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wild at heart
04-04-2011, 22:15
Long story.. my poor LO is almost 11 mths and has battled reflux friom birth. Eventually after months and months and months of failure to thrive and regressed development and muscle wastage due to weight loss or plateau, she was put on neocate when gastroenterologist said that she was allergic to cows milk and soy. Np testing was done, but the idea was that her reactions and vomiting was so severe that it was more of an allergic reaction (I was breastfeeding and I had been dairy and soy free for about 4-5 mths but it made no difference to her weight gain or reflux).

She's been on neocate for almost 4 mths but starting on foods is very hard and she is around her two older brothers who try to give her foods, so i thought it may be worth actually looking at what she can and can't eat. The gastro's vioew is don't worry about the foods- just give her a taste but keep her on neocate for nutrition, but i find that she wants to eat for the satisfaction feeling of feeling full and is more able to sleep if she has had some food as well as her bottle. Besides, at some point she will need to eat something rather than synthetic formula.

So last Tues we had an appt at an allergy place (a one stop allergy palce just opened in bris) as we are on the waiting list at the RCH allergist, Dr Peake. The Dr there is Dr Tye who just said test her for cows milk soy and egg- even though i excpressed concern about wheat (she had truied some coucous about 3 mths ago and she didn't cope well- screaming and crying afterwards). No reaction to the skin prick test. Dr still thinks allergic - but maybe growing out of it. He just said to challenge for soy eggs and dairy one at a time. That was it! He said that thdere would be no reasin to be concerned about wheat and that it was the trendy thing to stress over these days "like yeast and candida was in the 80s and 90s!".

Yesterday I did some reading that maybe the failure to react to the skin prick tests was because she doesn't have instantaneous results to those food if she injested them so she unlikely to have aln instant reaction on her skin- coukd that be right? I have also heard that sometimes SPT are not conclusive in babies under 18mths?

Anyway back to the point- we were encouraged to test her or challenge for wheat/gluten. Dr suggested we try her on durum wheat pasta (just a taste) or oats every day and then progress to more often. She went ok the two times we tried it (just a taste of pasta but I then tried her on a Heinz apple oatmeal breakfast jar as she had tasted it before, and i thought she was ok with it (No dairy just oats and apple- nothing except fruit and apple according to label, but that's not to say there is nothing else in there). That was y/day and all day she was really really really really bad. All day she was hiccuping, burping, constipated, crying and vomiting very badly. I am sure she was vomiting blood as her vomit was completely reddy dark brown in colour- like the colour of dark wood (she has vomited blood a lot of times but this was waaaaaaaaaaaaaaaaay worse than ever before..). She has done two poos today and they are literally like black tar (think meconium but firmer- SORRY TMI)- the first was just poo but the second one was the same meconium type substance but with lots of mucous as well. I know that this means that yes she does have a bleed somewhere in her GI tract, but i don't know whether it is just "one of those things that happen" with reflux bubs.

Would you bother trying again in a few more days to ensure it was wheat? I am sure she has eaten nothing else new over the last few days.

We are going back to gastroenterologist in ten days- should I ask for a wheat allergy test with the hospital allergist when i can finally get in??

I know everyone will say to do failsafe but it's not as though she is even eating a full range of foods, so i can't even say that i know that she doesn't ahve any other issues with other foods, so if i cut out a whole lot of her food (which i would if i started FS as she is only eating limited veges and only limited potatoes due to constipation so there would be not much else that she can eat yet). I am too scarec to start on gluten free stuff as much has other things that she can't eat like soy or dairy (like the gluten free breads and stuff). And i think i still need to add plain foods one at a time but i want to give her some carbs apart from rice cakes/baby rice cereal and plain rice!

oooh what do i do? The allergist made me feel so stupid, like i was stressing ovcer nothing when her tests came back _ve but inside i knew that things weren't hunky dory with her and foodm otherwise she wouldn't ahve been sooo very sick as a baby. The allergist just said to have fun with foods but this is NOT fun!

has anyone been in this situation? any other advice for me apart from "have fun"?? :(

c38
04-04-2011, 22:51
I haven't been in this situation. I'm a Paeds Nurse and I will be honest and say that I'm not much of an expert on allergy. But I am very concerned about her vomit and stools today. It sounds very much as you say, that she vomited blood and has a bleed somewhere in her diestive system, given the black stools. She needs to be seen in ER for a review. 11mth olds don't have a hugh circulating blood volume and can become very anaemic quickly and also dehydrated very quickly from such internal bleeding. It is vaguely possible that the bleeding could be due to her reflux, and a tear/inflammation in her oesphagus...but brown vomit and black stoold for >24 hours is quite a bit of bleeding. She may well need some fluids and some iron therapy.
I would be taking her to the ER for review, espescially if she has any more black stools. Tey can ring your GI and get his opinion and let him know what has happened.

