Severe reflux and excessive spitting up/vommitting

Alrighty so question...my boys are still struggling with some pretty severe reflux issues. We feed them 5-6oz every 4 hours from 6:30am until 10pm. I give them each 7.5mg of Prevacid Solutab at 6am and they get 1ml of Zantac at 9:30pm. We are currently using Similac Insomil formula. Sometimes the boys will immediately throw up the contents of their previous meal directly after getting their medication. Other times, while feeding, they will throw up half of their bottle right in the middle. I can usually sense when they want to throw up by how their stomachs move and will point them down facing the floor so nothing gets on them or the furniture (we have wood floors so easier clean up). We've been on the Prevacid for quite some time and just started the Zantac consistently about 4 days ago so I know I still need to wait a bit to see if that's going to work and the Insomil was just started about 2 days ago so again I know I have to give it time. I've tried to get the ped and the GI to give us Reglan for all of the throwing up but neither will do it.

We do thicken our formula, 1tsp of rice cereal per ounce of formula. They use Dr. Brown's bottles with a level 4 nipple. The level 3, while it doesn't clog to bad, is entirely too slow for them and they get tired of sucking after 3oz and the feeding time just takes a ridiculous amount of time (over an hour). The level 4 nipple works out the best since they are pretty aggressive eaters.

So my question is this, for those of you struggling with severe reflux and LOTS of spitting up (like 3-4oz at a time) when, if at all, did your babies grow out of it and what method/combo of meds and formula worked best for you. We can't afford to buy Nutrimagen or Alimentum because at 30 bucks a can for 14 6oz bottles we go through it like crazy and go broke, literally.

The boys aren't crying during the feeds anymore, don't show signs of pain after they eat or cry after they throw up but they are still coughing, regurgitating and gagging so I know it's the reflux in action.

Thankfully, despite all of the massive spitting up, we are still gaining weight like crazy. I just wish they would stop throwing it all up. I feel so bad for them when they do it.

 

Have you checked to see if your insurance will cover a portion of the cost of the Alimentum? or even WIC? both sometimes will if their Dr will write something up saying they need to be on it. However, I do not see a HUGE improvement on Alimentum but thats just my 2

 

WIC would be awesome IF we qualified. DH has excellent health care through the fire department so we can't apply for medicaid/medicare and our income is just barely over their requirements. The state of FL is very rigid with their WIC program and base it SOLELY on your income levels. They do not factor in the number of children or your expenses. And although we have good insurance if it's not a prescription medication, like Prevacid or Zantac, they won't pick up the cost. Besides when we were on Alimentum and Nutrimagen the difference in the amount of spitting up and the frequency was minimal. Nutrimagen was definetly a bit better than Alimentum but not by much.

 

Gosh it has got to be so stressful for you and them with all the vomiting! :hug: Have you tried Enfamil AR formula already? If you haven't and the Similac isn't working soon maybe you could ask your pedi about it. It is already thickened so you wouldn't have to add cereal, and that way you could maybe use a slower flowing nipple too.

 

Yes it is very stressful. At first, when they started doing it once/twice a day each, I thought it was my fault and that I was doing something wrong and that they weren't getting enough to eat. But everytime we take them to the pedi they just continue to amaze everyone by how much they are chunking up (over 13lbs now and we started at 4lbs).

I have been hesitant to try Enfamil AR because I'm not sure that it will be thick enough and it is a little pricey. We started the boys on Enfamil from birth but they just didn't tolerate it well so that's why we switched over to Similac.

 

We did use the Alimentum but I can tell you the best piece of advice I got from the Ped GI. Move up to 2 tsps of rice cereal per ounce of formula. For us, that was the magical number. It greatly decreased the volume of spit up in our house. We used the Dr. Browns bottles an the Y-cut nipple.

Make sure you keep them upright for 45 minutes after each feeding too.

 

I doubt the AR would be better. I believe it's a milk-based formula and a lot of babies with reflux cannot tolerate milk.

1tsp is hardly anything if you are trying to weigh down the formula. We used roughly 2.5tsp per oz.

Other than that, keeping them at an incline, even while feeding, and LOTS of burping.

 

I do keep them upright after most feeds and their cribs are at an incline so that their head is above their feet. I also feed them in an upright position but they fight me and will arch their heads back and stretch out their bodies.

So 2tsp of rice per ounce? Does that clog up the flow of that thingy you put in the Dr. Brown's bottle to help prevent the gas? I know when some of the rice doesn't mix well and it's super thick it won't flow through to the nipple.

