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Treatment for infantile reflux disorder - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Child Health
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2585 Questions
User :   We have a 7 month (4 mo. adjusted) infant. She had fundoplication open surgery on Aug. 9, 2010. It improved her respriratory ailments and she is thriving. Lately- she has spit up/vomited (not projectile) 3 times recently. Twice was positional but today she was not moved and threw up de-satted and then recovered. Does this mean the nissen wrap is coming undone? She has a comprimised airway and we are concerned the acid from the spit up will bring on stenosis of the airway again.
Doctor :   hi
User :   hi
Doctor :   let me read ur query
User :   she is also constipated...every other day Bm
Doctor :   So can you mention the medical diagnosis of the child
Doctor :   Also may i know the indication for fundopliction surgery ( was it for infantile reflux disorder? )
Doctor :   Are you there ?
User :   She was born 25 w 5 days. Chronic lung disease. Was in NICU for almost 6 months.
Doctor :   so she was preterm and was intubated, hence developed tracheal stenosis
User :   yes
User :   the nissen wrap was successful in getting her off vent
Doctor :   Now coming to the current situation, once a surgery like fundoplication is done, it is not going to unwrap by itself
Doctor :   though being a preterm baby, and predisposition for respiratory infections, the child will be fine
User :   my gi doc said to try mirolax for 3 days then see if the throw up still occurs.
User :   if she is still throwing up, then go back to surgeon and get a GI study done. She is on a g tube for feeding but other then that...thriving baby.
Doctor :   It will take some time for the baby to be completely normal and will have similar episodes due to irritability of the intestines and stomach
User :   so a little spit up with a nissen wrap is fine?
User :   how do I prevent more spit up from occuring?
Doctor :   presence of a gastric tube , will cause occasional diarhea, occasional vomiting and this is nothing to be worried
User :   he could have made it too loose I suppose...better than too tight.
Doctor :   No , that does not matter. if it was too loose, then chances of reflux and respiratory complications can be high
User :   my concern is not really the spit up but the paleness and de-satting when she wasn't even moved. I'm glad I was with her b/c the wedge bed she was in could have caused her to severely choke.
Doctor :   such procedures in young infants will be having slight side effects as you are confronted now
User :   does constipation cause this spit up? in other words...the material is not leaving the body on the lower end fast enough and she's sewn up on the upper part...Do you think the mirolax will work?
Doctor :   the pale stools are due to mucus and low secretions of the bile
User :   she does not have pale stools. She has wasabi green pastey stools.
Doctor :   miralax , will increase the GI motility and help the nausea and discomfort
User :   can the wretcching and coughing be a sign of reflux? she sneezes a lot also.
User :   she is on prevacid
User :   2x a day
User :   1.5
Doctor :   these signs indicate that the GI motility is very slow and the stomach contents fed are not passing through the intestines fast enough
Doctor :   miralax will increase the GI motility
User :   i just hate that we've gone through this major surgery and she is still having apparent signs of reflux...vomiting, sneezing, wretching,
Doctor :   and prevacid will reduce the secretions of stomach
User :   I'm wondering if its a sign she does not like the formula she is on. She was on breast milk for 7 months and has been on formula for a little less than a month
Doctor :   She will definitely come out through this
User :   should we increase the prevacid?
User :   upon doc approval of course
Doctor :   no need to increase the prevacid
User :   this came on all of the sudden...can a specific position cause reflux/ spit up?
Doctor :   formula milk, can be the cause here, as some infants , especially with one with GI surgeries, the high content of electrolytees in formula can cause similar issues
Doctor :   being in a prone position and upright position helps
User :   is there a formula specifically for GI surgery babies that you would advise>?
User :   maybe one that lessens the constipation?
Doctor :   you need to dilute the formula to some extent
User :   won't that increase the volume she gets? She currently is dose 60 and rate 60 for her bolus feeds then continuous feed for 12 hours at night.
Doctor :   you need to alter the dosage to some extent
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