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Suspected reflux, refuses to be fed. On formula breast feeding. On domstal and vomit regurg. Dangerous?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
My son XXXXXXX has been suspected of reflux. For 3 days he looks reluctant to feed even 30-50 ml.  His day averages:
2-5 feb 605 ml + 5.5 bfs
6-8 feb 410 ml + 6 bfs
Last seen on 5 feb, 5.6 kg
He,s on formula with breast-feeding since his second month, exclusive breed before that. Supplementation due to insufficient lactation.
domstal froIm 6 feb
histac + riflux contd.
Vomit regurg. unaffected .
Is there a case to consult a pediatrician or observe a while longer.
What is the next step.
If he brings up in sleep, is it dangerous?
Posted Tue, 17 Apr 2012 in Child Health
Answered by Dr. Hema Yadav 13 hours later

Thanks for posting your query.

Gastroesophageal reflux in infants is due to lack of closure of a protective one-way valve at the upper end of the stomach (known as the "Lower Esophageal Sphincter"). This is responsible for regurgitation.

This condition improves with age most of the time. It usually is completely cleared up by the time your baby becomes a toddler and starts walking for three months. Many babies get over reflux even sooner.

Sometimes when this regurgitation causes pain or refusal to feed, your pediatrician may prescribe medications such as the ones your son is gettting to help decrease the acidity of the stomach contents, increase the tone of the valve, and help the stomach empty. The medications that your son is getting are appropriate for the symptomatic treatment of reflux. Though the drugs do not "cure" the problem, it controls the symptoms until such time that the infant "outgrows" the condition.

Rarely, if the infant does not respond to medications and the symptoms are severe enough,
surgery may be indicated.

In your child at present, the situation doesn't seem to warrant surgical intervention as the baby is feeding adequately and weight is fine.

The medicines may take a week or so to have complete effectiveness, but if symptoms show absolutely no improvement then the next step is to consult your pediatrician.

The pediatrician may ,
1. make dose adjustments.
2. suggest investigations like milk scan to grade the reflux.
3. Suggest tips for home care like feeding smaller quantities, burping frequently, positioning the baby upright for 30 min after feeds in sling or backpack or raising head end of bed, avoiding pressure of tight clothing/diaper on stomach etc.
4. Rarely in resistant cases and high grade reflux, may refer to pediatric surgeon for further management.

As of now, I would suggest you the following:
1. You should try the medicines and home care for a week or so to watch for improvement.
2. You should encourage breastfeeding more than formula feeding as much as feasible as it may decrease the risk of air ingestion and spitting up.
3. If the baby spits in the night, gently turn him to one side so that the contents come out of his mouth and will not choke him.

Sometimes if vomiting goes unobserved in the night there is a danger of it causing choking or aspiration. Also if contents enter the airways and lung, it may cause frequent respiratory infections in the child.

Please do not panic when the baby vomits and just gently turn him to one side to prevent any complications.

Hope I have answered your query and it is helpful. Do accept the answer if you are satisfied with my response. Yet, should you have any additional concerns, feel free to post your queries here; I will be glad to assist you further.

Above answer was peer-reviewed by
Follow-up: Suspected reflux, refuses to be fed. On formula breast feeding. On domstal and vomit regurg. Dangerous? 2 days later
Your reply focuses on reflux management, all of which steps are already in place, but it is the sharp reduction in his feeding intake, recorded above ( from 600 ml + to about 400 ml and lower, in addition to breast feeds) that is a cause for concern for us. Of course weight gain is the final arbiter, and assuming there 's a lower then desirable wight gain, how long before further intervention and what should it be?
Answered by Dr. Hema Yadav 2 hours later
Thanks for the follow up.
The required intake for your child should be about 100 to 130 ml / kg / day which comes to around 600-700 ml per day including breast feeds. So though the quantity of formula feeding has decreased, the total nutritional intake is still normal. Also, infants with reflux may be more comfortable with breastfeeding and may prefer it quantitatively more. So the frequency of breast feeding being the same almost, the quantity taken at each feed might be more. If you are bottle feeding the formula, then the air ingestion caused during bottle feeding may cause bloating and discomfort. You may minimise this by using specially recommended feeding bottles for reflux patients as per your physician’s advice.
If after taking all the precautions and even after consuming the required intake, if your baby’s weight decreases more than two levels below on growth monitoring curves charted by his paediatrician at regular intervals for a month, it is only then that an intervention is needed.
In the first three or four months, your baby should be gaining to 600-900 g of wt each month. However, monthly weight gain in ages 4 –6 months is from 400 to 600 g only even for normal babies.
Considering the present weight to be 5.6 if your baby gains about 500 g in a month there is no need of any intervention. If he gains less than 400 g per month or his growth charts show a declining trend, then you might have to consult your paediatrician to rule out failure to thrive due to chronic reflux, infections etc and baby might need multivitamin and caloric supplements in addition to his normal intake.
If the condition still persists, then the severity & treatment of reflux should be reviewed by your paediatric gastroenterologist.
Hope that answers your query.
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