's not putting on weight I'd be more concerned and go back to the doctors asap.

jeanini · 05/07/2006 11:26

hi thanks liquidclocks and cads-i went to emerg doc last night as dd2 was screaming in pain when i tried to feed her she had had about 3 oz then wanted the rest but it obviously hurt her.doc checked her throat and said not thrush or red. i said to him that i didnt think the gaviscon had worked. he said prob not reflux then and to change the size of the teat. she is having slow flow 2 avent. should i change to the newborn size 1 teat? i have tried her on this and it took too long to feed her and she fell asleep so didnt have as much milk as normal. i know that she does guzzle her milk down and so must take a lot of wind down bless her. i mentioned zantac ranitine and he has given me a prescription for it and said it should be 1ml for 1 kg of babies weight. she is 4kg so its 4ml. he said i might have trouble getting this measurement in a syringe from the chemist. doc said to give her it 3 times a day in her bottles. im so confused ive got to go to chemist today to see what they can do. he said they might have to make a syringe up could take couple of days. then im also worrying about giving her a drug when shes only 5 wks old. she did sleep a bit better last night so i do think the gaviscon has done something but she is still in pain when i feed her and she still has bubbles out of her mouth and still getting hiccups but not as much. she is a healthy weight as she does like her milk. any help please im so confused. xxx

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jeanini · 05/07/2006 11:29

cads- how did you give randititine was it in a dropper into her bottles and how often? and what dosage? xx

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jeanini · 05/07/2006 11:30

sorry just remembered. when i go to give her cooled boiled water she pulls faces as though this hurts her throat. is this normal?

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CADS · 05/07/2006 11:39

Was the A&E doctor a paed because he is not talking much sense. Just because the gaviscon isn't working doesn't mean she doesn't have reflux.

Also, the dosage he gave you for the zantac sounds very wrong. DD is 9.2kg and is on 1.2ml three times per day. It should be 1 to 2mg per kg not ml then this needs to be converted to ml. 1mg is the lowest dosage and 2mg the highest. DD is on 2mg. Does this make sense?

The zantac strength is usually 150mg/10ml suspension or 75mg/5ml either way here is the calculation.

1mg x 4kg divided by 15

so she should be on 0.27 ml three times per day.

Speak to your chemist about this. Also, your chemist should be able give/order in the correct syringe. We have a 2.5ml syringe which is in 0.1ml increments.

Not sure about the teat size. I have always preferred Dr Brown bottles and found ds and dd fed better on these. Age 5wks they were both on the level 1 teat.

Good luck

CADS · 05/07/2006 11:49

Have other idea, as it is a hosiptal prescription you can go to the hospital pharmacy and pick it up. They will have syringes of varies size. We got 1ml syringe them ours. Ask for several because of the whole sterlising thing.

Don't mix the zantac with milk or anything else. Give it direct. Also, her the zantac about 30mins before bedtime, helps dd sleep better.

Another thing is zantac is very weight sensitive so you need to keep upping the dosage as her weight increases.

Water have the same effect as milk when it comes back up.

Make sure you burp her during and immediately after feeding. The further into the disgestion system the burp ups under the more acidic it will be. So no sleeping on the bottle, the pits when you desperate to get them to sleep.

Keep her as upright as possible for a least 30mins. Well, they say 30mins but I found I had to keep mine upright all the time.

Let me know if you have anymore questions. Hope this all makes sense because I have ds demanding my attention.

CADS · 05/07/2006 11:57

PMSL reading my post. I do speak english BTW. Brain speeding ahead of brain. Hope you manage to figure out what I was saying.

CADS · 05/07/2006 12:28

Oh, one more thing.

Zantac can take a couple of weeks to work so keep giving her the gaviscon as well. You need to give her the zantac 1hr before or after the gaviscon, not at the same time.

It is a real pain trying to work out the timings but don't give up. It's really difficult seeing them in pain and having to look after an older one too.

