OAL vs. reflux or both?

[Anonymous]

I’m just wondering if anyone on the forums has experience with both OAL AND reflux and how to know which one is what’s happening or when to know that it’s time for reflux meds…. I’m doing several things to help with OAL, feeding on only one side each time, reclining, unlatching the baby frequently while feeding, burping constantly (been doing these measures for a little over a week)…I’m also on a restricted diet, no dairy, soy, peanuts or gluten (because of a one time blood in teh stool incident). I actually am adding peanuts back in this week, I just had it for the first time yesterday and only had about a tablespoon and yesterday and today have been pretty bad….but I’m not sure if this is coincidental or not yet. But how do you know the difference between fussiness from OAL and fussiness from reflux? It seems like reflux to me….but I also saw improvement when I began treatment for OAL…just not as much improvement as I would like to see. Still a lot of crying during feeds, burps and lots of spit ups, projectile vomits, out the nose and mouth spit ups and more normal spit ups– just so many of them! I’ve checked the oal links on Laura’s opening page, and read Kellymom’s website on oal, and still can’t tell how to know the difference. Maybe there is no way to know. I’m ready to call and ask for zantac…but thought I would consult the experts here first! haha.

Oh, and I searched a searched for a dosing chart on Mylanta for a one month old– about 8 lbs 8 oz currently– and couldn’t find it? Laura is there such a thing on your welcome page? When I checked I had a screaming baby on my shoulder, so that might have hindered my progress.

thanks for any information in advance!

[hellbennt]

hi Anne!

mylanta: give in 1ml doses, up to 5ml over the course of a 24 hr period- if you see loose stools then back off. very scientific, I know…

as for the OAL: I don’t know a lot. watery stools (green), foamy stools (green). that’s about all I know…

http://www.llli.org/llleaderweb/LV/LVSepOct95p71.html

hang in there!

~laura

[Anonymous]

I had OAL and reflux with Hailey… in fact, they blamed the feeding problems on the OAL for so long that she didn’t get treated early enough. I think it’s really hard to tell the difference between feeding problems from OAL and reflux because some of the behaviours end up looking the same- the pulling off frequently and then going back on b/c still being hungry, the fussiness, etc. I found that if I expressed a bit before hand and then fed her then the initial flow wasn’t drowning her as much.

This is just my opinion, and I don’t really know, but I had OAL with Sarah as well, and she pulled off a bit at the start and kind of gagged a bit but then went back, and she pulled off a few times and I had to relatch her (she did not have reflux) BUT… she fussed during feedings (not miserable, unahappy, visibly upset crying), she obviously liked the idea of feeding (she only pulled off at the initial “spurt” of heavy flow not throughout the whole feed), she pulled off but then tried to come back for more and her pulling off was pulling away NOT pulling off, arching, screaming, stiffening, and me trying to get her to come back for more or her frantically coming back for more to soothe the burn.

The fact that she’s vomitting so much, means that she definitely has reflux. Even if the OAL is making the feeding worse, I personally wouldn’t take any chances having been where we were. BF is generally easier the second time around… that should have been my clue with Hailey that something more was going on. It was SO hard! I’d try reflux meds, even a PPI (just b/c of my paranoia about feeding aversions).

Good luck.

[Anonymous]

thanks, Laura! I’ve used it both last night and today. I’m trying to get in with the ped tomorrow. I just think we’re at that point of needing zantac, and then go from there.

Lori, it helps to hear your words so much. I’ve been reluctant to jump to reflux just because I wanted to feel rational about this decision, but everything is pointing to reflux and we’ve had some really rough nights and feedings recently. I’m not glad you struggled with this as well, but glad to hear about your experience trying to tell the difference. And you’re right, with a second it should be easier, I just had such a difficult time the fist time around I don’t have a “normal” to compare to. Thanks so much for all your support. I’m glad to hear things are going well for you. Lucas is still on zegerid, we tried cutting his dose in half and it was really not good. So, now he’s on 75% of his original dose and doing okay. He’s so BIG, just turned four, and sleeping great at night– although still on a special diet and I’m sure that is helping us in the sleep department. I’ll let you guys know what happens with the ped and Norah.

[Anonymous]

Hey Anne,

I had OAL and my babies both had reflux, though my son’s was MUCH worse.

I guess the way I knew that it was more than just the OAL affecting them was that once I had the OAL under control, there was less choking and coughing that caused vomiting. There was still the hard to burp and then resulting vomiting from the reflux though. Plus, I could tell they were in pain from the acid. My son especially would screech like a wounded cat after he would throw up and was so fussy all day long. He would also arch, stiffen, bury his head in my side, and it was like wrestling an alligator to get him to feed.

