First of all, I have to say you are so awesome! I thank you for your devotion to IRD and to our GERDlings. :smt041

I have contacted you about my youngest son, Iain and am curious to ask you how to best do a bottle intervention for him.

We went to the ped yesterday, and she figures reflux is back with a vengence again as we are right back to where we were medication wise yet again after enjoying a great summer, really. He is now back on flovent, ventolin (as needed) for his GERDy asthma as a result of "mild aspiration". (By the way, is mild aspiration like being a "little bit pregnant?! I do not get how you can be "mild"? Then again, I do not get how he could have a great summer and now be hit again?)

He is coughing like a champ and yet his lungs, ears, and throat are clear. It is his refluxy cough again. He is getting worse when it comes to eating and we are definately progressing more and more backwards to chewing and spitting or shredding food up for mealtimes. He is skipping loads of meals and definately only wants to drink his meals, if at all during the day. So, as you know we night feed.:oops: It has actually crept up to being about 70% of his intake again. We have tried water at night instead and it does not seem to make any difference for intake during the day. He is the one with that whole utensil problem as well. Got yet another complaint from daycare again today. However, I will do as you suggested for that and will put it on the backburner right now as it is not really my main concern.

My ped has added back in Zantac 2X daily to his prevacid 2X daily, plus an antibiotic for "just in case" something is brewing and we do not see it.

I think the game plan is to have the gurgling noises he makes abate, hopefully get what is seemingly asthma under control and see where that leaves us. I am on board with that, but I am worried about pulling his night feeds right now and the bottle. For one thing, he will not swallow his prevacid without the bottle at all and uses the bottle for night feeds. He just has NO skills for the sippy cup (understand that it is a GERDling thing and can accept that), but as he just learned to finally use a straw back in July of this year I am worried as he has been awful with using one the last month or so and actually will not even try most times or will just simply spill his drink. Same for open cups. He seems to struggle with them again, and yet we had a great deal of success with that before. I just do not get it.

So, I know to do it cold turkey is best, but I also know Iain is severely speech and language delayed and will not understand that he is a "big" boy now and the bottle has to go. He just will not. Developmental screen is supposed to happen now in January, I think. I am in Canada, so we do not hold our breath here for screens.

Do I wait for him to be on track for a week and then do it? He is great in the weight department, but even my ped knows this is because we are champions at supplementing. ;-) He was on nutren jr with fibre until early August and I pulled it as he was finally such a great weight and it seemed he was intaking enough to keep himself going. Apparently not as he has had several food strikes since then. My ped was surprised I pulled him off of the supplement and wants him back on for the day, use it when he skips a meal and to stop night feeds. I will do this, but am afraid he will drop like a rock when we do. I am able to supplement with tons of calories, but should I just let it go and see where he takes us? I am a neurotic Mother who has had a big kid hit FTT and quite a few complications and I know I will never let him lose that much weight again.:-)

Is the hope that if I pull back on fluid at night that he will intake more during the day? I have been here before and I have to say it was a dismal failure way back when. Having said that, I am willing to give it a try, but want to know what is reasonable for this and how long to give it. Again, he is a good weight so that is not a worry presently.

Thank you.

Dear GERD Moms:

I wanted to let you know that I will be "away from the computer" from today until Sunday, Dec. 3. I have been involved in an ongoing battle with my son Drew's new school district regarding retainment of his special ed. services. Tomorrow my husband and I are having our 4th ARD meeting with Drew's school. Drew started kindergarten this year and has a rare metabolic disease in addition to GERD and developmental delays which include learning disablilites. The district feels he "does not have an educational need" for special education services.They have picked a bone with the wrong person! As an ex-special ed. teacher and pediatric OT, it is insulting that they are doing this to my son. More importantly, I am concerned that Drew will quickly fall through the cracks.Sorry for getting on my soap box!

In addition, I have promised my 8 year-old a slumber birthday party this weekend. What was I thinking??? I promise I will get back to your threads this weekend when the smoke has cleared and I have caught up with sleep. Thank you for being understanding of my situation :)

Robynne

Dear Leigh:

Here is my response to your 11-28-06 thread.

Regarding Iain, yes, “mild aspiration” is like being a little pregnant. I really like that, btw! You and I have the neurological maturity to cough when we aspirate. However, little ones do not always have a coughing response when they aspirate. This is called silent aspiration and it is a reason why a modified barium swallow study may be necessary. Sometimes little ones have the “deer in the headlights” look, they sound “gurgly” after they drink and/or eat, their eyes may water, they sound like Darth Vader, or they have a rattle at the top of their chest or upper back. Kids who aspirate can also run low grade temps and have frequent upper respiratory infections, which can present like asthma-like symptoms. Aspiration over time can cause lung damage. If you cannot get an MBS study done, try some thickened liquids again. Liquids are usually the culprit and children are usually, but not always, safer on thick purees and solid foods. I would try 1-1 ½ tsp of Thick It or Thicken Up per oz. liquid. I think Iain’s asthma-like symptoms are worse now because his reflux is has worsened. Remember, you can aspirate 2 ways: 1. From food on the way down to the stomach and 2. From reflux coming up from the stomach and over into the airway. I am glad your pedi has added in Zantac (although it tastes horrible). Also know that an antibiotic will exacerbate reflux unfortunately.

I understand about the bottle and I am not going to slap your hand. I am concerned about the night feedings though. When little ones are horizontal, the reflux comes up more readily. You could be exacerbating his reflux by doing these feedings, and yes, he may exhibit more hunger behaviors during the day. Try Ferberizing him. This is Dr. Ferber’s How to Get Your Child to Sleep and it is the bible for problem sleepers. If Iain is a good weight, he doesn’t need supplemental feeds at night. You cannot do this cold turkey either, but quickly make a goal to stop doing this. Cut out 1-2 oz. each night and then use thickened water…YUCK! Use the straw during the day if he is more successful with it; however, thicken his liquid to slow down the flow rate. That intra-oral pressure/suction + large bolus formation can lead to easy aspiration. If it is thickened, there is less likely a chance for that. You will also help to strengthen Iain’s orbital and buccal musculature, which is very important for speech production. The last 2 bottles to go will have to be the night and morning bottles…those are the comfort bottles. Don’t try this cold turkey…Iain is not ready. You have to get him eating better first. I hope this helps. Write back with questions.

Robynne