NOTE: The information contained in this section does not replace the care of a health professional. If you are in any doubt about the health or well being of your child seek professional assistance.

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Question: I'm now dairy free to help him, but which formaula will be best?

"Hi Glenda
I have a 4 1/2 month old boy Jackson who was a very hard to get to sleep, would scream himself to sleep unless he fell asleep on me, would wake crying and only sleep for 30-40 minutes each time, archs back at feed time and often gets very upset also at feed time (breastfed). The days were very long tiring and both him and i were stessed as we were both exhuasted. We went to plunkets parent centre in CHCH for some help and he has not offically been diagnosed with silent reflux however has been put on the ranitidine by the plunket and doctor as they believe that this is the problem. And from some of the question on this site that i have read his signs are almost exactly the same as the children who have been diagnosed.

Since starting this a week a go he has changed alot, he is more settled at sleep time, still wont fall to sleep on his own, needs me to rub his back whislt he fals asleep in his cot but is happier and doesnt seam to sleep in pain, seams to eat better and overall appears to be more settled during the day.

Do you have any advice as to how we can get him to sleep longer during the day as he is still very tired, if he doesn't get at least 4-5 sleeps he is exhausted? Sleeps well at night wakes at 3, 5 and up for day at 6.30am.

They have also reccomended i go on a dairy free diet (hard) to help with his bowel motions as they are still very runny and watery all the time at least 3-4 times a day. I have done this for a week now and have noticed no change, could there be another problem here. I am going back to work in 4 weeks, Jackson is coming with me as i manage a preschool, i plan to breastfeed him morning lunch and night however will need to put him onto formula for the rest of feeds, what do i put him on with the dairy free thing.

Any advice would help.
Regards
Mandy "

Glenda Answers:

Hi Mandy,
It sounds to me like he has been diagnosed with reflux, given that the doctor prescribed Zantac (and because it seems to be helping). It is great that you have noticed a big change already- that is confirmation for you that you are on the right track!

It is possible though that he will continue to improve, and you may find his sleeps improve as time goes by. Sometimes it can take several weeks before you see the full effect of medication. Be aware though, if he does continue to have problems, then it’s possible his medication will need to be increased, so please keep in contact with your doctor. Zantac especially, often needs to be increased as bub puts on weight, in order to remain as effective. This can sometimes be as often as every few weeks.

I am really pleased to hear they have suggested you go on a dairy free diet- as hard as that may be. It is definitely worth considering. It can take a while to notice any change there, but unfortunately, this is a really complicated area, as other foods can also be involved. Sometimes it is worth taking soy out of your diet too, as about half of the children who react to cow’s milk also react to soy (from what I hear, the proteins are very similar). If you have substituted soy for any cow’s milk you eat, that may be one reason why you haven’t noticed any change. It may be best to talk to a dietitian who specialises in food sensitivities, as they can help you work out what foods are best avoided or even minimised, to give you the best chance of success.

With formulas, there are some prescription formulas that may be worth trying, such as Neocate and EleCare. They are available without a prescription, but much more expensive than if you get a prescription. Talk to your doctor about that option. Sometimes HA formulas may be suitable, but you would need to discuss it with your doctor, and if food sensitivities are an issue, may not be broken down enough to be effective.

Keep in mind that food sensitivities aren’t always the answer either. There are so many different treatments and so many possibilities- trust your instincts, and do what you feel is right. It is often a matter of time as you work your way through different treatments; and trusting your instincts can be an important factor.

I hope that all makes sense. It sounds like you’re doing well, and I hope you find the answers to the rest of the puzzle (before you go back to work).

Glenda

Question: Do you think his reflux is playing up again?

"hi ya my baby is 9 weeks and was downing 180mils of milk easy each feed he is on baby gaviscon for reflux (no milk comes up just wind) that was working realy well and he was happy. he had his 6 week jabs and didnt want to eat just wanted to sleep then he got a wee cold after that and started snacking on the bottle but now his cold is gone and he still is snacking as well as getting upset after the first 40 or so mils and then cant drink any more, he gets real un happy but wants to drink, its like he cant get the milk to go down, iv taken him to the docs as its been going on for a week+ but the doc says i have to just ride it out its his reflux. some times hes not even getting 500mils all day so iv started giving him infacol an hour be fore each feed it helps to get the wind up and he is farting more but still only drinks 110mils on a good feed and still wants to drink but has that trouble. also i give him a bit of warm water, some times with gripe water or ginger mix when he gets a real sore tummy as he has just stared getting again after a feed. do you think his reflux is playing up again??????????? "

