HELP I NEED LOTS OF ADVISE

[Anonymous]

Hi – I have a 5 month old with protein allergy (milk and soy) and GERD. Spits on a good day 6 times with burps and 6 times in between feedings. On a bad day 20-25 times a day.

He is on Nutramagin and Zantac

Questions

He is 17 lbs – He takes Zantac 1 ml 3 times a day. Is that enough? Do you give the Zantac before or after feeding?

He eats 6 times a day so he is only getting the Zantac during 3 feeding because of the dosage. It has not really helped the spitting much but he seem a bit more comfortable – but not all the time.

Can you give the Mylicon drops and the Zantac?

He seems to spit less when laying down – even flat. I know it is weird. Car seats are a nightmare. He spits constantly in it and is very uncomfortable. He screams at the sight of it. Any suggestions? Also for his saucer – he LOVES his saucer and I do not want to deprive him of it or anything that is developmentally good for him – but he spits constantly in it. I guess from the movement and him leaning on his tummy in it. The thing is – the only way to reduce the spit up is to strap him in an infant seat all day and that is not good for him developmentally. I am sooooo frustrated. He also won’t roll on his tummy and hates tummy time and I think it is because he is unconfortable. He is behind on rolling over and pushing up on arms because of this.

Tried rice cereal and it was nightmare – he spit even worse! Is oatmeal better?

Is Alimentum better than Nutramagin?

Also I use Avent Bottles. I tried Dr Brown once and it seemed worse (but maybe it was just a bad spitting day ) Are there any bottles out there that are tried and true to help?

Also what about baby holding bottle. My guy is starting to want to do this and the problem is he suck more air in his attempts – is it bad to deprive him of this developmentally?

Thanks for all your help. It is nice to have some support with this. This sight is such a life saver. Nobody else understands – they just say well babies spit up! I am so frustrated. I want to fix it and can’t seem to find the right combination- just when I think I do – it stops working.

[Anonymous]

Hi. I don’t have answers to all of your questions, but I’ll do my best.

H2 Inhibitors, like Zantac, and Proton Pump Inhibitors, like Prilosec, Prevacid, and Zegerid, do NOT stop spitting. They stop the stomach from producing acid, so the spitting doesn’t burn. You can find good information about reflux meds at http://www.marci-kids.com.

There are many reasons why babies spit, and sometimes you can stop them and sometimes you can’t. For example, many babies have a weak lower esophageal sphinchter (LES), which allows stomach contents to flush out of the stomach easily. It is very common. What you are saying about the carseat leads me to suspect that your son may have this issue. There’s not much you can do about it, other than keeping pressure off of his stomach. I’m guessing the carseat keeps him too bent, which makes the reflux worse. You may have better luck switching to a convertable carseat, which keeps the baby more upright. We had the same problem and the convertable helped.

MSPI also causes reflux. I’m wondering if your babe is so allergic to milk protiens that even Alimentum or Nutramigen are too much. As to your question about which is better–it depends on the baby. You just have to try them both and see which works best for yours. However, you may want to consider an elemental formula like Neocate or Elecare. They are very expensive and pretty yucky from what I can tell, but for kids with severe milk protien sensitivities, they are a lifesaver.

It’s pretty common for MSPI kids to have a hard time with rice cereal. You can try oat. If it doesn’t work, there are products called Simply Thick and Thickit (I think these are the names, we haven’t used one, we thicken with rice), which you can add and shouldn’t be as much of a problem. With spitting this severe, formula thickening may really help you. (For others it does nothing, it’s another try it and see thing.)

Avent bottles were terrible for us; we love Dr Brown’s. Maybe try one again and see? The benefit of the Dr Brown’s is that it decreases the amount of air babies take with the bottle because there’s no vaccum inside the bottle. For alot of babies, excess air causes the reflux to be worse. Some have had luck with Playtex Nursers.

