What Goes Down, Shouldn't Come Up

February 23, 2012

aka Managing Infant Reflux

When Lily was about a month old, we started noticing that she would have episodes where milk would come squirting forcefully out of her nose, shortly have a feed. At the time I was mostly breastfeeding with some supplementation via the bottle, because of her poor growth.  When it first started I didn't think much of it, but over the next week it quickly got progressively worse, and we ended up receiving a diagnosis of infant reflux.

She was put on 2 ml of Omeprazole once daily, which is just a generic version of the popular stomach med, Prilosec. While the Prilosec did help, it didn’t get rid of the reflux altogether. Over a span of only a few weeks the situation went from bad to worse. By the time Lily was 2 months old she was routinely projectile vomiting full feeds 1-2 times a day! She was fussing at both the breast and bottle after taking in only an ounce. Getting her to eat 1-2 oz was a feat in itself.

At her first endocrinologist appointment, she was referred to a speech therapist for poor feeding. I couldn’t understand how a speech therapist was going to help us, but I was game for anything at that point. I was WRONG! That man was a saint, and he helped us tremendously.

Here is a summary of what I learned from him, from friends that also have babies struggling with reflux issues, and via trial and error.  I share this today, because it was a lot of work collecting this information and a lot of pain (on both our part and Lily’s) went into experimentation for what worked best for us.  I’m hoping that another family struggling with infant reflux will find this helpful.  Also, even though we were told it was not related, the picture I’ve drawn from talking to other mother’s of TS girls is that reflux is very common among these girls.  Just another TS awareness fact for you this fine February! 

We found that the Playtex Nurser bottles – the ones with the disposable bag inside – with the latex (brown) nipples worked best for us.  She refuses to suck on anything silicone to this day.  The latex is softer.  I’m not sure if this is due to the transition between breast/bottle feeding or something else.  But seriously, I bought EVERY SINGLE bottle Target sells, and this was the one that finally worked.  It was also the last bottle I bought and tried.  Murphy’s Law?  Not sure.  I just know that I was really against the disposable bags for environment purposes.  Luckily our garbage company recycles that type of plastic, so they don’t go in the trash! 

Ready to Feed Formula
After trying everything from breast milk to soy, and having her projectile vomit it all, we finally found that a ready to feed formula worked the best for us.  Best meaning that the projectile vomiting is down from 1-2 times a day to 1-2 times a month!  Ready to feed formula is apparently easier to digest than powdered formula, and it is slightly thicker than regular formula, and much thicker than breast milk, which may explain why it stays down better.  Please no comments here about how breast is best.  I completely agree that breast is best, but it doesn’t work for every mom, and it doesn’t work for every baby.  I needed my baby to keep whatever she was ingesting in her tummy, and this is the only thing we found that stayed down.  Specifically we use the Gerber Gentle Ready To Feed formula.  I’m able to find this at Target, Walmart, and Babies R Us.

Feeding Tips
After working with the speech therapist we discovered that Lily was breaking her seal on the bottle with each suck, especially when she sucked vigorously and at the beginning of a feeding.  This was making her inefficient at sucking, and allowing her to suck in more air than she should be.  He worked with us to give her support on her chin to try and stop this with a finger just pushing up gently on the tip of her chin.

One of her main patterns was to suck down about an ounce in 2-3 minutes, and then shut down or start to fuss, and refuse to take any more.   Our speech therapist told us that if you put 100 babies in a room with reflux, 80-90 of them would show the same behavior. The stomach at 2 months holds about an ounce, so that is the point where the stomach starts contracting in babies with reflux. Babies can eat more than an ounce, because the milk starts processing through their small intestine immediately as they feed.   We worked to split her feedings into 3 parts, following this pattern:
   -- Feed her until she slows down or stops
   -- Stop for approximately 5 minutes, burp and take a break, giving the stomach time to empty
   -- Repeat x 2           

Of everything we tried, this was the most effective at getting her to take bigger volumes, minimizing reflux and spitting up, reducing fussiness.

Medication Tips
The shelf life of most reflux meds is very short.  The pharmacy will typically give you a 30 day supply at one time, but by the time you get to the last 1-2 weeks of the supply, the effectiveness of the med is greatly diminished.  Ask your pharmacy to authorize the full 30 days from your insurance company, but only make half, then in 2 weeks call them and have them make the other half.  We use Target pharmacy, and they have been more than accommodating doing this for us.

If you are giving a med like Prilosec make sure you are giving it on a mostly empty stomach.  Prilosec requires stomach acid to work, and it isn't as effective on a full stomach.  We also found that if we gave this med immediately after a feeding the full feeding was coming up as vomit all over us!

Beware of Certain Meds and Vaccines
Amoxicillan can flare reflux.  I found this out the hard way - by experience.  After doing some informal research talking to other moms of reflux babies, it sounds like any antibiotic ending in ‘cillan’ can create issues for some babies with reflux.  Ask for something different if you need to use an antibiotic.

Rotavirus vaccine can flare reflux.  I wish someone had told me prior to the 2 month vaccines that Rotavirus vaccine (taken orally) would be a nightmare!  The following days were some of the worst for us, reflux-wise.  I declined the vaccine at our 4 month visit.

Other Tips and Tricks
Other things we found that helped were holding the baby upright in an inclined position for 15 minutes after a feeding, changing her diaper on her side  if she had to be changed immediately following a feeding, and preventing any sort of compression on the stomach (i.e. putting the baby on her stomach) up to 30-60 minutes after a feed. 

This is all practical advice, that I hope you find helpful, but if you take anything away from this, it is that it will get better.  It will seem like complete hell when you are in the middle of it.  It will feel like you are drowning in frusteration some days.  You might beg with your baby to just “eat” a little more.  There will be tears - from both you and your baby, but all of this will pass!

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  1. Sarah, This is all fantastic advice! I wish I had known particularly about the pausing mid-feed. Both of our children had reflux with our son being more severe than his sister. The feeding upright made a huge difference for us.

    So glad that cute little pumpkin is doing so well! (And you as well.) :)

  2. I'm so happy to hear that you've figured out a feeding strategy! Congratulations! :)

  3. This is great advice! I don't have any kids (yet) but I'm sure glad I have people who will have loads of experience and advice.


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