Saw the GI today, what do you think?

[aubrey's mom]

Well, we saw Aubrey's GI spec today. She is almost 4 months old. She continues to seem miserable at 50% of her feedings. Crying/screaming every time I stop feeding and arching like crazy. I fed her there and of course she was fine, but I told him EVERYTHING.
She's on 10 mg of Nexium 3 x a day. I asked about adding an H2 or Karafate and he said he didn't think that would help. I asked about doing a ph probe and he said the only test that he thought was important was the upper GI which she already had. I asked about eliminating foods from my diet and trying nutramagin. He said it was unlikely to help and that GoodStart was about the same and cheaper. Basically, he said to wait this out and that she'll outgrow it eventually. He said that the volume she's taking may be making things worse. She drinks 26 oz from a bottle + 3 VERY short and 1 long nursing session per day. He suggested adding an extra 1/2 scoop per 4 oz of formula and 2 T of rice and to start solids (1/2 a container 3 x a day). Last time we tried adding cereal with a wider nipple, she drank so fast it seemed to make things worse. Any thoughts?

[gorgemom]

Hello, I feel for you! When my daughter was an infant (she is 15 months now) she was having so many problems with reflux it was scary. She would choke and cough and have reflux come out of her nose. She would hardly sleep at all as she was in pain from the reflux alot of the time. Our pediatrician seemed concerned but the GI doctor was hardly concerned. I really had a hard time getting him to take us seriously. He basically said the same thing yours did, that hopefully she would outgrow it.
(here is the thread from our last appointment with him: http://infantrefluxdisease.com/forum...ad.php?t=42705)
So we dealt with it the best we could. He did put her on prevacid which is what my 5 yr old is also on and I do think it helped. She would still reflux but it didn't seem to cause as much pain once she was on the prevacid. Starting solids did seem to help a bit also if I remember right. I have since found that milk products really cause problems for my daughter as do tomatoes or anything with tomatoes in them, so we eventually switched her to soy formula once I weaned her from breast milk and that seemed to help also.
My daughter still refluxes, but nothing like she did as an infant. Hopefully your little one will get better with time as well. We are just about to go back now that my daughter is over 1 yr old, but I am not sure if they will do anything differently.
Hang in there and if you don't feel like you are getting a good response from the GI maybe you should see a different GI and get a second opinion? It couldn't hurt. I am not sure why the GI you saw was so against some of the options you mentioned. Anyway, it will get better! Please keep us posted!

[andrea]

At this age, I cant say I'm really surprised that the GI didnt want to pursue more testing.

With that said - GoodStart isnt "as good" as BF'ing and eliminating. Easier, yes, but it for sure still has milk proteins in it and stuff. He is probably thinking she's not allergic to milk/soy, but she certainly could still be intolerant of it.

Also, adding an H2 blocker like Zantac could certainly help her (**IF** acid is still the problem). I dont know much about Nexium dosages so I cant help you there... my one thought though about maybe why he said that is that H2s need to be spaced at least 4-5 hrs from the PPI. So, since the Nexium is split 3x a day, it would be extremely difficult to find somewhere to stick the Zantac. If you are thinking that her issue right now is that she still is not properly medicated then I personally would try giving her Mylanta when she seems the most uncomfortable, and see if that helps. If it does then that is a great indication that her meds need to be tinkered with (whether it is switching to a different PPI, increasing the dose, or changing the frequency and adding another med).

As for feeding qtys. For sure the best thing to do is to feed her smaller amounts less often (less in her tummy to come back up). I'm not sure that adding cereal is necessarily going to solve or help your problems (it has certainly helped some people though, dont get me wrong), but if you do add it make sure you stay away from brands like Gerber where they toss in extra milk and soy. Solids actually are more likely to exacerbate the reflux, if anything.

I'm a little confused about why he has you making her formula more concentrated, and I would really question that. Generally in a baby that young, its not recommended to make the formula any more concentrated than it already is. Its rough on their kidneys and can mess with their electrolytes. Also, 26 oz isnt a lot water-wise so cutting back on that would concern me as well. On top of that, if shes taking 3 "very short" nursing sessions - it doesnt sound like theres actually that much volume in there at once to begin with... I would think that the issue may be more of an intolerance thing than a volume thing (I could be totally wrong though). When their little tummies have to work harder to digest things (which it would have to do with a more concentrated formula, or with solids, etc) with extra fat/cals - this is one of the big things that make the reflux worse. It just seems absurd to me that he'd suggest adding extra formula if her issue isnt lack of growth but that she's miserable. But hey I guess hes the one with the MD, not me

Anywy, sorry this post is so disorganized... I swear it made sense in my head before I typed it

[Mary]

OOOOOHHH, I read your post and got really upset with your GI. *insert me tearing out my hair here*

Okay, I am so in agreement with Andrea. First, what you're describing sounds very much like it might be related to an intolerance and, if you are able and willing to continue BF'ing, it's the BEST thing you can do for Aubrey. Just as she said, formula might be easier for you than the diet, but it could very well be the start of a nightmare for Aubrey. It does contain milk proteins and, if this formula doesn't work, you'll begin the process of switching around and trying to find one that does...and all along, you'll never really know what she's reacting to.

