what is the best type of treatment?

[jessgray]

my son has recently been diagnosed with reflux and he is 4 days off 1 month old. the dr hasnt been very forthcoming with information on how to cope with reflux or manage it. i am confused about what i am being told by different ppl.
some say use thickner in my breast milk. others say stop breastfeeding and use a thickned formula. some talk about gripe water not sure what that it. and i have been told to use infacol. the dr doesnt want to start treatment till everything else is ruled out.but i just want something that will make him seem less in pain and less irratable. i dont mind the vomit.

[RISA]

Hi Jessgray
Thanks for contacting our organisation, and congratulations on the birth of your son. Well done for being able to get a diagnosis of reflux at such a young age. As you already know, coping with a new baby can be demanding and stressful, but when the baby also has reflux, it can become overwhelming.

Reflux can be such a difficult condition because what works for one child may not work for another. That can be the reason why so many people seem to have a differing opinion. They may know something that worked for a child, but there are no guarantees it will be the answer for your own. Many people also don’t realise that reflux can be anything more than a baby who spits up occasionally, so most likely don’t understand that he has pain with it. It isn’t unusual, by the way, for family or friends not to understand, and therefore not offer the support you may desperately need.

There are lots of different strategies you can try, but it remains trial and error to find what works best for you and your son. Some bubs will do really well using thickened feeds or formulas, but others won’t. Some bubs may respond to colic remedies, and again, others won’t. The best thing to do is to trust in your own instincts, and if someone suggests something you are interested in trying, then go ahead and try it- but only if you feel comfortable with the idea and only if it will suit you and your family. If it works, then great, but if it doesn’t, it doesn’t, and you may need to find other options.

If you are interested in trying using thickened feeds then there are a few ways you can go about doing it. It can help to know that thickened feeds generally won’t stop them from refluxing, but may reduce the amount of vomiting they do.

Using a thickener doesn’t mean you need to stop breastfeeding. You may choose to give him a spoonful of thickened milk before, during or after a feed, which can be effective as well. You can thicken milk with a variety of products on the market for that purpose, or you can do as I did when I was breastfeeding and opt to use a very small portion of commercially thickened formula.

There is no indication at all to stop breastfeeding, if that is what you would prefer to do. Breastmilk has many advantages over formula, and apart from those you would already be aware of, I believe studies have shown that babies are less likely to reflux on breastmilk than formula, or if they do reflux, it isn’t quite as bad. Breastmilk empties out of the stomach quicker so there is less in the tummy to reflux back up. Also, it can help to think of it like this- breastmilk is the perfect food for babies. If they are struggling somehow with breastmilk, then why would formula be better? Formula does strive to be as good as breastmilk, but can never quite be as perfect.

With the suggestions about gripe water, and infacol, I would say that they are confusing reflux with colic (especially as many people believe they are the same condition). If your son has problem with wind, then they may be very effective, but if you don’t think that is much of an issue for him, then maybe they won’t be. Again, follow what you believe is best. If it’s something you want to try, then do so, and if you don’t, that’s okay too. Some colic preparations have muscle relaxants in them, which can also worsen reflux in some babies.

If you find something that works, and you feel comfortable with (and has medical approval) then by all means, continue doing what works!!! That is the bottom line, as sometimes it can be all about survival. If you find the general management strategies don’t help, or aren’t enough to help him feel comfortable, or you have any concerns, it is important to get further medical guidance.

There are quite a few things you can do at home that you may find helpful, such as-
- keep him upright as much as possible throughout the day. Use whatever products that are available to help- there are lots on the market for this purpose.
- consider trying a baby sling/pouch to keep him with you, and upright, though be sure he doesn’t slouch in it, as any extra pressure on his tummy can cause reflux
- keep him upright (as much as possible) while feeding, and for 30 minutes after it
- avoid tight elastic waistbands, and ensure nappies are loose around the tummy, so there is no extra pressure causing more reflux
- consider using a dummy if that suits your beliefs, and if he will take it. Dummies can help some babies as they can encourage the production of saliva and also encourage swallowing. It can wash out and neutralise the acid in the oesophagus and help them feel more comfortable
- feed him smaller more frequent meals (but try not to get it less than 3 hrs)
- aim to provide play times/tummy time before a feed rather than after
- change nappy before a feed rather than after
- when changing a nappy, roll him side to side rather than lifting his legs up
- elevate the change mat so he isn’t lying totally flat
- elevate his cot/bassinet- this may not help but can be worth trying. All the studies that have been done have been done when bub was lying on their tummy. They know an elevated position is best in that situation, but aren’t sure if lying on their backs affects that. It can be worth considering though
- since you are breastfeeding, avoid eating foods such as spicy or fatty foods, carbonated drinks, caffeine, chocolate, and acidic foods such as tomato.
- Some bubs do react to foods, so if you are comfortable with the idea, it can be worth avoiding all dairy items (even traces in food), though you will need to seek medical advice regarding this option

I hope this helps and if you have further concerns, please talk to your doctor. If we can help with any other issue, please let us know,

Glenda

[jessgray]

i have been told that a milk intolerance is sometimes the cause of reflux:confused: how is that different to lactose intolerance? i am lactose intolerant but can now eat small amount of dairy before getting a reaction.
i come form a very allergic family, i have asthma and eczema and hayfever my 18 month old son has asthma and hayfever and eczema and he is also lactose intolerant.should i ask for an allergy test on my newborn son before taking dairy out of my diet?
the rest of the info was a great help :)

[RISA]

hi Jessgray

I’m glad you found the information helpful. Sorry I didn’t explain the cows milk sensitivity better though. Quite often it seems to be the protein in cow’s milk that causes reflux in some children (in one study I read it was just over 40% of reflux infants were cows milk protein allergic or intolerant). I believe that the intolerance to protein is far more common than lactose intolerance but see no reason why a lactose intolerance couldn’t trigger reflux as well. It seems like anything that stresses their body is able to do that.

