mother of a month old baby with possible gerd

Hello Jan!  Thank you for your quick reply!

Yes, our MD and I have discussed different courses of treatment for my littlest son...  The first of which is sleeping at a 45 degree angle (or as close to it as I can get)...  But it seems like he is actually choking MORE in this possition than the one I had him in before...  <sigh>  Doc wants him sleeping on his back, and I prefer to sleep him on his side...  I have never had a baby with this issue, so I am unsure how to proceed...  I have been sleeping him at the 45 angle like MD wants, but I am putting him on his side like I prefer...  But his is STILL choking more than before...  (That's why my pedi. wants to start meds...)  He DOES seem more comfortable in the upright possition, but it seems like he's having a harder time yaking out the spit-up than he was in the laying down possition...  But now, when I try to lay him flat on his side, he starts to cry right away...  <sigh>  So what do I do now?!?!?! I'm now at the point where I'm LITERALLY not getting any sleep...  I'm up all night waiting for him to choke on what he just ate, while not having any other possition to put him in!!  I could sleep with him on my chest in the recliner, but then I'm still in the same boat I'm in now, AND teaching him the "bad habits" of co-sleeping (which I don't want to try to  break him of later!!!)...

We've also discussed the possibility of it being something in MY diet that he's not responding to very well...  But the food trials that I've tried to eliminate from my diet does not seem to make any difference...  (The two obvious eliminations have been dairy and citrus...)  We've decided to hold off on getting blood work done for a little while longer because of the issues with false possitives/negatives... 

The other thing I wanted to talk to someone about was the possibility of the reflux being caused by a lack of burping...  I have a really hard time getting him to expell his air after he eats...  Could that be causing any of this?  Also, when he was born, he spent a couple of days in the NICU...  During his stay there, the neonatologist ended up suctioning out his stomache (I don't remember the cause)...  Could that have traumatized the little flap at the base of the esophogus/top of the stomache and, as a result, be causing these issues??  <sigh>  so many questions... 

Any other ideas would be very helpful!  It gives me something more to discuss with the doctor...

Thank You for your knowledge and help with this...  Nicco isn't my first son, but he's the first baby I've had to deal with with this...  <sigh> 

Sincerely,

~Cory Forneris

Dear Cory,

It sounds like you have a wonderful doctor working with you to determine the best treatment plan. When a baby is choking so much, regardless of positioning, I can understand why the doctor is inclined to recommend medication. The airway is set up to protect itself from aspiration. However, with a little baby and a little airway, the risk of aspiration is worrisome. I wonder if you have tried a commercially made wedge with a sling such as the Tucker Sling or AR Pillow. The baby is positioned high on the wedge and held into place by a sling that is similar to a baby carrier with velcro.

You might want to ask the doctor about testing the stool for milk soy protein intolerance. I agree that it is too soon for allergy testing. Some doctors test a baby for anemia. If the gut is irritated, there may be some anemia.

The only other non medication treatment I can think of is expressing breastmilk and adding a thickener such as rice cereal. The thickening often reduces the vomiting. This method is very time consuming. Again, it is a way to reduce or eliminate medication if that is your goal.

I would ask the doctor to review the hospital record to find out why his stomach needed to be suctioned. IN addition, I wonder if your little guy has had an upper gi to make sure the anatomy of his digestive system is normal.

If all road lead to reflux, you might want to consider medication in the near future. I understand your desire to try the non medication approaches first. That is always the best way to go.

Hang in there and know that I am waiting right here to answer your questions and hear your concerns.

