Infantreflux.org | Still trying to figure things out

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March 12, 2006 at 12:50 pm #3632

Anonymous
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Hi everyone,

It seems like I’m posting on here all of the time these days. I really appreciate everyone’s help. Maybe someday I’ll know enough to be useful myself. A couple of questions…

1. Does reflux tend to be worse when a baby is tired? I ask because Tess’ reflux has improved a lot and the main thing that we’re still struggling with is her sleep. Whenever we’re trying to get her to sleep she will drift off pretty easily but then will be woken up with reflux episodes every 15-30 minutes. Once she’s in deep sleep it seems to go better but that can take an hour or longer, especially with the reflux annoying her. I’m not sure if she really has more episodes at these times or if it’s just that I notice it more because I’m frustrated at trying to get her to sleep. Anyone have info or experience with this?

2. How can you tell when you have the meds just right? We started on Zantac and that helped a lot but we still had some issues. We moved on to Prevacid about a week ago and so far it’s no different than the Zantac. I wonder if this is just as good as it’s going to get for us, regardless of meds? Should she be completely reflux free if we’ve got it right or will there always be episodes that bother her?

I thought I had another question but I can’t remember it now. Too tired, I guess. TIA!

Karen

March 12, 2006 at 3:41 pm #3640

Anonymous
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On the medicine question it takes about 2 weeks before prevacid would really be working so it is too early to tell if it is working or not.

March 12, 2006 at 4:10 pm #3645

Anonymous
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Is she sleeping flat? Some babies just can’t tolerate it and reflux like mad as soon as you lie them flat (my dd being one of them). What’s her dose of prevacid again? We’re also on day prevacid now- day 9- with no improvement, but i found out the dose wasn’t right and we can’t fix it yet, so hopefully we both catch some ZZZZZZs soon! s&h’s mum2006-3-12 16:11:50

March 12, 2006 at 8:02 pm #3656

hellbennt
Keymaster

I’d continue with the zantac until the prevacid ‘kicks in’ and also just keep going with the zantac afterwards, too- can’t hurt- just make sure you give it at least 2hrs seperate from the prevacid

what form prevacid?

I’d check out the ‘prevacid 101’ link to check the dose, form, & how to give it…

the sleep issues will get better once the meds get better

March 12, 2006 at 8:47 pm #3668

Anonymous
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Sarah – So you think the Prevacid doesn’t start working at all until 2 weeks? I would think that it would slowly build up. At least things didn’t get worse when we switched.

Lori – I should have specified. She sleeps either in a wrap during the day (in an upright position on me) or on our chests in a recliner at night (pretty much upright). So it’s not because she’s flat. These episodes happen even when she’s pretty much vertical. As for her dose, she’s taking 3/4 of a 15mg solutab once a day. So I guess that’s just under 12mg/day in one dose. I see from the marci website that this might be too low (she’s 11.5lbs).

Laura – Our doctor wanted us to discontinue the Zantac. We’re using the Prevacid solutabs. I’ve read the 101 twice actually. Thanks. I would like to think the sleep will get better but as time goes on I start having doubts.

momtotess2006-3-12 20:57:23

March 13, 2006 at 9:34 am #3685

Anonymous
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It really doesn’t help until 2 weeks at all in my opinion. Then after the 2 weeks it works quickly to get them to happy baby status! We have switched ppi’s 4 different times so unfortunatly we have too much experience with this.

March 13, 2006 at 12:50 pm #3709

Anonymous
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I have always noticed the same day whether the meds are working or not. I always upped the meds until it worked for my son. He had the prevacid in the powder form that he took twice a day (so I was able to experiment with doses without my doctor’s permission, because for each dose you mixed up 15mg of prevacid and had to toss the rest you didn’t use.) I wish I had known about the marci-kids website back then, so I felt more comfortable with the “high” doses I was giving my son – which turns out are the correct doses.

I would suggest Prevacid in the AM and Zantac in the PM. My son started that combo a month ago and he sleeps through the night most of the time now. He never slept through the night before, always woke about 5 or more times and he’s 2.5 yrs old!

