BF moms or moms of babies with reflux?

[jjjo1112]

Hi,

I have a 5 week old that I think has reflux. She is exclusively breastfed. We have been to the pedi 3 different times so far to discuss this. I have cut dairy/soy out of my diet which made no difference. At the last appointment, I requested a trial of medication (Zantac) but my practice doesn't prescribe meds for reflux anymore. They said that research has shown the meds are not effective and most babies diagnosed with reflux don't actually have reflux. I requested a referral for a GI specialist and have an appointment next week. My pedi suggested that I do a 4 day trial of nutramigen instead of breastmilk- to pump and store instead. She thought that if nutramigen made no difference we could rule out dairy sensitivity and foremilk/hindmilk imbalance and that the info would be good for the GI specialist to have. I'm nervous that if I stop nursing for 4 days and it doesn't help that I won't be able to tranisiton back to breastfeeding. Has anyone tried this before? How difficult would it be to transition her back to breastfeeding? I would hate to do this trial, have it not make any difference and then be stuck bottle feeding. Anyone's pedi recommend this before? Thanks

[kbud]

As a mom of 2 exclusively breast fed babies your pedi advice sounds awful. I am glad you are going to a pedi GI. I'd skip that recommendation and see the Ped GI. Also visit infantreflux.org. There is great info on the message boards there. In my research breast milk rarely causes reflux, formula is usually worse. Good luck!

[Katigre]

I would not switch to nutrimagen for 4 days with a baby that young - there are other side effects that could result from it.

I am so sorry your little one is suffering :(.

[nfowife]

I would not stop BFing. First, if it doesn't help, you can have really hurt your supply at this early date. If baby does have reflux then it is a problem with the anatomy, not what baby is eating. What symptoms are you experiencing?

With DS, he had silent reflux. He was very gurgly and would not sleep unless held upright for months. I started with axid and moved on to prevacid, under my regular ped.

With DD2, I suspected it and went to the ped around the same age and she resisted and suggest I wait a few weeks. I did and she got much better.

5 weeks is a hard time. It's almost the height of fussiness (6 weeks). I wouldn't subject my babe to any very invasive testing without major symptoms and possibly lack of weight gain.

[KpbS]

I haven't heard a ped say that reflux meds aren't currently prescribed for infants and "studies" show meds to be ineffective. I personally find that attitude to be RIDICULOUS and obviously your ped has never had a baby with reflux who needed medication. I am stunned. Keep your appt. with the ped gi and go with their recommendations about formula v. breastfeeding. It is true that some infants do not respond positively to elimination diets, my DC were that way. They had too many allergies and sensitivities so hypoallergenic formula was a true lifesaver for us. Most of the time bf is best but not always. Remember to make 1 change at a time and see the results, perhaps first medication and then try formula if necessary. Sending huge :hug:, I've btdt 3 times.

[jjjo1112]

Thanks- she is gaining weight fine- 2.5 pounds in 5 weeks. When I believe she is refluxing her symptoms include gagging and choking and then crying. She does spit up frequently(10-20 times per day) but only a small amount. However, when she does it, it seems like she is having a hard time managing it- gasping, gagging, swallowing constantly. When we are in the car and I can't see her, I can tell it's happening by the noises she is making and then the screaming follows. The pedi thinks that breastfed babies rarely have reflux and that she most likely is having problems with my milk- either a foremilk/hindmilk imbalance or a sensitivity to something and therefore the nutramigen would take care of those issues.

[daisymommy]

As a mom of 2 exclusively breast fed babies your pedi advice sounds awful. I am glad you are going to a pedi GI. I'd skip that recommendation and see the Ped GI. Also visit infantreflux.org. There is great info on the message boards there. In my research breast milk rarely causes reflux, formula is usually worse. Good luck!

:yeahthat: How absolutely ridiculous! Find someone who WILL prescribe Zantac and keep on breastfeeding. I did what your Pedi suggested, and I still regret it to this day. Formula made it worse, but by then my milk had dried up and DS1 wouldn't go back to the breast. Awful experience. Zanatac made a huge difference.

[brittone2]

Another vote for continuing BFing until you see the specialist.

[jjjo1112]

Thanks for the opinions!! It's nice to see that I'm not crazy. This was my 3rd trip to the pedi to try and convince them to let me try a reflux med. I am more comfortable trying zantac first and then trying a formula- but I would like switching to formula to be worst case scenario. Also my DS had reflux- was started on zantac and progressed to other meds and I'm a RN that worked in the NICU with tons of babies with reflux/on reflux meds- so it's not like I have no experience with the subject.

[swissair81]

After Zantac, my GI recommended nutrimagen (offhand, kind of to see how I would take it), and I said no. We changed to prevacid and levsin (for stomach cramps) and it was all fine. I've had more kids with reflux that have been his patients and he already knows I don't do formula. He has never suggested it again.