Glenda Answers:

Hi,
Thanks for contacting our organisation. I think that yes, it could be his reflux playing up again. Unfortunately, there are a lot of things that can flare reflux, with a lot of parents reporting their child’s reflux worsens in situations like you have described. The types of things that commonly seem to flare reflux are- vaccinations, illness (even colds or other viruses), being overtired or out of routine, teething, constipated, crawling, and even a change in weather (often really cold or really hot days). It has been really cold lately and that seems to be a factor for some babies. Sometimes you can notice bad days or weeks followed by good ones- as reflux can run in cycles.

It is also possible for it to be worsening of its own accord- as he is becoming more active, without being able to sit up etc- and this is commonly a time that parents notice them worsening. While it may be a matter of riding it out, it still may warrant talking to your doctor about using medication. While medication may not be something you like the idea of (most people don’t), it may still be necessary if he is becoming increasingly distressed. I would recommend talking to your doctor about that option.

I wonder too, given that he gets so much wind, whether he has some food intolerances- cow’s milk seems to be the most common food sensitivity. It may be worth talking to your doctor about whether trialling a specialised formula such as Neocate or EleCare would be helpful. There are a large number of babies with reflux who are intolerant or allergic to cow’s milk protein, and that is becoming more widely recognised too.

It may help if you keep a written record of what is going on- write down his feeds, and how well he takes them, whether it is disturbed and whether he seems uncomfortable, and also how much he drinks. Also take note of his sleeps, how much wind and when, his wet and dirty nappies, and any obvious reflux signs- anything at all, as it can help you see what is happening, and surprisingly, it can also help the doctors understand what is happening. For some reason, they seem to take more notice of things if they are written down.

You may also like to talk to a paediatrician if things don’t settle.

There are unfortunately no easy answers with reflux. It can often take a lot of trial and error (and time) until you find something that works. Keep trusting your instincts and doing what feels right, so long as it is safe. And especially if things don’t settle down, keep in touch with your doctor, and keep pushing for answers.

I hope you find something that helps and I hope his reflux flare (if that’s what is happening) settles down soon.

Glenda

Question: He has signs of being lactose intolorent

"hi glenda my son orin is 3months old and from birth has had problems with feeding he has lots of signs of being lactose intolorent and weve tryed him on karecare soy formulia,with no change also a thickning formulia which constipated him ive now got him on karicare gold but stil the same he always makes pushing/grunting sounds then crys after feeds pulls his knees up 2 his torso and is now not wanting to finish his bottles he also dosnt ever want 2 b on his back and dosnt sleep during the day as it wakes him up hell be lucky to sleep all up 2hours a day in spaces of 10 to 30 minutes help :o( "

Glenda Answers:

Hi,
Hopefully I’ll be able to offer you some ideas, but sorry, I have a lot of questions for you first.

If you have already spoken with your doctor, and have a diagnosis, then that’s good. It gives you some place to start. With your saying he has lots of signs of being lactose intolerant, has that been confirmed? A lot of people confuse lactose intolerance with cow’s milk protein intolerance, but they are two completely different things. Cow’s milk protein intolerance/allergy is really common in reflux babies (but lactose intolerance is quite rare).

Soy formula is not always the answer unfortunately, as if he does have problems with cow’s milk (usually the protein), then it’s also possible for him to have problems with soy. Some of the children in RISA are actually more intolerant to soy than they are to cow’s milk.

Sometimes too, medications are warranted if they are really uncomfortable and distressed (as well as, or instead of the specialised formulas). There are lots of other conservative strategies (lifestyle changes) you can use as well such as burping more often during feeds, keeping him upright after feeds for 30 minutes, avoiding slumping, changing his nappy before a feed rather than after, and so on.

Sometimes too, when feeds are an issue, some babies will feed better when they are drowsy, so targeting times when he is just going to sleep or just waking up, can sometimes be more effective and they will feed better- I think just because they aren’t awake enough to realise what they are doing.

If feeds continue to be an issue, then it may help to also talk to a speech pathologist who specialises in feeding and swallowing issues in children. They should have lots of strategies you could try too. Feeding issues are best dealt with earlier rather than later, before the difficulties become worse.

I hope those ideas help and that you find the answers you need soon. Don’t forget that you are important too, and you need to take time out to look after yourself. I hope your family and friends are offering you support and helping out as I’m sure you must be as sleep deprived as he is.

