InfantReflux.Org Forums: Struggling to know the right type/dose of med

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Ting66
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Topic: Struggling to know the right type/dose of med
Posted: 04 August 2011 at 5:40am

My baby girl is almost 4 months old and has been diagnosed with reflux since 6 weeks old. Since then, she was being put on Zantac and has changed to Losec when she was about 2 month old. Although she is sleeping relatively well but her feedings have been a nightmare since then. She would fuss, often cry, pushed bottles away.
We've also changed recently changed her formula about 10 days ago to Neocate. I do not seem to think she has improved much.
I am starting to suspect that there needs to be an adjustment on her medication. As she is clearly still in pain during her feed and also anytime right before her projectile spitting. She is currently taking 10mg of Losec (I am writing from Hong Kong, so the names of medication might be different).
The ped here seems to think all the different reflux medications are about the same thing (i.e. Zantac and Losec are about the same thing, etc.) But by researching on the net, I seem to get a different sense.
I am no expert in prescribing medication to treating infant reflux, but I would like to hear all your thoughts and advises, so that I can raise it up to the GI specialist we are already seeing here.
Right now, the only way that we can get any food down her is by rocking, white noise, distraction, dream feeding..and I feel like this will NOT end unless I get her pain under control...so any HELP would be highly appreicated!!

Ting66
Aaron (March 2009) - Premature but healthy
Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy
Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate

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hellbennt
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Posted: 04 August 2011 at 10:26am

hi & welcome!

you've found a great place to research!

Sounds like you're on a good path!

Ok, first I would calculate proper losec dose (you'll see it as prilosec) and find proper FORM of it- it's all here:

Prevacid 101:

scroll to the last page of this post, (it's actually also about other PPIs like prilosec, too)
http://www.infantreflux.org/forum/forum_posts.asp?TID=1936&PN=0&TPN=1

then, you'll want to find proper dose of zantac:

Zantac dosing- my/other’s question (has axid & pepcid doses, too):

http://www.infantreflux.org/forum/forum_posts.asp?TID=8288&PN=1

then, you'll want to know why your baby might be on neocate:

MSPI 'Main' page:

http://www.infantreflux.org/forum/forum_posts.asp?TID=2697

best EXPLANATION OF FOOD ALLERGIES/INTOERANCES and their RELATION TO REFLUX that I have found, to date: 2nd post: http://www.infantreflux.org/forum/forum_posts.asp?TID=2697&PN=2

how Neocate & Elecare work: http://www.infantreflux.org/forum/forum_posts.asp?TID=6013

~laura~
Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos
Ari 7/06 REFLUX FREE, so miracles do happen!

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Ting66
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Location: Hong Kong
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Posted: 05 August 2011 at 12:46am

Hellbennt,

Thank you so much for the post. Before I go through to check out the right dosage of Losec and Zantac, my question is that it is necessary true that the two should be taken together in order for the medication to be effective?? As currently, my girl is only taking Losec alone, which was advised by the doctor here.

Once again, thanks so much.

Ting66
Aaron (March 2009) - Premature but healthy
Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy
Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate

IP Logged

hellbennt
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Joined: 28 August 2003
Location: United States
Online Status: Offline
Posts: 13402

Posted: 05 August 2011 at 8:37am

they can be taken together, make sure to space them 4hrs apart!

when starting a PPI (losec), yes, baby needs to be on both bcse the losec doesn't 'show' it's full effects until then (it could show earlier! but it can take up to 14 days- it was day 12 for my son). after being two weeks on a PPI (losec), your baby should not need the two together, but it's not unusual if she does- it's a good idea to give the two until you get her situation under control- you can then back off of the zantac

there were times my baby was on both- when there needed to be a med increase, when there was break-through acid, etc...

~laura~
Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos
Ari 7/06 REFLUX FREE, so miracles do happen!

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Ting66
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Location: Hong Kong
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Posts: 6

Posted: 06 August 2011 at 2:41am

Although we never transition her into losec with Zantac, but she has already been on Losec for over a month. Her milk aversion has gotten worse since then. She simply cries and refuse her bottle most of the time. We can only manage to get around 600ml into her within 24 hours with the distraction of white noise, music, rocking, or dream feed.

I just don't know how we can continue this going forward. Will there be case where babies do not react well with Losec all together? Should I simply change her medication to something else?

