Silent Reflux - thickeners, mylanta?

[~Kimba~]

My boy is almost 8 weeks old and since birth he's been gagging/ swallowing/ poking tongue out/ grimacing during and after feeds, and has always disliked being put on his back to sleep (would cry if I put him down while awake).

Now he's older, his symptoms are even more noticeable, and on a good day would include the above plus wet-sounding burps and the occasional little almost clear vomit (usually some time after a feed, like an hour or more). I can also hear him 'refluxing' at odd times and he has a loud, dry cough at odd times also, sometimes while sleeping.

On an average day particularly in the afternoons when he's more tired, he's quite unsettled, fights sleep, catnaps, cries when put on his back, fusses at feeds, and wakes suddenly crying or with a cough. And on a really bad day it's all the above plus refusing to sleep, fussing/ fighting/ back arching/ screaming during and after feeds, sucking his fists and dummy like mad, and inconsolable 'pain' crying. He's quite snuffly in his sleep too.

He is breastfed but due to low supply I also top him up with 30ml of formula at his afternoon/ evening feeds.

I'm pretty convinced that he has silent reflux (will get GP to check it out) and I already try most of the suggestions such as keeping him upright after feeds etc. But I'm curious as to whether milk thickeners will help, or whether thickeners are only useful for babies who actually vomit a lot?

Would I be better off getting a pre-thickened formula, OR getting some thickener and mixing with water or breastmilk? I'm also curious as to what dosage of Mylanta is recommended?

[RISA]

Hi Kimbaleo,

Congratulations on the birth of your little boy. It sounds like you have been having a really hard time with him though. It also sounds like you have already done a lot of research, so good on you for that.

He does sound really uncomfortable, so you are definitely doing the right thing by taking him to the doctor to have him diagnosed. That is the first thing I would have to recommend too. While he does seem to have all the signs of reflux, there are also other conditions that can present similarly, such as a urinary tract infection. It is really important that your doctor is satisfied it is reflux before you do start following further treatments for reflux, even if it is thickened feeds or antacids.

I’m sure your doctor would have an opinion on what would be best for your little boy if he is satisfied it IS reflux, and may even prefer to start medication.

To answer your questions, thickeners do tend to help those babies who vomit a lot, more so than others, but they are all different, and impossible to predict. Thickeners have been determined to lessen the amount of vomiting/regurgitation but not necessarily the amount of refluxing. For some refluxers, it is a great answer, but for others, it can actually make them worse as it can be harder to clear from the oesophagus.

Thickeners, if they are helpful, can be just as effective by using a spoonful of thickened milk or water before, during or after a feed, but as I said earlier, they are all different.

As for what dose of Mylanta is recommended- goodness, every doctor has a different opinion on that one!!! It’s generally more important how much Mylanta is given in a 24 hour period, as opposed to how much in each dose. Talk to your doctor about how much is appropriate.

I hope that helps. If your doctor is happy that your son does have reflux, then please feel free to contact us again and we may be able to offer some management strategies to help

Glenda

[~Kimba~]

Hi Glenda,

Thanks for the fast and detailed reply :kiss:

Doctor's appointment is next Tuesday (when bub is also having his first needles - not looking forward to that, I can tell you!) So I'll let you know how we go, because if it is reflux I'd love to hear some more suggestions for relieving his distress.

When he's having a good day he's just so adorably sweet, so I'll do whatever it takes to help him be more relaxed and happy on his 'bad' days (or avoid them altogether :fingerscrossed:)

thanks...

[~Kimba~]

Hi Glenda,

Went to our GP today and explained my DS's symptoms and (after quickly checking with a paed on the phone) she agreed it presents like reflux. She prescribed 10mg Losec to be taken once a day as a 'trial': if it clears up the symptoms in 4-5 days we know it's reflux and if it doesn't, it must be something else. (Note: she also asked for a stool sample just to rule out dairy/ lactose intolerance)

I'm a little hesitant to put my baby on medication at just 2 months old, especially if it's NOT reflux, then we're medicating him for nothing - but then again I want him to be well, comfortable, content and happy!

My questions:

Is giving Losec (10mg) a bit extreme, does it have any side effects, could we possibly try alternative strategies first? Or should we just start with the Losec?

What alternatives are there to medication? EG Gaviscon, Mylanta, thickened feeds etc - would it hurt to try these first and then go get the medication if they don't work?

With the losec, my GP told me to crush the tablet and mix it with formula or expressed breast milk and give it to bub to drink - but the Losec instructions which I've read say NOT to crush the tablets so that the pellets within the tablet are not damaged. Will it still work if the tablet is crushed and mixed with milk?

thanks
Kimba :)

[RISA]

Hi Kimba,

That’s a positive step by getting a diagnosis, albeit not a certain one. Unfortunately reflux is often a diagnosis by exclusion and the best we can do is follow our doctors guidance and also our instincts.

It’s sometimes a difficult decision about putting your child on medication, so it may be best if you discuss it further with your doctor (or pharmacist). They may be able to put your mind at ease about giving him medication, but I can definitely understand your shock and concern. I imagine not in your wildest dreams would you have considered medicating your baby at any stage!!