Glenda

Question: 4 weeks old and she only dirty's her nappies every 2 days

"hi, my name is lisa and im having a little trouble with my newborn. she is now 4 weeks old and she only dirtys her nappies every 2 days or so and seems to become really unsettled around day 2, like she is really uncomfortable. is there anything i can do to help her do more poos? she hasnt regained her birthweight yet and my lactation nurse recommended a range of things to help me get my milk up, and i was wondereing if this is the cause of her not doing enough poos? "

Glenda Answers:

Hi Lisa,
I’m not sure that I’m the right person for you to ask, sorry. I presume you have been in contact with your doctor over the fact that she hasn’t regained her birth weight yet? If not, then please talk to them about it. That sounds like an issue that needs to be addressed.

Does she feed okay? Or has the problem been identified as a low milk supply?

If she has been diagnosed with reflux, I may be able to offer some ideas, but at this stage, I’m not sure that I can offer any ideas. Perhaps your child health nurse would be able to help.

Kind regards,
Glenda

Question: All the AR formulas are making him extremely constipated

"Hi Glenda,
My 5 month old son has shown reflux signs since he was about 2 months old. He would projectile vomit after every feed and I would constantly smell vomit on his breath. He only sleeps well and for longer periods of time on his stomach and with the help of my CHN we changed his formula (I self diagnosed reflux so it is not medically confirmed) but I have found that all the AR formulas are making him extremely constipated and he whines and screams with stomach pain. You can hear is stomach working overtime and he also has bad wind. He squirms and screams in his sleep at night and then he will pass wind and calm down again until the next time. This has been going on every night and all night. I have tried the HA-AR Karicare formula previously due to advice from a friend and he seemed fine on this formula but I am unsure if he should be having it as I see no sign of an intolerance but he seems to digest this formula easier and is not in discomfort while on this one. Should I just stay with this or return to plain AR formula and give him other methods for his constipation, stomach pain and wind. I live in a rural town and do not have access easily to specialist, paediatricians etc... I would appreciate your opinion.
Thanking you in advance
Rebecca "

Glenda Answers:

Hi Rebecca,
It sounds like you have been doing well by trusting your instincts. Does the CHN agree with your thoughts about reflux? It does sound like reflux is a possibility, but at the same time, it is still important for you to talk to your doctor about other possibilities too. I cannot diagnose reflux, and even though your son has responded to the new formula, it is still important to have that diagnosis. Other conditions can present similarly and it is important to be sure.

Once/if you do get that diagnosis, then my thoughts on the formula:- Thickened formulas are not the answer for all babies with reflux, and as you have found, they can make some babies more unsettled. That is actually quite common, though for some babies, thickening their feeds may be all that they need.

HA formula – if you find he is better on that, then that makes me wonder if he does perhaps have some mild food sensitivities. The protein is somewhat broken down and easier to digest, but whatever the reason, if it works for him, then that sounds like a great option. Is he still having some problems with that? There are other formulas that you can get on prescription that are broken down even further, so if he is still having problems on the HA AR formula, it may be worth talking to your doctor about trialling one of those.

Given that he has responded well to it does make me think that food sensitivities may be a factor for him. Approximately 40% of babies with reflux do have food sensitivities, although that doesn’t necessary mean they are easy to identify. According to information we have from Joan Breakey, dietitian who specialises in food sensitivities “Food may be a factor in diarrhoea, tummy pain, irritability, difficulty settling, poor feeding, sleeplessness, and excessive activity, as well as in eczema, asthma, sinus, and yes, reflux is a symptom that may also respond to dietary investigation.”

Is there a reason why you aren’t keen on using it? I don’t think it matters whether you can identify a food intolerance; just the fact that he is doing better on it may be enough. If you aren’t sure that’s the right thing to do, then please talk to your doctor.