RE the baby holding the bottle. You will not deprive him developmentally by helping him. Nursing babies never hold their own bottles and they’re not developmentally deprived. If he insists on holding it, you can hold him upright in your lap and help him. Babies only benefit from being cuddled by their mothers during feedings.

One thing I couldn’t tell from your post is if you think your baby is in pain. If you think he is, moving to a PPI may be really helpful to you. Zantac is great for some, not so great for others. For us, it was like giving water. We’ve been on both Prilosec and Prevacid and they have been livesavers for us.

[Anonymous]

Tiffany offered lots of great advice so I don’t have anything to add there. I just want to comment about the bottle holding. My daughter is 19 months and weaned off of the bottle a month ago. She NEVER held her own bottle and is not developmentally delayed in any way. It really shouldn’t be used as a developmental milestone (although I see if mentioned on lists and it infuriates me) because like Tiffany said nursing babies never hold a bottle.

[Anonymous]

Hello. You have come to a great place. Everyone here is very helpful. Regarding the spitting. That is so common in reflux babies and my Emma spit up like crazy at 5 months, 20-25 times at least. I just got used to that part and she finally just stopped completely around 8 months. I would recommend elevation, it does not stop spitting but it does help. Elevation in his crib and elevation after feedings, they say to give 30 minutes after feeding but sometimes that is hard to do so as much as possible. Laying flat just makes it worse. Zantac is based on weight so they easily grow out of the dosage and become accustomed to it, basically it just stops working. I highly recommend a PPI (http://www.marci-kids.com explains all the meds & dosage), Emma is on Zegerid and besides Alimentum was a lifesaver. She has been a different child ever since. For the formulas it just depends on the baby and some prefer the RTF. We never tried Nutramagin. I would try Alimentum though that way you would know if it can help. Some babies do do better on Oatmeal. What kind of cereal is he on? A lot of mothers use Beechnut, I use organic brown rice & oatmeal. I have to say though my Emma could not handle cereal at 5 months so for me it was to decide whether to put her in pain or deal with the spitting. I know it is a pain but most babies will out grow it. I know more will chim in on this issue and others. Emma did not start to attempt to roll over until 5.5 months. She absolutely refused tummy time even a couple of seconds, but I continued every day with that couple of seconds and eventually she did it. This is probably over a month span of time if not longer. The only bottles that was better for Emma was the ones with liners, the Avent bottles were the absolute worse. Keep hanging in there, it will get better.

[Anonymous]

One more thing Alimentum and Nutramigen are the same type of formula just different brands. The milk proteins in them are completely broken down making it very unlikely that a baby will react to them. The makeup of the two formula’s is a little different so some babies do better with one over another. Some do better with ready to feed vs powder too because the make up for the same brand is even different.

We had the best luck with Dr. Brown’s bottles but again that can be a personal preference too.

Good luck!

[Anonymous]

All 3 of us just posted at the same time, sorry I repeated the some of the same stuff. I agree with what Stacey and Tiffany said on the bottles. Emma just started holding her bottle at 11 months and I really don’t see why that is considered a milestone at all!!

[Anonymous]

THANK YOU TO ALL! It is so wonderful to hear of other going through the same things and have a resource for advise. I will definately try Alimentum and Oatmeal. I got the organic stuff to be safe. I will try Dr Brown bottles again.

I am definately going to call Pediatrician to check on switching to a PPI – the effectiveness of the Zantac is wearing off as you all warned.

While he is on the Zantac though – do you all recommend giving before or after feeding – he only takes 3 times a day so he would not get at every feeding anyway.

[Anonymous]

Looks like you’ve gotten some good advice I have a few things to add/agree with.

