Advice needed for my 31 weeker

[amyboo]

DS2 was born at 31+2 and after 5 weeks in the neonatal unit he came home with no long term problems. He's now 13 weeks (5 corrected) and seems very unsettled almost constantly. He weighs just about 5kg (11lb). He's ebf on demand and is still quite slow at feeding and seems to suffer from terrible reflux. The paediatrician prescribed gaviscon after feeds but he frequenly just vomits it straight back up again. Sometimes he vomits up stuff that looks like curdled milk but other times (like this morning) he vomits back up pure milk and what seems like almost all his feed.

I'm really starting to struggle as it seems sometimes like he's only settled when he's on my boob. It's particularly bad in late afternoon which is really hard as by then I have DS1 (age 3) back from school. I'm almost at the point of wanting give up bf, but am worried that formula will jut make it worse. Does anyone have any advice on how to deal with this better? The paediatrician has mentioned early weaning (at 4.5 months actual) but I'm not sure I want to go down that route as it seems so early....

Hello Amy, I don't have any personal experience of this to share but a very good friend has a DS who was born at 31 weeks and had similar problems... He's nearly a year old now She tried giving up dairy herself as she was also BF and found it made a slight improvement but eventually moved to mixed feeding with a prescribed formula (nutramigen I think). Her DS was also prescribed renatidine for the reflux. She also followed medical advice given to her to wean on to solids early... She did this when he was around 6 months. He's doing really well now but it's been very difficult at times. Sorry I've no advice but thought you'd like to hear of my friend's experience

Hi, my dd wasn't premature but did have awful reflux to the point of losing a pound after birth and being admitted to hospital at 10 days old. She wasn't bf but would regularly vomit whole bottles. She was eventually put on ranitidine and erythromycin (which is an ab but apparently helps the stomach to empty faster). Eventually with the meds she didn't appear to be in pain but she did continue to be quite spectacularly sick until she was 1 (including after we weaned her early- all this did was make the puke multi coloured), when it stopped suddenly. She was always low on the charts weight wise as a result but when she stopped puking became a lovely chubby 1 year old .

Have you been given advice about keeping your ds upright as much as poss especially after feeds? You can prop his basket up as well. I found gaviscon to be pretty useless for my dd to be honest, it just made her constipated. There are other meds such as omezeprole which are used - you might need to push for it.

Hi Amyboo

My DS was born at 31 weeks and spent 6 weeks in neonatal. Came home with undiagnosed silent reflux and it sounds very similar to your experience, thought we didn't have the vomitting, just the discomfort, very difficult to feed and wanted to be held all the time. Basically, most of the issues are due to immature digestion, it is very common in prems. I would go back to the paed and try to get some better medication, infant gaviscon does very little imo. I used omeprazole, which blocks stomach acid, so helps with the cramps and discomfort that they often feel. There are other meds that can help with the vommiting but I have no experience of those. We also used a prescription formula (Aptamil Pepti) which is for Cow's Milk Protein Intolerence, you can achieve the same results but cutting out dairy if you are breatfeeding.

When you make any changes, try meds etc give it a few days to see if it's working before you change or stop.

If you try omeprazole don't get the liquid, it's rubbish. The tablets are much better, though they are a faff to give. The trick is to dissolve them in a tiny bit of sterile water and then use a syringe to suck up the liquid and dissolved tablet and give it to your LO. Don't dissolve in milk as that doesn't work. There are a few support threads for reflux on MN that should help you.

I bought a sling and used that a lot to get stuff done, get out and about as DS was a velcro baby. I think they just need the comfort so much when they are struggling with feeding.

I weaned at 6 months, four corrected. It was a very slow process so food only really properly replaced milk at about a year.

It does get easier, they do grow out of it and you get your life back!

Hi Amyboo. My 31 weeker had awful reflux too - does seem quite common in prem babies. I agree with the poster above who said that gaviscon isn't great (or certainly wasn't for us) and that stronger meds helped - we had ranitidine and domperidone, but I hear that omeprazole is the best thing now. In terms of feeding - I managed to keep going with bf though it was a struggle. Winding was important early on in the feed - I'd take him off for a burp after a few minutes, as any trapped wind coming up later on would bring the whole feed up! Also I kept him upright for half an hour after every feed - a sling and a very upright bouncy chair were crucial for that.

