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Pediatrics/Acid reflux


My daughter is 6 weeks old and at 3 weeks was diagnosed with acid reflux.  It falls more into the silent reflux category, she doesn't have projectile spitting and is eating fine and gaining very well.  The biggest symptom is back arching when spitting up but she also grunts and groans and will cry out when she spits up or right before she spits up (it is a pain cry and it horrible to hear). She is formula fed and we use a slow flow bottle designed for colic (older sister was very gassy/fussy).  We hold her up while feeding, keep her up for 20-30 minutes after feeding, burp her on our shoulder and not with the leaning forward, her bed is inclined...her dr prescribed Zantac which we used for a week and it did nothing at all so the dr switched us to Prilosec.  After a week she was not better so we went back and they checked a stool sample and said it was negative for blood and to continue on the Prilosec.  We were told to give it 2 full weeks and it has only been 9 days but we are seeing very little improvement.  My husband is against probiotics which were suggested recently and really hates using the PPIs (or any meds for that matter) but we don't want lasting damage.  The dr said not to switch formulas yet and just keep going on the Prilosec and since baby can have an hour or so at a time of laying and playing happily and will sleep for 4-5 hours at night that Dr is not too worried.  We have days though where she can't sleep unless she is being held upright and I currently have 4 spots of spit up on my shirt from the last 30 minutes and she was obviously in pain, wiggling around and crying/screaming before and after each.  I don't think the diagnoses is wrong but what else can we do?  And if the PPI isn't really helping do we have to continue it for the next 4 months or so or are there other options?  This is our 3 kid so we know spit up happens and we aren't worried since she is gaining so well but she is the first that has reflux and we are trying to figure this out.  Thanks!

Hi, Erin,

For some reason, I didn't get this to you in my usual timely fashion.  I apologize.

First of all, probiotics are safe and I have a hard time understanding why one wouldn't try those, but is willing to use PPI and antiacid meds.  I don't think the probiotics really will help, but no problem giving it a try.

If the PPI is not working, either increase the dose, with your docs advise, or try another PPI, knowing that a few infants with this history may have eosinophilic esophagitis, a condition where one doesn't really have reflux, but reflux symptoms.  

I would encourage a trial of either a milk free formula, soy, or a partly elemental formula, like Nutramigen.  This will not hurt.  We sometimes have to use expensive amino acid formulas, where the proteins are completely broken down into the constituent amino acids, the building blocks of protein.

A referral to a peds hospital based gastroenterologist might also be considered.

I'm sure your doctor knows all this stuff, but if not, see someone who does.

Good luck, Dr. Olson


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David Olson, MD


I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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