1. As for meds I agree about checking out the information at http://www.marci-kids.com/. The researchers there believe that PPI’s (Prevacid and Zegrid) are the best treatment options for babies with REFLUX. My second born had silent reflux and was treated with Zantac. It never seemed to help her that much, but I didn’t know there were better options then. My newest babie (also 5 months old, 18 pounds) has REFLUX with vomiting/spitting. He’s been on PREVACID (10mg/3x’s daily) for a few weeks and is doing much better. He still spits up, but he’s much more comfortable and is eating much better. My doctor originally only had him on 7.5 mg a day which was not enough. I copied all the information from MARCI-kids and sent it to her and then she allowed me to increase his medication to what the researchers reccommend. If your little boy seems to be in pain, you may want to ask your doctor about a PPI drug for him.

2. I agree with the others, none of my three children ever held their own bottles. I think it’s better that way because then they don’t get so attached to it and it will be easier to get them off of the bottle when the time comes. Babies who hold their bottles use them more as a security object, I think.

3. Both my babies who have/had reflux hated tummy time and were/are a little behind developmentally, but I don’t worry about it as much with my son as I did with my daughter because I saw that my daughter caught up as soon as she felt better. She didn’t roll over until she was 7 months old, and was a late walker (14 months) but she did everything else at average times (sit/crawl, etc.). Also, my daughter was a very clingy baby (probably because she felt lousy, but I didn’t realize it then) and she was held almost constantly until she was 8 months old. I’ve known lots of other moms with clingy babies who were held alot. They still developed normally despite having very little tummy time or time on the floor to play. With my son, I do what some of the others have suggested. Put him on his tummy very briefly a few times a day – a minute after a diaper change, a minute or two on the bed with mommy, etc. Even short periods of time will help.

4. About Oatmeal cereal. I never gave any of my babies rice cereal because I found it to be very constipating. I started all my babies on oatmeal and my doctor said that was fine. As for the Organic Oatmeal – I buy it too (Earth’s Best brand), but I find that it isn’t as fine as the GERBER and I have trouble getting it to mix thoroughly in his bottle – so it tends to clog the nipple. So, I use the GERBER oatmeal for his bottles, and the Earth’s Best organic for his spoon feedings. I just thought I’d mention that in case you have the same problem if you are thickening his formula.

5. Related to spending so much time in a bouncy seat – my boy does too because it’s one place he doesn’t spit up so much. I recently found another seat that he loves and it allows him to sit upright. It’s called a Bumbo Sitter and you can find it here http://www.onestepahead.com/shopping/search/resultsmain.jsp? SelectCat=0&Ntt=bumbo&Nty=1&Ntx=mode+matchpartia lmax&N=0&Ntk=All&Nu=Leader+ID

6. As for bottles, I agree that Dr. Brown’s are the best. I’ve tried them all!! Avent were the worst for us, too. I think the wide nipple is hard for some babies to wrap their mouths around and make a tight seal. Even my first baby who didn’t have Reflux had trouble with Avent bottles.

Welcome to the site. Hope your little guy grows out of his reflux soon. That’s what we are all waiting and hoping for. Sorry this post is so long. You had so many good questions!!

[Anonymous]

You all have been soooooo awesome. Thank you so much. I called pediatrician and she prescibed previcid. I am picking up tommarow. I beleive the dosage will be too low based on the marci site – but I will try it and then argue the point if it does not work. I brought up Zegrid and she acted like I was out of my mind.

I fed Oatmeal cereal for the first time today. I did not thicken I just spoon fed before feeding and on the second I fed a spoonful here and there when I stopped bottle to burp. Is spoon feeding as effective as thickening? I had tried thickening before and my little guy would hardly eat cause he is a lazy sucker. I tried thick feed nipples (but they were Advent – which after all the feedback I will not be using anymore!) and they flowed too fast. I cut my own and they flowed OK but he still had to suck a little harder. I am going to try to switch to Dr Brown. Are the cereal cut nipples for those bottles good?

Does the Oatmeal cereal give gas? Tyler did do a little better with spit up on the cereal but he had terrible gas and was very colicky. He was actually more colicky with the gas than he is from the reflux. I am going to try for a few more days just to see if it was a fluke, but it not I am going to have to take him off the cereal.

