QUESTION: I have a 3.5 month old who was diagnosed with reflux at 2 months by doing a ph probe test. We are currently on 15 mg of Prevacid split. We still don't have the reflux under control because he is having feeding difficulties. He will squirm, detach from the bottle and sometimes cry. He is currently on allimentum for possible allergies but nothing is helping. I constantly have to clear congestion out of his nose and can always hear the milk rattling in his throat. Do you think there is something else going on? Is his dosage correct? Often times after we burp him and try to give the bottle back he will gag and refuse the bottle. Any suggestions? Is there anything we can give him for abdominal cramping besides the infant gas drops?
ANSWER: Hi, Mandy,
If a valid ph probe made this diagnosis, this is kind of the gold standard. The dose seems fine. The only other thing I would recommend, and maybe already has been done, is to try to combine a med like ranitidine, usually the first line med we use, with the Prevacid. I would be sure a peds gastroenterologist is on board with the care plan and would just remember that a condition called "eosinophilic esophagitis" can mimic GERD and needs to be at least considered.
Good luck, Dr. Olson
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QUESTION: Thank you for answering my question. If giving the Zantac it has to be spaced 4 hours apart from the Prevacid, correct? We are currently waiting for the referral to a new GI specialist so I'm trying to avoid bottle aversion, etc. his intake is really decreasing so its really for me worried. Could the Prevacid be causing him discomfort? Is it possible to go higher than 15 mg a day? Also, is it true that Prevacid contains traces of dairy that could be causing discomfort if there is an allergy involved?
I personally give them at the same time, but others may differ. I doubt the Prevacid is making things worse. Feeding aversion happens a surprisingly often time in this situation. I have never heard of traces of dairy in Prevacid, although you may have information I do not know. If it does, I can't believe what must be an incredibly tiny amount could cause this problem. The 15mg a day is a reasonable and even high dose, but I have heard Peds GI people even using this dose twice a day in this age group. It is interesting to me that some studies even claim that Prevacid and other similar PPI meds are really not of value in GERD this age, even though many of us still use them.
Good luck, Dr. Olson