Dear XXXXXXX

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

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Dear,

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

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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.

Regards

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