OAL vs. reflux or both?

[Anonymous]

thanks, guys. I read on the MARCI kids website that giving zantac one hour before feeding is the way to do it, so I tried that this weekend and that’s helping a lot. The ped had said to give it 20 mins before feeding if i could but that it really didn’t matter, so i was giving it right when she woke up crying before eating. Also a friend with OAL suggested taking the baby off the breast and hand expressing right when i feel my letdown for 15-30 seconds and that also seems to have helped. When i thought the zantac was needing a higher dose I called the ped on Friday who immediately suggested Reglan (which we refused to give Lucas the first time around) and an upper GI. DH and I discussed and we are going to make an appt with Lcuas’ ped gi to see what he thinks. I would rather start a ppi than have an upper gi– right now. At this point, it seems obvious she has reflux and the acid reducer is helping as long as it’s in her system correctly and dosed correctly. I’m going to email dr. phillips, thanks for the suggestion, Laura, I had forgotten that route!

[Anonymous]

oh, I also wanted to thank everyone else for your suggestions. It seems to help the most when I interrupt her frequently so she can catch her breath (this OAL thing is really crazy…she’s breathing like she’s running a marathon, thrashing around, etc. etc.) I have been burping her when she clenches up her body or swings her arms around (Lucas did the same thing when he had to burp, sort of like a windmill around his head with his free arm while nursing) and that seems to also help. Burping her is rough, can’t always get the burps out, but when she can spit up at the beginning– I think due to the OAL then she can at least finish a feeding a little calmer. We’re still having lots of breakthrough acid in the night. I just don’t think the zantac is strong enough, although it’s helping more than not.

A friend of mine read the baby Whisperer (which I have not read) and said that author suggested burping by rubbing on the left side of their back, sort of “up” the esophagus/middle of the back and then circle around to do it again. the author apparently thinks that jarring the esophagus (with the sort of hand thumping burp technique ) taht’s already hurting with acid isn’t a good idea. Has anyone heard of this? I’ve tried it a few times and a few times goten burps out of her, but I just can’t stop myself from the traditional patting the back burping. Do you think this is really bad for them or hurts them worse? Lucas and Norah both seem to calm down once they are up on the shoulder and getting the back patting from us. …

[Anonymous]

Here’s Dr. Phillips reply to my questions on zantac dosing and the safety of ppis for such a young infant:

Zantac is not really an ideal agent for reflux. Children develop tolerance

to H2 blockers rather quickly (like in days). Best to use PPI drug such as

Zegerid. PPIs are actually safer than H2 blockers although both groups of

drugs are very safe.

Dr P

[hellbennt]

oh, but I wanted to know about the 5-10mg dose, LOL!!!!

I am SO curious!

[Anonymous]

Anne, the circle on the back type of burping is how I burped Ben. I just couldn’t get them out of him otherwise. It really seemed to help. Otherwise, I felt like I was just pounding on him on the time.

I also took Ben off my breast during letdown, and it really helped us too.

[Anonymous]

I really wanted Dr. P to answer straight to the question, too! But it does make me feel better about putting such a young infant on a ppi. We’ve got an appt with Lucas’ ped gi for next Wed….and things the last few nights have been going down again. Last night we were up the better part of the night between 1:30 am and 6:30….NOT good! Sooo much acid. I used Mylanta once, with a 2 ml dose and would have used it more, but I can tell she gets looser stools if I use too much in a short period of time. I called to get us on a cancellation list for the doc’s office.

Bensmama– thanks for the info about your situation. It’s helping a lot to hear about what you went through since you had both reflux and OAL. I can tell now that I’m taking her off for letdown that the OAL is going much better and now I can really see that there is a LOT of reflux going on here…. hopefully we’ll be on zegerid the minute we can get in with the ped gi.

[hellbennt]

just to add more to the mix:

caracream is now buffer babies & is now available, too!

Caracream: https://www.infantreflux.org/forum/forum_posts.asp?TID=11191&PID=94236#94236

[Anonymous]

Hi guys,

We just got a rx for zegerid today from Lucas’ ped gi for Norah. i just checked MARCI kids recommendations and Norah’s dose is WAY low compared to theirs. I emailed Dr. Phillips to see what he recommends. I just hate being that mom who is like, “Well, I read it online” and it sounds so crazy. I emailed Dr. P and asked him if he has strategies for talking to doctors about upping the dose based on their recommendations and if I could have my doc contact him or anyone else there on staff. I just hate to wait two weeks nad have her still be miserable and then have to wait longer to get a higher dose, you know?