Thanks again. You guys are lifesavers! :)))

[Anonymous]

Can you give Mylanta with the Previcid? Do you need to space it out?

THanks

[Anonymous]

Hi again. I’m glad to hear you are starting Prevacid. It helps my baby alot. Like you said, you may have to press your doc for a higher dose. My doctor was very receptive when I mentioned the research at MARCI and sent her the information. As for thickening – I’m not sure if it’s better than spoon feeding. I’ve done both and sometimes my baby throws up either way. Also, I had to try several nipples and combinations of textures to get the flow right for him. I settled on one tablespoon of cereal for every two ounces of formula. (This is what my doctor recommended, and seems to be the best to me). I had to try three or four nipples until I got it right. I use the Dr. Brown bottles. They do have Y-cut nippples for cereal, but I don’t have any so I don’t know how they work. (I just ordered some.) For now I am using a level 3 nipple for his cereal bottles, but I still had to cut a tiny hole in them to get it to flow right. It’s tricky, but if you experiment you’ll get it right. I can’t wait until he is off the bottle!! Good luck to you.

[Anonymous]

I got Zegerid from my ped GI doc. When I brought it up to her regular ped he told me that they will not prescibe it b/c it is to new and they do not know anything about it. They would also would not prescibe prevacid over 15mg. I would highly suggest a pediatric gastroenterologist. That is there speciality. What I did was print the info off of http://www.marci-kids.com and took it to her ped GI and they gave me what I wanted at the dosage DR Phillips recommends. You can even email Joel and Dr Phillips info you can give to your ped GI. If he will eat off a spoon I would keep doing it that way and he will stop eating when he is full. If he is better off a spoon than the bottle, I would definetly keep doing it, it is giving him great practice too!

I have to say when I gave Emma oatmeal or rice cereal earlier in life she was very gassy and bloated, she just couldn’t digest it very well. I stopped giving it to her and just dealt with the spitting, it made for a much happier baby b/c the spitting didn’t bother her just me. She finally started handeling it at around 7-8 months and it was the organic kind. She never did handle the Gerber brand. You can also try Simply Thick instead of cereal or oatmeal.

Mylanta is more like zantac, only immediate relief and they say not to give them together, more like 3-4 hours apart. I can honestly say I have given them 30 minutes or an hour apart b/c Emma still has gas and mylanta is the best thing I have found for gas, it is awesome.

[Anonymous]

I just wanted to add that i loved the dr brown’s y cut nipples! They worked really well when Isaac was about 3 months old. Also i think that introducing any new cereal is going to cause a little gas (well at least it did with Isaac).

[Anonymous]

Thanks again for all the help. I am going to continue for a few days with the cereal to see how he adjusts – but I am going to use the Mylanta to try to offset the gas it causes.

ndrose was right about the Zegrid. My doc had never even heard of it and then said well that is not approved for infants.

I am going to try the Prevacid and cereal – up the dosage if necessary and try the Dr Brown’s bottles. If all of that does not help then I am going to seek a GI. I am also going to try Alimentum to see if it makes a difference. I need to try one a time though to see which one is actually working! I am very impatient be nature so this is tough!

Funny thing is today was such a good day. I am doing all this work to try to resolve and beleive it or not he hardly spit today. He only spit 3 times (an absolute record!), did not cry even once, and hardly any gas – he didn’t even burp sometimes! I still had him on the Zantac and using the Advent bottles – Since I picked up both the new bottles and PPI up tonight. I did not give the Oatmeal today because I had a new babysitter watch him for a few hours and I thought better of it with all the crying from the gas. This happens sometimes he has a few good days and I think maybe it’s over and he usually goes back to the same old a few days later. I will take the good days as a sign of hope though!

Thanks again. Wishing us all luck on this journey! 🙂

[Anonymous]

Just wanted to add that Eden is 13lbs 10 ounces and is on 2ml Zantac 3 times a day!! But that is only because she is in a lot of pain when she isn’t on the highest dose possible!!

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