Reflux and 'thickened feeds'

[Everrgreen]

I'm posting on behalf of my friend who has a 2.5 month old baby (and she knows I'm posting this). The babe was recently diagnosed with GERD and has been on prevacid for about 2 weeks. My friend has not really noticed a change. The babe is nursing constantly and spitting it all up. She is going to the dr weekly to monitor the babe's growth, and this past week she had no weight gain (but didn't lose weight). The dr has said that she may need to offer thickened feeds. My friend doesn't really know what she meant by this, but thinks it was something like adding rice cereal to the milk (I guess she'll have to pump?) so that it has more weight and stays in the babe's tummy. The dr also told her that she should be going 3 hours between feedings because it is a bad habit for babies with reflux to nurse more than that.

My friend is feeling totally exhausted, the babe isn't really sleeping, cries a lot, and my friend is feeling out of options.

So, to me I am thinking, this dr is crazy! But I have no knowledge of reflux, so maybe this stuff is true/necessary, I don't really know!

Please help my friend!!!

[PatioGardener]

Breastfed babies have less reflux than formula fed babies, so to your friend!

My baby has BAD reflux. Like affect his breathing reflux. NEVER did his team of pediatricians mention thickening his feeds. They said:

nurse more often so he will take less with each feed
nurse with him upright
keep upright after feeds
sleep at a 45 degree angle (raise the matress)
medication (prevacid) twice a day http://www.marci-kids.com/dosingppis.html

and I also cut out dairy and soy (before reflux diagnosis) and worked on oversupply

I would post in life with a babe and health and healing forums for more options too.

is the ped a specialist for reflux?



nak

[sahmmie]

I had two reflux babies so I know what she is going through. One of them puked up nearly everything he ate. I have no idea how he survived. I fed him very small meals every two hours because if he consumed more than 2 ounces he'd immediately puke it up.

Thickening is rarely effective and can actually make things much worse. Babies that young have very immature digestive systems and cannot digest grains well, so they usually develop gas, bloating, and constipation from rice cereal. I would not thicken for that reason. Also, the baby tends to eat less when their feeds are thickened and therefore they get LESS breast milk, which is the last thing this little guy needs.

Prevacid worked great for my little guy but it can take up to two weeks and many doctors don't give a high enough dose. Check out this site on infant dosing or PPI meds to see if his dose is high enough. www.marci-kids.com Also, ask her what form of Prevacid he is on. If it's the compounded/liquid form it may be ineffective because many pharmacies do not compound it properly. If he's on the Prevacid Solutabs he should get relief from his pain as long as his dose is high enough.

One other thing, medication for reflux does not stop the spitting up and puking. It stops the heartburn pain so the baby can sleep and is not so miserable, but the spitting will continue until the baby outgrows his reflux. My son outgrew it about 9 months (so did my daughter who also had reflux but was not a spitter).

Here's another website that has a wealth of information on infant reflux.

www.infantreflux.org.

[PatioGardener]

Originally Posted by sahmmie

Prevacid worked great for my little guy but it can take up to two weeks and many doctors don't give a high enough dose. Check out this site on infant dosing or PPI meds to see if his dose is high enough. www.marci-kids.com Also, ask her what form of Prevacid he is on. If it's the compounded/liquid form it may be ineffective because many pharmacies do not compound it properly. If he's on the Prevacid Solutabs he should get relief from his pain as long as his dose is high enough.

Dosing is so important. They started my guy on Fastabs (Solutabs in the USA?) right away, but only once a day. Now that we have increased the dose and are dosing twice a day he is doing SO much better.

Originally Posted by sahmmie

My son outgrew it about 9 months (so did my daughter who also had reflux but was not a spitter).

Thanks for posting this - it gives me hope that we may only have 4-5 months left! Our specialist said 12 months, so I'll take 9 if we can get it

[sahmmie]

I forgot to mention that there are medicines to reduce spitting up in babies with reflux and/or DGE (Delayed Gastric Emptying) but the side effects are dangerous and these drugs should be avoided unless absolutely necessary. My son also had DGE. I don't know if your friend's baby has this or not, but just wanted to throw that out there. The drug they usually suggest is Reglan and it's downright dangerous and can cause all kinds of neurological problems. So, it's best to hang in there, feed them very small, frequent meals, and wait it out, as long as the baby is not losing weight or failing to thrive. There's another drug called Motilium. I don't know much about that one, but we didn't try it.