I agree with Lori, that your little one has reflux and that starting a medication would be a good idea.

Good luck. I remember how hard it is the not knowing aspect of this whole mess. But you are on the right track! Hang in there.

[Anonymous]

The quick update is that we went to the ped, got on zantac and the sleeping at night improved immediately. Still lots of crying at feeding time and arching and general fussiness. I’m using mylanta as well….does anyone know if Mylanta needs to be spaced apart from Zantac? I’m giving the zantac around 8 am and 8 pm and trying not to use mylanta until wee hours of the am or mid afternoon. Today I used it at 12 noon cause she was freaking out so badly and had been crying on and off for quite a while– seemed like two hours of crying burping, falling alseep, waking crying burping, etc.

ALSO, our ped says working range of zantac is 4-6 mg/kg???? This is MUCH lower than the doses listed on this forum. He has her at the 6 mg/kg and I wonder if it’s just not high enough to help for the whole day and night. Any thoughts?

[hellbennt]

yep, lots of thoughts! my ped said the same thing, so I started this thread:

Zantac dosing- my/other’s question (has axid & pepcid dose, too): https://www.infantreflux.org/forum/forum_posts.asp?TID=9539&PID=82914#82914

& yes you can mix the mylanta & the zantac

[Anonymous]

Thanks, laura. I apparently read the other threads on zantac but not this one yet! How do I tell my ped that “I read about a higher dose online?” hahahaha. We’re taking the zantac efferdose (I just posted about this on medicines forum) and basically it’s a 25 mg pill that he wanted me to break in half to give the dose. I could tell him that I can’t get it to break evenly– all true– and just give a higher dose? Is this somehow bad to not give the doc all the info? I feel weird not telling him that I want to give a higher dose, but feel like he won’t recommend a higher dose. Is it rude to call Lucas’ ped gi to check up on the dosing range of zantac and then tell the ped?

[Anonymous]

I always felt weird about this issue too. I think what you could maybe do is go ahead with the higher dose then tell the doc, but blame it on not being able to break the pill. But let him know that the smaller dose wasn’t working, but this one is… Then show him the marci-kids info. They are a real reflux institute, so maybe he would be more likely to go by that info. than just any old website.

also, it may feel rude to call the gi, but you have to remember that these people are working for YOU!

[hellbennt]

well…you could:

say you know a pharmacist (not entirely an untruth- sheri IS a pharmacist…) who looked up the dose for you?

OR you could verify higher dosing w/ the ped GI & then tell the ped that you were going through notes from when Lucas was a baby and found the higher dosing so double checked w/ ped GI bcse you were confused?

OR go to actual pharmacist and ask the pharmacist to please humour you & for her/him to please check their ipharmacist for the zantac dosing

(I vote for this one, LOL, bcse I want to know if it works, LOL!) & see if there are the 2 doses and then give the higher dose and when you tell the ped, you can tell ped that pharmacist checked for you AND you recall higher dosing for lucas…

[Anonymous]

I hope things are going better for you guys. A few things I wanted to share. First is, I noticed you said you were taking the baby off to burp a lot. That can actually make things worse because when you burp the baby the acid is coming up. I know that can sometimes be recommended, but I disagree. I actually didn’t even burp my boys unless they really seemed like they needed it. In most countries it is foreign to them that we burp our babies because it is just something they don’t do. The other thing is it can helpful to give the mylanta before a feed that you know is usually going to be a struggle. A lot of reflux babies have some hours of the day that are worse than others and those are the times to take note of and give the mylanta. I really hope things are going better soon. Please keep us updated.

[Anonymous]

so I left a message for our ped gi who left me a message back and said he is familiar wtih the same dosing range as our ped: 4-6 mg/kg. I said in the message I knew a pharmacist (sheri) who goes with teh higher dosing and he said he’d be happy to talk to the pharmacist….yikes! I don’t even really “know” sheri. She’s on the boards? Does she practice in the US?

We still have a lot of crying during feeds and lots of fussiness even on the higher dose. Not sure what to do….a ppi at this early stage? I don’t know if it’s the OAL, either… sort of starts to make you batty.

[Anonymous]

Are you taking fish oil by chance? I just read that taking fish oil while breastfeeding can help the reflux. Not that that helps your pharm. question, but just a thought.

[Anonymous]

Sheri is Canadian. The only US pharm I know if Dr. P! Hope things improve soon.

[hellbennt]

anne: could you email dr phillips w/ your question re: the two dosings for zantac?

ask him if it’s true for the US?

[email protected]

hellbennt2008-11-02 19:45:39

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