Reflux and small frequent feeds

[Lauren30]

Hi
I was wondering if anyone could help me and my 3.5 month son who has been diagnosed with reflux.
My son has been on 9mg of Losec twice a day for the past 2 weeks or so. The Losec has done a good job of reducing the obvious discomfort he felt whenever he ate (i.e. screaming, back arching etc), however he is now only having very small feeds very often throughout the day and night (i.e. 8 feeds a day). Each feed consists of about 5 minutes on the breast plus about 20 mL of formula (if I am lucky). I have tried food thickener but nothing seems to help. Are small, frequent feeds a symptom of reflux? If so, is there anything I can do about it? Should I be worried that he is not getting enough food? Should I try offer him food more frequently?
Also, he has a terribly blocked nose in the night which makes sleeping extremely difficult. Other than this, he is showing no signs of a cold and is generally happy (unless feeding!). I have tried saline drops which haven’t made any difference. Could this be a sign of reflux?
Many thanks

[RISA]

Hi,
Congratulations on the birth of your son. It sounds like things are really tough for you though!!
It’s great that the Losec has made such a big difference, and hopefully you will be able to work out what else he needs so that he feels more comfortable. At least the success of the Losec proves to you that you’re on the right track!!

Your instincts are right too, as small, frequent feeds can be a sign of reflux; it’s generally known as comfort feeding. Because he is doing that, I wonder if the pain isn’t fully controlled yet. Some babies like to comfort feed because they figure out that when they are feeding, it is quite soothing, so they therefore like to do that as much as possible. I think for some of them, they don’t know what hunger is, and it’s the pain that drives them to feed. (It was with my own son)

The concern about whether he is getting enough food should be answered by how much weight he is putting on; is he gaining weight satisfactorily, or is it a bit of a struggle. Have the doctors mentioned anything about his weight? Is that why you are giving him formula as well?

Reflux bubs who comfort feed can tend to put on heaps of weight (which can sometimes make it hard for the mum to get the medical help they need as they look so well), so perhaps that helps a bit. Sometimes it is really difficult to break this cycle of comfort feeding, simply because of their pain. The best thing is to remember if he is trying to feed very frequently, say every hour or so, is that he would be refluxing as that is when the stomach is most actively digesting the feed. If you feed then, you aren’t letting his stomach empty and it causes them to reflux more. If he does want to feed then, it may be best to try to distract him, or try to gradually extend each feed until they are better timed.

If he is feeding much less often than that, then it may be okay- often refluxers do better with slightly less volume, slightly more often, but it’s better not to feed more often than every 3 hours. (they are all different though, and you need to figure out what works best).

Can I ask why you are offering him formula as well? Is there a reason for that? Is that because you are worried he isn’t taking enough, or because he shows signs of continuing to be hungry? It can be really hard to work out what is going on, and perhaps some Mylanta or Infant Gaviscon which can offer short term relief, would help you figure it out (talk to your doctor if you haven’t been advised to use it).

Sometimes just really concentrating on getting into a routine can help, as a lack of routine can actually flare reflux (might be nearly impossible I know, if reflux is not well controlled). Other things that can flare it, which may be contributing are things like teething, immunizations, being overtired, and being sick.

Your instincts are pretty good, as a blocked, congested nose can be a sign of reflux. If you have a look at our website, you will see it is listed under how reflux presents “Congestion, ‘snuffling’ or appearing to have a cold”. Are you able to raise the head of his bed more, or is it already quite high? If you haven’t raised it, that might help.

I’m gathering that because you are giving him 9mg that he is taking a suspension. If so, did you know that it depends on what the compounding pharmacist used as a suspending agent for its shelf life? Some suspensions only have a shelf life of 10 – 14 days, and others are much longer (up to 45 days I believe), so if the pharmacist didn’t tell you, it may be best to find out how long it is. (it’s also important that a compounding pharmacist made up the suspension rather than a general pharmacist).

I hope that information helps, and I hope you find ways to help him feel more comfortable,

Glenda

[Lauren30]

Hi Glenda
Thanks so much for your detailed and quick response. Sorry for the delay in replying 0 it has been a crazy few weeks.

