Caution with traditional painkillers for babies and children - Paracetamol should be used in preference to Nurofen in babies and children with reflux if there is a history or higher likelihood of gastrointestinal bleeding, ulcers or asthma. Nurofen is more likely to upset your child’s tummy.
For more on reflux and your baby - read here
Proton pump inhibitorsThese inhibit or stop stomach acid production e.g. Losec, Nexium, Somac, Zoton.
PPI tablets are made up of small pellets covered in an enteric coating which helps the small pellets get through the stomach to start working. It is very important that they must not be chewed or crushed. It may be mixed in a small amount of water, and then add it to a spoonful of pureed pear. Do not add to formula or breast milk as it stops the medication working.
PPI's do not stop vomiting, this will still occur however it takes the pain factor away. Do not suddenly stop the PPI as the stomach may suddenly make a larger amount of acid, reduce it gradually. Many doctors prefer PPI's to H2 blockers as they are more potent. Children and babies often need higher doses than an adult as they are metabolised much faster by children.
Losec can be made into a suspension to make it easier to give though many parents of reflux babies say it is not as effective as a crushed tablet. The suspension is obtained from a compounding chemist and can come in flavours such as banana, butterscotch and strawberry. If it is made with bicarb, it can last as little as 10-14 days before it stops being effective (and may make baby very windy); and if made with cellulose gel, it can be as much as 45 days if stored in the refrigerator.
If your baby is also prescribed an H2 blocker administer them at separate times in the day, 4 hours apart. H2 blockers can sometimes stop a PPI from working effectively.
H2 blockersThese medicines block stomach acid production: e.g. Zantac (Ranitidine), Pepcid, Tagamet, Prilosec. These acid blockers can take from 30 minutes to 2 hours to take effect, yet can last for up to 8 hours. They are usually given twice a day. If reflux awakens your baby give a dose one hour before bedtime. H2 blockers commonly lose their effectiveness and even within a week from starting them.
Antacids or acid blockers
These neutralize stomach acids e.g. Mylanta, Maalox, Gastrogel. Given three or four times a day with each feed (dosage is prescribed by a baby paediatrician or GP and is commonly 1ml before each feed). They start working rapidly but the neutralizing effect lasts only a couple of hours or less. Mylanta Original Formulation is suitable for use in children from one month of age.
Alginates & thickening agents
These reduce regurgitation by thickening the contents of the stomach e.g. Infant Gaviscon (NOT liquid Gaviscon - completely different medications).
There are also feed thickeners that can be added to infant formula or expressed breast milk or are already present in the infant formula e.g. Karicare AR, Aptamil feed thickener, There are a variety of thickeners available. For example, there are commercial milk thickeners, rice cereal, ‘cornflour’ (made from corn or wheat) or bean gum. These aim to make feeds heavier, to try to keep them down in the stomach and not rise back up the oesophagus and spit up.
Caution if using thickeners with Infant Gaviscon. Infant Gaviscon should not be used with other thickening agents or thickened formula as it can make the stomach contents too thick.
Are feed thickeners beneficial?Some parents will say they are, however, there is no research to back up these claims. According to Australia’s, National Health and Medical Research Council (NHMRC), thickening of feeds “has some benefit in decreasing the amount regurgitated, but is not effective in decreasing the number of episodes of GOR or acid exposure, and so has no real place in the management of complicated GOR.”
Thickeners can reduce how often a baby vomits, but not alter how often his stomach contents rise into his oesophagus. There are increased gut problems with thickeners so they can cause the actual thing that they are meant to be helping e.g. colic, constipation, cramping, diarrhoea and coughing. NHMRC indicates that feed thickeners have some adverse effects, such as increasing the length of time it takes for feeds to pass through the stomach and even increasing reflux. They are contraindicated in premature babies as they can cause NEC (necrotising enterocolitis).
Adding feed thickeners to expressed breast milk can be problematic as live enzymes in the EBM breaks down the starches that make up many thickeners. Adding thickeners to EBM also changes the carbohydrate balance of the EBM. So feed thickeners are not really an answer to reflux as they cause more problems than they prevent.
Reflux babies do much better with breast milk than on any infant formula. Many reflux babies have cows milk protein sensitivity or allergy so giving formula can actually make the symptoms worse. Also, breast milk passes through the gut twice as fast as formula making it a much gentler option on a reflux babies gut.
Once babies get to 4 months plus introducing solids can really help reflux. Read more on this here.
Motility medicationsIn reflux, the gut is more sluggish than usual so needs a little help to speed it up. These work by increasing muscle tone and tightening the lower oesophageal sphincter muscle, or increase the movement of muscle tone of the stomach and upper intestines, and increase stomach emptying. They are sometimes referred to as prokinetics. The most common ones currently used in order of frequency are Osmolax, bethanechol, metoclopramide, cisapride.
And hopefully, soon this is where you will be ... sleep and peace.
You might also consider baby massage
Massage is great for removing toxins from lymph fluid and improves circulation. Using the correct strokes and oils, massage can improve babies' physical health. It can relieve minor ailments and help promote a healthy digestive system, easing colic, gastro-oesophageal reflux and constipation.
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