Here’s a link to show the docs:

Proton pump inhibitors limit acid secretion in the stomach. In the adult population, proton pump inhibitors facilitate rapid resolution of symptoms and healing of the esophagus in 80-90% of patients. The use of proton pump inhibitors (PPI’s) has been evaluated in the pediatric population. Published studies in adults and children indicate that PPI’s are superior to H2-receptor antagonists and promotility therapy in promoting the healing and preventing recurrance of esophagitis. It has been shown that the weight-based dose of these medications is higher than that used in adults. Recent evidence confirming night-time break-through acid secretion in patients receiving PPI’s may occur. Concomitant administration of an H2-receptor antagonist in the evening appears effective in such individuals.

http://www.aboutkidsgi.org/GERD.html

FYI: Prevacid and Prilosec are PPIs – shuts off acid pumps

H2RA is Zantac or Pepcid – Blocks acid

I think hitting the reflux with this one-two punch really works great, you’re covering all the bases this way.

March 13, 2006 at 3:39 pm #3729

Anonymous
Inactive

Emma’s GI doc prescribed Zantac while she was on Zegerid. Did your ped say not to? So many of them say no (mine including) and I will not say out loud what I think about that #*()*$. I just think it is absolutely insane and I know it is b/c they don’t know enough about H2 blockers and PPI’s. Anyways, I was very happy with the combination, even more at night. She still woke up at night but it was more b/c it was habit but she was not crying. I could tell Emma was hurting b/c she was crying at night and waking up crying. She doesn’t do that anymore. With the help of both meds her reflux is under control and as been for awhile (since about 10 months old)!!! When she was having reflux problems she would go to sleep and wake 30 mins later and several times at night. I definetly agree with 2 weeks for it to work. Have you seen a ped GI??

March 13, 2006 at 3:43 pm #3730

Anonymous
Inactive

OH, are you breastfeeding or what formula is she on? For us wasn’t just the meds but the combination of the right formula and meds for her to be reflux free!

March 14, 2006 at 10:48 am #3797

Anonymous
Inactive

With the right form and right dose of a PPI, it should not take 2 weeks before you start seeing a difference. At the doses recommended on the MARCI-Kids website (especially with Zegerid) most parents see results within a few days.

As far as combining an H2 blocker with a PPI…This is ok as long as they are given far apart. Dr Phillips recommends that they be spaced out at least 4 hours from one another. If they are given too close together, they will interfere with one another and not work as well. It is generally good medical practice to give an optimal dose of one drug rather than a suboptimal dose of two drugs. In this case PPIs are the much more effective drug of the two and it is better to give a higher dose of them rather than lower doses of PPIs along with an H2 blocker.
Also remember that the body develops a tolerance for H2 blockers very quickly (often within a week) and they will stop working. If they are given intermittently (every few days) then this tolerance will not develop.

March 14, 2006 at 7:37 pm #3853

Anonymous
Inactive

When Lucas started his first ppi, it took 12 days to see a a real difference. When we switched from a nearly ineffective compounded form of prevacid to zegerid, it took about five days to have a new and improved child. What you are going through sounds like the ppi hasn’t kicked in (or is possibly underdosed), and also sounds like classic reflux and sleeping problems to me.

Have you looked into other meds to use at night? Mylanta Cherry Supreme, carafate, and the zantac can be really helpful if given at the right intervals and right times. MArci-kids isn’t so fond of carafate, but we used it quite successfully for over a month at night-time when things were really scary.

My son refluxed like crazy while sleeping and we’ve had 18 mos of sleepless nights– but hte last six mos have been better than the first 12. Have you investigated Milk Soy Protein Intolerance– MSPI? This was a large source of problems for us but I didn’t realize it until he was 8 mos old and finally removed dairy and soy from my diet (I was bfeeding). Allergies can contribute to nighttime wakings, as can the MSPI problems. See this site for more info:

http://www.disa.com.au/

Also, an incorrectly dosed ppi, no matter how great the drug, will not help in the way that a correctly dosed ppi will help. I know this sounds elementary, but many docs underdose in my humble opinion, from reading over the last year on this site, and in my own experience. Correct dosing of the ppi can make a WORLD of difference.

The biggest issues for us with reflux were: realizing Lucas was MSPI, doing the elimination diet and removing offending foods that he was overly sensitive/possibly allergic to (beef, fish, dairy, soy, and now wheat and gluten). Also, finally having an endoscopy and ph probe done to confirm our suspicions and finding out he has a hiatal hernia, which although very rare, can be a contributing factor for kiddos who have reflux that is not getting better with age and appropriate meds and dosing. The ultimate biggest factor was a combo of good meds and TIME. Growing helps the reflux so much, and has even helped us with the situation of the hiatal hernia.
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