I'm sorry that your GI does not seem to be listening nor explaining things well to you. It seems highly likely that she is reacting to the Oates from yesterday. You are correct in that skin prick testing is not 100% accurate in the under 2yr olds. And it is possible to have anegative skin prick test, yet still be orally intolerant of a food. As SPT only tests one type of Immunoglobulin reaction. Also inflammation caused by a reaction to something is the result of a release of chemicals from the immune cells (generally mast and esinophils) some of these chemicals have an imediate effect, others can take time to cause the imflammation... know as late phase effect. This doesn't not show up in SPT either.

cindye
05-04-2011, 22:12
This article (http://home.vicnet.net.au/~disa/Food%20intol-alergic%20baby.html) is one I found really useful in working out the differences between allergies and intolerances. I highly recommend you read it.

Because intolerances are more to do with the digestive system, I believe that skin prick tests are not always a reliable method of diagnosis.

My girls have both had issues with certain foods.

DD1 had severe eczema from when she was virtually a newborn. She had teething rusks (with dairy as an ingredient) before we saw a dermatologist and because of the eczema around her mouth he suggested we have skin prick tests done. She had them done at 6 months and they showed up allergies to dairy, soy and eggs. The egg one was severe and it was recommended I eliminate eggs from my diet while I continued breastfeeding her. She is 3 next month, and it was only last November that her skin prick tests indicated she had finally grown out of the egg allergy. She grew out of the dairy and soy ones at around 2. She has since had a reaction to a macadamia nut and continues to have terrible eczema. She did have reflux, but was a "happy chucker" and it didn't bother her in the slightest.

DD2 had severe reflux from within a fortnight of her birth. She literally screamed 6+hrs a day EVERY day until she was at least 4 months old. She was on a cocktail of medications - Losec / Zantac and Mylanta and I was on a completely dairy and soy free diet. Her poo was slimy green mucous and around this time last year she was pooing blood regularly, loosing weight and refusing to feed. I gave her one bottle of prescription formula in a moment of desperation which she projectile vomited. I went off all all soy / dairy / wheat and eggs for a month until her insides healed and then re-introduced wheat and eggs. At around her 1st birthday in December I was able to introduce dairy again in my diet. It's only just now at 15.5 months that she is eating dairy herself with no issues. We had a "failed" challenge at 14 months.

DD2's paed GI said that to do a challenge you should feed them a "reasonable" amount of the food to be challenged every day until the following three symptoms occur -
Return of reflux
Tummy cramps
and Mucous in the stools.

The mucous is the absolute sign that the food is not being tolerated - since the other things can be attributed to other factors.

Based on that, I would say your DD has failed the wheat challenge...

I would be talking to your GI about the allergist's results - he might prefer to keep managing your DD's case exclusively.

There are lots of non dairy and soy foods that you can give your little one. I would be trying more things like sweet potato, pear, etc Rice is good for bulking up meals, and meat (particularly lamb and chicken) are unlikely to cause her grief.

My DD really only started eating solids at 11 months, and it's only since she turned 14 months that she's discovered her appetite. I'm hoping her voracious eating at the moment will propel her out of the 3% on the growth charts ;)

I'm hoping that in my ramblings there is something useful. For a start, read that article - it's really good. And know that you're not alone - I feel your pain!

If there's anything else you can pick my brain with, please feel free!

Good luck and I hope your DD feels better soon. :hugs:

wild at heart
05-04-2011, 22:46
thanks for the replies..

she has been vomiting blood again today (still) and hicupping and just being refluxy and irritable all day again.

i ended up getting a call from the hospital allergy dept saying they could fit me in for an appointment on thursday. I figured that since i was on the waiting list anyway it couldn't hurt to talk to the allergist about it. The clinic i went to last week was not a paediatric clinic and i really didn't leave feeling i worked anything out at all.. i will see what the allergist says (maybe nothing different) and talk about the wheat "challenge"- the allergist can recommend whether there is any role for her to play or whether we should have it managed exclusively by the paed gastro.

I will look at that article- thanks

c38
06-04-2011, 09:22
If your child is still vomiting blood PLEASE take her for medical attention today

babywez
06-04-2011, 09:28
I'm not a Dr, but I can't imagine vomiting BLOOD is a good thing at.all. I'd be in the ER if it was me. Better safe than sorry. Poor little mite must be feeling really awful.

smog
06-04-2011, 10:03
i too think you def need to go to the hospital
and probably try to find a new allergist too

cindye
08-04-2011, 11:00
How did your appointment go yesterday? Has all the vomiting and blood in the poo stopped?