We weaned at 6 months (4 corrected) as that was the advice - check out the Bliss website as they have some useful stuff on weaning etc.

Good luck!

Yep we weaned our 32 weeker at six months actual too, but, I think really that's not enough, to just wait for that, and you'll have to go back and insist on more help for the reflux now.
Reflux is really common with prems. I don't think ff makes it any better though I have to say.

11lb at 13 weeks is alright too!

Thank you so much for all your comments. I'm really struggling today - he is just crying constantly unless he's feeding. He then eats too much and chucks half of it back up again :( i'm really feeling a bit rubbish about it all, as I'm not enjoying DS2 very much because of all this. I also feel bad for DS1 who is hetting sidelined because of all the attention DS2 demands.

I've tried keeping him upright and it doesn't seem to help that much and he oftens vomits all over his bouncy chair. I think I'm going to try a new paediatrician as I'm not that happy with my current one (I live in Belgium, so can thankfully choose my doctors) and see of I can get some better medication. I don't think his iron supplements are helping though, as he often vomits up his iron in the morning.

I'll take a look at the info on the bliss website. Thanks for the help.

Poor you, it's really tough going but definitely see if you can see another doctor if you have the option. I think suggeting infant gaviscon and early weaning in your situation is rather lame. I expect he's feeding for comfort and then, as you say, having too much. Try to find other ways of making him comfortable, if you can. I used a Moby sling which was easy to wear around the house too.

It's very hard when your baby just seems unhappy all the time but as they get older it does get so much better. I used to think that my DS was either crying or asleep. I walked a lot (easier when you only have one child).

Now he's a bouncy, cheeky two year old who I absolutely adore and has no problems, you are in the worst of it and it WILL get easier and you'll enjoy it more. Good luck.

Hi,

My DTs were 31 weekers and also had terrible silent reflux. They were on gaviscon, ranitidine, domperidone and omperazole at some points too. Definitley agree you need to push for more meds than the Gaviscon - all it does is act as a thickening agent to try and keep it in the stomach but doesnt do anything to help with the acid. Overfeeding is a symptom of silent reflux as it helps with the acid pain and then they can't contain it so up it comes.

Most silent reflux in prems is due to the valve at the top of the stomach not being properly developed and you have to wait until they grow out of it. Early weaning won't cure it.

if you do get more meds remember that they have to be adjusted with weight gain or they are not effective - if you notice it getting worse again you need to go back to the paed and get the dosage adjusted.

Good luck.

Thank you for the comments and suggestions. I have an appointment to talk to the Belgian equivalent of the health visitor tomorrow and will get her to recommend another paediatrician. Today has been tough and I can't carry on like this...

By the way, being in a bouncy chair didn't work as 'keeping upright' for either of my prems, I had to have them up over my shoulder. That did seem to help.
But then you might get to where you are feeding for an hour, holding up for an hour, then... Oh hungry again! So yes, definitely push for some different medication!

We been through similar. My lo was born at 32+5. He also had problems, bringing a lot of milk back up and still seeming hungry. He is breast and bottle fed.
We tried in infacol and gripe water for trapped wind that helped. Also different anti colic bottles.
Then we associated the problems to the sytron he was taking. The problems always occurred in the evening after taking it. We stopped it for a few days and he was 10 times better. I read that iron can cause tummy upset. I spoke to the gp and he said to stop taking it.
We occasionally have bouts of sickness, milky and lump. I recently figured out it was after I'd eaten garlic!

It has just been trial and error with us but my ds as do much better now

I am no expert in these matters as I did not have a preemie but I did ebf my daughter and it turned out she had a transient lactose intolerance. Using colief (a lactase enzyme) completely transformed within hours of beginning its use. It's worth a try as it will not do any harm if it is not a solution. Its a bit tricky to administer with bf'ing but what I did was hand express about half an ounce to an ounce then added the colief drops and fed it to her using one of those medicine syringes. Then proceeded with rest of feed as normal. Worth a shot you should know within hours or a day at most if it is making a difference but it is quite dear at a tenner for a tiny bottle