Dealing with Reflux in Infants
February 28, 2009 3:14 PM Subscribe
How can we help our 4 month old son feel more comfortable while bottle feeding if he does indeed have GER? Bonus question: how long might it last? (more info inside)
According to the pediatritian, my 4 month old son may be exhibiting some signs of GER, and this is a great amount of stress to both my wife and I. While he has never been a spitter, and he is mostly fine with the rice cereal and oatmeal, for the past two weeks bottle feeding has become more of a challenge. He cries, he arches his back, and he refueses to drink during his day feedings only (night feedings so far have been ok - knock on wood).
Right now we're planning on seeing the pediatrician again on Monday (he went last monday for his 4-month) about this, but given that we have to go the next 36 hours until we can get him some help, some advice and/or experienced tips would be helpful.
According to the pediatritian, my 4 month old son may be exhibiting some signs of GER, and this is a great amount of stress to both my wife and I. While he has never been a spitter, and he is mostly fine with the rice cereal and oatmeal, for the past two weeks bottle feeding has become more of a challenge. He cries, he arches his back, and he refueses to drink during his day feedings only (night feedings so far have been ok - knock on wood).
Right now we're planning on seeing the pediatrician again on Monday (he went last monday for his 4-month) about this, but given that we have to go the next 36 hours until we can get him some help, some advice and/or experienced tips would be helpful.
Our youngest had this, and we also elevated one side of his crib, which helped a lot.
posted by misha at 3:55 PM on February 28, 2009 [1 favorite]
posted by misha at 3:55 PM on February 28, 2009 [1 favorite]
One of the babies I nannied for had terrible GER, which went away at 15 weeks. Second taking a lot of breaks, burp every 1.5 ounces, and feed him while he's leaning upright in a baby chair (like this). I'd also suggest thickening the formula with rice cereal, as runnier fluids are harder to keep down and cause more digestion troubles. Also make sure to keep him upright but not bouncing around while he digests. Your pediatrician may very well tell you to increase solids during the day, with bottles on hand for hydration, and keep maximum bottle feedings for the night.
posted by zoomorphic at 4:06 PM on February 28, 2009 [1 favorite]
posted by zoomorphic at 4:06 PM on February 28, 2009 [1 favorite]
We're dealing with this with our 14-week old. She's been on Prevacid for two weeks and, knock wood, it seems like it's the solution for her. We tried Zantac, and it didn't help and gave her a rash. So your pediatrician might decide that drugs are a good option and there are lots of them to choose from. So think positive for the next 36 hours because this isn't a permanent condition.
Here's what helped us
posted by Mayor Curley at 4:11 PM on February 28, 2009 [1 favorite]
Here's what helped us
- feeding on a wedge (you can buy one at any baby store), or you can get even more extreme and lean your baby up against you so he's titled better than 60 degrees or so.
- position the bottle as close to horizontal as possible. My instinct was to tilt the bottle close to vertical to prevent her from swallowing air, but this lets the baby drink too fast and aggravates the reflux
- burp frequently. It feels wrong to stop the baby if he's eating okay, but a well of gas meeting a gulp of formula can start a reaction
posted by Mayor Curley at 4:11 PM on February 28, 2009 [1 favorite]
Best answer: <>
Many infants spit-up (reflux) due to 'incompetence' of the gastroesophageal sphincter, which is supposed to stay closed while the stomach is churning away to digest the food and force it out through the pylorus and into the duodenum. When the G-E sphincter leaks and the stomach contracts, food can regurgitate up the esophagus, and occasionally out of the mouth. When this happens chronically, it can irritate the esophagus (due to the low pH) and make babies miserable (crying with feeding, back arching, etc.). Medications typically don't fix the problem (immature sphincter) - rather they raise the pH of the gastric contents so that it isn't so miserable on the esophagus. The only things that fix the leaky sphincter is time (for it to 'mature') or surgery (when there is a genuine anatomic problem).
Fortunately, most infants have mature G-E junctions by a year, which fits with the fact that infant reflux has its peak at about 6 months of age, and then declines thereafter.
My recommendations have always been as follows:
- Don't overfeed. New baby stomachs are tiny. At 4-months, a 4-5 ounce feeding should be fine.
- Keep elevated after feeding for a period of time (> 45 degrees).
- Burp well.