 

Yep, 2. Worked great. We had no issues with it clogging the nipple. We used the Y cut though so I dont know if it would clog a 4 or not. I would totally try that and see if it helps them. Spitting sucks.

 

I preferred Beechnut over Gerber rice for thickening. It seemed to dissolve better and not clog as much. I used Dr. B's stage 3. I think I might have started with the Y cut, but if I remember right, they were drowning with those.

That's part of the reflux. How long have they been on the meds? When you feed them/put them at an incline, be sure that their legs are not pushing up on their bellies, as that can make the reflux worse.

 

I know and it makes feeding difficult. It still takes me 30-45 minutes to get 5-6oz in them because of the amount of movement they have. I have found that if I hold them tightly it helps prevent them from all the activity...they are getting better at sitting still to eat.

We've been on Prevacid for about a month I want to say. The addition of the Zantac at night is very recent.

When I feed them their legs are straight out, not bent up against their bellies. My boys are future soccer stars, they kick like crazy.

 

I agree, we did 2 - 2.5 tsp of cereal for each oz. of formula. DS also slept in his carseat place in his crib for the first 3 months b/c of his reflux. Yes, he needed to be that upright. After that, I bought a wedge positioner. Sometimes to keep them upright for meals, I would put him in a bouncy or recline the booster/highchair and place it on the floor an sit next to him. Then, put him in something entertaining that was upright for a good 30 mins. after feeding (bouncy/entertainer, etc.). At that time, I didn't care if he fell asleep in the bouncy or swing...at least he was upright and had kept the food down. Also, I would talk to your GI Dr. (is this a pediatric GI Dr.??) and see if there is a different formula he suggests. If it's not a Pedi GI, I might suggest looking for one that specializes in pediatrics. Ours was awesome eventhough we had to drive an hour to see him. And his nurses and social workers and entire staff really cared! I know mine had difficulty with milk protein as well as soy. He actually did pretty well on the Nutramagin. I know how expensive it is. I often asked my pedi if they had any samples. Sometimes they did. Also, you could see if they do better on already made formula. I know it's more expensive, but for some reason some babies do better on the stuff that's already prepared and you just pour it in the bottle (of course you'd have to add the cereal). Also, do you have a mixer that you're using to get the formula really mixed up and the cereal really mixed into it well? That's all I can think of right now. If I think of more, I'll come back. I know how frustrating it is. My DS actually had an endoscopy to see what was going on as far as any allergies or what was causing the reflux. That may be something they need to consider in the future. The last thing is that if you don't feel your Dr.'s are doing everything they can to help your boys, find different ones. Nobody says you have to stay with them and you're their advocate and Mommy...you know them best and what works and what doesn't. Hang in there.

 

I have read that is often the case. I wish I would have known that when we were going through the battle!

 

I know mine had difficulty with milk protein as well as soy.

We didn't know until 8 months when we finally got a referral to his Pedi GI Dr. I pumped for 5 months and felt so bad when I found out that he had milk protein allergy. It's like I could have avoided a lot of his discomfort by avoiding dairy and also with the formulas we were giving him. They usually do out grow it though, which is good news for the future.

 

MLH, we see a pediatric GI specialist at one of the country's best children's hospitals. We also have to drive an hour out of our way to see him but he is very good and the staff is also very good. He doesn't seem to think that the type of formula we use will make a difference with their reflux so we just have to do trial and error to find the one they like the best. The did OK with Similac Advance actually (which is milk based) but we decided to try out the Insomil because it was soy and we thought they might do a little better, so far it's about the same. As for placing them in an upright position after feeds, with them it really doesn't matter. They can be completely upright and in a full seated position and it still comes up and out. It's even happend a couple of hours after they eat so their position during and after feeds doesn't seem to matter.

My regular pedi gives us samples of formula in bulk but it's not enough to last until we have another appointment so even on that method we still can't afford the ready made or the hypoallergenic formulas.

I think I will try a feed with 2tsp of rice and see what happens. I've got some Y cut nipples floating around so I'm all set there.

 

Part of the problem may be that there is just too much in their stomachs and they throw up whatever doesn't fit. Mine didn't start taking 6 oz consistently until they hit about 5 months old. You may try feeding 3-4 oz and just doing it every 3 instead of every 4. I know that is more work but the time spent cleaning puke may be less! Many babies with reflux think they are hungry because the milk soothes their throats and the sucking relaxes them...if your babies are gaining good weight then it is safe to cut back a little as they are probably overfeeding. Thickening should also help and may also cut down on the amount they eat too if it fills them up a little longer.