Glenda

Question: She throws up from one feed until another

"Hi Glenda
We are having a horrendous time with our 15 month baby girl, Hannah. We have had ONE good week out of the 15. She throws up from one feed until another. She has a little couch after throwing up and is very irritable. At baby group she was the only one not lying on her back without screaming and being on her tummy just lead to more puking. In the one good week she was able to lye on her tummy and back and actually rolled during that same week. I am very concerned that all this is stunting her development. My husband and I are battling with the continuous screaming and need to be held upright in a standing position. She tosses and turns at night and throws up in her cot. She wakes up SCREAMING, not slowly niggling like the other babies in the group. If she starts to push out a poo, she immediately starts to throw up. She is forever hic-cupping as well. I am fustrated and having a hard time with motherhood right now. I AM FUSTRATED AND TIRED OF THE SAME OLD ADVICE : "SHE WILL GROW OUT OF IT". Reality is that both of us have to go to work and we are both exhausted and feeling really rejected. I want to help my little girl, but it seems so many people are willing to give unsolicited advice and when you really do need usable advice ... there is none to be found. PLEASE HELP! WE ARE GOING INSANE. "

Glenda Answers:

Hi,
I am presuming you mean your daughter is 15 weeks old, not months? (based on you having one good week out of the 15).
I am so sorry that you are having such a tough time- and a lot of parents report that their mother’s groups only make it worse- I think because they can easily compare the differences between their baby and everyone elses’. (and of course the endless ‘advice’ that is thrust at you because everyone else easily compares the differences too).

Like you say, the reality is, whether she is going to grow out of it or not, you do still need to cope with what is happening now!! Caring for a baby who has reflux can be extremely stressful and overwhelming, and it’s made worse by the fact that most people don’t understand that (even if they can see the difficulties). Because society in general thinks that reflux is just a baby who spits up occasionally, the parents’ cries for help and support are unfortunately often ignored.

It may help for you to know that there are lots of reflux families out there who are experiencing something similar to what you are going through, even if you feel like you are the only one. It is very normal for you to feel the way you do too, and perfectly understandable.

I can remember bawling when my eldest was only a few weeks old- I felt like such a failure, so inadequate as a mother. At the time, I didn’t know about reflux. I felt like it was my fault and that I must have been doing something wrong (especially as everyone kept telling me things that made me feel that way). It is important for you to know that this is not your fault and you are not doing anything wrong. Finding the answers for reflux, and how to make your daughter more comfortable, can be really difficult, and it is often a matter of trial and error.

Firstly, have you been to talk to your doctor about what is going on? Has the doctor diagnosed her with reflux? If not, it is really important, because there are other conditions that can present similarly, such as a urinary tract infection. If you haven’t been to see your doctor, I think that is an important first step.

If you have already been, that’s great. Don’t forget to stay in touch too, so your doctor is aware of what is happening, and whether you are coping, or not. Your community child health nurse may also be able to help.

Has anyone suggested you consider food sensitivities? Babies with reflux often suffer from that, and particularly cow’s milk protein (not lactose, which is a milk sugar). If that is part of the problem, it can make a big difference by changing her diet. You don’t mention whether you are breast or bottle feeding, but it can be achieved either way. IF you aren’t sure, then please talk to your doctor, or perhaps talk to a dietitian who specialises in food sensitivities.

If you are breastfeeding, it may involve you avoiding all traces of cow’s milk and also soy (under a dietitian’s guidance). For some babies, that may be enough, but other foods are sometimes involved. If you are bottle feeding, then a specialised formula that is available on prescription might help e.g. Neocate or EleCare. You would need to talk to your doctor about that possibility. There is a lot of information online about cows milk allergy and reflux, so that is one possibility. Are there allergies or food issues in the family that may make you suspect this could be a problem? What about asthma, hayfever or eczema? There doesn’t have to be a history, but it may be an indicator.

Of course, not all reflux babies have food issues like that- that would no doubt be too easy.

Sometimes thickened feeds can help, though again, it isn’t the answer for all babies.

There are ways you can achieve tummy time- sometimes just very small amounts frequently throughout the day may help. Other times, you could use a wedge (so long as she is fully supervised by you, and she is never left to sleep on a wedge). Talk to your child health nurse about different options there, but if it comes down to no matter what you do, you cannot achieve tummy time at all, then try and focus on getting her reflux under control and then try again. My son wasn’t able to lie on his tummy at all- he would reflux and choke, and we needed to wait until he is older. He did fine, and is a perfectly normal little boy now. It just may help for you to know that.

You can only do your best!

Other things you may be able to try, is to carry her around with you in a baby sling? This can help keep her upright, but give you some spare hands during the day. Make sure she isn’t slumping, as that can put pressure on her tummy and cause her to reflux. The pressure on her tummy is also probably why she vomits when she poos- just that can be enough to set off some refluxing.

