Dear Reflux Mom,

I have a 3 month old baby who has been diagnosed with severe 'silent' reflux...he takes 7.5 mg of Prevacid 2x a day and is on Elecare due to allergies.  Plus, I add SimplyThick and a little ground rice cereal to his formula to weigh it down on his tummy and keep him satisfied.  My question is this - it seems the past 2 weeks he has gotten worse?  Is it true that babies will get worse before they get better?  I'm trying to avoid giving him more medication and if this is part of the natural course, then at least I can reconcile myself to it.  Someone had told me that during 4-6 months of age, babies with severe reflux can get very fussy; only time will calm him down.  What are your thoughts on this?

Hello!

Reflux certainly has its ups and downs. The symptoms can change from day to day and week to week. There is no “one size fits all treatment” for reflux-every baby is different so each treatment plan is different. Often you need to work with the doctor daily/weekly/monthly to adjust the treatment as the symptoms change.

Here are some thoughts-

Illness: When a baby is fussy, it is always a good idea to rule out an illness such as an ear infection, sore throat, thrush, stomach virus. An older baby may become fussy due to teething.

Diet: You mentioned that he has food allergies. Some babies are so sensitive to the food they ingest that even a hidden ingredient in the medication or an additive to the formula (Thick it, Simply Thick, rice cereal) may need to be looked at again. Thickeners can cause constipation, another cause of fussiness.

Medication: Review with the doctor the timing of the medication. Prevacid is time released and often it works best on an empty stomach before a meal. This is often a challenge for a 3 month old baby! I remember my doctor had me give the split dose of Prevacid on an exact 12 hour schedule.

Review with the doctor the method of preparing and giving the medication. I recently talked to someone from Prevacid about the dosing recommendations.  If the medication is mixed in the bottle or mixed with certain foods, it might not work.

There is some evidence that babies metabolize Prevacid and Proton Pump Inhibitors rapidly and may need a high dose. The doctor will decide on the dose based on the weight, age and symptoms of your baby. Keep in mind that Prevacid is a strong medication for reflux and more is not necessarily better.

Day to day management of reflux: The goal of treatment is to reduce/eliminate pain. Certainly fussiness is often an indicator of pain or discomfort. Sometimes a short trial (week or two) of increased medication or another medication is a way to "test" if pain is the cause.

It is also a good idea to consider other methods of soothing. I wrote a blog about Dr. Karp's methods of soothing a crying baby. I "wore" my reflux babies 24/7. They often slept on my chest at night as I was propped up on pillows and stayed in a front or back carrier by day. Keep in mind that there is a fine line between "home care" management and being the medication. If your arms are aching from holding and comforting your baby 24/7, you might be "the medication". It is a good idea to check in with the doctor and describe the burden of caretaking to keep your little guy soothed.