Waking Up Gagging

[pebilz]

Hello!

My 5 week DS woke up gagging on Sunday night struggling with foaming at his mouth, watering eyes and a little bit of milk coming out of his nose. This was the second time this has happened so we called the ambulance and took him to the hospital and it also happened again today. The incident only lasted for about a minute and the docs monitored him for 24hours and have since diagnosed him with reflux. He does seem like a very windy baby and is quite restless especially at night time. He is currently both breast and formula fed. I have been trying to get him back to breast only but it's been very difficult to get my supply back up.

The hospital docs prescribed him Zantac but my GP said he shouldn't take it. I'm very unsure what to do as in general he doesn't seem like a very spewy baby but more windy. He also seems to feed quite often - sometimes even hourly.

Are there any other symptoms I should be looking out for? What would you recommend?

Thanks for reading.
Marissa

[RISA]

Hi Marissa,
I can imagine how scary the situation was the other day for you!!! My son choked when he was a baby, and we also called the ambulance (and he was also diagnosed with reflux as a result). It is absolutely terrifying to watch your child struggle to breathe, and the ambulance, at least for us, seemed to go soo slowly.

Can I ask why your GP told you not to give the Zantac that was prescribed for him? Did he explain that to you, as I’m not sure why he would have said that, given the hospital gave you a diagnosis of reflux? Did he offer any other treatment for him instead? I’m sure you are keen to avoid any further events like he has been having. Did he suggest anything like using an apnoea monitor as perhaps that can offer you peace of mind? If you are still not sure what to do, or still have concerns as you do, I think it is important you get further medical advice.

While every reflux baby is different, and will present differently, there are lots of signs and symptoms they can have. Some refluxers will vomit- profusely and frequently. Others may regurgitate occasionally. Others still may never vomit at all (like my son), but can still have severe reflux. Some will want to feed almost constantly (as your son does, and mine did), while others may refuse to feed at all. Some will cat nap throughout the day, and generally sleep really poorly, while others will sleep well all night long!

Some appear to have pain, while others don’t. Some will have respiratory issues with their reflux, while others don’t. All in all, it can sometimes be very difficult to diagnose reflux in some children, especially if they don’t vomit a lot. If you wanted to see what other ways they can present, there is a list on our website at http://www.reflux.org.au/presents.php

Hourly feeds are not unusual with reflux babies, and it sounds like he is quite smart- he has worked out that when he is feeding, it feels better. Often a reflux baby will drink frequently like that because they have learnt that having a feed can wash any acid out of their oesophagus and they feel better- so every time it starts to hurt, they want to feed. (others can work out that the feed is the problem and refuse to feed at all!!) The problem with feeding too often is that they are quite often refluxing an hour after a feed, as that is the time the stomach is the most active. If they are fed then, the stomach never gets a chance to empty, and they will be actively refluxing about an hour after that feed, and so on it goes. It can be REALLY hard to break that cycle (been there, done that, as I didn’t know any better).

Another issue may also be that he can get too much lactose if he is feeding frequently, as foremilk contains more lactose; and not enough hindmilk (which has more fat and protein) If he gets really distressed without a feed at the hour mark, then perhaps try to use distraction, offer him a dummy, or talk to the dr and see if it is okay to give him some antacid or other short term relief medication. Keep him upright too, to lessen the chances of him refluxing.

The fact that he is windy can mean that he is getting too much lactose, that he is sucking in a lot of air when he feeds and/ or cries, is intolerant to something he is eating, or something else entirely. It can be sooo difficult to figure out what exactly is going on, and you can really go nuts trying to figure it all out.