[sntm]

I don't think many peds prescribe Zantac for reflux unless baby is not gaining weight. Some reflux in infants is normal - its just part of being a baby. Fwiw, my 4 1/2 week old does the same: small volume spit up 10+ times a day, spit up sometimes has no reaction and sometimes has some gagging or crying. It is better if I keep him upright.

The studies from what I've heard are pretty weak on the use of Zantac, etc. basically, babies given a placebo are just as likely to improve per the parents. It will all get better in time.

[acmom]

My DS had reflux and eventually it was treated and controlled with prevacid. He had a lot of gurging, gagging and throwing up whole feedings - he and I would both be soaked. He was bottle fed a combo of pumped breastmilk and formula (due to my awful nipples, supply issues and his breastfeeding difficulties). I think we started talking to the pedi about it at the 2 month visit.

We tried a number of things before going to the prevacid. We did try soy formula (made no difference) since we were already doing formula, but we were pretty sure it wasn't the formula we were using bc it happened equally with BM and formula. Our pedi suggested nurtramigen as another option, but we only tried that for a few days with no change - my DH is a pedi as well and didn't really want to go that route bc he wasn't confident it would make any difference and doesn't love that formula in general.

We tried several different bottles/nipples - found playtex ventaire helped a little with the gagging. Finally we went back to pedi and tried Zantac. Helped some, but were still having some issues, so he had us do a swallow study to rule out aspiration. Swallow study showed that he wasn't truly aspirating, but also did not have a smooth swallow mechanism. They gave us a few positioning and feeding tips. Finally after that our pedi switched us to prevacid, which was way more pricey, but clearly helped! He was on the prevacid til a little over a year and weaned off it with no difficulty.

I wouldn't make any big changes like switching to formula before seeing the peds GI doc.

[kellij]

My DS did the same thing. I think the cutting out milk has helped him though. He's 11 weeks though and I really think the biggest helper was time, so his system could mature a little bit. We got a Happi Tummi and that really does seem to sooth him some. Also, the rock n play sleeper seems to make him pretty comfy. Finally, the chiropractor really seems to help. My dr. also didn't think it was acid reflux. He was actually vomiting there for awhile... a bunch.

[Katigre]

The pedi thinks that breastfed babies rarely have reflux and that she most likely is having problems with my milk- either a foremilk/hindmilk imbalance or a sensitivity to something and therefore the nutramigen would take care of those issues.
That may be one of the more ignorant things I have heard a ped say - why would a breastfed baby be 'rare' in cases of reflux????

[AnnieW625]

I actually kind of agree with SNTM's opinion about the Zantac, however I think your peds. view of it is rotten and if you can I would try another practice.

DD2 got Zantac at my request at 3 or 4 weeks old. She had constant spit up, but worse than the spit up was the pain she was in after eating despite rocking her and holding her up. I did dairy elimination when she was less than a week old, that lasted till she was a month and I saw no change. Once we started the Zantac the pain went away. That in itself was worth to us. She continued to spit up until she was 9 months old and on a whim I tried the Playtex Drop Ins bottles. Those worked liked magic for her. I wish I would have tried them sooner. Ahe stayed on Zantac until she was 14 months old.

I am not in the camp that formula is evil, although if I needed Nutramigen or Alimentum I would have paid a milk bank the equal amount for breast milk or continued to pump and bottle feed when I went back to work. We found that Similac Sensitive worked best for DD2.

I know a lot of people here rec. the Intra Reflux board, but I found it completely overwhelming (no offense to the mom that runs it who posts here) and it was just too much information for me to understand.

Best of luck and hope your little one gets better soon.

[jjjo1112]

Thanks- I'm not going to make any changes until I see the GI specialist on monday.
The pedi said that all of the new research is showing that most babies diagnosed with reflux don't actually have reflux. She said that when they were actually doing the acid ph probe study that most of the time, the spit up was not acidic. She also said that the new research is showing that zantac and other reflux meds don't seem to get better results than placebo drugs.
I haven't seen any of that literature and I know that at the hospital I worked at many of our babies were on zantac which helped cut down on their heart rate drops from reflux- so I know that it can be effective.

[okinawama]

I'm SO sorry you're going through this! I say your ped's advice is completely ridiculous and I hope you get better advice from the specialist! I'm sure you've done this already, but I'd Research research research. there is so much information out there on infant reflux and the meds that are often prescribed ( zantac prilosec) and how they work. go into the specialist appointment well informed and with any questions you may have. Putting a baby on Meds is a serious decision, but for me, it was a no brainer.

We started in Zantac and saw a slight improvement, but even on Zantac my little guy continued to drop significantly on the growth chart. It wasn't until we started Prevacid that we saw an improvement in the hours and hours of crying, Never sleeping and no weight gain.

Good luck at the specialist!!

[Kindra178]

One of my bugaboo issues is when people say that breastfed babies don't get reflux. My three kids never got that !@#$#^ memo! I read all that research about Zantac barely working, but it works a little, and enough to prevent a kid from arching his back and crying in pain. It definitely doesn't stop the puke, but it makes feeding way more pleasant.