X

jeanini · 05/07/2006 14:53

cads your a star-thankyou so much for all this invaluable advice...i rg the hosp and they adv me to ask my chemist for .025ml dosage so its about what youve calculated. they've had to order syringe i will pick it up tom. they never told me not to give zantac at the same time as milk. so thanks for that advice..i just wondered why not does it not work as well? also is it a pain to get it on her tongue when shes asleep? xxx

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jeanini · 05/07/2006 16:45

cads- i also wondered is it better giving it before the milk or afterwards- or does it not matter. they have given me the syrup with no leaflet about the drug. i will look it up on the net see if i can find any info. i dont suppose you know of any good sites on zantac? xx

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jeanini · 05/07/2006 16:53

hi ive just thought of something else. if i use dr browns bottles they say dont shake the milk. but you have to really shake the bottle to mix the gaviscon. and do you stir the milk with a spoon like they say or do you just shake the bottle? xx

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CADS · 05/07/2006 20:12

I found this on one of the info websites

"If you need to take an antacid you should take it at least 1 hour before or 1 hour after ranitidine. Ranitidine will not be as effective if taken at the same time as an antacid."

which doesn't appear on the Zantac information. and as far as I know gaviscon is an antacid.

This is the manufacturers info on Zantac:

www.gsk.com.au/gskinternet/publishing.nsf/Content/Zantac

Your need to choose the Zantac Syrup PDF doc.

Actually, Dr Brown's aren't the best bottles to used with thickening agents/thicken formula because it clogs up the air system, so don't really no what else to suggest.

Just found that the avent teat is quite firm in comparison and my two found it easier to latch onto the Dr Brown ones. I think they are very good but the only problem is that they are a pain to wash (too many bits) and I move them onto avent when they are older. Also, they leak easier.

HTH

Have been up since 4.30am today, so please ignore all my senseless posts.

jeanini · 06/07/2006 16:11

thanks cads-ive been giving her the rantitidine 1 hr after feeding but earlier i gave it 1 hr before and she has just projectile vom after having 3oz. i thought the gaviscon was meant to stop this happening or could it be the rantitidine? she seems to be getting worse as well with feeding. everytime she feeds she has the first say 3oz ok then doesnt want the teat in her mouth and screams when the milk goes into her mouth. im taking her to docs tom anyway so i will mention this. xx

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CADS · 06/07/2006 16:19

Hi

Sorry, you still having difficulty. Poor baby. The ranitidine shouldn't make her vomit. Can you make the milk any thicker by increasing the gaviscon?

I would definitely ask to be referred to a paed, just in case things get worse.

Also, what milk is she having? Any possibility that she might be cow's milk protein intolerant. One of the symptoms is reflux, it is part of the problem with my too.

bye for now

jeanini · 08/07/2006 20:57

hi latest update. i went to the docs on fri and said that she was getting worse ie screaming with every feed and she had been projectile vomiting. the doc said she would refer me to hosp so i went that afternoon. the paed there wasnt very good. she basically said that not all babies are the same and just because my first one was good doesnt mean the 2nd one is.

this is when is said about her not sleeping flat. i hadnt even mentioned my ds1.

the paed sent me home no better informed with an appt for next fri.

forgot to mention that while i was there i fed dd2 and she had it like a dream no sickness no screaming can u believe it! it made me look like a liar!

that evening i gave ranititidine 1 hour b4 the milk and she brought up her milk projectile. then she brought up some of her next feed as well. so i rg the childrens ward of hosp and they asked me to bring her in today.

they was going to do a blood test. but they didnt in the end i spoke to another paed who was much better than last one. he said sounds like classic symptons of reflux and advised us on burping sleeping etc..

they have taken her off ranititidine and have given us domperidone for 3xaday. 8ml. i havent given it to her yet. is it the same give it 1 hour before milk or can you give it just before?

they said carry on taking the gaviscon as well. i took her to be weighed on fri as well and she is fine. i am scared to burp her now in case she is sick i hate it.

ive still got the follow up appt on fri. so i will see how she is on the domperidon. xx

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