[sahmmie]

Originally Posted by PatioGardener

:
Thanks for posting this - it gives me hope that we may only have 4-5 months left! Our specialist said 12 months, so I'll take 9 if we can get it

Hang in there. I know how hard it is, but one day reflux will be nothing more than a distant memory.

[Everrgreen]

Thank you everyone for all the quick replies!!

The ped is not a specialist, and she says it was actually a resident that suggested thickening the feedings. But I'm assuming the dr didn't oppose the idea.

And I believe she has actual pills that she has to dissolve before giving to the baby.

I sent her the link to this thread so she can see all of your replies and the links. Thanks - keep it coming!

Did anyone else have issues with a baby not gaining weight? I guess if she can encourage more frequent but shorter feedings that might result in less spit up and therefore more weight gain. I think that up until now she has been feeding pretty much on demand. But I know she has had problems with oversupply/fast let down, so that doesn't help.

[LadyCatherine185]

lots of great advice from PP's. I also had a refluxy babe who needed prevacid. I also had to cut all dairy from my diet, as well as tomatoes and strawberries (for whatever reason he reacted to them).

hang in there!

[PatioGardener]

There is some excellent info on over active let down and over supply. I had to work on both. Plus, I read that 50% of reflux babies are made worse by dairy/soy.

I'll see if I can find the info for her.

Mine slowed a lot with weight but never stopped growing. He had trouble breathing. It is so much better now that he is well medicated.

a link to start with http://www.kellymom.com/bf/supply/fast-letdown.html

[Mrs.Music]

My DD had pretty bad GERD. The reason the doctor is telling her not to nurse too often is that often babies with GERD have heartburn (who wouldn't?) and nurse to try to soothe themselves and end up overfull. Obviously, if baby is hungry, she should be feeding him. Thickened feeds actually make reflux worse, I've heard from a lot of sources, including my own pediatrician AND gastroenterologist. So I'd recommend against that personally (though obviously I have no been to medical school). My DD was on Prilosec until she was 12 months and outgrew the problem. The prilosec came after we'd tried zantac for a while. Have the baby lay upright for a while after nursing, try not to overfeed, maybe lay the baby to sleep in a bouncre (since it's at an angle, my DD slept best that way, and then moved to the bed with us to sleep on my chest with the next nursing), adjust her diet... See a specialist to make sure the dosing and medications are right... And just try to tough it out. It'll be ok. As long as the baby is wetting enough diapers, I'm sure the weight gain will come.

[mom2tig99Nroo03]

another mama with a relux-y babe. zantac wa sworthless for us, but the prevacid seemed to help a lot. i didn't even bother dissolving it, i just crumbled the tablet between my fingers and put it in his mouth. more actually got into him that way,. he'd spit out the med mixed w the water.

[mom2tig99Nroo03]

oh and i too agree with more frequent feedings and not thickening them.

[PatioGardener]

Originally Posted by mom2tig99Nroo03

he'd spit out the med mixed w the water.

i mix w breastmilk and he seems to like it

nak

[anj_rn]

I will add in my 2 cents....

The most effective way to gain weight & reduce the reflux is to bf with the baby as upright as possible, and keep the baby sitting up (at least 45 degrees) after feeds. Gravity is your friend. Also frequent small feedings work well.

There are 2 types of reflux meds ones that increase gastric motility 9moving things out faster) and ones that decrease acid in the stomach (to protect the esophagus). None of these actually prevent reflux.

I would recommend seeing a GI doc if there is still a lack of weight gain. Thickening feeds used to be a common suggestion (10 years ago), but is really only used in severe cases (in order to avoid surgery).. There are thickeners (simplythick gel and thick-it) that can be added to EBM, but it alters the taste.

Also in order to be effective, prevacid should be given on an empty stomach at least 30 min before a feed.