There is no set treatment plan for every child with reflux, so it is always a matter of trial and error. Your doctor (perhaps on the advice of the paediatrician) has prescribed Losec, but perhaps another doctor would have suggested trying Mylanta first. (Gaviscon and Mylanta are also medications, but they are used to give short term relief). Perhaps another doctor would have recommended thickened feeds, so if you are really uncomfortable with the idea of administering losec, then please discuss it further. Perhaps using Gaviscon or Mylanta would give you a quicker answer about whether it may be reflux, but I didn’t find it helped with my children particularly. It is such an individual decision, and very personal as sell, so you need to follow your instincts on this, and also talk to your doctor.

Regarding your question whether giving Losec is a bit extreme, not necessarily. It is used quite commonly for reflux babies now, and has been used quite successfully for quite a few years. In our organisation, there are a lot of children/infants who take losec, and many of them are on much higher doses. My own children have all taken losec too (my youngest is now 10 yrs old). I guess it depends on whether you think medication is warranted. The doctor has not prescribed a huge dose either, so perhaps that is something that will make you feel more comfortable. There is a National Prescribing Service's Medicines Line you can call as well, which can provide independent pharmaceutical advice. Their phone number is 1300 888 763 (9 am to 6 pm).

I have seen it take longer than the 4 or 5 days to be effective as well, though some babies can improve almost straight away. This is because the acid production is stopped quickly, but if there is any irritation or damage in the gut, it may take longer to notice any benefit. Like everything else, they are all so different. Some babies don’t respond until the right medication and right dosage is discovered, and that can sometimes take time too. (it can be such an overwhelming condition to deal with and to treat!!!)

If you do decide to go ahead with giving Losec, it is important that the granules are not crushed as they have an enteric coating, and they may become less effective. (The granules need to stay intact until they reach the intestine). It is also important not to administer it with breastmilk or infant formula as it isn’t acidic enough, and the medication will again be less effective.

These are the instructions from the manufacturer of Losec (Astra Zeneca):
 The tablet may be dispersed in non-carbonated water (mineral water is not suitable) or non-carbonated fruit juice. Water should not be warmer than room temperature. OR
 You may disperse it in a small amount of water, and then add it to a spoonful of pureed apple, pear or yoghurt (if appropriate). If using something other than water, it must be slightly acidic and soft enough so that the child won’t chew it (to ensure the tablet is not chewed or crushed).
 Do NOT use milk/breast milk or formula in place of water, as it isn’t acidic.
 Please note that the tablet will not dissolve completely in liquid- the small enteric-coated pellets containing the active ingredient will remain intact. Please take care not to crush these pellets.
 Once the tablet is dispersed in liquid, it must be consumed immediately or within 30 minutes.
 Give at the same time each day

There is a Losec suspension you can get from a compounding pharmacy as well, which may be another option, but it is more expensive. You can find a list of them in the phone book.

To administer the capsule, what you would need to do is dissolve it in a small amount of water. Some parents will put it on a spoon and add a few drops of water, then spoon it into the child’s mouth. Even young babies can sometimes manage this (and each time any granule comes out, put it back in). Others put the capsule in a syringe with a wide opening (like a panadol syringe), or a dropper, give it a gentle shake, and then syringe it in the side of the baby’s mouth (again, replacing any granules that slip out). Others will mix it with apple or pear puree but your son is perhaps a little young yet for that (speak with your doctor about whether a tiny spoonful of it would be okay)

Have you tried the lifestyle management strategies like:
- keeping him upright during the day, especially for his feed and ½ an hour afterwards? Sometimes using a baby pouch or sling can help
- Ensuring his nappy is loose and there are no tight waistbands
- Using a dummy occasionally if you are comfortable with the idea (and he will take one)
- Offering smaller meals more frequently (but not closer than 3rd hourly)
- Avoid him slumping as that can put more pressure on his tummy, causing more reflux
- Avoid overfeeding.

Deciding whether or not to medicate is often a very personal decision, so I hope that extra information helps. Please continue to follow your instincts and I am sure you will make the right decision for your son,

Glenda
PS Gorgeous photo!! what a cutie!!

[~Kimba~]

Have you tried the lifestyle management strategies like:
- keeping him upright during the day, especially for his feed and ½ an hour afterwards? Sometimes using a baby pouch or sling can help
- Ensuring his nappy is loose and there are no tight waistbands
- Using a dummy occasionally if you are comfortable with the idea (and he will take one)
- Offering smaller meals more frequently (but not closer than 3rd hourly)
- Avoid him slumping as that can put more pressure on his tummy, causing more reflux
- Avoid overfeeding.


Hi Glenda,

Yes I got the tips from the RISA website ;) and am trying ALL of these, with the exception of not feeding closer than 3 hourly - I don't have heaps of breastmilk so bub still feeds 2 hourly or so during the day. But I'm pretty sure he's not getting overfed! so I guess that's OK...?

I double-checked with my GP and pharmacy and they both advise that it's fine to crush the Losec tablets and mix with either milk or water - the pharmacy told me that they actually crush the tablets themselves and mix into a liquid for some patients! So now I'm a bit confused...anyway I think I want to try just thickened feeds first to see if that helps and if not then I'll give the Losec a crack.

Thanks for all your help! And thanks for the compliment I think he's cute too ;)

cheers
Kimba :)

[RISA]

Hi Kimba,

It sounds like you are doing a great job, and just continue to trust your instincts and things will be fine, I'm sure.

I have to say too, about the Losec, I'm confused too. We specifically verified the information with Astra Zeneca a while ago as there was a lot of confusion about how to give Losec, and that was their response. The only thing I can suggest, is if you do use Losec, is to perhaps check with Astra Zeneca themselves????

Sorry to confuse you, as that wasn't my intention.

Glenda