Naomi,

Did you take him off at every letdown for every nursing? I’m hand expressing at the first and second letdowns — about 50 squirts (sorry, I don’t know what to call it!) after teh first letdown and about 25-30 after the second….then I’m not really doing it for other letdowns if the are in teh same sitting– but in the next nursing, i do the expressing all over again. I’m also block nursing I’ve put myself on about a 4-6 hour blocked schedule, depending on her napping, etc. it seems to be helping but I wanted to check nad see if there is anything wrong or bad about expressing every time. I don’t enjoy it, but it seems to help her a lot. I wanted to see what you think. Thanks.

[Anonymous]

Hi Naomi,

I’m wondering if you remember for how long you had to continue taking him off at the letdown? I take her off at every letdown, sometimes even teh second one in the same nursing session to hand express. I am block nursing for 4-6 hours at a time, depending on time of day. I am leery of nursing out in places because of the whole take her off, she screams, I hand express– and it’s just like a tornado for about a minute and a half until she’s back on again. It’s really limiting our getting out into the world. I don’t mind, but I’m trying to get a baseline for maybe what to expect.

Also, she’s on zegerid now (I think you’ve been responding to my other posts, too on that–THANKS!) and it seems that she’s better able to handle nursing? Does that make any sense at all? I’m wondering if some of what I thought was OAL was really complications from reflux? It’s so weird, but I was sure that her crazy projectile vomits were from the OAL and usually happened early in a nursing session (so I was thinking it was the extra foremilk, and force/speed of the milk coming out, etc.) and the last 24 hours, although she’s spitting up still and I think had one or two projectile it’s been nothing like what it was. Does this make any sense? And she’s able to stay latched on longer and doesn’t need to burp as much and definitely spits up less…..? This seems so strange to me. Lucas spit up less after going on a ppi, but he still spit up TONS even on it. Also, she’s eating a LOT more, and also keeping more down. It’s great, but I am just wondering how this all fits into teh OAL picture. It’s been difficult for me to tell exactly what’s reflux and what’s OAL during feedings. Thanks for any thoughts you might have.

[Anonymous]

Hey Anne!

I’m SO sorry that I didn’t see your previous post. I didn’t mean to leave you hanging like that.

You know, for as horrible as it was, you would think it would be permanently fixed in my mind, but I’m having a hard time remembering exactly how long I would take him off the breast like that (I guess that’s good news, that the bad stuff you really do forget, huh? ). My OAL manifested in multiple letdowns during a feeding and, for the initial feeding, it would literally spray out several feet. I never had to express at all. So, if you are really having to manually express the milk, maybe you have more of a foremilk/hindmilk imbalance and not the OAL that you thought??? And, from what I understand, doing the block feeding is the best way to combat that. One mom on this board would only feed on one side for up to 8 hours or so!

Ben was born in September, on the 14th, so I’m trying to remember the time of year that things really got better for us… I think I was decorating for Christmas (so late November or early Dec) when he took an extended nap for the first time. That was about the time that we finally got him on a good dose of Zegerid too!

But, let me see. It seems like my supply changed as he started to grow, so that I didn’t have the multiple letdowns anymore, or, maybe only two instead of 3 or 4 per feeding. REally though, I think it was when he started eating solid foods (around 6 months or so) and my supply decreased that I was able to not have to take him off the breast. He was big enough then that he didn’t seem to be struggling to gulp it all down. But, for several months before that, I was able to ONLY take him off for the first letdown. If there were any multiple ones, he seemed fine with them.

However, if Norah is doing so much better on the PPI, maybe give it a shot and see how she does not being taken off the breast like that. Maybe try it at a later feeding in the day, as the morning (at least for me) tends to be the worst for OAL. I would maybe wait a few more days though, just to get her stabilized on the meds before trying that. It’s hard to really say what her symptoms are stemming from – the reflux or OAL, but the OAL shouldn’t cause her any pain. I will say that Ben’s vomiting would increase and then decrease with no predictable pattern. It was so frustrating to me not knowing what the heck was going on, always questioning and never really getting any good answers. So, I understand your frustration too.

I totally sympathize with you on the whole not nursing in public thing, too. I always felt like such a sticky mess after each feeding, and was SO envious of those moms who could just pop baby on and off with no problems. It was such a big production for us each time – boobs flashing everywhere! That didn’t last for forever though. I think I ended up nursing Ben for so long (nearly 20 months) because I wanted to really have some time when I actually enjoyed the nursing experience with him!! I think he would have quit long before that.

I don’t know if I was able to answer your questions or not, but hopefully, something will help. I was very happy to read that she seems to be doing so much better.

Hang in there!

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