Gagging and Vomitting

[Anonymous]

Hi,

My daughter, Emily is 4 mths old. At about 6 weeks, she became extremely fussy at the breast, scremaing and arching her back during feedings. She spit up about once a day. Her ped put her on Zantac, but she always spit it up so we only ended up giving it to her for 2 days. Slowly, the reflux seemed to start getting better and I was able to take her out without the constant wailings.

However, since last mth, she bagan gagging all the time, whether it be while suckling on her fingers, tongue or as soon as she got on the breast or midway thru’ a bottle (and this is not when she is full).

She also seemed to be eating less and less and her weight gain from the 2nd mth to the 4 mth was minimal (though her ped thought this was okay). Her poop has also been very watery and mucousy. I think this was because she mainly consumed foremilk and very little hindmilk. Anyhow, seeing this, I decided to wean her off the breast so that she would take in more hindmilk from a bottle. I pumped about 4 times a day, even at 4am or 5 am in the morning. Now she absolutely refuses my breast, unless she is asleep. She was doing pretty good on the bottle for almost 2 weeks, drinking about 4 oz each time despite the constant gagging.

Then, last Thursday, she got her 4mth vaccinations, developed a fever and vomitted 4 times on Friday. I think the vomitting on Friday really scared her and now she refuses to drink more than 2.5 oz every 3 hrs. I’m so worried about her growth and development (or lack thereof). She is only 12 lbs 9 oz for a 4 mth old. I feel so helpless and upset at myself. I’ve been crying every night worried about what is going to happen to her. At the same time, I don’t feel like eating and my energy levels and milk supply has gone down significantly. The ped at the hospital recommended that I feed her less, but more frequently. She will only eat every 3 hrs and every time I try the 2 hr schedule, we end up wasting at least 1 to 2 oz of breastmilk. I want the best for her, but I don’t think I can handle the stress, lack of sleep, worrying and pumping much longer. I want to put her formula, but I know that formula is harder to digest and breastmilk is better for reflux babies.

Would I be making a horrible decision by weaning her off breastmilk and giving her formula instead? Is there a particular formula that is best for reflux babies? Should I start with rice cereal? Will this help or is she too young for this? Is it common for reflux to apppear to go away and then come back all of sudden? I just can’t get over how things got so bad so fast.

Is gagging a sure sign of reflux? Can you recommend any ways I can feed her without her gagging and vomitting everything? There are so many telltale signs that we are going to have many feeding issues down the road. It is so disheartening watching her go thru’ all that discomfort and not being able to eat when she needs her milk so badly. I think she must have lost at least a pound or two from all the vomitting during the past couple of days.

She is on Zantac again (1.2ml a day). Do you have any suggestions as to when is the best time to give this to her and whether I should split the dosage?

I’m sorry for the long post, I just feel so lost and frustrated. I have never felt so helpless before. It is so hard watching her eat less and less and experiencing the pain of constant gagging and heartburn.

Thanks for reading!

Sarah

[hellbennt]

sarah,

welcome!

choosing to stop bf is a very personal decision.

you do not have to bcse of reflux, but if you decide to, everyone here is extremely wonderful and supportive!

what I would do is to first address your baby’s pain and then deal w/ the choice of bf vs formula…

sounds like the zantac dose is very low?

please please read this:

https://www.infantreflux.org/forum/forum_posts.asp?TID=853&am p;PN=1&TPN=1 – it’s my welcome/intro & you can even bookmark it

there’s a link about zantac dosing…

and there’s a ‘section’ about bf your reflux baby…

(& more)

glad you found us,

~laura

ps: from everything I’ve read the mucousy stools would be from mspim not from hind/foremilk imbalance- I’d say to research some…but again, mspi can be addressed once the pain is dealt with…

[Anonymous]

Laura;s intro is great… i will try to post later tonight when Matthew is sleeping… what happens after 2.5ounces? Does she cry or just will not open mouth… does she swallow, have hiccups… any signs of discomfort?

