Prescribed Pepti-Junior...

[FellowTraveller]

My 9 week old daughter has been diagnosed with reflux by our paed. She is on Zantac and he has also put her on Pepti Junoir. She also has trouble with her bowels - having a bowel movement only every 2-3 sometimes 4 days. She is not constipated as such as her poo is very soft - when she finally does poo! She clearly becomes very uncomfortable by the time she finally has a bowel movement and passes heaps of foul smelling wind. This formula smells awful and she really struggles to drink it - so i am concerned re weight loss too. Our paed suggested mixing it with her original formula - which i think makes it all a bit pointless really. She still seems to vomit alot & i dont see a huge change in her reflux distress either. Our paed said this was all trial & error - just to see what works. Is there a formula on the market which is better for babies with reflux? I have this urge to just put her on a goat milk or soy formula. She was on NAN HA. I am feeling really frustrated and worried about her unrest. I am aware of not making too many changes at once. I would always consult with my Dr before making any changes. HELP!

[RISA]

Hi,
It sounds like things have been tough for you all. Finding the right treatment, what works best for each child can be extremely difficult, but it sounds as though your doctor is quite knowledgeable with dealing with reflux, which is great. They are also aware it is often a matter of trial and error- not like a lot of other conditions where you get diagnosed and treatment is standard. With reflux, it is often not that easy unfortunately. It believe is really important that you trust your instincts, as you are doing, and do what you feel comfortable with (in conjunction with your medical dr, in order to find the right answers.

It sounds like your dr suspects food sensitivities, as you perhaps are as well since you had her on a hypoallergenic formula initially. Is there a history of food sensitivities in the family? or allergies? Pepti Junior is often used in food sensitive children, and can be quite successful, but considering she still has problems with her bowels and the foul smelling wind, I wonder if it would be worth talking to your doctor about trialling one of the amino acid formulas like Neocate or Elecare. Unfortunately, they both taste horrid too, but if they aren’t causing any problems for the bub, it’s surprising just how many will drink them despite that. Does she have problems with her weight yet, or are you just concerned that problems might develop?

I suspect your drs reasons for suggesting adding some of her old formula to the pepti jnr was so that you could accustom her to the taste and then gradually lessen the amount of old formula she is receiving until she is on only pepti jnr. It was probably not a permanent solution, and one that can often work (if you do it gradually). Given that you haven’t noticed much change in her, I’m not sure how effective it would be anyway.

The goat or soy formula may be an option as well, particularly if her issue is just with cows milk protein (and also because your instincts are telling you to try them). Unfortunately it is impossible to tell, and there are a lot of babies who have problems with cows milk protein who also react to protein in soy and / or goat formula. The proteins are apparently very similar, so there are no guarantees it will make any difference, but it still may be worthwhile trying. Have you talked to your doctor about that option? Was he/she hesitant about using either? If so, I imagine that would be why. Even though they are similar, and reactions are common, I have seen some babies who do remarkably well on soy formula, where they hadn’t on cows milk formula. I wish I could tell you whether it would help for your bub, but as your doctor said, it’s all trial and error.

Alternatively, do you think she could be constipated? It may not be likely, but that could account for a lot of the foul smelling wind and her discomfort until she goes as well. If she is constipated, even a little, it can flare reflux even more, so you can end up with quite a vicious cycle. Sometimes if you clean out the bowels, the other problems resolve, or at least improve.

Something else to consider is medication, in an attempt to control her discomfort as much as possible. She is on Zantac, and perhaps the dose needs to be increased. As babies put on weight, it generally needs to be increased anyway, and doctors often start at quite low doses. When my son was on Zantac, his dose had to be increased every couple of weeks, until they changed him to a more effective medication for reflux- for him it was Losec. Perhaps that is also something else you could try? There are several medications that are used in that category of medication- Losec, Zoton and Nexium seem to be the most commonly used in babies. It may be worth talking to your doctor about trying one of those, and if you don’t find one of those helping, even using a combination of one of those with Zantac e.g. Losec and Zantac.

I hope that gives you some ideas, and I hope you find something that helps her,

Glenda

[FellowTraveller]

Thankyou so much for your reply - very helpful and I made my husband read it too! We did listen to our gut feelings and have switched her to goat milk formula late last night (at 11.30 last night I was driving around looking for a supermarket that stocked Goat milk formula!!) - after a HORRIBLY restless day. She seems to be more settled today - sleeping and drinking heaps better. But not pooing!! Just two very quick questions - whilst technically she is not constipated (I don't think and neither does the paed) as her stools are very soft when she finally has a bowel movement (every 3 days give or take) I have read that Zantac can cause constipation in babies - is this common (her dose is 1.5ml twice a day - we just had it increased)? I am worried that this will slow down her bowels even more. And if so, is there another reflux med that is less likely to cause constipation?? Is there something I could do to help her bowels (I do the bicycle movements, warm baths, massaging, adding extra water and have tried infants friend)? Do you think I should worry about it or not??

[RISA]

Hi,
I am happy to know that I have helped in some way- sometimes just being more confident to trust our instincts can make a huge difference.

I have my fingers crossed for you that this change in formula will help- though even if it doesn't, you know you have tried.

I guess if the paed is happy she isn't constipated, and you are doing so much already, you don't really need to worry. Hopefully the change in formula will be the answer she needs. The only other thing I can think of at this stage is brown sugar added to her feeds, but I would talk to your doctor or child health nurse to see what they think. My only hesitation with the constipation, is that my child was constipated for a very long time, because her poos were soft and looked normal, and it wasn't obvious at all. It's what made me think of constipation, and I know that it can cause the offensive smell and the discomfort as well.

