Remedy for Reflux?

Dear  Mamas,

Our five-month-old is having a really tough time! He’s a formula baby (long story about that) and has always been a terrible spitter. It seems like he loses up to ½ of each feeding, and he’s gassy and uncomfortable all the time. We are still feeding him formula every two hours because he gets hungry that fast (probably because he gives back so much of what he eats) and even then, he gets squirmy and crabby after eating.He never seems full and happy, but we hesitate to start solid food before figuring this out.

His pediatrician diagnosed acid reflux and started him on Zantac, which hasn’t helped one bit. Now he’s suggesting we try him on Prilosec, which isn’t covered by insurance, costs a fortune, and doesn’t even come in children’s liquid form!

Along with the feeding problem, he has eczema on his face and neck that gets better and worse, but never fully disappears. The doctor suggested a lactose-free formula but it smelled and tasted awful and he wouldn’t drink it (I don’t blame him – it was gross). I feel so bad for our little peanut. What do we try next?

Claire

 

Dear Claire,

Poor tiny guy! It sure sounds like his tummy is upset and looks like it is associated with feeding. Put that together with his eczema and the fact that Zantac didn’t make it any better, and my detective antennae are screaming… milk sensitivity!

It’s not clear from your question whether you were able to give the lactose-free formula a try, but in any case, there are other things in milk-based formula he could be sensitive to besides lactose (the milk form of sugar), like milk protein or added ingredients.

If you haven’t tried it yet, I’d suggest giving soy formula a shot. The protein and sugar components are different and sometimes make all the difference with babies who seem gassy and colicky on cow’s milk formula. It might even improve his eczema and rash issues. Soy formula is the nutritional equal of milk formula, so no worries there. If you do decide to give it a try, stop the milk and start the soy cold turkey. Chances are he won’t turn up his nose at the different taste (if he does, you can use a more gradual approach, mixing the two while increasing soy and decreasing milk over several feedings).

Keep in mind it takes five full days after starting soy to see a difference, so be sure to hang in that long before deciding yay or nay. In the meantime, try to keep everything else constant. Continue the Zantac and hold off on introducing any other new foods. If you change too many things at once, you will never know which made the difference.

One last note of caution: soy formula can cause more constipation than milk-based formula in some kiddos. If your guy seems to be straining more, consider offering him some dilute prune juice; 1-2 ounces a couple times per day.

The good news about spitters is that the problem almost always improves once they are sitting up (6-7 months) and spending more time in a vertical, rather than horizontal position. Gravity makes a big difference, and it tends to coincide with the full development of the muscular valve, which prevents food from traveling back up the esophagus. Between figuring out his food sensitivities and getting him more upright over the next month or so, you should be able to get this problem handled. If things don’t seem to be improving by then, you may want to try a new medication for the acid reflux.

Good luck!
~ The Mamas

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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