What kind of symptoms do you and your son get with your lactose intolerance? I don’t think it always follows all your children will have food sensitivities, but in light of your bub's problems, it may be worth considering.

It would be best to discuss allergy testing with your doctor, but I believe that it is not always necessary (or accurate in babies). Only allergies will show up on the testing as well, not intolerances, so a negative result doesn’t exclude any problems. The most accurate way of determining if there are any food sensitivities is to remove them from the diet and see if it makes any difference (and then challenge it). It is really important to do that with guidance from a doctor or dietician though as a balanced diet is doubly important when you are breastfeeding, and it’s also important to remove all traces of milk from your diet if you do decide to try this option.

It can be difficult taking dairy completely out of your diet, so it’s not always an easy choice. It may also not be the answer, as there are a range of different causes of reflux, but if you do decide to trial this, you need to feel comfortable with the idea and feel it is right for you and your family

I hope that helps further

Glenda

[jessgray]

thanks :)
my 18 month old son has vomiting and the runs and will get a sore tummy when he reacts to dairy. i only react now if i eat or drink alot but i get the same symptoms.

[RISA]

Hi Jessgray,
Has a doctor formally diagnosed lactose intolerance? As I said in the previous response, cow's milk protein intolerance seems to be far more common than lactose intolerance, and the signs/symptoms you describe can also fit in with the protein sensitivity. (if it is lactose, you should be able to tolerate cheeses, yoghurts and cooked dairy products).

It does sound like that is something you may need to consider at some stage, but please seek medical guidance if you do take it any further. Remember that I am just a reflux parent like you, and have no professional training in that area. I can only tell you what I think from talking with a lot of other reflux families over the years.

I hope that helps, and I hope you get the answers you need. Reflux bubs are all different, and it can be tricky working out what works and what doesn't!

Glenda

[jessgray]

yep i was diagnosed as a bub but till the age of 2 i was really sensitve to anything that had lactose in it, its how my 18 month old (diagnosed this year after easter) has been till now, he now is able to eat yoghurt (wasnt a fan of lactose free ones and soy makes him vomit)
i am going tomake an appointment to see the dr hopefully i can get in on monday:fingerscrossed: then test results would be back by wednesday morning.

sometimes TJ wont burp and i know he needs to coz he will smile and stuffbut he will fall asleep before burping what is a way to combat that?

[RISA]

Hi Jess,
I think it’s a great idea to talk to the doctor. Did they know of your history and Cody's, with lactose intolerance? If so, I wonder why they didn't consider that possibility. It will be interesting to see if TJ does as well.

Getting a bub to burp sometimes can be really difficult. Some bubs seem to burp effortlessly, while others just cant seem to. You may have tried these already, but I have heard other mums say have him held upright on your shoulder and just walking around while patting him can help. Alternatively, sitting him on a gym/exercise ball and very gently bouncing him on it can sometimes be successful. (some of the mums in our group have sworn by that method). Perhaps if you can get the reflux/intolerance issues sorted, you may find this much less of a problem. Hope so anyway.

Best wishes at the doctors and I hope you get the answers you need

Glenda

[jessgray]

thanks i will let you know what the dr says.

[jessgray]

just wondering. can reflux cause a baby to have diarrhea(sp?) i cant keep dairy down anymore and i now use soy instead i used to be able to have small amounts of dairy. he doesnt seem sick.but his spew is more milk like and less curdled farex looking. the only thing different i had was bread and weetbix

[RISA]

Hi Jessgray,
The diarrhoea can be related in someway to the reflux; it may be a result of whatever is causing the reflux, but reflux in itself I don’t think would cause diarrhoea. Could he have a gastro-like illness at the moment? They don’t always have to look sick, to have some kind of bug. Is he teething etc? Are you concerned by the change in what his vomit is like? Has it changed in volume, frequency, discomfort, or anything? I guess one answer may be that it may be a result of your change in diet, but considering he has diarrhoea, then I would suggest talking to a doctor again.

Because of the diarrhoea, it sounds possible that he has other food issues, which is not unusual either in reflux bubs. Apparently the protein in soy is very similar to the protein in cow’s milk, so there are a lot of bubs who are intolerant to both. I know of some who are actually more intolerant to soy than they are to cow’s milk. Wheat seems to be another food that refluxers can have problems with as well, so that may account for the changes you noticed.

It is all very complicated, and very confusing, so I think talking to a doctor (and a dietitian) about the possibility of allergies/intolerances may be worthwhile, especially in light of the family history. It may also be worth talking to them about the possibility of infection.

Other than that, I’m out of ideas, sorry. I hope you can get to the bottom of it soon, so he can be more comfortable and you can enjoy your little man more.

Glenda