Ting66
Aaron (March 2009) - Premature but healthy
Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy
Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate

IP Logged

hellbennt
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Joined: 28 August 2003
Location: United States
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Posts: 13402

Posted: 07 August 2011 at 10:28am

I would check the DOSE and the FORM of losec before giving up on it- once you understand about the dosing and the form of the PPIs, and your baby is on the proper dose and form, then you might change to another PPI like prevacid...in the meantime, if you have zantac, you could try giving that, too, at the proper dose & making sure to give it 4hrs separate from the losec...

Carafate:

http://www.infantreflux.org/forum/forum_posts.asp?TID=13485&KW=search+feeding+aversion+forum

here's more to help:

http://www.infantreflux.org/forum/forum_posts.asp?TID=13904&KW=feeding+aversion

http://www.infantreflux.org/forum/forum_posts.asp?TID=13876&KW=feeding+aversion

http://www.infantreflux.org/forum/forum_posts.asp?TID=13875&KW=feeding+aversion

http://www.infantreflux.org/forum/forum_posts.asp?TID=13866&KW=feeding+aversion

http://www.infantreflux.org/forum/forum_posts.asp?TID=13809&KW=feeding+aversion

http://www.infantreflux.org/forum/search_results_posts.asp?SearchID=20110108140213&KW=feeding+aversion&PN=2

Feeding Aversion:

http://www.infantreflux.org/forum/forum_posts.asp?TID=13904&KW

Carafate spacing from PPI:

okay I did a quick search and here is what I found... 3rd post down from Sheri who unfortunately isn't on much anymore... says space it 2hrs apart.
http://www.infantreflux.org/forum/forum_posts.asp?TID=10620&KW=carafate

~laura~
Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos
Ari 7/06 REFLUX FREE, so miracles do happen!

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Ting66
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Joined: 04 August 2011
Location: Hong Kong
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Posted: 07 August 2011 at 10:18pm

My girl is about 12lbs now, there seems to be many links to links you've attached here and the Marci site is under construction. So what exactly should be the right dosage for her on Losec then?

I've been told by two doctors that her 10mg are the max for her at this stage.

And when you say if it is at the right form; may I know exactly what it means? She is taking the 10mg Losec Mups, which we give to her 5mg in the morning and 5mg before she sleeps at 8pm. We do add a tint of Ribena (to make it less bitter, as otherwise, she would gag and spit up the whole thing) when administrating.

She drinks 'ok' when we dream feed her, does that mean she is no longer feeling the actual pain, but it's all physcological too?

Sorry for all these questions, as doctors (even GI specialists) here in Hong Kong seems to be a lot less specific on medication type and dosage.

THanks!

Ting66
Aaron (March 2009) - Premature but healthy
Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy
Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate

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hellbennt
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Joined: 28 August 2003
Location: United States
Online Status: Offline
Posts: 13402

Posted: 08 August 2011 at 10:14am

marci-site is under contstruction, but I urge you to read through

Prevacid 101:

scroll to the last page of this post, (it's actually also about other PPIs like prilosec, too)
http://www.infantreflux.org/forum/forum_posts.asp?TID=1936&PN=0&TPN=1

there is a link to the marci-kids dosing chart, from Prevacid 101.

marci-kids is the organization based from the University of Missouri. they are at the forefront of the research of PPI dosing and infants.

I don't know about losec mups, is this a powder that you add liquid to?

You need to give it on an empty stomach, followed by a 'meal' 30 minutes later.

feeding aversions happen when the baby associates feeding with pain. the feeding while asleep is a survival tactic- you have to make sure that your baby eats- but it is not ' normal' and you need to address it now so that you don't continue to have problems down the road...

in the meantime, I would find proper zantac dose and give that to her, too, until you get the losec dose 'right' - I don't know why some doctors think there's one dose and others are willing to increase it? Some parents take matters into their own hands and increase the dosage (I am not a medical professional & I cannot tell you to do this)...

you might want to make sure that nothing 'else' is going on before (or if you want to) taking matters into your own hands (increasing the dose)- this would be an Upper GI. This does NOT TEST for relfux, but it looks for structural abnormalites...there's also an endoscopy, which goes in and looks at the esophogus- this might be good to SHOW your doctor that your baby's esophogus is irritated (so time for more meds) and also they will take biopsies and if there are EOS cells present this means there's an allergy to milk and or soy proteins.

also, in the meantime, please read abou CARAFATE (links above in propr post) and perhaps TELL your dr that your baby needs this. It's a SHORT TERM solution, not a long-term one. Long-term is getting on proper dose and form of PPI together w/ the neocate...
you can do this!

when you get a chance, please

go to the top of this page, click on Settings and please then click on Edit Profile, then scroll down to

Signature & put:

baby (name if you want or nickname), age (can put month & yr of birth), meds, doses & forms of meds, breastfed or formula fed

thanks!