Other strategies that may help are:

• Try to burp her more often throughout the feed
• Try slightly smaller feeds more often
• Change her nappy before a feed rather than after
• Make sure her nappy isn’t too tight and she has no elastic waistbands/tight clothes
• Hold her upright for half an hour following a feed; don’t lay her flat straight away
• Consider offering her a dummy if you are comfortable with the idea
• Avoid exposure to tobacco smoke
• Try wrapping her, if you aren’t, and see if that helps her settle.

Even though it is a common idea, elevating the head of a baby’s bed is no longer recommended. It has not been shown to reduce reflux in a baby that age and the recommendation is for a flat bed now. Ensure you follow the guidelines set down by SIDS and Kids with regard to safe sleeping.

If you are doing all that, and it’s not helping, then a visit to your doctor once again may be in order. Sometimes medication are warranted, even though it may be something we don’t like the idea of.

And of course, making sure you take time out to look after yourself is important too (for both of you). Perhaps consider joining RISA, as we can offer a lot of support, and it can help just to know you aren’t alone.

Sorry this was so long, but I hope some of those ideas help. Just focus on taking one day or one moment at a time. Keep trusting your instincts, and doing what feels right (so long as it is safe!)

Glenda

Question: Does this mean she should go back on the reflux formula?

"Hi there, My granddaughter has been on S26 Reflux formula up until about a month ago, Now she is on S26 birth formula and she seems to get very constipated. Does this mean she should go back on the reflux formula? "

Glenda Answers:

Hi,
I’m not sure how old your granddaughter is, or whether there are any other factors involved, but if the reflux formula was working, and the new one is causing difficulties, then I can’t see any reason why not to go back to the reflux one. If you aren’t sure, I would recommend you talk to a community child health nurse or her doctor.

Hope that helps,
Glenda

Question: Are there any other foods that are known to upset reflux?

"Dear Glenda,
My beautiful baby boy is 4 1/2 months old and suffers severe reflux and associated feeding refusal and is fed milk with a nasal gastric tube. We are slowly introducing solids to his diet and i have heard conflicting advice when it comes to apples and bananas. Will these foods make the reflux flare up or are they safe to give him. Also are there any other foods that are known to upset reflux? "

Glenda Answers:

Hi,
Thanks for contacting our organisation, and I am sorry to hear how difficult things are for your little man.

Can I ask why you are looking at introducing solids now? Is it because the doctors want to introduce solids in an attempt to help control his reflux? If so, that’s fine, but I would recommend you only introduce solids early on a doctor’s advice. If that is the reason for early solids, it’s generally best to introduce only one food until he is old enough to start introducing other foods (i.e. 6 months or so). For example, if you have started him on rice cereal, then it’s usually best to just give him rice cereal for the time being. (Unless your doctor has advised otherwise, there is no need to introduce a range of foods yet. His tummy may not be ready to digest other foods and that can inadvertently add to the problems). I know it seems natural to try different foods, but it may just help to be aware of that (and if he wasn’t on solids, he would be only having the one food each meal anyway).

With regards to introducing other solids e.g. apples and bananas it all depends on the child. They are all different, and they all respond to different treatments and different strategies. Some babies will struggle with apples and/or bananas, while others won’t. The best you can do there is to trust your instincts, and do what you feel is right. There are unfortunately no set rules for introducing foods that will work for every child, so if you want to try it when he is a bit older, then that is fine.

If you do try to introduce any, it may be best to go very slowly, and give him a small amount and don’t try to introduce anything new or make any other changes, for 5 – 7 days, so you can recognise whether it makes any difference to him. Talk to your doctor if you are unsure.

The foods commonly associated with causing issues are spicy foods, citrus fruits, tomatoes and other acid foods and fatty foods. If you find there are any issues with any foods, this can be an indicator that food intolerances should be investigated (according to Joan Breakey, dietitian who specialises in food sensitivities).

One other thing I’d like to mention. You don’t say whether food sensitivities are a factor, so if that hasn’t been considered, you may like to talk to your doctor about it. Approximately 40% of babies with reflux are considered to be cow’s milk allergic, and many have other food sensitivities as well. Is your son on an elemental formula, and if so, has it made any difference to him? Something to think of if you haven’t tried it.

Are you getting support? It is important that you are able to look after yourself. RISA has a lot of services that may help too – online parents groups, online chats, get togethers, newsletters, and we also have a group for parents whose child is tube fed or has had surgery. If you do need more support, you may also like to think about joining.

I hope that helps.
Glenda