[kbud]

My understanding is that bf babies are less likely to have reflux but they still get it. Both of mine had it. My oldest had it so bad (mostly silent reflux) that I found her chocking at night when I went to check on her. She literally wasn't breathing and I did the heimlich on her to clear it. She very severely aspirated. They tell me she would have been fine but I'm sorry she was not breathing! I know back sleeping overall is safer but never again did I put her flat on her back. In fact she slept in her infant seat for many months. Meds were wonderful for us but zantac did nothing for either of mine. I don't think it does much for babies with bad reflux. My oldest is 8 now and still has reflux episodes. I have it too.

[daisymommy]

Fwiw, many times reflux babies are big chunky babies, even if they have true reflux. My DS1 was off the charts (and had bad GERD as diagnosed by a Pedi GI specialist). They gain weight just fine. But that's because they nurse/bottle feed constantly to soothe their painful sore throats from all the acid coming up. Weight gain is not a true and only measure of whether or not their reflux is bad enough to warrant a trial of medication.

[MSWR0319]

Fwiw, many times reflux babies are big chunky babies, even if they have true reflux. My DS1 was off the charts (and had bad GERD as diagnosed by a Pedi GI specialist). They gain weight just fine. But that's because they nurse/bottle feed constantly to soothe their painful sore throats from all the acid coming up. Weight gain is not a true and only measure of whether or not their reflux is bad enough to warrant a trial of medication.

I agree. DS1 had reflux and fell on the charts. DS2 was just diagnosed and jumped up on the chart. I'm fairly certain it's because he's eating to soothe the pain. No question he has reflux and the pedi just couldn't figure out why he gained so much weight last month.

[pastrygirl]

Ugh, I would've been steaming mad if I'd gotten that advice!!

Zantac didn't work at all for my younger son, but Prevacid solutabs worked like a charm. I was able to dissolve it (half tab? I can't remember) in a tiny bit of water and use a syringe to put it in his mouth like Zantac.

[jjjo1112]

Yes-she is constantly eating and that is why she is gaining so much. The GI specialist I'm seeing is at Children's in boston, so hopefully they will have some better advice than my pedi.

[hellbennt]

see my sig.
your ped is out of her/his mind! grrr!

meds help with the pain. that's the truth.

[indigo99]

Both of my boys have had reflux and taken meds. I could definitely tell a difference when I missed doses with them. Now that DS2 is sitting up and crawling, we tried tapering him off. He started having reflux again though so we're gonna continue for now (even though it's a pain because it has to be compounded at a little pharmacy with bad hours).

What I've heard is that the meds don't necessarily make them spit up less, but it makes it less acidic so that it won't hurt when they do. I did notice that both of my kids had less reflux into (and out of) their mouths with the meds though.

[123LuckyMom]

My DD (11 weeks) had exactly the situation you described. She was eating lots, gaining lots, and having lots of vomit and choky spit ups. She is BF. My ped, whom I really trust, said that if she's continuing to gain and is a "happy" spitter in that her reflux does not make her miserable or prevent her from sleeping, there's no reason to medicate. He says the spit up doesn't damage the esophagus as it would with an adult. It's not harmful, just messy. At 11 weeks she no longer chokes, but she's still a major spitter upper! My DS was miserable with his reflux. We did give him Zantac and tried all manner of ways of getting him to sleep. Nothing worked but his growing out of it. I wouldn't rush to medicate, and I certainly wouldn't stop BF!!!!

[jjjo1112]

I just wanted to give you guys an update. We saw the GI specialist today at Children's and they thought it sounded like a classic case of reflux. I didn't do the trial of Nutramigen and he said that wasn't something he would recommend at this time. I'm so glad I didn't listen to the pedi. They prescribed Zantac and told us to try it for 2 weeks and if it isn't effective to email him for a PPI medication. So we will be starting Zantac tomorrow.

[sntm]

Thanks for the update. My gaining well spitter is getting worse an his sleep is now being affected. I'll bring this up with our ped next week.

[hellbennt]

...saw the GI specialist today...
If you wind up loving your ped GI, well, actually, even if you don't!
Please post your experience (and this goes for all of you!:waving4:)
here, so that you can help others in your area:
Looking for GI: http://www.infantreflux.org/forum/forum_posts.asp?TID=660 (http://www.infantreflux.org/forum/forum_posts.asp?TID=660)
there are recommendations for ped GIs in your area...



...They prescribed Zantac and told us to try it for 2 weeks and if it isn't effective to email him for a PPI medication. So we will be starting Zantac tomorrow.

how much does baby weigh? I can help you calculate zantac dose

Zantac dosing- my/other’s question (has axid & pepcid doses, too):
http://www.infantreflux.org/forum/forum_posts.asp?TID=8288&PN=1 (http://www.infantreflux.org/forum/forum_posts.asp?TID=8288&PN=1)

hth