Any of the reflux medications can cause constipation, though it doesn't seem to be a major concern with Zantac, as far as I can tell- they are all different though, so it's hard to know. A lot of refluxers seem to have bowel issues- either constipation or diarrhoea- and the bowel issues can be part of the reason why they have reflux too, so that's another possibility.

This is one more thing you have to trust on your gut instincts- they seem to be serving you well, so take the time to listen to them on this too.

Glenda

[FellowTraveller]

Hi again Glenda...

I feel fortunate to have found this forum site and really appreciate your feedback and hope I am not taking up too much of your time....one last thing (yet again!!)....

My daughter's situation could well be similar to your daughter's. SInce changing to formula from breast milk my DD has always had this sluggish bowel problem. Whilst our paed said he would not say she is constipated - he maintains that that having a bowel movement every 3 days or so is not good enough for a formula babe. He said she should have a daily bowel movement - if not at lease every 2nd day. With this, he initially suggested that I try different formulas (but was not specific about 'which ones' I should try) until i found one that suited her. I was hesitant about chopping and changing formulas. When I took her to a GP (just because our paed could not see her) he suggested giving her prune juice or coloxyl (?) drops - but paed said 'no' as her bowels were soft anyway.

I was really interested when you said that the reflux and bowels bizzo could be linked as I am sure that her reflux (and spewing) gets worse as she gets closer to finally having a bowel movement (I used to think this was my imagination!). Then when she finally has a poo she her reflux also seems better - and she just seems a different baby! Relief!!

Whilst my daughter's health nurse said not to worry about her bowels (as this could just be the way she is) I do feel she becomes very uncomfortable and distressed - and thus think it needs addressing.

Can you tell me more about the sugar in her feed? Did this help your daughter?

[RISA]

Hi,
I am really happy that I have been able to help once again, and please don't worry about writing (though if you are interested, you are of course very welcome to join our organisation- there is more information at www.reflux.org.au) It can help - knowing you aren't the only one, and feeling like things are ‘normal’ can make a huge difference too!

My daughter's constipation was unusual because she always had soft poos too, and it actually got quite severe before anyone realised. It might be best to see whether your daughter stablises with the change in formula though- before any other changes are made. Apart from anything else, it can end up being very confusing.

Our paed gastro explained that being constipated puts pressure on the stomach, which can cause reflux. It may have been why you have noticed her getting worse before she goes. I wonder if you kept a written record, it would make it much clearer for you- so you could confirm how much her bowels impact on her. Is her reflux still a problem straight after she has moved her bowels? I was just wondering how much it was impacting, and a written record can help make what's happening really clear- you can notice patterns that you may not have noticed otherwise. It can also help the dr see what is happening- and for some reason, they seem to take more notice of that, than what we are saying.

Did your paed outline why the prune juice wouldnt be effective? I can understand the coloxyl as that is a stool softener, but prunes are more of a stimulant (I thought). Brown sugar, in young babies, can apparently work in a similar way. It has something to do with young babies not having the enzyme they need to process it yet. I think that it would be best to talk to a child health nurse or your doctor about how best to use it, though there is of course information on the internet about it. My daughter was older when her constipation was recognised, though it was a concern to me all along- so we never used brown sugar. A lot of kids in our group are prescribed lactulose or Movicol- but of course you need to talk to your doctor about that- and also if either would be suitable.

I agree that things are worth pursuing- simply because your instincts are telling you that you should! Hopefully the change in formula will be the answer, and you have already solved the problem, but if not, please keep looking for the answers she needs, and keep reminding yourself how much of a good job you are doing!

I hope that helps
Glenda

[FellowTraveller]

Hi Glenda...
Good news and bad news....My DD's reflux appears undercontrol with Zantac and we had to persist with the Pepti-Junior (as directed by the paed) due to her bowels - 4 days. We have finally conquered that and now she is taking the Pepti-Junior. She only sometimes drinks the whole bottle (140mls) more often she only takes (80 - 110mls). So weight too is an issue. It appears that she is becoming 'constipated' as such with hard stools. Last time she had a bowel movement (3 days ago) it was clearly painful and hard - and I noticed a drop of watery blood too. I think the Zantac is making her constipated. I am really frustrated and really upset regarding her bowels. :crying: She is difficult to settle and has sudden bouts of screaming - like craps I think. It seems that one end gets cleared up and the other end clogs up. I tried some anal stimulation tonight with a cotton bud and vaseline - needless to say I was so bloody tentative and hated the whole proceedure! I rang my paed and he has not rung me back. I am going to ask to be put on a different medication. I am so tempted to stop the Zantac but I know her reflux will then return. What do you think? Any thoughts?

[RISA]

Hi,
I am glad that things are finally looking better. Constipation seems to be a common problem in reflux bubs, and you may find that her reflux flares as a result. It puts extra pressure on their tummies, and the natural consequence of that is reflux.

Zantac may cause constipation, but so a lot of other medications, including Losec. It may be worth trying, though of course there are no guarantees. A lot of families have to use other things to treat the constipation, ranging from pear or prune juice, extra water, to medications such as Movicol or Lactulose.

I'm glad you are talking to your doctor about this, as it definitely sounds like something that needs attention. I wouldn't recommend stopping the Zantac without talking to your doctor. It may not even be the Zantac that is causing it- perhaps its because she isnt drinking all her bottles, and perhaps it is the pepti jnr, and perhaps it is simply part of the whole reflux issue- gut motility issues seem to go hand in hand with it.

I hope that helps and I hope you can get her bowels sorted out quickly so she feels more comfortable.

Glenda