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3 months baby vomiting milk 5-6 times. Dr advised 1 mg of domperidone with Gaviscon. Expert advice required

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My son is 3 months and 3 weeks old full term, born as vaginal delivery
Birth weight 3.2 now 6.25
Complains of vomiting since birth
Has normal bowel motion 1 episode /day
He is active
He is on similac (the infant likes it)
The vomits contains milk only no blood no greenish stain
Sometimes after feeding or even after3 or 4 hours from feeding if he develops hiccup there will be no vomiting at all
I asked a dr about his condition as the vomiting is everyday about 5 times & sometimes it is sever that he developed chocking few times
The impression is GERD
he advised me to start 1 mg of domperidone before feed by 30 minutes three times daily with Gaviscon 1 mg before each feed also !I need you opinion please
i want your expert advice
Do I need to do any investigations like barium meal...?
Is the AR pillow helpful?
Do we need to change the formula to AR?
Posted Mon, 30 Apr 2012 in Child Health
Answered by Dr. Taher Kagalwala 16 hours later

Thank you for posting your query.

I understand your concern.

I think that after looking at the weight gain of your child, I am convinced that although there is some degree of GER, there is no GER-D, which means that he is doing quite well for himself despite the reflux.

I am quite impressed by the very precise information that you have given.

You could continue with the medicines if they are helping to reduce the vomits, but a better way would be to start thickening his milk feeds with pre-cooked rice cereal added in the milk in small quantities (an example of such a cereal would be Nestle's NESTUM RICE). This will help the child to retain feeds as he grows.

You can use AR(ACID REFLUX) formulas, they might help. AR pillow will also help.

Burping will definitely help.

If his reflux is not better till he is six months old, you might want to consider a MILK SCAN or a BARIUM STUDY.

Please revert to me if you have any further questions on this issue.

With warm regards,

Dr. Taher Kagalwala
Above answer was peer-reviewed by
Follow-up: 3 months baby vomiting milk 5-6 times. Dr advised 1 mg of domperidone with Gaviscon. Expert advice required 31 hours later
Thank you for your reply
What I will do for now
1-change the formula to AR
2-will buy the AR pillow
I stopped the medications after using it for 1 day cause my son was uncomfortable with it as far as I know it may causes diarrhea but he developed constipation (may be coincident?) & there was no improvement
Do the medications take days to show the effect? Should I keep giving the medications? Or stop it
The condition of my son is worsening by the mean that these days even when he is sleeping he will vomit while he was not vomiting during sleeping, now even changing his diaper will makes him vomits
He had this problem since birth & for the last month he got better but in the last 4 days the condition had been worsen as i mentioned (by the way he has no flu or other new problem to say it is exacerbating it)
But still he is smiling even when he is vomiting
Now we r giving him 120 ml of milk 5-6 times a day I think by his age now we should increase the milk, but with his condition I think the vomiting will be more..So I don’t know when to increase the milk like 150 ml /feed
If I send you the growth scan that the mother had during pregnancy by 4d u/s Doppler will it be helpful for the confirmation of the diagnosis of GER
So my questions about
1-medications continue or stop
2-milk when to increase amount
3-should we wait for age of 6 months for investigation
4-we are not sleeping to observe the child we are afraid of chocking what you suggest for us
Thank you

Answered by Dr. Taher Kagalwala 4 hours later

Thank you for reverting. Your questions and their replies are listed below:

Medications continue or stop: Usually, the medicines take up to 10-15 days to show results when given for chronic conditions like GER. Hence, I would suggest that you continue using Domperidone as before. The constipation is coincidental, and not all children develop diarrhoea following its use; in fact, very few do.

Milk when to increase amount: instead of increasing the amount of milk, which he really does not need, and may not even tolerate, why don't you try adding Nestum to the milk and thicken the milk; this will increase his calories AND reduce the chances of vomiting. This is a tried and tested therapeutic measure for infants with GER.

Should we wait for age of 6 months for investigation: in view of the excellent temperament and weight gain, you could wait, but this is an individual call and difficult to confirm. If, as you say, he is worsening, try thickening of feeds, and wait for 15 days to see if this works; also, you would be continuing with Domperidone and his AR medication and using the AR pillow. So, at the most, you may wait for a month.

We are not sleeping to observe the child we are afraid of chocking what you suggest for us: you could let the child sleep with you in your bed so that you can feel or see anything untoward. Other than that, there is no other way to overcome this inconvenience. Try not to give late evening feeds so that he learns to sleep early and stays asleep for at least 6-8 hours non-stop. At the same time, train him by delaying night-feeds so that he doesn't wake up more than once and that too after XXXXXXX

With best wishes,

- Dr. Taher Kagalwala

Above answer was peer-reviewed by
Follow-up: 3 months baby vomiting milk 5-6 times. Dr advised 1 mg of domperidone with Gaviscon. Expert advice required 21 days later
Hi this is the update of my son
He is 4 months 2 weeks, 6.5 kg
For the last 2 weeks he got some improvement after we changed the formula to S26-AR same amount 120 ml & we r giving him5-6 feeds/day
For the last 5 days he got some worsening that increased in the frequency & amount of the vomiting more than 5 time /day milky content.
We noticed he has increased burping
He started to have coughing without flu or fever only dry cough
Also increased salivation I don’t know if it is related to teething
Yesterday I started him on domperdone suspension 0.4 mg/kg (total 2.5 mg) three times a day
I have some questions
1-about domperdone what is your opinion about is it the time to start it or should we wait? The dosage? & frequency & should I give him every 8 hours sharply what I mean if he is sleeping is it ok to wait till he is awake …
2-should I give him omeprazole also? Dosage? Frequency?
3-what formula u advised us? S26 AR? OR ENFAMIL AR? NAN AR? WHAT IS THE BEST AR FORMULA?

Answered by Dr. Taher Kagalwala 11 hours later
Hello and thanks again,

Domperidone which is an antiemetic is useful in treating vomiting. They are given in a dose of 0.8mg/kg/dose and can be used three times a day. You may go ahead and use it.

Your son's symptoms suggest that he is probably suffering from a viral upper respiratory infection. Don't worry, it will settle soon. I don't think teething has anything to do with this problem.

Omeprazole preparations that are available are for adult use. An infant of 4 1/2 half months need less dose. There are few proton pump inhibitors available for pediatric use like 'Junior Lansoprazole'. This is a prescription drug. You may consult your doctor to prescribe Jr. Lansoprazole for your child.

As far as AR formulas are concerned, any AR formula is okay as long as it agrees with your son.

Hope I have answered all your queries. Please accept my answer if you do not have any more queries.

Above answer was peer-reviewed by
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