- Elevate head of bed at night
Thickening formula doesn't make a difference (so sayeth the evidence). And again, Zantac, Prevacid, Pepcid, Protonix -- in my opinion they're all horribly overprescribed. Clinically significant GER is best evaluated by a pedi gastroenterologist and a pH probe study.
Patience and time will get you through.
Hang in there.
<>
posted by scblackman at 5:55 PM on February 28, 2009 [2 favorites]
Many infants spit-up (reflux) due to 'incompetence' of the gastroesophageal sphincter, which is supposed to stay closed while the stomach is churning away to digest the food and force it out through the pylorus and into the duodenum. When the G-E sphincter leaks and the stomach contracts, food can regurgitate up the esophagus, and occasionally out of the mouth. When this happens chronically, it can irritate the esophagus (due to the low pH) and make babies miserable (crying with feeding, back arching, etc.). Medications typically don't fix the problem (immature sphincter) - rather they raise the pH of the gastric contents so that it isn't so miserable on the esophagus. The only things that fix the leaky sphincter is time (for it to 'mature') or surgery (when there is a genuine anatomic problem).
Fortunately, most infants have mature G-E junctions by a year, which fits with the fact that infant reflux has its peak at about 6 months of age, and then declines thereafter.
My recommendations have always been as follows:
- Don't overfeed. New baby stomachs are tiny. At 4-months, a 4-5 ounce feeding should be fine.
- Keep elevated after feeding for a period of time (> 45 degrees).
- Burp well.
- Elevate head of bed at night
Thickening formula doesn't make a difference (so sayeth the evidence). And again, Zantac, Prevacid, Pepcid, Protonix -- in my opinion they're all horribly overprescribed. Clinically significant GER is best evaluated by a pedi gastroenterologist and a pH probe study.
Patience and time will get you through.
Hang in there.
<>
posted by scblackman at 5:55 PM on February 28, 2009 [2 favorites]
Response by poster: I have to say, many thanks to everyone's answers... Dr. Blackman, I hope to ride in your charity event in the next few years.
posted by Nanukthedog at 6:59 PM on February 28, 2009
posted by Nanukthedog at 6:59 PM on February 28, 2009
I have been there. It sucks. I really believe that the most important thing that helped us was holding the baby upright 20-30 minutes or more after a feeding. From 4-6 months he did try Zegerid and it seemed to help. Best of luck and remember that this WILL pass.
posted by mattbucher at 8:28 PM on February 28, 2009
posted by mattbucher at 8:28 PM on February 28, 2009
Four months is *really* early to start on any kind of solids, surely?
posted by pharm at 5:55 AM on March 1, 2009 [1 favorite]
posted by pharm at 5:55 AM on March 1, 2009 [1 favorite]
For both my kids, switching to lactose-free formula solved the problem -- seriously, like night and day. (With my first, we went the whole zantac route and everything; nothing helped until we switched to the lactose-free stuff.)
posted by mothershock at 8:08 AM on March 1, 2009
posted by mothershock at 8:08 AM on March 1, 2009
Are you feeding your baby breastmilk, or formula? My baby had issues and it turned out they were food sensitivities to what I was eating. They didn't present as classic "allergic" symptoms, so we didn't realize it til much later.
posted by mdiskin at 11:30 AM on March 1, 2009
posted by mdiskin at 11:30 AM on March 1, 2009
Response by poster: Pharm, a baby begins to indicate that he or she is ready for simple solid foods (rice cereal) to be introduced when certain milestones are reached, the biggest of which is cessation of the tounge thrust. Before the four month appointment, the tounge thrust had ceased and my wife made sure to clear it with the pediatrician that we were going to start solid foods.
posted by Nanukthedog at 9:12 PM on March 1, 2009
posted by Nanukthedog at 9:12 PM on March 1, 2009
Nanukthedog: Just because a baby may be physically capable of eating solids that early doesn't mean that it's a good idea.
posted by pharm at 9:45 AM on March 15, 2009
posted by pharm at 9:45 AM on March 15, 2009
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When she came home we had to use a Tucker Sling:
http://www.tuckersling.com/
The Enfamil AR Lipil helped us a ton. While it's like spackle when you mix, our daughter did very well with it. We had to take frequent breaks when feeding her, but if we did that the back arching slowly went away. Caution ... it's more expensive than regular formula.
http://www.epinions.com/review/Enfamil_A_R/content_170885549700
Another thing that helped us was elevating one side of her mattress with a triangle of foam.
posted by zymurgy at 3:22 PM on February 28, 2009 [1 favorite]