Posted By Posting
Nov 08, 2011
cath2907
Sleep - Help please!
Hi, My daughter is 9 months old and had fairly severe reflux up to about 7.5 months. It took a few visits to the hospital to see a paediatrician to get a diagnosis and good medication. She was on Infant Gaviscon and Ranitidine. She never took anywhere near as much formula as recommended for a baby her age and weight. We started weaning at 4 months and her vomiting and discomfort slowly improved until about 7 months when she stopped vomiting altogether. She also started refusing her milk. The paediatrician recommended slowly reducing her meds and she now takes nothing. Around 8 months she refused formula altogether and the dietician is happy that she now eats only food and drinks water (with some vitamin supplement). We have always had difficulty with her sleeping however. She sometimes goes to bed without a fuss and other times will scream blue murder for an hour. We have an excellent bedtime routine with quiet time, bath, book, etc.. She goes to bed at the same time nightly and we make sure her naps are not too close to bedtime. She wakes two or three times every night and sometimes goes back to bed herself and sometimes needs us to stroke her head and offer some comfort. The health visitor thinks she is “testing” us and we need to do controlled crying. However I really feel that this is still her reflux. Last night she went to bed and dropped off to sleep within 5 minutes. She woke 10minutes later screaming blue murder and I picked her up and cuddled her. 1 hour we walked slowly round the bedroom. She’d scream and thrash about for 5 – 10mins and then stop abruptly and drop off to sleep for a few minutes before starting up again. She was desperate to go to sleep. This has been ongoing for about a fortnight – some nights she is fine, others she will scream for an hour. I have put her back on the Ranitidine this morning – 0.5ml 3 times daily. She is fine during the day but sometimes objects violently to being laid down for a nappy change. Is it common / possible for her to seem 100% fine during the day but to be having some serious pain on some evenings? Is there anything other than / as well as the Ranitidine that I can do for her to help her go to bed pain free? Am I correct in refusing to believe my Health Visitor who tells me that Ellie is “testing me”? Surely she’d either get better as we stick to our guns or be consistently difficult? We tried controlled crying for a fortnight but it changed nothing and I hate to leave her screaming in what sounds like pain to me.
Nov 08, 2011
dcd
I am not a doctor, but I am at this point a fairly experienced reflux/MSPI mom. And my opinion, wholeheartedly, is that your daughter is NOT testing you. 9 month old babies do not "test" their parents in this way. She's not faking it or trying to get attention. It sounds like she is very uncomfortable/experiencing pain. Reflux is notoriously worse at night, when babies are laying down vs. sitting/standing upright. You are her mom. You believe she's crying in pain? -- Trust your gut.

I do not have much faith in Gaviscon or Ranitidine for reflux. PPIs (proton pump inhibitors) like Prevacid, Zegerid, Prilosec, etc. are considered the gold standard in treating reflux because they actually stop the acid before it starts, vs. work to neutralize it after it already occurs - which is how H2 blockers like Ranitidine, or Zantac, work. Other problems with H2 blockers is that they are EXTREMELY weight-sensitive, so you need to constantly update the dose, AND the body can quickly develop a tolerance to them, - so even if you're giving her the right dose for her weight, it just may not be working anymore.

It sounds like your baby is desperate to sleep, and she would if she could only get comfortable. I would get her on a PPI ASAP and see if that makes any difference. Remember with the PPI, it's essential to administer it correctly - i.e. on an empty stomach, at least 1 hour before a meal. Ask your doctor for an Rx the Zegerid powder packs, or buy the Prevacid capsules over the counter, cut them open, and sprinkle the beads on a spoonful of applesauce. (Of course talk to your doctor before trying any new med.) And if you continue to give the Ranitidine, make sure she space it out from the PPI or they'll cancel one another out.

The fact that she refuses formula is another red flag. Personally, I would not be comfortable with a 9 month old only eating solids and water. What about whole milk? Almost ALL doctors/dieticians will tell you that babies need either whole cow's milk, soy milk, or a formula in their diets up until the age of TWO. Without one of these options, it is VERY difficult for them to get the amount of fat and protein they need for proper brain development. I know you said she has seen a dietician. I would seek a second opinion...my daughter has a pedi, a pedi GI, an allergist, and a dietician, and I have participating in a lot of reflux and food allergy forums for nearly 21 months now - and I've never once heard of a doctor signing off on a baby under two not drinking a "milk" every day.

The fact that your daughter threw up all the time and was uncomfortable on formula - and then eventually weaned herself off it altogether, which is when the vomiting stopped - makes me think MSPI (milk soy protein intolerance) could be at play along with the reflux.

MSPI is actually quite common in infants under the age of one, and it often goes hand-in-hand with reflux. The symptoms of both conditions mimick each other and can make it hard to tell which is the root problem. In many causes, it's both.

Please go to Neocate.com and read everything under the "Parents" tab to learn more about MSPI. Most babies with MSPI do not need Neocate, which is an elemental (or, completely broken-down) formula. Most babies with MSPI will thrive on a hydrolized (or, partially broken-down) formula, like Similac Alimentum or Enfamil Nutramigen, which you can buy over the counter.

Since your baby is older and has been off formula for a while, it might be a challenge to get her to drink a hydrolized formula, since they don't taste good. What about soy formula? Has she ever tried that? (Some babies with a milk protein intolerance also have a soy protein intolerance, but others don't, so soy would be worth a try.)

Anyway, my advice is to get her on a PPI ASAP. I would also get her on a "milk" ASAP - she needs it for the nutrition. Given her history, I would start with something that does not contain cow's milk protein, since my guess is that it has caused her tummy upset in the past.

Please keep us posted and come back with any questions or more information you may have. I hope you get things sorted out for your little girl and she starts feeling and sleeping better soon.

Nov 08, 2011
dcd
p.s. I misspoke here:

"Almost ALL doctors/dieticians will tell you that babies need either whole cow's milk, soy milk, or a formula in their diets up until the age of TWO."

I meant to say that babies under the age of two need either whole cow's milk or formula. Regular soy milk does not contain enough fat or protein. Her options, at 9 months old, would be whole cow's milk (I would avoid because of concerns about MSPI), soy FORMULA, or a hydrolized formula like Alimentum or Nutramigen.

If it were me, I would start with soy formula or Alimentum. (Because soy tastes better than the hydrolized formulas, and Alimentum tastes slightly better than Nutramigen.)

Nov 10, 2011
cath2907
Thanks
Hi, Thanks for the advice. Ellie does not drink milk but she does have her cereal made up with whole cows milk, she eats yoghurt, fromage frais, butter and cheese. I do try to stay pretty heavy on the dairy. We did try both soy and lactose free formula and found no improvement in her condition after a month on each. I will certainly go back to the doctors and discuss further re PPI and possibly more dietary advice. The more help the merrier as we really do flounder around in the dark. Since deciding to give her "the benefit of the doubt" and assume bad sleeping is mostly caused by pain we all seem to be a bit happier. She is starting to improve a little after 3 days back on her ranitidine so I can up the dose as necessary (paediatrician told me to keep her under 5ml a day but to vary dose upwards as necessary).
Nov 10, 2011
dcd
It's rare for a baby to be lactose intolerant. Lactose is the type of sugar in milk. Most babies that have a problem with milk are intolerant to the milk PROTEIN. If that's your daughter's case, it makes sense that her condition would not have improved on the lactose-free formula. That's why a formula like Alimentum or Nutramigen, in which the milk proteins are partially broken down, might be worth investigating. I would definitely ask about a PPI...
Check with your
doctor first!