What to expect: Gastroenterology referral

[WillabyWallabyWu]

Recently I posted about DS's reflux (4.5 months), and how it was well managed.  We went for his 4 month appointment and were advised to try moving him from his RNP to his crib.  DS is 16.5 lbs, and quickly outgrowing the RNP, so we knew this would have to happen soon.  We have his crib inclined, but when we tried to put him to sleep in there he would scream and cry.  We tried putting him in there already asleep, and he would wake up as soon as the angle of his body changed.  I think even with the incline, we aren't able to get the crib to the same angle as the RNP, which is apparently the best angle for DS. 

So, we switched from Zantac (twice a day) to Prilosec (once a day-before bed), to see if that would help him. After a week on Prilosec we saw improvement at night (he slept for 6 hours in a row one night!!!!), but his afternoons and evenings were MUCH worse.  He fusses and cries, then I can hear the reflux happening.  Sometimes it's just once and he swallows it back down, more often its 2-3 times and he can't swallow it quickly enough and it comes out.  He calms for about a minute afterwards, then the cycle repeats.  So, we have an appointment with a pediatric GI specialist on Wednesday.  Has anyone been in this situation?  What should I expect from this appointment?  I feel stupidly nervous/anxious about this whole situation.  I just want him to feel better!

[redheadk]

We were referred to a pedi GI specialist around the same time, a bit earlier, as you. In our case, DD was not gaining and was borderline Failure to Thrive. She was diagnosed with Severe Reflux, we had already done the upper GI imaging, etc., but our pedi wanted to be very cautious as DD was on a high dosage of Prevacid and still struggling. So, a little different situation though we also struggled with not being able to sleep in the crib.

DD rolled very early so we tried to ditch the RnP and swaddle for safety reasons. She basically didn't sleep for any significant amount of time for an entire month. The GI doc told us to reswaddle her and put her back in the RnP, she just wasn't ready and was in too much pain to sleep flat in the crib. Reclining the crib just didn't work. You could ask about using a Tucker Sling or Res-Q wedge since your DC is outgrowing the RnP. They are devices that go in the crib, basically wedges that keep baby in one place so they don't slide down the incline. They are recommended in Baby 411.

Aside all that, your DC's behavior a few hours before it's time for his Prilosec is very similar to DD's in the 4 hours leading up to her evening Prevacid dosage. The pedi had us add a second dosage in the morning, so she was getting it every 12 hours. This pretty much solved our issues with pain from the reflux. It was a very high dosage (the absolute max for her age/weight) but nothing else worked.

The pedi GI was amazing. She was incredibly nice and very thorough. DH met me at the appointment and I was glad to have him with me because she talked to us for a long time about what DD was experiencing at home, what we had tried, how she responded, etc. She examined DD, etc. They took her weight and height, temp, pretty normal pedi stuff. In our case, she determined that DD was on the appropriate dosage of Prevacid (2x/day) but because her weight gain had stalled out, we needed to concentrate her feedings. She was incredibly supportive of my desire to breastfeed and brought in her pedi nutritionist who developed a feeding plan for DD. We also came up with a plan and timeline for weaning DD from the Prevacid. It was a very, very positive experience and really made me feel so much better and in control of DD's GERD issues.

Good luck!

[WillabyWallabyWu]

Jul 31, 2014 10:25:02 GMT -5 redheadk said:

<abbr></abbr>She was incredibly supportive of my desire to breastfeed and brought in her pedi nutritionist who developed a feeding plan for DD. We also came up with a plan and timeline for weaning DD from the Prevacid. It was a very, very positive experience and really made me feel so much better and in control of DD's GERD issues.

This is exactly what I needed to hear!  While my DS has no issues with weight gain (81st percentile) I just hate seeing him be so uncomfortable each evening.  It's really heartbreaking.  I hope our doctors are as supportive of my desire to continue breastfeeding.  Thank you so much for your response.  It really helped me feel more reassured!

[ilikedonuts]

Ours GI visit (and DD1's isses) were very similar to redheadk. DD1 did have a dairy intolerance as well. Along with making the minimum requirements for failure to thrive. The barium swallow was done after we saw the GI though just because our pedi wanted to make sure that the GI didn't want to do something else instead (because DD1 was literally puking everything she ate).

The GI will definitely help you come up with a game plan (ours was formula change, various medication trials, and the barium swallow)! Also, the RnP weight limit is I think 25 lbs so unless he's flipping himself out, I don't think you have to move him. We had DD2 in it until 7 months and just swaddled her arms and buckled her lower half in once she was rolling.

[ilikedonuts]

Oh and DD1 was 4.5 months when we saw the GI for the first time. And we went every 6 weeks until she was a year old and then every 8 weeks until she was finally able to weaned off the reflux meds at 18 months.