~laura~
Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos
Ari 7/06 REFLUX FREE, so miracles do happen!

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Ting66
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Location: Hong Kong
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Posted: 11 August 2011 at 4:05am

Thanks for coming back again. The GI specialist I've just seen has changed my girl's medication to 15mg Takepron - which is known as Prevacid in the U.S. I am breaking the pill in half which I give her half in the morning and half at night.

I did not ask about Carafate, but will definitely do so at my next visit.

The doctor does not seem to worry too much about my daugther as she gains weight 'alright' - following the curve that is. But of course, one of the reasons she gains some weight is because we do try every ways to feed her, which is not normal as you've said.

Again, paediatircian here in Hong Kong seems to think more lightly on the matter relating to GERD or feed allergy. I've seen all together 5 different doctors already and they all tell me that it will get better and that she is already on the max medication she can take for her weight. But I guess what I fear the most is how she will be when she starts solid in two months...will she also hate eating all together...?

Ting66
Aaron (March 2009) - Premature but healthy
Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy
Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate

IP Logged

hellbennt
Admin Group

Joined: 28 August 2003
Location: United States
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Posts: 13402

Posted: 11 August 2011 at 7:56am

hang in there!

research!

decide what is best for YOUR baby!

YOU are her best advocate!

I don't know if 15mgs a day is enough? there's a dosing chart in

Prevacid 101:

scroll to the last page of this post, (it's actually also about other PPIs like prilosec, too)
http://www.infantreflux.org/forum/forum_posts.asp?TID=1936&PN=0&TPN=1

~laura~
Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos
Ari 7/06 REFLUX FREE, so miracles do happen!

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Feeding Issues and Aversions
InfantReflux.Org Forums : Feeding Issues : Feeding Issues and Aversions

Author	Message
Ting66 Newbie Joined: 04 August 2011 Location: Hong Kong Online Status: Offline Posts: 6	Topic: Struggling to know the right type/dose of med Posted: 04 August 2011 at 5:40am
	My baby girl is almost 4 months old and has been diagnosed with reflux since 6 weeks old. Since then, she was being put on Zantac and has changed to Losec when she was about 2 month old. Although she is sleeping relatively well but her feedings have been a nightmare since then. She would fuss, often cry, pushed bottles away. We've also changed recently changed her formula about 10 days ago to Neocate. I do not seem to think she has improved much. I am starting to suspect that there needs to be an adjustment on her medication. As she is clearly still in pain during her feed and also anytime right before her projectile spitting. She is currently taking 10mg of Losec (I am writing from Hong Kong, so the names of medication might be different). The ped here seems to think all the different reflux medications are about the same thing (i.e. Zantac and Losec are about the same thing, etc.) But by researching on the net, I seem to get a different sense. I am no expert in prescribing medication to treating infant reflux, but I would like to hear all your thoughts and advises, so that I can raise it up to the GI specialist we are already seeing here. Right now, the only way that we can get any food down her is by rocking, white noise, distraction, dream feeding..and I feel like this will NOT end unless I get her pain under control...so any HELP would be highly appreicated!!
	Ting66 Aaron (March 2009) - Premature but healthy Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate

	IP Logged

hellbennt Admin Group Joined: 28 August 2003 Location: United States Online Status: Offline Posts: 13402	Posted: 04 August 2011 at 10:26am
	hi & welcome! you've found a great place to research! Sounds like you're on a good path! Ok, first I would calculate proper losec dose (you'll see it as prilosec) and find proper FORM of it- it's all here: Prevacid 101: scroll to the last page of this post, (it's actually also about other PPIs like prilosec, too) http://www.infantreflux.org/forum/forum_posts.asp?TID=1936&PN=0&TPN=1 then, you'll want to find proper dose of zantac: Zantac dosing- my/other’s question (has axid & pepcid doses, too): http://www.infantreflux.org/forum/forum_posts.asp?TID=8288&PN=1 then, you'll want to know why your baby might be on neocate: MSPI 'Main' page: http://www.infantreflux.org/forum/forum_posts.asp?TID=2697 best EXPLANATION OF FOOD ALLERGIES/INTOERANCES and their RELATION TO REFLUX that I have found, to date: 2nd post: http://www.infantreflux.org/forum/forum_posts.asp?TID=2697&PN=2 how Neocate & Elecare work: http://www.infantreflux.org/forum/forum_posts.asp?TID=6013
	~laura~ Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos Ari 7/06 REFLUX FREE, so miracles do happen!
	IP Logged