Matthew is extremely sensitive to fevers – and some babies jsut are. If he has any temperature, he will throw up… anything bothering him, he will throw up. It may have scared her but i would really think it is something else…

There are 2 ways to approach it i guess: medication and change in diet. Some people prefer one first the the other. I never breastfed and so we attacked both at once,,, although was too late

sorry matthew screaming will post later

[Anonymous]

Hi and welcome. I’m sorry to hear about the hard time you are having with your little girl. I certainly know what it’s like to have a baby who won’t eat, or gags and throws up while eating. I’ve had two babies with reflux, and it’s been very, very difficult both times.

My son started out eating fairly well, but would never nurse, so I pumped and fed him. Very difficult to say the least. As he got older his reflux got worse and worse and like you are describing he eventually go to the point where he would never eat more than 2 ounces at a time, though I know he was hungry. He gagged a lot when I fed him and he arched and screamed during feedings. To make a very long story short, I eventually got him on a PPI drug (Prevacid). His dose was too low and for at least six more weeks he continued to suffer from painful reflux and his eating continued to get worse. Finally I convinced my doctor to put him on the higher dose that the researchers at marci-kids recommend and he finally improved. I had printed this information and faxed it to my doctor and she finally agreed. Hopefully, your doctor will be aware of this research or at least open to examining it.

Here’s the link with the information I printed for my doctor. http://www.marci-kids.com/

Zantac is very weight sensitive so even if it does work initially, babies quickly outgrow their dose and need an increase. My daughter was never helped by Zantac at all. It seems from reading these posts that most babies do better on PPI medications like Prevacid or Zegerid.

As for cereal, many babies do benefit from cereal in their bottles, but it’s really trial and error. Lots of babies get gas and/or constipation from rice cereal, so be aware of that. I always started my babies on oatmeal for this reason and they all did fine on it, but some babies will find any grains difficult to digest until they are much older. I guess you just have to experiment. The main reason to put cereal in a reflux baby’s bottle is to make their milk thicker which sometimes stays down better, and sometimes is easier for baby to swallow without gagging. My son definitely did better on thickened breast milk. He’s better now and can drink it either way, but for a long time he could only drink thickened milk without choking.

Also, it might be a good idea to have your daughter evaluated for a swallowing problem…I think they call it a swallow study. Some babies have problems with swallowing and they aspirate and choke becuase of it. I think these studies are done by speech therapists…but hopefully some other mom’s out there can advise you better on that.

Again, I’m sorry things are so hard right now. Hopefully with proper evaluation and treatment she will be feeling and eating much better very soon.

[Anonymous]

My little guy only ate 2 oz every 2 hrs or so until he was about 3-4 months old. At 4 months his intake literally almost stopped for 3 weeks he was eating at the most 10 oz a day (thickened formula)until I switched him to lacto-free formula..He’s 6 months now and still only eats 4 oz every couple of hours(2-3)..as tough as it is to waste the milk, you might want to try the 2 hour schedule again. My son’s bottles are REALLY thickened, he gets 3 tablespoons of oatmeal per 4 oz of formula, his ped origionally said 1 tbs per ounce (4 tbs per 4 oz) but that was a bit to thick for him..if I see his reflux kicking up a bit I’ll up it to 3 1/2 tbs of cereal. He has done great with the cereal, but like everyone said, every baby reacts differently!!! I would push for the ppi, Aidan is on prevacid, the soltabs, and they have been wonderful for him, it really IS trial and error until you find what works for your little one!! good luck, oh and as to the formula verses breastmilk, like Laura said it is a very personal descision, but I honestly don’t think there is a huge difference health wise, I nursed my older son until he was 2, and he still ended up with asthma, allergies, and recurring sinusitus. With Aidan, I decided way before he was born not to breastfeed, and have no regrets about it. I don’t think either breastfeeding or not breastfeeding is the right/wrong thing to do, just make sure if you want her to have breastmilk, you keep pumping no matter how much she does/doesn’t eat to keep your supply up.Oh, and try to keep a log of how much she eats and how often and how she reacts at each feed, video tape her eating if you can….it’ll help the dr’s see how she is reacting to see it for themselves!!!

[Anonymous]

Hi, same problem with the choking and gagging on feeds. Did a swallow study at 4 months and found a mild swallowing dysfunction. Another one of those “she’ll grow out of it” things. We were able to start feeding therapy early on which was great because of the issues many refluxers develop.