 

I was going to suggest lowering the amount of formula in each bottle as well. Even if they are sucking down everything in the bottle, they may be doing it more to soothe their throats than becasue of hunger. Being over-full will definitely make the spitting up worse. You may want to try reducing the amount in each bottle for a couple of days and see if that helps. You may need to feed them more often this way, but if it cuts down on the spit-up, it may be worth it.

As for thickening, if the rice cereal is clogging the bottles, you may want to try a gel thickener. We used simply thick (www.simplythick.com) with my oldest and it mixed much smoother than cereal. Someone posted a recipie for making simply thick a few weeks ago, so you could try that version as well.

I know this last part is not what you want to hear, but unfortunately, you may just have to deal with the spitting up for a while. As long as the acid is under control and they are not in pain, sometimes there just isn't mcuh you can do for the spitting. My oldest DS spit up so much and for so long that we had to replace the carpet in our living room once he finally outgrew it (at 18 mths!).

Good luck!

 

We have the same issues with James. I agree that cutting back on the amount they eat might help since they gaining ok. The other 2 things we do with james are to make sure to burp him after every ounce or so (we have to put a pacifier in his mouth the first couple times during a feeding because otherwise he screams cause he sucks formula down so fast). I'm not one for putting babies on meds (my dad is a pharmacist) so we give him a couple ounces of aloe a day mixed in with his bottle. The aloe helped BIG time! It soothes and helps heal the throat and belly from all the spitup, helping with feedings all the way around. Its also cheaper and safer than meds. We tend to stick to the enfamil formula because a lot of the similac ones have corn syrup which can also be a bith on the harsh side for the tummy. Good luck!

 

I wanted to mention that WIC is National and is not a medicare program so the guidelines are not exactly the same. It may still be an option. They do count the size of your family and paystubs too.

Secondly, if WIc is a no go, I saw cans of formula at a local used retail shop here. I realize your not in Phoenix, but you may want to check in your area. Instead of 27.00 they were 14.00. I hope your babies get better soon.

 

Wow. I was so in your shoes a few months ago. I wrote post after post asking for advice and help with my little pukers. They've been on Axid, Prevacid, and now Prilosec that has to be specially compounded into a liquid form. We've switched formulas a million times...we started on Enfacare due to their prematurity and that went really wrong a week or so after they came home from the hospital...we then tried Enfamil AR for the rice starch thickening the formula, they hated that and writhed with every bottle and got severely constipated...I tried the Good Start gentle formula with rice cereal added, same problem with the rice. Good Start Gentle formula alone came up almost immediately, whole bottles at a time. The doc asked us to try the Nutramigen and that was the worst by far, they hated the stuff. It seemed like it was almost painful for them to take it. So we settled on the Enfamil Gentlease about 4-5 months ago.

We've tried it all. We've tried smaller amounts of formula at more often intervals. We've tried medium amounts less often, etc., etc. We've tried wedges and pillows. We've gone to the pedi, we've gone to a very unhelpful GI specialist. We've held them up for 30 minutes after each bottle, 40 minutes and even an hour with no luck. Most of the time they puked up whole bottles at the time about 2 to 3 times a day. Now we're down to about 1 bottle a day, and most of the time that's only for Andy....ha, and as I was writing this, I was just called into the nursery by my husband to help clean up one of Andy's pukings. He had Will on the changing table when Andy decided to puke in his crib! :wacko:

Needless to say, we are still going through all of the fun reflux/puking issues, but it has gotten better. Once the boys starting rolling around proficiently and started wanting to sit up more, the pukings have decreased in number of times a day and sometimes less in amount of puke, too. I hate to be a party pooper when it comes to this subject, but in my experience, time and patience are the only things you have to work with until things improve. Now this is only if they are still growing fine and your pedi isn't concerned about the pukings inhibiting their growth and development. Not good news, I know, but month after month, you should notice improvements. Good luck!!!

 

How are your boys doing??

I'm really watching this thread because I'm dealing with this right now with one of my 2 month old twins...this is day 3 of the projectile with no other symptoms and we are doing alot of trial and error right now. So frustrating! I hate this spitting up thing...it's aweful for everyone.

