Gasroesophageal Reflux

Gastroesophageal Reflux (usually called GER or reflux) occurs frequently infants and may be a contributing factor to your baby's increased secretions. It could also cause apnea (stop breathing) and bradycardia (slow heart rate). Reflux is the vomiting or the bringing up of stomach contents into the back of the throat (airway). It is caused by normal stomach movement which should push food into the intestine but instead it pushes the food back up in the esophagus. Reflux does not always mean that your child will vomit stomach contents. It can be silent. Some signs and symptoms of reflux are:

• Coughing
• Choking
• noisy breathing
• weight loss
• it may not show any symptoms at all.

The following are suggestions that will help keep the stomach contents from refluxing into the baby's airway.

Proper Positioning

Place baby in an elevated position, (30^o to 60^o), to help keep food and formula in baby's stomach.

Awake Time:

Placing baby in a car seat, swing or infant seat to prevent reflux. Baby should always be supervised when seated or in a swing. As always, check with your doctor for specific medical advice for your child.

Sleep Time:

Position baby on his or her side at a 30o angle. Elevate the crib by placing blankets or telephone books under the head of the mattress or adjust the side positions of the mattress or crib. You may simply want to place blocks under the head of the crib.

Proper Feeding

Keep your baby in an upright position during feeding and 1 hour afterward.

NEVER PROP YOUR BABY'S BOTTLE!!

You may be instructed to thicken formula feedings to help the feedings stay down.

• To thicken formula: add two tablespoons of rice cereal to 8 ounces of formula or as ordered by your doctor. You may need to enlarge the bottle's nipple opening so that the baby can suck out the thickened formula. Enlarge it only enough to help sucking, NOT enough for formula to pour out. Formula that pours out too quickly could cause your baby discomfort or even cause him or her to choke.

• While feeding: try to stop and burp the baby every 1 or 2 ounces. This will help keep excess air out of the stomach which also can lead to regurgitation.

• Feeding Frequency: your doctor or nurse may also advise you to feed your baby more frequently but in smaller amounts. Your baby may tolerate smaller feedings better, with less vomiting or reflux.

• If the baby is on medication: give the appropriate dose at the appropriate time. PLEASE GIVE AS DIRECTED!

Special Considerations:

• The amount of the medication to be given will vary depending on your baby's weight. As your baby grows, the amount of the medication will change.

• Liquid medications are measured best with a syringe (without needle). It can be washed and reused.

• Young babies usually do well taking the medication in a nipple.

• Never change the amount of medication or stop administering it without your doctor's knowledge

• Have your prescription filled before the last dose is given.

Medications

Your baby may also require medications to assist in the digestive process. We usually prescribe a combination of medicine to relieve symptoms. The dosages are regulated by the child's weight.

REGLAN: (Metoclopramide Hydrochloride) Helps increase the digestive activity of the stomach. It also helps to empty the stomach contents.

• How to Administer - Give the medication approximately 15 to 30 minutes before feedings. It is given four (4) times per day. DO NOT GIVE ANY FOOD OR DRINK WITH THE MEDICATION!!!!!!!!!!!

• Possible Side Effects - Diarrhea, irritability, drowsiness, rash, nausea, restlessness, insomnia, jitteriness. If your baby vomits after taking the medicine or he experiences any of the above symptoms, CONTACT YOUR DOCTOR! These symptoms may disappear spontaneously or respond to a reduction in the dosage.

ZANTAC: (Ranitidine) Helps decrease gastric acid secretions

• How to Administer - It can be given with meals or by itself.

• Possible Side Effects - Diarrhea, nausea, insomnia, vomiting, rash, dizziness, abdominal discomfort or pain. If your baby vomits after taking the medication or experiences any of the above symptoms - CONTACT YOUR DOCTOR! These symptoms may disappear spontaneously or respond to a reduction in the dosage.

TAGAMET: (Cimetidine) Preventative and relief agent from heartburn, acid indigestion and sour stomach.

• How to Administer - one half (1/2) hour before eating twice a day.
   
  
• Possible Side Effects: Diarrhea stomach pains
   
  
• Ask the doctor before using if you are taking
   
  
• Theophylline (oral asthma medicine)
• Warfarin (blood thinning medicine)
• Phentoin (seizure medicine)

PRILOSEC: (Omeprazole) Decreases acid production

• How to Administer - Take before eating
   
  
• Possible Side Effects: Stomach pains, nausea, diarrhea
   
  

• Suspension (stable at room temperature for 7 - 30 days depending on how it is mixed) Ask your pharmacist. If refrigerated - stable up to 6 months