Also, milk soy protein problems here too. Painful gas, hard tummy, mucousy stools, eventually there were little peices of black that was really blood. They did a simple stool swab in the gi’s office to check for the blood.

If you think she is worse, maybe trying a ppi would be a good idea since babies plataeu on the zantac. We used the zantac with the ppi because it takes 14 days to kick in fully. Space them apart by 2-4 hours so they didn’t cancel each other out. the meds needed to be split up because the babies metabolize so fast. Nobody told me this at first so my dd suffered so much. Made me so mad that I had to do my own research, but after many posts and lots of hours searching this site, I finally started giving her the meds right and I knew just what to ask the docs for. Also, we gave mylanta cherry supreme before bottles and elevatedher in a sling/wedge combo that helped alot with her discomfort. I don’t think we laid that child down flat for the first 6 months of her life, I even changed her propped up on a boppy pillow! Ohh… just wondering if you are giving the zantac on an emtpy stomach and waiting 30 mins before feeding her? May help her alot with splitting up the dose and administering it differently. Good luck!

[Anonymous]

Just to hopefully make you feel a little better, my daughter who will turn 4 months on Friday, weighed 12 lbs 4 ounces at her appointment last week and my doctor said she was growing just fine. I know how it feels when they don’t eat – you feel like they are starving. Just when you think that, they pick up the pace again.

Hope everything works out for you!!

Robin

[Anonymous]

Sarah – how much did your baby weight when she was born? I ask because I have a 3 1/2 month old with reflux who only weighs 11.2 lbs and only eats 3 oz every 2 1/2 hours…and the doctor has not been worried about her…so technically what your little girl weighs and is eating does not seem too bad.

As for formula vs. bf…I personally stopped bf at 3 months because it really seemed to be bothering her. The formula (alimentum) has made a HUGE difference in the gas and the reflux. So it can be a good thing. But as someone else said, its a very personal decision and one that I was VERY sad to make.

I agree with what others posted here regarding getting her onto a PPI like Prevacid. My DD is on Prevacid and Zantac and still sometimes gags and throws up but not as much and it doesn’t seem to bother her too much (other than the surprise of it and the annoyance of having to be redressed). Have you seen a GI specialist? Perhaps that should be the next step?

Hope you get things figured out soon — we all know how hard it is to watch your baby be in pain but it will get better!

[Anonymous]

Thank you everybody for your responses! You’re right, the Zantac prescription seems low. her first script at about 6 wks was 0.8ml 2x a day whereas her 2nd script now is only 1.2ml once a day.

I started administering the Zantac 2 days ago, and so no improvement whatsoever. In fact, she seems more cranky. How do you normally give your babies Zantac without them spitting it out? Also, when did you start seeing an improvement (if any) with Zantac?

In terms of switching to formula, I’m pretty certain that I want to wean Emily off. I haven’t had dairy since she was born I haven’t tried the TED, but have eliminated many things but the mucousy/watery poop has not gone away. Is there a particular formula I should start with? How should I go about introducing it?

Any further advice you have to offer would be greatly appreciated!

Sarah

I feel that we are on a neverending roller coaster ride. Every time during a feeding, I pray that she will finish her 3oz, then if she doesn’t, I’m always unsure whether I should try to get her to finish it. After she’s off the bottle, I’m terrified that she is going to puke everything out. And when she does, I’m so worried that she will refuse the next bottle. After each feeding, I can’t wait fir the next one to see if she will do a little better and not puke.

To add to all this, I just got into an aweful argument with my MIL whom I live with over the most ridiculous thing. Geez, when things get bad, everything just comes at once. =(

[Anonymous]

Gosh, I’m so out of it that I put my name in the middle of my email. Sorry.

[Anonymous]

I would recommend starting with something like Alimentum or Nutramigen…maybe even Nestle Good Start with comfort proteins…seems like a lot of moms have had success with it here.

Hang in there…its nice to have this board because you know you’re not the only one going through all of this.

[Anonymous]

SARAH,

OMG! I’m so sorry I forgot to reply to your email. I have been very busy the past week.

