Silent reflux/ CMPA/ normal?

[HenrysHome]

Hi all,

My little boy is coming up to 5 weeks old (2 weeks adjusted). I was breastfeeding him until just before 2 weeks when he started becoming very difficult to settle after a feed, arching his back, straining and groaning and having trouble passing wind. I began combi feeding as my mental health was plummeting due to him wanting the boob every 40 mins at night and barely settling in between. The symptoms carried on worsening so HV said to try comfort milk which I don’t think has helped particularly. I took him to the doctors who gave us infant gaviscon but again no particular difference. He was draining 3oz then 4oz bottles so started on 5oz last week. It got to crisis Point a few days ago where had was screaming for hours and refusing to feed. The doctor referred us to a paediatrician who said he was over feeding and actually needed around 2oz per feed instead of 5oz! She told me to feed him 2oz every 2 hours instead of 5oz every 4 and put him on omeprazole. Today will be day 4 of taking omeprozole and his new feeding schedule and the screaming fits seem to be under control fingers crossed although he is still very difficult to settle after a feed to the point where I dread him waking up and he groans and moans loudly all through the night! He slept well in the day yesterday for 2-3 hours at a time and appeared to be in a deep sleep then 12am- 8am groaned and crumbled and slept very fitfully. The paediatrician suggest cmpa might be our next option to explore. Has anyone Experienced anything similar and have any advice? Thank you x

Forgot to mention that when I was combi feeding he much more agitated after a breast milk bottle and his only projectile vomit has been a breast bottle. As I couldn’t pump due to his screaming he is now only ff.

Are you just ff now? Just asking as this will change my advice
Are you doing paced feeding to prevent him from taking too much?
Does he burp when you wind him?

Has he been assessed for tongue tie by a lactation consultant?

Hi @Thatwentbadly, yes just ff now, C&G comfort for colic and constipation (HV said to stick on that one rather than the reflux one?) yes we keep the bottle straight rather than tipped and I e just changed back to size one teats as I read size two could mean it’s coming out too quickly and making him drink more than he needs/ take in too much air? He sometimes burps when I wind him but not always, I try him in the sitting position and over my shoulder. No he hasn’t been assessed for tongue tie, who do I ask about that?

It’s unlikely that as a bottle feed or to be honest even if he was a bf baby you will get him assessed by a qualified lactation consultant in the NHS - you would need to do this privately. A local breast feeding Facebook group will be able to tell you where you can be seen.

Paced feeding is about having regularly feeding breaks when feeding rather than a constant stream of milk. Give it a go.

Try holding him upright for 30 mins after each feed. It’s exhausting but it may help. A sling is good for this during the day.

Is he constipated or is it infant dyschezia? Have a google of it. It’s very normal for babies to do this.

I would give this all a go first.

CMPA is simply a case of trialing different prescribed formula until you find on which agrees with him but the formula are not pleasant and many babies don’t like to drink them.

We have an appointment tomorrow to discuss prescription milk so fingers crossed that will help! He hasn’t pooed in two days and before that it was four days even though I am giving him 2oz water a day so I think it’s constipation? I try and hold him upright after a feed, easier in the day than the middle of the night! We’re also trying Dr Browns bottles so fingers crossed for a better night!

We are going through similar. We are still breastfeeding but she screams through feeds and pulls off archs her back.
We tried gaviscon but that only helped a bit but was causing her trouble pooing. We have switched to omperazole but that's not working properly either. We have a review tomorrow.
No advice but you definitely have my sympathy. It's positive that they are investigating it early. We started having symptoms at 3 weeks but it was not until her 8 week check up that all the symptoms joined up pointed to reflux.

I'm on my second baby with CMPA and reflux.

Reflux can be caused by CMPA and/or tongue tie so it's important to rule out those two causes - if they are addressed the reflux might be resolved or reduced which means you don't have to give as much medication (or any at all).

Good sources of information about CMPA are www.allergyuk.org/information-and-advice/conditions-and-symptoms/469-cows-milk-allergy and if breastfeeding dilanandme.com/confirm-cmpa/

If a baby has CMPA they would usually have other symptoms (examples on links above) and not just reflux.

You can find information about tongue tie at www.tongue-tie.org.uk/tongue-tie-information/ and it's important to get baby properly assessed by someone trained and qualified (most midwives and HVs are not). Your best bet is a tongue tie practitioner or lactation consultant, if you can afford to pay privately, but you can also ask the HV to refer you to the infant feeding team (NHS).

There is a good book about reflux called "Colic Solved" by Dr Bryan Vartabedian, a paediatric gastroenterologist.

PS If it's CMPA, baby will be significantly worse after giving formula (because there's obviously much more cow's milk protein in formula than in breast milk) so it seems unlikely for your baby, OP, although it's worth considering if baby has other symptoms on the list.

Same here, started cow and gate anti reflux last week and it worked wonders, actually enabled her to take a whole feed and settle for a good long nap. Problem is it's making her constipated so will speak to the HV tomorrow and see what can be done.

How long have you been giving the omeprazole? It can take a few weeks for the throat to heal from the acid. Also, don't forget the the dose needs reviewing regularly. DD tends to struggle more when she's due a weigh in.

Sorry you’re also going through the same thing @Superscientist, it’s so hard isn’t it! I feel like I haven’t been enjoying my little boy or motherhood at all! We had similar problems with the gaviscon. The doctor said omeprozole would start to work straight away but the nurses at the hospital said we wouldn’t see much before 10-14 days, were on day 6 now so still a while to go and it seems like a very long time! It’s so difficult to administer too so I don’t think he’s getting his full dose at all.

Thank you for all the information @NameChange30, will definitely do some research on tongue tie. We were prescribed similac alimentum yesterday and he does seem much calmer so far, he slept three hours straight last night which he hasn’t done since he was two days old and is settled much quicker after a feed but I’m scared to get my hopes up incase it’s a fluke! He did a proper poo for the first time in 5 days (oh my goodness the smell I was physically sick which I never am!) so surely he’s got to feel a bit better after that!

We’re on day 6 today @LittleMissNaice so sounds like we need to keep plugging away with it. He does the most heartbreaking screams when what I’m assuming is the acid coming up we have a review of the omeprozole early next week.

Hi, sorry I know this is an old post. But I could have written your post myself. My baby is 3weeks old and has a lot of symptoms of silent reflux and cmpa. Doctors palmed me off with gaviscon at 1 week which did nothing. Have another docs app today and I want them to trial him on cmpa milk and reflux medication.

I wondered how you got on in the end and what worked for you?

Thanks