Jan

Dear Cory,

I feel your frustration. My little guy is 3 months old & his reflux seems to just be getting worse. My daughter had reflux & colic, but the treatments (alimentum formula & oatmeal cereal to thicken) corrected the problem. I am so worried about my son. He sleeps all the time. I feel like such a failure as a mom & to boot, I am a nurse so  I feel like I should be able to fix him. He gurgles constantly & we even had him in the ER last week because he was so wheezy & gurgly. He stopped breast feeding at 2 weeks old. Then we started enfamil ar formula with success for a while. He just seemed so congested, I finally swithched him to thickened soy formula last week. We also started axid last week. Now that he is on the soy, he eats half of what he did before. He is not fussy, actually a very happy baby, but he wants to sleep all the time. We had a chest xray in case he was aspirating, but it was negative. We were at the doctors a couple of days ago & she told me to feed him more (like I already didn't feel crappy enough). I asked her for suggestions on getting him to eat more & all she could say is "he needs at tleast 28-32 oz/day to meet his caloric needs & if he doesn't get that the only other treatment is a very invasive surgery". See, i get so upset I'm crying now typing this. My mother in law tells me what to do "or he could end up with failure to thrive". Despite doing everything I'm supposed to, his breathing is still very wet & he still wants to sleep a lot. Anyways, here is a list of all the things I've tried; elevate head of bed with a pillow under the mattress, thena  sleep positioned to maintain position, burp frequently & don't give up until you get the burp (at least evey 2 oz), enfamil ar formula, soy formula if you suggest a milk alergy (i think this is why liam makes so much phlem), sit still upright after eating for at least 30 min. I will let you know hiw the soy works out. In the meatime, resolve yourself to knowing that you are a good mom, formula feeding is not the end of the world (hey, your kid may eat & keep it down & you may get some rest before losing your mind), & medicine is ok. If the problem is not corrected, baby can get pneumonia, so prevention is better than hospitalization. Good luck & know that many, many moms are going through the same. Comforting to know that eventually baby will grow out of this. As for your preemie, he probably had to have his belly suctioned to prevent aspiration of stomach contents into the lungs (be it food or acid). This may have injured his sphincter, however, again it is better than compromising the babys airway.   Jodi

Dear Jodi~

   Your reply made my heart ache for you!  What a horrible possition to be in where you feel like you're not doing anything right!!  Nicco actually seems to be doing better than a few weeks ago, but I don't know if it's because of preventions or simply maturing a bit more...  <sigh>  I have given up sleeping him in an upright possition...  It actually seemed to make him choke worse than side sleeping...  So we're back to that...  Although I DO have his mattress propped up slightly so that he's not laying COMPLETELY flat...  That seems to be working the best...  He still spits up, but at least he's not choking on it as much!!  He seems to be sleeping more soundly as well...  I DO win the burping battle more often than not now...  Every once in a while (Those night feedings are MURDER sometimes) I'll let it slide, but I'm pretty determined to get a good burp out of him no matter how long it takes!  Fortunately, I haven't had to stop breastfeeding...  I do try to keep him upright after feeding (something that my husband hasn't figured out!!  He get's spit up on more often, now, than I do!! LOL!)  Keeping him up seems to ward it off for a little while, but without fail, he's going to spit up on you at some point!  It doesn't seem so mucusey anymore, though...  Could that be because I was eating something that didn't agree with him, and he's gotten use to it?  I cut back on my Dairy intake...  Maybe that has something to do with it? 

     The Pedi and I have decided to ward off medication unless he starts to choke on it again, or he starts to become uncomfortable...  Other than that, it's all just a waiting game...  I do wish you and your little one the best, and I hope that he starts to feel better soon...  My lactation consultant suggested a product called "Catnip and Fennel" by Natures Sunshine.  The information I found on it via the internet boasts it's digestive properties, so I'm going to try that...  At the very least, it might make him feel better, in which case I will feel like I've at least tried everything I can!!  Worth a try, right?!

     Sincerely,

     Cory Forneris

Cory and Jodi,

My son is 10 weeks on meds, positioning,etc..etc..He has very noisy breathing and wheezing which does go away with repositioning, but i wonder if he's aspirating as well. I'm a respiratory therapist and feel like a total idiot with my own child. I'm up a lot at night worrying about his breathing and choking...He's going for the upper gi and emptying scan this month i hope it will show something...I also was worried my son was sleeping to much so i wrote down his nap times, and its ok..He is thriving with his weight, but i have noticed he doesn't cry a whole lot to eat. Maybe its because i feed him every three hours with smaller amounts and i don't give him time to cry..i don't know..reflux is trial and error it seems..My son eats pumped breast milk during the day and isomil at night with rice..I had to physically stop breastfeeding because he would choke and gag a lot lying down.. My son also has some colic and painful gas which doesn't help..I watch  my diet, but then again i don't even have time to eat.. good luck