In need of advice

[Anonymous]

I posted about this on the Boo Hoo I need you board, but it seems to have much less traffic than this board.

My little boy Owen was born at 36 weeks. Around 3-4 weeks we started to figure out that he had a reflux problem. He has always grunted continuously while on his back and he started projectile vomitting. Shortly after, he started to refuse nursing and would arch his back in pain at the breast or bottle. His feedings went from 3.5 oz to an ounce at a time. He would still average the same amount through out the day, it was just constant feeding.

The doctor prescribed Zantac and thickening with rice cereal. We were using Dr. Brown’s bottles and could never find the right cereal amount with the right nipple so we gave that up. The Zantac worked great for two weeks and then things went back down hill. Doctor then prescribed Prevacid. Each night Owen would cry for two hours. I just assumed this was “witchery hour”. After a week of this, he cried all night. Then he cried off and on while I was at work the next day. We discovered that he had a horrible reaction to the Prevacid and it caused stomach pain and explosive bowel movements.

Within a day of stopping my little guy was back to normal. We started with the Zantac again and I discovered NUK bottles. The placement of the hole works wonders for reflux babies. It is also easy to add cereal to them. We found that adding 1 tsp per 4 oz is right for our little one. I thought we were finally on the right track doing all of this and inclining his bed.

Now, after a couple of weeks on the Zantac Owen is back to refusing the bottle and arching his back in pain during feedings. He looks uncomfortable when he eats all the time and now is showing signs of pain for awhile after he eats. He is extremely congested and wheezy. In the last two days he has projectile vommited 4 times. It is in the amounts that seem like a whole bottle. It takes him 5-10 heaves to get everything out.

I am at my wits end of what to do. The doctor makes it seem like our only options are Prevacid and Zantac. Neither of these are working for my little guy and I feel so bad for him. He is the happiest little baby despite all of these eating issues. I guess this big long story comes down to me needing some advice. What should I do next? Do I ask to see a specialist, or just wait it out. Should I try Mylanta two hours after the Zantac to maybe help with the burning?

[Anonymous]

Hi and welcome. The reflux roller coaster is very tough!

It sounds like your baby is in a lot of pain and zantac is very weight sensitive, that is probably why Owen is doing OK for a couple weeks and then going downhill again.

I have heard of other babies having problems with Prevacid and stomach cramping. Was it the Prevacid solutab? If you are using a PPI drug like prevacid, prilosec or nexium, you need to give it on an empty stomach and then feed 30 mins later. This can be tough for a newborn but necessary for the drug to work properly and for you to notice your baby get more comfortable!

We had a lot of luck with Nexium. it comes in powder packets and can be mixed with water and given (on an empty stomach).

If you don’t think your baby can wait it out, there is also Zegerid. once it is mixed it becomes an immediate release PPI and DOES NOT need to be given on an empty stomach, so there are def other options out there!!

You can check out http://www.marci-kids.com for the proper dose for your baby’s weight. There is a dosing calculator on their website. Most babies do best on the max dose for their weight & even better of the drug is split up and given 2-3x daily for maximum coverage.

p.s. you can DEF use Mylanta in the meantime and in between dosings. It needs to be spaced 4 hrs from a PPI like prevacid. If you are just using Zantac spacing doesn’t matter as long as you aren’t overdosing. I think 1ml 4-5x a day is ok. Maybe someone can chime in about that!

HTH!

Jill

jilly782009-06-16 10:24:17

[Anonymous]

Jill,

Thank you so much for replying! I went ahead and called the pediatrician today. I asked her if there could be something in my diet causing Owen additional pain because this morning he was very very uncomfortable but this afternoon he didn’t seem so bad. He still wouldn’t eat more than 2oz at a time but he wasn’t arching his back and kicking his legs after he finished eating.

The pediatrician said to try cutting out wheat next. I already discovered that Owen is sensitive to dairy. She also said that we can try a different PPI if I do not see any results. For now I am going to start trying to mix his Zantac with Cherry Supreme Mylanta and watch my diet for any additional intolerances.

I really just want him to be comfortable, it’s so sad watching him stare off with tears in his eyes along with all of the other signs of pain he shows.

I appreciate your response and the tip about nexium! Sometimes it’s nice just knowing that someone understands. 🙂

[hellbennt]

hi there!

another option, not to make you crazy…is caracream/bufferbabies. this is another way to take a PPI and it does not have to be timed around meals.

there is more about it here:

Prevacid 101(last post on the page): https://www.infantreflux.org/forum/forum_posts.asp?TID=1936&PN=0&TPN=1

also you might want to stop thickening? this can cause distress on already sensitive digestive systems…

you can also give zantac, too, just space 4hrs from the PPI. to find out maximum dose for weight, we can help you or:

it’s 10mgs per kilo and here’s a conversion chart

conversion chart: http://www.sfca.co.uk/match/kilolbs.htm

don’t just take my word on the dose, read here:

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

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

also, like Jill posted, check out http://www.marci-kids.com to make sure your baby is on a PROPER PPI dose…

hang in there!

