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Why do you think the losec stopped working?

My baby is just over 4 months old and was recently diagnosed with silent reflux. She has been a poor feeder and has gained only small amounts of weight since birth. She is being bottle fed expressed breast milk. She started on losec on Christmas Eve and improved drastically within a few days. Feeding was much easier and she was taking around 850-900mLs over 24 hours which she wasn`t doing previously. About a week ago, she started going downhill again to the point where I am struggling to get 700mL in over 24hrs. She just doesn`t seem hungry - she just won`t suck. She sometimes wriggles and makes this strange noise that sounds a bit like clearing of the throat, but she keeps doing it. In the afternoons, she seems to be in pain while she`s asleep. Shes figdeting, struggling to settle, crying and often trying to ram anything in her mouth (hands, her arm, toys) while making this horrible angry grunting type noise. It`s heartbreaking. I`m not sure why the losec worked for only a short period of time. She is on 5mg twice a day. The paediatrician wants to trial rinitidine in combination with losec, but I`m a bit concerned because she has been on rinitidine twice before and it made her worse. Will it be different used in combination with losec. I`m going to try a complete dairy free diet to see if that helps - I already am reasonably dairy free, drinking rice milk and not eating obvious dairy sources. Should I be reading all labels and avoiding everything with dairy derivatives?
Should I also be going gluten free, as I understand there is a link between gluten and reflux?
Why do you think the losec stopped working????
Thanks so much.
Kelly.

Brend...
Answer: Hi Kelly, Thanks for your question about your little 4 month old, I`m sure with all of these changes going on, it`s hard to see what is working and which direction to head now. The important thing to remember is to trust your instincts and know that you are already making really positive steps towards making your baby comfortable, where possible. As each baby is different, and as an infant grows and develops, you`ll find that what may work one week (or day) may not work the next. Knowing this makes it a little easier to cope, especially if a medicine or strategy doesn`t work one week, it could possibly work in the future. While we are unable to give medical advice, and it is difficult to know exactly why the Losec is no longer working, or if a certain combination will work for your child, we do really recommend being in constant contact with your paediatrician, and possibly seek additional support from a local health care nurse in your neighbourhood. Are they aware that you don`t think she is thriving at the moment? Glenda mentions some tips for Losec in an earlier question to Em, however your doctor should be consulted for direct questions on your infant and what may or may not be working in your situation. As your baby grows and internally develops, you may find a different reaction to that which occurred before with ranitidine, now that she has passed the 4 month mark, the same with the sucking of anything that can be put in her mouth. All babies start to explore their world, via their mouths, and it could be a behavioural trait. Even taking a video of the noises & what she is doing, so you can visually show your doctor /nurse next time you see them, as it`s hard to determine without physically seeing what she is up to. Ensure your paed. is aware of your concerns, and ask them for any possible side effects to look for, how to administer the best way, and what you should do if you feel it isn`t working out with the medications. At least having a plan in place will make it easier and more comfortable in case you are still concerned to allay any unnecessary stress for you. There also could be numerous reasons why she is fussing or not eager to drink your milk at the moment. It could be, as you mentioned a direct reaction to any dairy or gluten that it is your diet, or any one of the many food items that can cause upset stomachs for sensitive infants, or the heat, or even a change in her tastebuds that may pass or change as she changes. By eliminating all dairy and gluten, including any of those items with even traces of dairy, lactose or wheat/gluten within could give you an idea if these are the main culprits, however some children who do have sensitivities to milk, also have issues with soy protein as well. (Please do not do this without seeking advice from your doctor and/or a dietitian who specialises in food sensitivities so they can guide you) If you have other family members with gluten or dairy intolerance or coeliac disease, then you may wish to consider consulting an allergy specialist for testing in a controlled setting as well in the future. It takes time for non urgent cases at the major medical allergy clinics for appointments, but ask your doctor for a referral to start the process if this is a major concern. Having similar experiences during breastfeeding, I found it really difficult to decide which type of foods could be causing my child`s reactions, and it ended up being a combination of issues. It may be worthwhile starting a food & behaviour diary so that you can take note of your food intake, her sleep patterns, days or times when she is settled or worse. Then, you`ll have a written record when you next see the paed. or a specialist, and perhaps a pattern can be seen that could help solve part of the riddle. Seeking guidance by a nutritionist who specialises may give you some assistance if you find that there is a great difference. You may find these changes make it more comfortable for your baby to feed. Ensure you keep up enough water intake for yourself, especially during the heat of summer as you are breastfeeding, and perhaps consult a lactation nurse or similar to gain hints in this department. Sometimes even changing the location of her feeds, keeping her close and snuggled close to you while she has the bottle or in a quiet calm location, enlarging the teat hole in the bottle, or a combination of all or any of these suggestions could assist. If you haven`t already taken a look, there are management tips on RISA`s website www.reflux.org.au for some other suggestions, and don`t ever doubt your instincts. Let us know if you require further information, always happy to assist. Best regards, Brenda
Answered: 22 Jan 2009