Your GI is right in that the majority of babies do outgrow this; however, while they're refluxing, they are in PAIN! Perhaps I read things into that post that I shouldn't have, but I got the feeling he's sort of shrugging his shoulders and blowing you off. Many (most, perhaps?) of us have found that adding an H2 blocker in addition to a PPI can really help with breakthrough reflux in the long run. I'm just so surprised he didn't want to even try t his. It's been a long time since I had a little baby like Aubrey so I can't remember the dosage, but I do know for a fact that I (and many moms here) gave my babies Mylanta before bed and sometimes before feeds to help soothe their sore little throats/esophagases (is that the correct plural spelling?) and it did help. Someone will chime in and help me with the dose on that, I hope! If you do decide to try this, just know that it can't be given within 2 or 3 hours of the Nexium because the two drugs will cancel each other out.

Also, if this continues and you really just don't see improvement, I'd wonder about either tinkering with the timing and amount of her doses (perhaps 10 mg x 3 isn't keeping her reflux down because each dose is so low--I'd wonder about trying 15 mg x 2 or something like that) or possibly switching to another PPI. Before you get there, though, I'd try the elimination diet and adding OTC Mylanta to her medication schedule.

*sigh* I'm so sorry. It's horrible when you're dealing with a screaming, barfing baby who has trouble nursing...and it's even worse when a doc blows you off and tells you she'll grow out of it. What about NOW?

[EllaGracesMom]

On a side note.....
If you are BFing, try to avoid dairy, caffeine, chocolate, tomatoes, yeast etc....This can also help to avoid reflux reactions. My DD is particularly sensitive to those things when I eat them. I find what I eat to be as important as what she eats - it all has an impact on her.

[gorgemom]

Me...chiming in.....When Selah was a baby they told me to give her 1/2 teaspoon Mylanta for reflux pain.

[aubrey's mom]

Thanks for your feedback, you have certainly given me a lot to think about. I have been eliminating dairy since Sunday and have not seen improvement yet, but will continue for a couple more weeks. I guess I need to research what doen't contain soy too. I am supplementing with Nutramagin - which by the way smells AWFUL!
We have a well visit with our Ped next week,so maybe I'll try to get an H2 from her or at least her opinion on seeing another GI or who to see. I have been doing Mylanta, but never knew about spacing 3 hrs apart from Nexium, so I'm sure I've been creating even more problems. (VERY FRUSTRATED that the gi dr never told me this!)
Can anyone give me an example of how much, how often for a "small/frequent" feeding schedule. Aubrey is SO CRANKY in general and especially when she's tired. I'm not sure how to feed her more often and still get in a few decent naps.

[erinsmom1964]

Oh I read your post and wanted to pull my hair out also. I know when Erin was having so many problems at first and I at the time didnt have a clue about reflux (wish I still didnt LOL) her Ped kept saying things like every baby is different...she'll grow out of it....she seems fine to me. Then when I came to him with my research he said well lets try Zantac and if it works we'll know if your right. AGGHHHH So when it worked then didnt he sent me to GI. The first thing she said to me is most babies outgrow this and we dont do anything except for 3 certain symptoms. I dont even care if she sleeping or not. Well luckily(????) she had one of the symptoms...whezzing. What i am trying to say in my long winded way is follow your mommie instincts and dont stop until your satisfied. DRS are responsible for and see 100's of kids. You have the one. Keep up the good fight.

If you are going to try the cereal in the bottle and foods my suggestions from our experiences is if your LO isnt having reactions to milk we love the change the Enfamil AR helped with. It is thicker and then we still had to add cereal, not sure how much sorry I did it by trial and error by look. We use Playtex drop ins to cut down on as much air as possible. You can squeeze air out of bottle before feeding. I use fast nipples but between formula and cereal it doesnt come out too fast I have a problem with plugging. I tried to start Erin on food as young as your LO but she wasnt having it. She was almost 6 months old before she wanted to eat. Also I would really take each new food slow so you can tell if it makes reflux worse. I made a horrible mistake not to long ago when I bumped up to stage 2 fruits. I assumed she could eat them because she had already eaten all those fruits in stage one. No.

As far as meds.....sorry we haven't used nexium so I am not familar with that

GOOD LUCK!!