I’m sorry to hear that things have become worse with Emily. We ultimately had to stop BF at around the same time, mainly because Hailey’s feeding aversion was so bad that she wouldn’t suck and I couldn’t keep on with pumping anymore. It was a hard decision for me as well, so I understand how stressed you must feel at having to decide what you want to do.

The best advice I can give you at this point is basically the same thing I’ve said before: get an appointment to see a ped GI. I think they’ll be better able to help you. It sounds like Emily may need a PPI, and hopefully that will help her. I know that you are in TO, but as I said, we’ve yet to have much luck finding a good GI. None will dose anywhere near the marci-kids recommendations, and all the docs we’ve seen (even our current one at sick kids) seem to take the approach to let them wait to outgrow it. The other thing I would tell you is not to waste your time with these kinds of docs. Keep looking until you find someone who takes you seriously. I spent too much time with the same GI (who was so nice and was very supportive) but basically didn’t do much except weigh her, and wouldn’t up her meds enough. I think that if we hadn’t wasted so much time with her and had moved on earlier in search of a doc who would dose a bit more aggressively, then we might have been able to avert this whole disaster.

I hope that things settle down with your MIL. We’ve been there too and it certainly makes things harder.

Please feel free to email me if you want to talk more (I can give you my number also if you’d rather). I will try to respond more promptly next time. Hang in there. It does get easier.

s&h’s mum2006-6-1 21:38:25

[hellbennt]

sarah,

email me via the profile button at the bottom of this post if you want to discuss anything about breastfeeding your reflux baby…if not, not.

Please get to a ped gi asap

~laura

[Anonymous]

Hi,

Well, we have been administering Zantac for about a wk now and she appears to be spitting up more. The doc at SickKids did say that it doesn’t start to kick in until after the 1st wk, so I will follow thru’ for a mth to see if it makes any difference.

For those of you who have found relief from Zantac, did the discomfort (i.s. screaming, arching) and spit-up stop or does Zantac merely coat the throat so that it doesn’t burn the esphogus? I’m so confused!

Currently, I’m still pumping and bottle feeding Emily. I have also been trying tointroduce her to Good Start. For the past week, we have been giving her about 2 to 4oz of GoodStart (with ARA & DHA). She seemed ok with it, but during the past 3 days, she spit up everytime she had it (but only the first meal in the very early morning (ex. 3am) or 7am. I read on this forum that a lot of reflux babies have trouble with DHA & AHA in formula, so I purchased another GoodStart, but without the DHA & AHA. She spit up again and really doesn’t seem to like this formula, though I don’t htink the taste should be any different. Anyhow, I’m going to give it a couple more days to see if she will take it any better.

Emily is still drinking about only 2 to 4oz (max) per feeding and it seems like she is refluxing more now. In the meantime, I have made an apptmt to bring Emily to my doctor to request a stool sample to check for parasites (her poop is still very loose). Her ped refuses to do a stool sample claiming that her poop is normal. After reading the many posts on the forum and talking to other people, I am beginning to doubt her ped more and more. I’m hoping that the stool sample and rule out or confirm a parasit problem. That way, I will know if the problem is MSPI.

Ideally, I would like to provide Emily with both breastmilk and formula since I find that my supply appears to be dwindling and it is very difficult to be either pumping or feeding her all day.

And so the roller coaster ride continues…

Thanks again for all your advice! Honestly, I don’t know what I owuld have done if I had not found this group.

Sarah

[Anonymous]

Sarah,

I responded to your email, but will summarize here in case you don’t check it often.

I assume that you saw an ER intern and not a GI at sick kids, right? I would really try to get in to see a GI somewhere. Based on the problems you’re having, I’d also try to get on a PPI. If you want to wait it out for the zantac to see if it helps, that’s a fine idea, but I wouldn’t wait to ask for a ped GI referral. Our system is very slow and it takes a long time to get appointments. We also couldn’t get anyone to do a stool test here for occult blood. Seems like they don’t do them fairly regularly. What tests has she had done. You might want to consider an UGI to make sure that all structures are normal, and also a feeding assessment (which they do at sick kids, but takes a long time for an appointment). Good luck. I hope that things improve for you soon.

[Author]

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