Ting66 Newbie Joined: 04 August 2011 Location: Hong Kong Online Status: Offline Posts: 6	Posted: 05 August 2011 at 12:46am
	Hellbennt, Thank you so much for the post. Before I go through to check out the right dosage of Losec and Zantac, my question is that it is necessary true that the two should be taken together in order for the medication to be effective?? As currently, my girl is only taking Losec alone, which was advised by the doctor here. Once again, thanks so much.
	Ting66 Aaron (March 2009) - Premature but healthy Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate
	IP Logged

hellbennt Admin Group Joined: 28 August 2003 Location: United States Online Status: Offline Posts: 13402	Posted: 05 August 2011 at 8:37am
	they can be taken together, make sure to space them 4hrs apart! when starting a PPI (losec), yes, baby needs to be on both bcse the losec doesn't 'show' it's full effects until then (it could show earlier! but it can take up to 14 days- it was day 12 for my son). after being two weeks on a PPI (losec), your baby should not need the two together, but it's not unusual if she does- it's a good idea to give the two until you get her situation under control- you can then back off of the zantac there were times my baby was on both- when there needed to be a med increase, when there was break-through acid, etc...
	~laura~ Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos Ari 7/06 REFLUX FREE, so miracles do happen!
	IP Logged

Ting66 Newbie Joined: 04 August 2011 Location: Hong Kong Online Status: Offline Posts: 6	Posted: 06 August 2011 at 2:41am
	Although we never transition her into losec with Zantac, but she has already been on Losec for over a month. Her milk aversion has gotten worse since then. She simply cries and refuse her bottle most of the time. We can only manage to get around 600ml into her within 24 hours with the distraction of white noise, music, rocking, or dream feed. I just don't know how we can continue this going forward. Will there be case where babies do not react well with Losec all together? Should I simply change her medication to something else?
	Ting66 Aaron (March 2009) - Premature but healthy Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate
	IP Logged

hellbennt Admin Group Joined: 28 August 2003 Location: United States Online Status: Offline Posts: 13402	Posted: 07 August 2011 at 10:28am
	I would check the DOSE and the FORM of losec before giving up on it- once you understand about the dosing and the form of the PPIs, and your baby is on the proper dose and form, then you might change to another PPI like prevacid...in the meantime, if you have zantac, you could try giving that, too, at the proper dose & making sure to give it 4hrs separate from the losec... Carafate: http://www.infantreflux.org/forum/forum_posts.asp?TID=13485&KW=search+feeding+aversion+forum here's more to help: http://www.infantreflux.org/forum/forum_posts.asp?TID=13904&KW=feeding+aversion http://www.infantreflux.org/forum/forum_posts.asp?TID=13876&KW=feeding+aversion http://www.infantreflux.org/forum/forum_posts.asp?TID=13875&KW=feeding+aversion http://www.infantreflux.org/forum/forum_posts.asp?TID=13866&KW=feeding+aversion http://www.infantreflux.org/forum/forum_posts.asp?TID=13809&KW=feeding+aversion http://www.infantreflux.org/forum/search_results_posts.asp?SearchID=20110108140213&KW=feeding+aversion&PN=2 Feeding Aversion: http://www.infantreflux.org/forum/forum_posts.asp?TID=13904&KW Carafate spacing from PPI: okay I did a quick search and here is what I found... 3rd post down from Sheri who unfortunately isn't on much anymore... says space it 2hrs apart. http://www.infantreflux.org/forum/forum_posts.asp?TID=10620&KW=carafate
	~laura~ Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos Ari 7/06 REFLUX FREE, so miracles do happen!
	IP Logged

