Reflux questions

[Oscar's mum]

Just a few questions. Isla has been on Zantac now pretty much since birth and it has not been working for us at all. I tried taking her off it for a week or so then putting her back on it etc. So yesterday I went back to the Dr and explained that it wasn't really working and she was if anything worse now that ever.

They also weighed her and at almost 5 months she has only gained 2.11kgs since birth which they said was of a concern:confused: .

So, I have been given Losec to give to her twice a day.

I was hoping perhaps 1. you could explain what Losec does - will it help keep the vomit down or just ease the pain associated with reflux?

Also I was reading another thread in this section and you said:


Losec shouldn’t be given with breastmilk because it isn’t the right acid level to help with its absorption.

I was told to express a bit of breastmilk and mix with the Losec and then breastfeed her - is that wrong?

Thanks for your help.

Edited to add: I gave Isla the Losec for the first time today and she vomitted 10x more. Also the Dr said 1/4 of a tablet each dose - how am I meant to break the tablet into 1/4's?????

[RISA]

Hi,
Good on you for following your instincts, and addressing your concerns about the Zantac with your doctor. I hope you find the Losec to be more effective, though sometimes they may need quite large doses to be the most effective (which can involve a bit of trial and error). Losec doesn’t stop the vomiting as such, though you may find if she is in less pain, the vomiting may lessen (though it doesn’t always lessen it unfortunately). It generally eases the pain because it inhibits acid production in the stomach (much more effectively than Zantac).

Regarding administering the Losec, the information we got from the manufacturer when we approached them about it, specifically said not to give with breastmilk. This is their information:

To assist in the administration to young children, the tablet may also be dispersed in non-carbonated water (mineral water is not suitable) or non-carbonated fruit juice. Water should not be warmer than room temperature. Alternatively, you may disperse it in a small amount of water, and then add it to a spoonful of yoghurt (if appropriate), pureed apple or pear. 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.

I hope that extra information helps.

Hopefully with her reflux being better controlled, you may find that her weight increases, though I am sure the doctors will be taking an interest if they are concerned about it. Failure to thrive isn’t at all unusual with reflux bubs, either because they refuse to feed, feed with lots of difficulty, or because of all their vomiting (or a combination). What signs does she have? Is feeding difficulties and vomiting large amounts an issue with her?

If she is associating feeding with pain, then it isn’t surprising if she doesn’t feed well. Often these bubs will feed much better while they are drowsy, and some will even feed well if they are asleep. There may be other ways of trying to manage it. If she is vomiting so much that she can’t put on weight adequately, they may try using thickened feeds at some point too. When breastfeeding, you can still use that option, though of course it is slightly different than when bottlefeeding. You may be able to offer her a spoonful of thickened milk after a breastfeed, which may help a little.

I hope that is the kind of information you were looking for, and if you have any other questions, please don’t hesitate to ask,

Glenda

[Oscar's mum]

Failure to thrive isn’t at all unusual with reflux bubs, either because they refuse to feed, feed with lots of difficulty, or because of all their vomiting (or a combination). What signs does she have? Is feeding difficulties and vomiting large amounts an issue with her?

She have any difficulties feeding and will happily take the breast she just vomits alot.



If she is vomiting so much that she can’t put on weight adequately, they may try using thickened feeds at some point too.

I will speak to my Dr about thickened feeds thankyou for that suggestion.


I hope that is the kind of information you were looking for, and if you have any other questions, please don’t hesitate to ask

I did have another question - I was told to give 1/4 of a tablet as a dose, how do you break such a tiny tablet in quarters?

[RISA]

Hi,
That is a really good question!!! I can imagine you are having all sorts of trouble breaking it, and I would also imagine that you are losing effectiveness with it, just by trying to break it! It is really important not to crush or chew any of the granules so I'm not sure how you would successfully manage that.

I am presuming you are using a 10mg tablet? If you're using a 20mg tablet, the obvious thing would be to start using the 10mg so you are only having to halve it. If using a 10mg tablet, it makes me wonder if the dose is going to be big enough to be effective anyway.

If you find that things aren't improving over the next few weeks, it may be worth discussing that with the doctor. It can unfortunately take that long, and sometimes even longer, so maintaining lifestyle modifications, and perhaps using antacids, may be necessary. I hope you do notice an improvement much quicker than that though,

HTH

Glenda

[Oscar's mum]

I have taken my little one off the medication all together as even the Losec wasn't really helping, she was still super cranky and vomitting constantly. Her reflux was getting worse and worse so I thought I would try eliminating certain foods from my diet again (I had done this previously but it made no difference) (as I hadn't introduced solids yet as I was not really coping with the breastmilk vomits and so the thought of adding in pumpkin vomits etc really would have sent me over the edge.

Anyway, I discovered that whenever I eat anything with dairy in it (no matter how small the amount - ie 1 tbspn of yoghurt) she vomits again.

Here is the part that I am confused about though - everyone I speak to tells me that dairy will not cause reflux:confused:

[RISA]

Hi,
Congratulations on figuring out a huge piece of the puzzle. Dairy can most definitely cause reflux, and you are right, even small amounts can (even down to trace amounts in food, and its important, esp in the early stages, to avoid all traces).

Who is telling you that dairy cannot cause reflux? (isn't it amazing how many people seem to have an opinion, even if they don't know for sure!!??) Even going on anecdotal evidence, there are lots and lots of families in our group whose babies most definitely react to dairy- and some also to soy or other foods. There is a lot of medical evidence that also confirms that, with one study I am aware of quoting the figure at something like 40% of refluxers have an allergy to cows milk.

I am sorry that I never thought to mention the possibility ot you, but you have come to that conclusion anyway. Good on you for continuing to look for answers!!! As always, please trust your instincts- they are obviously very good, and they should be listened to.

Have you talked to your doctor about the link with dairy? If they aren't sure about it, I can provide some links to internet articles on that topic that may help, so just let me know.

Since you are already adapting your diet, it may help to talk to a dietitian who is experienced in the area of cows milk sensitivity too, to ensure your diet is well balanced- as that is so important of course.

I hope that helps, and good on you for figuring it out!! and for listening to your instincts

Glenda