Hello,

I am new to the site, but not to GERD. My daughter Taryn is 6+ months old (born 4/15/06), and was diagnosed at about 4.5 months with GERD. We have seen an OT, but I am having a tough time getting a call back for follow up, so thought I would see if you might have any suggestions.

Taryn's basic stats are:

on Prevacid Solutabs in AM and Zantac in PM
takes bottles ~ 6ozs at a time
gets AR thickened formula
HATES taking her meds...we have always had trouble getting them in her - she was on the suspension prevacid at first, but we couldn't get her to take it, then they switched to solutabs and she hates the dissolved version but seems happier taking it dry cut into chunks she can manage...she still makes a face though. Zantac is always a "sneak attack" using a pacifier delivery system (the prevacid is too chunky to use thing)
sleeps on a wedge her OT made with a "seat", bumpers on the sides and held in with velcro strapsQuestions:
1) Initially Taryn slept happily in her wedge, lately she has started pulling on her straps unless she is already dead to the world when put in, and starts immediately when she wakes...in fact, I think that is partly what is waking her up nights now, she sense them and starts pulling and 'voila' is awake. I am worried she will get them undone and fall, or get trapped, so she sleeps next to our bed (and I sleep little since she is so restless). So, any suggestion on how to elevate an "older" infant? In general she is no longer fond of anything where she is strapped in unless distracted actively. Can/should we try her sleeping flat again?

2) Taryn started solids at 5 months when she was not taking bottles very well...she was doing great, seemed to really like to eat that way, then she just started refusing them about 2 weeks ago (although now she seems fine with bottles). This did coincide with when she started taking the solutabs "dry" so I started trying the dissolved method again the last two days. Do you think this is the cause? Will she just start gravitating back? I try to keep feeding sessions positive, never force her, etc....What else can I do to persuade her back to solids?

3) How can I avoid her aversions to meds (and therefore stuff in her mouth) getting any worse? I hate that so much of the time I put something in her mouth it is a drug...but I know she needs them right now. Add in that she seems to be teething so gets tylenol and the poor thing is WAY too familiar with that darn dropper...

Any help would be much appreciated!!

Thanks,
Katherine (TLsmom)

Hi Katherine:

First of all, let me apologize for not answering your thread earlier.I have been busy answering threads in the sensory integration and sleeping problems areas.

1. I’m going to start by addressing your questions about Taryn on the wedge. I am not sure which wedge you are using and exactly how your OT has modified it, but if Taryn is in a “seat” or sitting position, she is not in the best position for gastric emptying anatomically. Anytime little ones are flexed at the hip, we delay and sometimes even worsen their reflux because of the pressure placed on the gastric inlet. This is why the pediatricians are telling the parents to take the infants out the car seats for sleeping (also for plagiocephaly or “flat head” issues). Yes, infants are absolutely supposed to be placed in supine (on the back) position because of SIDS precautions. Unfortunately, it is not usually the most comfortable position for our GERD babies. If you look at the baby on my profile in the RES-Q Wedge, he is on the “nest” side of the wedge. There is just a slight indentation in the wedge that allows for the baby to gently flex the shoulders and hips so they do not feel like they are hanging. They also get good head molding in addition to gastric emptying. You can flip the wedge over and it is designed like mom’s chest. The baby does sleep on the tummy, or prone on this side, with a physician’s prescription. Try taking your wedge completely out of the crib and propping up the head of the mattress with a pillow or two. Taryn may be ready for sleep with slight elevation and NO wedge. I do not know if she is ready for cold turkey. When GERD kiddos are horizontal, it is extremely difficult for them to get into a deep sleep state due to reflux coming up (lack of gravity and weak lower esophageal sphincters).

2 and 3. How do you give the Solutabs? My favorite method is to take 2 clean fingers and hold the tab in the front of her mouth until it dissolves, using a pacifier intermittently if necessary to facilitate the swallow. I do not advise sticking it into the cheek, as some parents do. Average age of getting the first teeth is 6 months, and Taryn is about there AND she has GERD. In addition, she gets the nasty Zantac, which is a horrible minty taste that most of my patients gag or aspirate on (even flavored). My advice would be to try some positive oral-alerting activities. Many of Taryn’s oral experiences have not been great ones. Oral alerting activities include finger plays to the face such as “Itsy Bitsy Spider” on the cheeks, tapping on the lips firmly with 2 clean fingers, freezing a washcloth with water and then gently rubbing her gums with it (for teething), holding a vibrating toy in your hand and putting your hand on her cheek, and taking her pacifier and dipping it into juice for “nice tastes”. Since she is showing aversion to solids, I would do away with the spoon for a while. Go to the toothbrush section of the grocery store and buy and Infadent or Nuk brush. Try feeding her purees with these feeding therapy tools to change things up a little. Write back with questions.

Robynne