[Anonymous]

Laura,

Thanks for responding! Do you think that the bufferbabies will work even though the Prevacid caused a negative reaction with my little guy? He screamed horribly and had repeated explosive bowel movements. I am willing to give up the rice cereal but sometimes that is the only way he will eat anything(I am already using the slow flow nipple). Lastnight I tried the Mylanta with the Zantac and he actually ate a 4 oz bottle! Although this was after projectile vommitting massive quantities. So this morning, I gave him a bottle with no cereal and he seemed to do ok. As long as he will eat, I won’t continue to add in the cereal. I’m trying to wait things out before jumping to another medicine, but I don’t think anything we are doing is going to stop the projectile vommiting. Do you think I should just ignore the projectile vommiting as long as he seems comfortable? I’m just so nervous that he is going to have the same reacation as last time.

[hellbennt]

you could try prevacid capsules- you open them up & give the beads in a tsp of applesauce; you give it on an empty stomach followed by a ‘meal’ 30 minutes later. my guess is the reaction was from the ingredients in the solutabs- there is flavoring, coloring, aspertame, etc.

if the dose isn’t an issue (check http://www.marci-kids.com ) then I would go ahead and fax your dr & just TELL that you’d like to switch to capsules. provide pharmacy ph & fax # in your fax. then follow up with phone call(s).

as for the vomitting: the meds don’t stop this…they stop the pain

glad to read the zantac & mylanta helped! have you calculated the highest dose of zantac?

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

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

conversion chart: http://www.sfca.co.uk/match/kilolbs.htm

when you get a moment, please go to the upper right-hand corner of this screen and click on ‘settings’ and from there you can edit your signature and let us know how old baby is, what formula or breastfeeding, MSPI or not, what meds and what doses and form of meds and how you’re administering-thanks! It’s hard to keep track of all these little ones

[Anonymous]

I will definitely keep the capsules in mind if we need to try another medication. I didn’t realize that the projectile vommiting wouldn’t stop with proper medication. When he first started Zantac (both times), he didn’t do this at all. Also when he was on the Prevacid he didn’t projectile vomit. He did spit up on a regular basis, but it was always small amounts. The projectile vommiting is extremely large quantities. Owen seems to be more comfortable during his feedings since I started the Mylanta, but he is still very uncomfortable during sleep. The only way he is not arching his back and kicking his legs when I lay him down is if it is on his back. I even tried to incline the mattress more last night, but it still didn’t work.

I’m pretty sure he is on a good size does of Zantac. He weighed 11.6lbs last Tuesday and he is on 1 ml of Zantac 3x a day.

Thank you so much for your advice, this is so helpful!

[Anonymous]

I meant on his belly, not back 🙂

[hellbennt]

the vomitting MAY stop but not necessarily- have you had him checked for pyloric stenosis?

sometimes w/ silent refluxers they BEGIN to vomit w/ meds (feel more comfortable; don’t try to hold it back/swallow it back down)

This is from the American Academy of Pediatrics & how they recommend that tummy sleeping is best for GERD babies. http://www.aap.org/new/sids/question.htm (thanks Sherry & Christine!)

BEANIE BABY: for day time naps I suggest this: Try putting her on her tummy & put a beanie baby on her back for 2 reasons- to see that she’s breathing (the beanie baby will go up & down )

& for the weight- put your hand on her back & then slowly leave it & the beanie baby is there instead…

For sleeping, there’s also the Tucker Sling that people rave about: https://www.infantreflux.org/forum/search.asp?KW=tucker&S M=1&SI=TC&FM=0&OB=2

as well as the Amby Hammock: https://www.infantreflux.org/forum/search.asp?KW=amby&SM= 1&SI=TC&FM=0&OB=2

11.6lbs= 5.2 kilos

5.2 x 10 = 52mgs total for the day of zantac

liquid is 15mgs/ml

so 52 divided by 15 = 3.5mls total for the day

so you can give an extra .5 ml if you need to (add it to evening dose?)

[Anonymous]

You are such a wealth of information! Our pedi did discuss other possible causes of the projectile vommiting early on. After our last appointment she felt confident that Owen didn’t have any of the other possible issues because he had very significant weight gain. At our first appointment he only weighed 6lbs 2 oz. At his 2 month check up he was up to 11lbs 6 oz.

With that said, I’m really confused by Owen’s symptoms. It doesn’t make sense to me that he projectile vomits only after taking zantac for awhile. During this time he doesn’t seem any more comfortable, he actually seems less comfortable. It also doesn’t make sense the amount that he is throwing up. The quantity is so much larger than any other reflux babies I have been around.

I may talk to the doctor about having him tested to see if maybe something else is going on. Overall he had a much better day today, other than only eating 2oz at a time. we haven’t ahd any projectile vomit episodes, so that’s a good thing!

Thanks again for all of your help! I’m going to keep tracking our progress for the next couple of days before I call the doctor and decide what our next step should be.

[Anonymous]

Have they considered DGE?

[Author]

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