Help reflux CMPA won't sleep

[user1489931797]

Second guessing myself...

Morning need some advice/sense check I think because it’s been so long that my LO has been unsettled with reflux and potential CMPA that I don’t know what normal is or should be and whether things can be improved.

He’s currently on ranitidine and nutramigen and has been for 4wks and dosage increased

But he’s still grunty/snorting sounds congested, struggles with a swollen tummy and struggles having bowl movements has a lot of wind both ends that upsets him
Regurgitates and spits up after every feed and a couple times every few days projectile vomits also baby acne flares up on face and neck not sure if related.
Lastly still only manages to sleep in Moses with a wedge for an hour once a day rest of time will only sleep in our arms he’s now 11wks old!

What needs to happen? Is it a diff formula, diff meds, thickener?! Cream for his face?!

Definitely a trip back to the GP to review reflux meds and formula choices. Omeprazole might be needed for the reflux pain. In the meantime, try a dose of paracetamol to see if pain relief helps his symptoms. If it does, you have a good case to present to the GP for why you need a review. Good luck, reflux sucks so much.

Thank you @TheGingerSnapped much appreciated!

Does he sleep well in your arms? In which case this is not a medical problem - it's a normal baby. Many aren't developmentally ready to sleep separately to a caregiver until much older, especially if they have issues which may cause them discomfort. Neither of mine had reflux or CMPA (they were checked because I believed all the books which told me they should be sleeping on their backs in a cot for long stretches from at least six weeks old, so assumed there must be something physically wrong with them) but wouldn't nap or night sleep well off of me until they were over a year old.

The vomiting needs addressing if it's excessive, but given your baby's age, the sleeping-in-arms is not a medical issue.

Second that, DD is 6 months now and the meds made a huge difference to her sleep! She is on aptimil pepti 1 milk, plus lanzoprazole (like omeprazole but one dose a day) PLUS ranitidine! She was also on domperidone for a while! As soon as the meds were sorted she was a different baby, naps and sleeps beautifully.

As a light at the end of the tunnel Were going back to the pediatrician this week as she hasn't needed to up her dose in a month so may be actually growing out of it!

Reflux is a total b%##
I totally feel for you and baby!! Everything you described we went through..

It took us two months to it get right by Gp. She's on pepti milk (now 2 as she's 7 months old)
Milk was lifesaver for us, we saw change in her pretty much straightaway.
Just wish we'd done it sooner and save ourselves a lot of grief.

Thanks @guesswhosback is that milk thicker then was that what made the difference for you?! X

Its not thicker if anything it's lighter than normal formula.. basically it's just whey and milk proteins have been broken down ...
See attached pic.
How this is of some help.

@guesswhosback @TheGingerSnapped @Bryonie2017

Hi hope you can help shed some light and give your thoughts

Spoke to GP yesterday about how despite baby on ranitidine and nutramigen and still seeing symptoms but GP unsure whether reflux and or CMPA so just targets one at a time now to change, the changes so far have just really been increasing ranitidine because she is reluctant to change formula yet as he is currently constipated she’s advised next 4days increase ranitidine to 1ml x3 a day and lactulose to get things moving as he doesn’t keep down water or water and OJ when he had it pretty much comes straight back up.
I asked what happens if this doesn’t work and she has said one option to add an an anti sickness medicine as baby regurgitates and spit up after every feed and once or twice a week projectile.

Is anti sickness medicine with ranitidine and sticking with nutramigen the way to go?! As I see from most ppl they say what worked was different formula and thickener?! I don’t know what I should be pushing for anymore!

Oh poor you and little one. It's never ending is it.

I'd probably stick with ranitidine increase as suggested and give it couple of days and see.

For me if nothing changed I'd push for new formula. Sorry just don't like the thought it anti sickness tablets on top of everything else.

Can't remember if you said or not but maybe a second opinion from another Gp?

Hope something works for you quickly as I know it's horrible seeing the baby going through x

How is his weight gain? Enough wet nappies? Do you think he is getting enough between upchucks?

My refluxers both had CMPI and what settled their posseting was eliminating cow's milk. I breastfed my first and mix-fed my second. She had Karicare Allerpro - but we are in Australia so I'm not sure what the equivalent is where you are. The Allerpro was substantially hydrolised, so the milk protein was quite broken down, but not as much as Neocate. Combined with ranitidine, she became a happy chucker with no more rashes.

We found we needed 3x per day for ranitidine and it had to be evenly spaced as much as possible, because the dose only lasts so long. It didn't stop her vomiting but others on here have said it did help them.

The other thing that helped was to sleep her on her tummy, so the vomit could drain out of her mouth while sleeping. On her back, she would awake within 11mins choking on her reflux. We got an under-mattress monitor for piece of mind.

She outgrew reflux meds at 14mo and weaned onto cow's milk around the same time, so the intolerance was probably causing the issues.

I'd push for another milk to try. Hope you get some rest soon.

Have you done your own research on CMPA? Are you in the UK? Because there are a lot of support groups on Facebook that have a lot of members with a wealth of knowledge to draw from. I’m only suggesting this because in my own personal experience GPs and even paediatricians are grossly uneducated regarding CMPA.

If you haven’t already I’d push for a referral
to a paediatric dietician or specialist. They are normally faaaaar better at understanding what’s going on. There’s a wide belief that it’s allergies that can cause reflux or worsen the symptoms

Have you seen any improvement at all since moving to nutramigen? What were the symptoms before? Any issues with the nappies? Ideally you need baby to be 6 weeks clear of the protein to see reliable results.

Can you afford to self refer to a Paediatric Gastroenterologist (or do you have health insurance)?

I had one child with reflux and one with cmpa. Both were Breastfed until they were 1. With the reflux we only had gaviscon and dc slept in a head elevated position. Cmpa was a whole different kettle of fish, screamed most of the first 3 months of life, very windy and miserable. I cut out all dairy from my diet, BM were smelly explosive and frequent. Tummy was bloated. As a child she was temperamental and unable to handle emotions, in pain and constantly had issues with her BM. Totally dairy free now which is easier than it used to be- even a may contain can set her back. The smallest hint of dairy takes weeks to work it’s way out of her system. She slept in a vibrating baby seat quite well, I think the vibrations helped release the wind? Also carrying her around and tummy massages helped- she’s 9 and still asks for tummy rubs!