What Goes Down, Shouldn't Come UpFebruary 23, 2012
aka Managing 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.
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
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!
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.