Ting66 Newbie Joined: 04 August 2011 Location: Hong Kong Online Status: Offline Posts: 6	Posted: 07 August 2011 at 10:18pm
	My girl is about 12lbs now, there seems to be many links to links you've attached here and the Marci site is under construction. So what exactly should be the right dosage for her on Losec then? I've been told by two doctors that her 10mg are the max for her at this stage. And when you say if it is at the right form; may I know exactly what it means? She is taking the 10mg Losec Mups, which we give to her 5mg in the morning and 5mg before she sleeps at 8pm. We do add a tint of Ribena (to make it less bitter, as otherwise, she would gag and spit up the whole thing) when administrating. She drinks 'ok' when we dream feed her, does that mean she is no longer feeling the actual pain, but it's all physcological too? Sorry for all these questions, as doctors (even GI specialists) here in Hong Kong seems to be a lot less specific on medication type and dosage. THanks!
	Ting66 Aaron (March 2009) - Premature but healthy Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate
	IP Logged

hellbennt Admin Group Joined: 28 August 2003 Location: United States Online Status: Offline Posts: 13402	Posted: 08 August 2011 at 10:14am
	marci-site is under contstruction, but I urge you to read through Prevacid 101: scroll to the last page of this post, (it's actually also about other PPIs like prilosec, too) http://www.infantreflux.org/forum/forum_posts.asp?TID=1936&PN=0&TPN=1 there is a link to the marci-kids dosing chart, from Prevacid 101. marci-kids is the organization based from the University of Missouri. they are at the forefront of the research of PPI dosing and infants. I don't know about losec mups, is this a powder that you add liquid to? You need to give it on an empty stomach, followed by a 'meal' 30 minutes later. feeding aversions happen when the baby associates feeding with pain. the feeding while asleep is a survival tactic- you have to make sure that your baby eats- but it is not ' normal' and you need to address it now so that you don't continue to have problems down the road... in the meantime, I would find proper zantac dose and give that to her, too, until you get the losec dose 'right' - I don't know why some doctors think there's one dose and others are willing to increase it? Some parents take matters into their own hands and increase the dosage (I am not a medical professional & I cannot tell you to do this)... you might want to make sure that nothing 'else' is going on before (or if you want to) taking matters into your own hands (increasing the dose)- this would be an Upper GI. This does NOT TEST for relfux, but it looks for structural abnormalites...there's also an endoscopy, which goes in and looks at the esophogus- this might be good to SHOW your doctor that your baby's esophogus is irritated (so time for more meds) and also they will take biopsies and if there are EOS cells present this means there's an allergy to milk and or soy proteins. also, in the meantime, please read abou CARAFATE (links above in propr post) and perhaps TELL your dr that your baby needs this. It's a SHORT TERM solution, not a long-term one. Long-term is getting on proper dose and form of PPI together w/ the neocate... you can do this! when you get a chance, please go to the top of this page, click on Settings and please then click on Edit Profile, then scroll down to Signature & put: baby (name if you want or nickname), age (can put month & yr of birth), meds, doses & forms of meds, breastfed or formula fed thanks!
	~laura~ Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos Ari 7/06 REFLUX FREE, so miracles do happen!
	IP Logged

Ting66 Newbie Joined: 04 August 2011 Location: Hong Kong Online Status: Offline Posts: 6	Posted: 11 August 2011 at 4:05am
	Thanks for coming back again. The GI specialist I've just seen has changed my girl's medication to 15mg Takepron - which is known as Prevacid in the U.S. I am breaking the pill in half which I give her half in the morning and half at night. I did not ask about Carafate, but will definitely do so at my next visit. The doctor does not seem to worry too much about my daugther as she gains weight 'alright' - following the curve that is. But of course, one of the reasons she gains some weight is because we do try every ways to feed her, which is not normal as you've said. Again, paediatircian here in Hong Kong seems to think more lightly on the matter relating to GERD or feed allergy. I've seen all together 5 different doctors already and they all tell me that it will get better and that she is already on the max medication she can take for her weight. But I guess what I fear the most is how she will be when she starts solid in two months...will she also hate eating all together...?
	Ting66 Aaron (March 2009) - Premature but healthy Alicia (April 2011) - Premature at 34 weeks. GERD, Cow's milk Protein Allergy Zantac, Motilum, Losec, Takepron(known as Prevacid) Neocate
	IP Logged

hellbennt Admin Group Joined: 28 August 2003 Location: United States Online Status: Offline Posts: 13402	Posted: 11 August 2011 at 7:56am
	hang in there! research! decide what is best for YOUR baby! YOU are her best advocate! I don't know if 15mgs a day is enough? there's a dosing chart in Prevacid 101: scroll to the last page of this post, (it's actually also about other PPIs like prilosec, too) http://www.infantreflux.org/forum/forum_posts.asp?TID=1936&PN=0&TPN=1
	~laura~ Jonah 7/03:GERDfree@12mos! Silent Reflux@birth(apnea episodes/NICU);Past Sandifer Symptoms, breastfed->15mos Ari 7/06 REFLUX FREE, so miracles do happen!
	IP Logged