 

Well we haven't upped the rice content to 2tsp per ounce yet because I'm still thinking about deciding whether or not I want to give this a go. We are on our last canister of Similac Insomil and after this is done we are going right back to good old Similac Advance. I have seen zero improvement on soy based or on hypoallergenic based formulas.

Yesterday morning I gave the boys their Prevacid at 6am and fed them at 6:30am (their last meal was at 10pm the previous night). Both boys threw up about 2ounces of formula but then finished the rest of their 6oz bottle...I'm guessing they made room from the puking. Well, I had to feed them a little earlier than scheduled (we normally go every 4 hours) for their afternoon meal so rather than going from 10am to 2pm I had to go from 9:45 to 12:45 because we had an appointment...well they didn't eat very much, still full I guess. 1 hour later, at the doctors office sitting in their car seats in their stroller, River threw up all over himself. When we got home I fed them again (this was at 4pm) and both boys guzzled their 6oz bottles and took a nap. When 6:45pm rolled around and time for another feed River, once again, ate 2oz and then threw it all up and refused the rest of his bottle. So yesterday was not a fun day, lots of throwing up.

They have been REALLY off schedule this week and have been very uncooperative feeders and not taking or wanting to finish bottles (I hate this because formula is so expensive that I hate to waste it but what can you do?). Sooo, I'm hoping that once I'm able to get them back on schedule with every 4 hour feedings until 10pm that they will do better and I know once I get them off of this soy crap things will slightly improve.

I don't think that feeding them less more frequently is going to do the trick because they will still be getting the same amount of food as they are now and will throw up well after the so called digestion period has passed, plus it's just not condusive to our schedules.

Hopefully this is just a phase that we are going through and it will pass. They don't cry about throwing up, it doesn't hurt them (or seem to anyway) and they aren't fussing with the bottle or even making wimpering or frowny faces at it before, during or after feeds. So it's not an issue of pain anymore so I think the meds are helping with that but we still have an issue of throwing up.

They see their pedi once they hit 4 months and I'll get their weights then. I know that when we saw their GI specialist 2 weeks ago they were just over 13lbs so if they have gained weight I will know that, while annoying, the throw up isn't affecting their ability to grow.

 

I don't know if anyone else suggested this, but you say you are only on 7.5 of prevacid. We got started on 15 mg of prevacide pretty quickly since the 7.5 wasn't working for us. My boys were small too and it was actually above what they "technically" needed for their weight, but they also said 7.5 doesn't usually do too much. I think they started twice a day at around 4 months, and my boys were not big at all. Zantac just didn't work for us. We were adding rice cereal also--just 1/tsp per ounce too, but the prevacid is really what worked for us.

 

Thickening our boys' formula with that gel thickener has been a life saver for us. I am so thankful I'm not still toying around with how much rice or oatmeal to add to their bottles and then dealing with clogged nipples and constipation!! The formula w/ gel thickener is super smooth and goes down and stays down. That recipe can be found here.

 

You may want to ask about Reglan (a med that helps the stomach empty more quickly) and/or an upper GI (to see what may be causing their stomachs to still be so full hours after eating). We had some pretty severe reflux here, one had pyloric stenosis on top of it, so I know all too well how frustrating all the puking is. Hang in there!

 

My oldest had severe reflux/puking, 7.5 yrs ago. I wish there had been as much information available then as there is now.

He was started on zantac and reglan in the NICU for it, he was 5.8 lbs when we came home. The dosage wasn't changed on his zantac until I asked for a referral to a pediatric GI at 6 months old!! I had no clue it was weight based, no wonder it wasn't doing a thing for him!!!

The ped GI said as long as he was gaining weight, not having problems eating, then there was no need to do anything, it was a "laundry issue". Oh how I hate those words.

Long story short, the puking got a little bit better around 1 yr of age, but I remember specifically that the last time he puked was the day he turned 18 months old.

We used to go through multiple outfit/bib changes for him, several for us, 2-3 burp cloths and several wash cloths each day. I feel your pain. :hug:

 

oh yes, we have so many burp cloths i can't even count them. it's gotten so bad that if the dogs are in a different part of the house and hear one of the boys start to cough or gag they start running into the nursery preparing to eat the puke off the floor (gross i know).

and they are still gaining (as far as i know, their last weigh in was at the GI ped specialist 2 1/2 weeks ago and we were just over 13lbs each).

as for getting them on reglan, both our GI and pedi refuse to do it because of the side effects. so we're stuck with the "laundry issue".