We started him on formula because initially, we thought he was unappy at the end of a feed because of a supply issue. He has always put on consistent amounts of weight (ie 100-200 g per week). Now it is confusing and difficult to tell if he is unhappy because of reflux or if it is really a supply issue.

On one hand, I'd prefer not to give him formula because I'd like to keep breastfeeding and topping him up clearly interferes with my supply. This is particularly the case if it is reflux that is upsetting him rather than hunger. On the other hand, I don't want him to be hungry and I worry that this is why he is waking so frequenrly! Trying to work out whether supply or reflux is the issue has been the hardest thing...

As for the blocked nose, we have tried raising his bed but found this didn't help and only interfered with his sleep. I think he may be lactose intolerent as his nose only became a problem when we started the formula.

One other question - do you know what causes reflux? Is it possible that the formula started it? We started seeing signs of reflux as soon as we started him on formula. If this is the case, should I avoid formula at all costs? Even if he is being medicated on Losex?

Also - in your experience - how long does it take for the Losec to work? He has been on it for almost three weeks and whilst it is helping, he is still not sleeping well in the day or night.

Thanks again for your help.

[RISA]

Hi Lauren,
It is confusing, isnt it, but please remember it isn't because you are doing anything wrong. It just can take a lot to work out all the answers you need for bub to feel more comfortable.

Given that his weight has never been an issue, and that he hasn't settled since you started topping him up with formula, I would perhaps think that he wasn't hungry. Of course that's a hard one to call too, but I'm just going on what you have said. If it hasn't helped by now, then it may be that it isn't the answer he needs. (That is just my thoughts though, and they are not necessarily right. Please do what you feel is right as your instincts are so important!!)

Something else that may impact, is that if he wasn't hungry, and he is still getting the 'top up', then he is more likely to reflux because of an overfull tummy. Could that be why you have noticed him becoming more snuffly since then too? Maybe it isn't the formula so much, but the extra volume he is getting?

It may still be the formula though. I wish there were easy answers for you, but that isn't the reality, sorry.

As for what causes reflux; there are a lot of different things that can contribute. For some bubs, it is food sensitivities, like cows milk protein, or soy, or wheat, egg etc; for others, it may simply be a loose sphincter, or a muscular, or neurological issue, or a heap of other things. I think thats one of the reasons why treating reflux can be so difficult. If there are food sensitivities, then a specific formula may make a big difference. Could it also be the bottle, or the teat?
Some are designed to reduce the amount of air that bubs suck, so i wonder if that impacts at all.

If you do find out it is the formula causing it, then perhaps just a change in formula would help. For some, the answer is using an elemental formula such as Elecare or Neocate, so I wonder if they are worth considering (they are prescription formulas so you would need to talk to the dr about them).

Also, from talking with other families, Losec will often work in a couple of weeks, but with some children it can take even longer (especially if the child has been particularly irritable/distressed). It's good that you have noticed a difference, so that at least is showing you are heading in the right direction; that it is reflux you are dealing with. I know when things are still quite difficult, you can start to doubt that!

It may be that it is going to take a little longer yet, or it's possible another medication may be more effective (e.g. Zoton). Have you made sure you have shaken the bottle of Losec really well each time, and that it has a longer shelf life than 10 - 14 days? From information we have been given from a doctor and a compounding pharmacist, if bicarb is used as a suspending agent, then the shelf life will only be that long. Additionally, sometimes they will add whey protein to extend the shelf life, which may not suit some bubs (who have a cows milk protein allergy/intolerance) as that is a component of cows milk. The other alternative I am thinking of still is the food intolerance/allergy angle- perhaps that is why you have seen an improvement with medication, but not as much as you would like? It would be worth finding out whether they have used whey protein in it, and also what agent they did use.

I'm so sorry I can't give you the answers you need. I really wish I could, but perhaps that will give you some ideas again, and I hope it helps,

Glenda

[Lauren30]

Thanks so much Glenda for your additional advice. I will ask the chemist about the whey protein issue.
Thanks again.