My daughter is 6 mths old & takes prilosec 3 ml 2x daily for reflux. She exhibited symptoms right after birth (arching, bearing down & turning red & even purplish, and making faces like her milk was coming up/burning her throat), as well as cried excessively & even projectile vomited once, and seemed to stop breathing for several seconds in her 1st 2 wks of life. As a 1st time Mother, desperate for help-I told my dr (actually the PA) at her 2 mth chkup & was prescribed Prilosec with no tests (no upper GI etc) without trying anything else. Knowing a little about reflux from my past job, I stopped dairy & acidic foods as I was breastfeeding & also tried to switch to Nutrimigen to see if she also had a milk protien allergy (she also received formula supplement) It seemd the crying stopped immediately but couldn't tell if it was the food change or med or both that worked. She did great until we removed her from the med at about 4 1/2 mths old since she was doing so well. Immediately after stopping the med she was crying & spitting up again so a new dr (we'd switched) told us to keep her on the Prilosec. She was taking 2 ml 2x daily but has since been upped to 3 ml 2x daily. Again shes been doing great up until about 2 weeks ago or so.
Recently shes been congested, sneezing & coughing. (shes always had an on and off dry cough occasionally) She also threw up 2-3 x in the past 2 wks & has also been spitting again about 1-3x daily. Usually over an hr after eating too which is strange. We always prop her after eating for 30-45 minutes & burp her before ending her meal. She eats about 3 1/2 -5 oz of formula every 3 hrs(no breastmilk for about a mth or a bit longer now) And she also has been eating rice cereal (less than 1/4 cup 2-3 x daily) & occasionally about 1/4-1/3 jar of baby food a couple times daily as well. She likes peas & apples but seems constipated by sweet potatoes & carrots. We recently tried to add a bit of gentle Ease formula to try to wean her onto it instead of Nutrimigen due to the costs & fear that if she isn't truly lactose intolerant & that she could benefit eventually from dairy when older so we are trying it out. Now we think we should only give Nutrimigen in case this is also irritating her reflux, although she had started throwing up again a day or 2 before we even introduced the Gentle Ease.
We are mostly concerned about conflicting med info- Is it safe? Should she have been prescribed this heavy duty med so early/young w/out further testing or trying other meds/approaches first? We worry we should take her off the med or try to decrease it to 1x daily or decrease dosage as it seems to not be very effective anymore- so why take med risks? Does she possibly need a higher dosage or med switch? Would she be worse w/out the med at all? Our dr seems uncertain as well and we are so concerned-We don't want to have an upper Gi unless ncessary as we hate to put her thru it & it sounds pretty sad/invasive from folks we know who've had it. Please help give us any advice you can-We'd sooooo greatly appreciate another opinion!!! Thanks, Regan

Hi,

Lots of ways to look at and evaluate and treat GERD. It sounds to me that the chance of her having GERD is high. Most of us don't do barium swallows or other reflux tests in an infant if the symptoms are striking and respond well to simple safe meds. The tests we have aren't very good to definitively make the diagnosis.

A step up or step down approach can legitimately be used. Your doctor tried an aggressive or step down approach and this is fine. I would assume that the med has worked in the past and an increased dose per day would be reasonable. This could be given in a larger single dose or a slightly larger two times a day dose. I generally use it once a day and this usually works.

Regarding stopping the med, I thought you had already done that and when it was reinstituted she was better. This is a safe med for infants. The dose could be increased (although I'm not sure in your case how many milligrams per ml your pharmacist makes this) or another med such as ranitidine could be added. There is really no accepted right or wrong approach here.

Hope these thoughts are helpful to you, Dr. Olson