NOTE: The information contained in this section does not replace the care of a health professional. If you are in any doubt about the health or well being of your child seek professional assistance.

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Question: Would Losec help with the food refusal?

"Hello,
my 10 week old baby may or may not have silent reflux.  Sometimes I think yes, and other times no.  The paediatrician prescribed ranitidine which made her a lot worse.  I now give her gaviscon before each feed.  She has lots of symptoms i.e. refusing food, waking up lots, generally unhappy, cries sometimes when laid on back etc. My main concern at the moment is the food refusal.  She is a nightmare to feed, sometimes taking over an hour.  She wasn't gaining weight breastfeeding, so I express and bottle feed so I know how much is (or isn't) going into her. She's not a big spewer, but she just is not interested in food.  Sometimes she has 25mL and then tries to push the bottle out.  She doesn't even weight 10lbs yet.  It's normally a struggle to get 700mL into her in 24hrs - often I can't get that much. I'm so worried about her weight.  She is a very active baby, and has lots of happy moments - smiles, laughs and lots of chatter, but her weight is a real issue.  I'm waiting to see the paediatrician team at the hospital.
Would Losec help with the food refusal???
Thanks so much,
Kelly. "

Glenda Answers:

Hi Kelly,
I can understand why you feel confused; reflux is a difficult condition to understand and it can present in lots of different ways. It sounds as though your paediatrician has diagnosed reflux (based on prescribing Ranitidine), and she is displaying a lot of the typical signs that you might expect to see- and weight gain issues and feeding issues are very common in reflux. Some babies can present with food refusal and no other signs at all and still can have quite severe reflux, so it does fit with her diagnosis. If you aren’t convinced that reflux is the problem however, then please talk to your doctor about your concerns. Your doctor may be able to discuss how they came to that diagnosis, or you may be able to explore other avenues as well.

Losec may be an option for her, especially if she is struggling to eat because of her reflux/discomfort – and it can make a huge difference for some reflux babies. It is generally much more effective than Ranitidine, so even though that didn’t work, Losec still might. If you want to try it (or any of the other medications in that class), then please talk to your doctor (or pharmacist) about it.

Something else (or as well as) that you may like to talk to your doctor about, is the possibility of food allergies. This is quite common in reflux babies (and particularly cow’s milk protein and soy protein) although other foods can be involved as well. Eliminating these foods from your baby’s diet (and yours while she is having breastmilk) can have a huge impact if allergies/intolerances are part of the problem. You may like to read the article on cow’s milk allergy being associated with reflux at:
http://pediatrics.aappublications.org/cgi/content/full/110/5/972.
If you do find that food sensitivities are an issue then I would recommend you talk to a dietitian who specialises in this area.

I wish you well and I hope the paediatric feeding team can make a difference to her eating. Please keep looking for answers, and trusting your instincts.

Glenda
RISA Inc

Question: Would the slow flow teat on his bottle be helping him?

"Hi,
My baby is nearly three months old but was seven weeks premature. He is fed expressed breast milk, as his sucking action is not efficient. He has always vomited a little after eating, passed lots of wind (particularly when feeding) and burped and hiccuped lots. He also always appears to have congestion in his nose. Three weeks ago he started to choke on his bottle and ate less. A few days later he started to appear to have severe pain after eating and would not let me put him down. I took him to the doctor and they put him on Zantac. I am also using Infacol to help get the burps up earlier after the feed. This has got his appetite back but he still seems to always seems to be chewing on something distasteful after a meal.

The reflux seems to bother him the most in the afternoon and reduces by midnight when he finally sleeps soundly between feeds until the next afternoon and the cycle goes on. He seems to want to have an afternoon nap but the chewing seem to keep him awake. I store expressed breast milk and have tried mixing up the order I feed it to him in, so it shouldn't be diet related. Is there anything more I can do to help ease his discomfort and help him get some sleep?

When he started choking on his bottle I changed to using a very slow flow teat? Will this be helping him? As he is a very inefficient suffer his feeds are taking a very long time.
Thanks. "

Glenda Answers:

Hi,
Reflux is common in babies, but even more so in premature babies and it sounds as though you have had a difficult time of it. It is good to hear though that the Zantac has helped him feel more comfortable, so that’s promising.

Does your doctor know that you are still having some problems? The fact that the Zantac has helped shows you are on the right track, but I would recommend you let your doctor know that he is still uncomfortable at times, and his sleep is still being disturbed. The doctor may want to review his medication e.g. increase his Zantac dose or look at changing it, especially as they often start out with a low dose and increase it as necessary. (Also, Zantac is a weight related medication and as your baby puts on weight, the dose may need to be increased to keep up with it.)

The choking can be scary – and it may be one of the signs of reflux, or it may also be possible it is associated with his sucking problems. Do you think the slower teat has helped? Sometimes babies get frustrated with a slow teat but if he isn’t getting frustrated it may be okay (depending on how long his feeds are taking). It may be worth contacting a speech pathologist who specialises in infant feeding and swallowing issues to find out what the most appropriate teat is for him.  You may have already been in contact with a speech pathologist or a feeding team because of his sucking issues but if not, they are generally available at children’s hospitals.

One other thing, it still may be possible that some of the issue is diet related. Even though you are switching around the order, if for example there is some food that you have routinely, it may not make any difference what order the expressed milk is used. Mothers of babies with food sensitivities have reported that even trace amounts of those foods in the mother’s diet can cause havoc so that is another area you may want to consider.

I hope that information is helpful and I hope that he continues to improve.

Glenda
RISA Inc