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Would the nasal congestion be part of his reflux?

Hi Glenda
I have a 6.5 mth old DS who has a nasal Gastric Tube due to failure to thrive. He has had this since he was 4mth old. The Ped has said that he has severe reflux and Cow`s Milk Protein Allergy. We have tried all the formula (neocate, elecare, etc) none worked, refused to drink them. We have him on S26 AR and seems to be better on this then anything as well as giving Losec.

Our other problem is that he has been Mucousy since birth and we have tried all the nasal sprays on the market, but none seem to work. We are constantly at the DR and Ped, but keep getting told that he has a Virus??? (for 6mths). We have also been informed that he as Staph when they take a nose swab. We have had blood tests, NAT`s, etc but they have all come back clear.

Would the nasal congestion be part of his reflux or would you know of any other therapies we could try to help clear this problem, as it seems to be stopping him from drinking his bottle properly. When drinking bottle alot spills out the side of the mouth, when he doesn`t seem to want to drink anymore, he will let you put the bottle back in, but just gum the teat.

He doesn`t sleep very well at night either, waking about 1am, 4am, 5am then 6am sometimes he settles, sometime we need to let him sleep on us (not a good thing). He is elevated in the cot and is fed at 90 degree angle, he is more of a silent reflux baby, not much comes up.

He also has difficulty in eating solids, takes it in, but then spits it out again, gags or brings back up, very active baby doesn`t stop moving even when strapped in to eat.

You may want to refer this onto another person if it is not in your area, but wondering if this has alot to do with reflux. Thanks

Glend...
Answer: Hi, It certainly sounds like you are having a lot of difficulties with your son, even though you have been trying lots of different things. Reflux can definitely present in the way that you are describing, and particularly with the congestion, however I am not a medical doctor and cannot tell you that that is definitely what the problem is. Allergies can also cause congestion and perhaps it is a combination of both that is causing the congestion to be so bad. I’m not sure from your email, but does your baby see a paediatric gastroenterologist? If not, that may be an option for you to consider. I am a little confused with the Neocate and EleCare, sorry. Did they not work because he refused them or did they not work for another reason? I do know that some babies cannot even tolerate these elemental formulas but if they were tried earlier, when he wasn’t tube fed, then perhaps they would be worth considering again now. Are they given through the tube despite his refusal to drink them? There are also some tricks to getting babies to take the elemental formulas – some will take them straight away, while others must recognise they taste BAD (bitter) and refuse them. Some of the suggestions, if you weren’t able to try them, are to very slowly change over formulas by adding more of the elemental formula over 1 to 2 weeks (or longer, if necessary). Another suggestion to disguise the bitterness is to add sugar or golden syrup to the formula (this was advice given to us by a dietitian). Vanilla is sometimes suggested but the dietitian said that some babies are sensitive to it. The impression I am getting is that allergies are playing a huge role so perhaps you need to see a paediatric allergist and or a dietitian who specialises in the area of food allergy and intolerances, if you are not already seeing them. The dietitian can help with the introduction of foods so that you know foods you can try and foods that should wait. It is a very complicated area and if there are other food sensitivities, other than cow’s milk protein, it may explain why you are having trouble giving him solids. It is quite common for other foods to be involved. Another avenue for you to consider, is that a speech pathologist may be worth seeing as well. If you do go down this path, you need to specifically see one who specialises in feeding and swallowing issues in children – they are generally available as part of the feeding teams at large children’s hospitals. I also wanted to mention that there can be a large range of medications and doses/combinations that can be effective for treating reflux and so perhaps his medication needs to be reviewed, especially if it hasn’t been for some time. It may be that a higher dose, or a different medication, may be more effective. I have also asked Brenda to comment because she has a lot of experience with food allergies and the extra information may be helpful. I hope some of our suggestions help and I hope you can find the answers you need so your baby feels more comfortable soon. Glenda

Brenda Answers:

Hi there, just a few extra words from me to add to Glenda`s response. As Glenda mentioned, it would be worth trying to investigate if allergies are causing the underlying infections and extra symptoms for your baby. The reactions and avoidance of some of the formulas could be his natural reaction to his body’s rejection of it, and it`s good that you are seeking answers to your child`s situation. The point you make that your son is really active is great news. My little son also had an infection and lots of complications from around 5 months... it took a while for the doctors to really figure it out. As Glenda suggested, I requested extra specialist care and the advice of a good nutritionist to really get to the bottom of it. As it turned out, with allergies being the problem, with a yeast infection, even the introduction of the humble banana, mashed carrot or bread as a typical baby mush triggered made him chesty, sleepy or rashy, and this started the merry go round of antibiotics and underlying infections. It turned out there were many more things he could manage to try compared to those he couldn`t. Sweet potato, pumpkin and mashed potato were big hits in my kitchen, even now, 3 years later. I’m not suggesting that this is the problem for your little one, but just giving you examples – anything could be causing these reactions. The point you make that your son is really active is great news. I would also suggest that you start keeping a diary or journal, so you can help monitor your baby’s reactions, add things like type of food you`ve tried, times of feeds, and this will also help when you do have time to meet with specialists. This can be really useful if you need to pin point other reasons for the behaviour. Every baby is different and no matter what your baby’s underlying issues are, whether allergies, infection, or something else entirely, I hope you find out what they are and how to best manage it. Brenda
Answered: 15 Nov 2008