Some other things you may be able to do, at home are-
- keep him upright as much as possible, including when he is fed, and afterwards for at least ½ hour. You may be able to use products like baby slings/pouches to help as a lot of reflux bubs seem to like being carried. Just make sure he doesn’t slump in it as that can cause more reflux.
- Try to elevate the head of his cot and change table
- Change his nappy before a feed rather than after, and keep his nappy and any waistbands loose
- Roll his legs side to side rather than lifting them up when you change his nappy
- Consider using a dummy if he will take it as that can help reflux bubs
- Offer him play time before a feed rather than after, when his belly is full
- Talk to the doctor about introducing thickeners- this can be done using a spoonful of thickened formula, or thickening water or breastmilk with some thickening agent. It may not be the answer for him, but it may help. Once again they are all different
- Alternatively, as cow’s milk protein sensitivity can be a problem for a lot of reflux babies, it may be worth removing dairy from his diet to see if that makes any difference (if you do decide to try this idea, then please talk t your doctor or dietitian about this option)

I would also suggest you talk to a lactation consultant to build up your milk supply, as I’m sure they would have some great ideas for you. It isn’t easy maintaining your supply when you are so stressed, so that’s a good reason for you to look after yourself!!!

Please continue to follow your instincts, and please continue to seek medical advice when you have any concerns,
Hope that helps and that I have given you the information you were looking for

Glenda

[pebilz]

Hi Glenda

Thank you for your very prompt reply.

Our GP said that using the Zantac might affect his stomachs germ killing properties for some reason. Anyway I talked to my pharmacist about it and he reassured us that it's perfectly fine so I have gone with my instincts and started using it and have noticed a small improvement already.

As for my milk supply I have tried vitamins, diet changes and feeding constantly (as is pretty easy at the moment with his snacking) but at the same time a little hard with 20 month old who wants to be entertained. I have now just started taking Maxalon but unfortunately that has slowed my body right down to the point where I can barely pick up my DS so my hubby and I are considering reverting to formula only. So my questsion is do you recommend a reflux formula? We just bought a tin of the S26-AR.

Thanks again for all your help.
Marissa

[RISA]

Hi Marissa,
I’m glad you spoke with your pharmacist about using Zantac. I know it is commonly used on a lot of children with reflux; and I had thought it was a generally very safe medication, but it’s always good to hear other perspectives as well.

In case you weren’t aware, Zantac is very much a weight related medication as well, so as your son puts on weight, it may be necessary to have the Zantac increased. It may not be necessary, but it can’t hurt to know.

It certainly sounds like you have been doing a lot of things right to re-establish your milk supply. It also sounds like Maxalon isn’t the right drug for you- have you spoken with your doctor about its side effects?? (on the other hand, has it been since you’ve been taking that, that you’ve noticed an improvement in your son, as it is also a medication that is occasionally used in the treatment of reflux in children) The improvement you’ve noticed could partly be due to you taking maxalon, rather than starting zantac.

I had heard from one of the other mums in our group (who is a midwife) about a natural preparation that may help with your supply, though I don’t know anything about it. She says that there is a herb called “Blessed Thistle” that can help with supply, and it generally works within 3 days. As I said, I know nothing about it, so if it is something that interests you, please check it out first.

As for which formula to use if you do find it necessary, that is all trial and error unfortunately. I have heard that S26 AR is okay for some refluxers, but it is impossible to predict if it will be the most suitable one (sorry). Thickened formulas can be really effective for some children with reflux, particularly if they vomit a lot (and they may not even need any other treatment), but for others, it may not work at all. (it can even make some worse). Thickened formula generally helps to reduce the amount of vomiting, but may not necessarily have any effect on the reflux. It may be all trial and error, but since you already have a tin of it, it could be worth trying. I’m sorry I can’t help further.

I hope that helps,

Glenda

[pebilz]

Hi Glenda

Thanks again for getting back to me so quickly.

We'll be making an appointment with the doctor from the hospital this week so hopefully he'll be able to fill us in whether or not we'll need to increase the Zantac or not.

Fortunately it wasn't until we started the Zantac not the Maxolon that he seemed to get better. But I will try some of that Blessed Thistle - anything is worth trying.

At the moment he is sleeping which is his second nap of the day - a total miracle! So fingers crossed things are looking good.

Many thanks again
Marissa