GRSNNZ & Crying Over Spilt Milk are funded by NZ Lottery Grant Board.

Gaviscon Infant powder – every feed for three days

Not working?

Referral to a paediatrician - start Ranitidine (see dosage schedule)

Not working?

Can dosage be increased??

Not working?

Not working?

Can dosage be increased?

Omeprazole not working?

 

Tests confirm reflux oesophagitis??
(With no evidence of gluten sensitivity and/or no response to change in diet.)

 

• Testing may be appropriate at any time throughout this process. However, it is essential that before surgery is considered, all tests are repeated to evaluate the nature and extent of the reflux at that time.

• More than one treatment option or test may be recommended at any one time as each child’s family history, gastric reflux symptoms or combination of symptoms may differ, and indicate the need to quicken the process of getting symptoms under control (e.g. failure to thrive) or indicate the need for a different approach (e.g. family history of coeliac disease)

• If a pH study shows reflux, but a gastroscopy shows no oesophagitis, this is confirmation that although the child has reflux, it is well controlled on medication. Other reasons for continuing symptoms should be sought.

• If you have a child who gets both pain from reflux and vomits/spills, you will need to refer to the charts showing treatment options for both “Silent Reflux” and the “Happy Chucker”.

• However, an important point to note is that with babies who get pain from reflux as well as vomit, it is important to control the pain and acid first before considering the use of thickeners or thickened formulas. When the pain/acid is under control with appropriate acid reducing medications, then try the options on the "Happy Chucker" chart. Babies who get pain due to reflux all have some degree of oesophagitis (inflammation/ulceration of the oesophagus). Studies have shown that although thickeners and thickened formula may reduce the number of episodes they prolong the length of time of the remaining episodes as thickened fluid does not drain as well from the oesophagus. It is these prolonged reflux episodes, when they contain acid that can do the most damage.

*The time frames mentioned for these diets are the length of time that the diet should be trialled for by the breastfeeding mother before deciding that they are not helping and before returning to a normal diet. The dairy free diet and/or gluten free diet needs to be a complete removal of these foods as cheating does matter. A positive response may be seen earlier than the time frame indicated. If the baby has started solids then these also need to be free of dairy and/or gluten. If the diet is successful in resolving symptoms then it needs to be continued or another form of feeding considered. Breastfeeding is nearly always best for the baby with gastric reflux but the mother’s health is also important, so consider this decision carefully with the help of a paediatrician for future feeding options.

**There are three options for non cow’s milk based formulas.

1. Soy based formulas are not recommended when soy is the only source of nutrition. Therefore, a child who is bottle fed only (with no solids) would be best not to be on a soy formula.

2. Goat milk formula is often effective in children with reflux problems due to cow's milk protein intolerance. (Opinions vary about the suitability of goat’s milk due to the proteins being similar to cow’s milk so this may need to be discussed with your health professional.)

3. Hypoallergenic formulas are best recommended by a paediatrician as a special authority number is required to receive these subsidised (otherwise they are around $100 per tin).

See our fact sheet on “Infant feeding” for more information. If the baby has started solids then these also need to be free of dairy.

NB: The evidence to date is that delayed gluten introduction (at about 12 months) reduces subsequent risk of coeliac disease. However, this risk is also reduced if gluten is started in the baby’s diet whilst still breastfeeding. It is thought that this may be because the mother's milk contains antibodies to gliadin (component of gluten) which will prevent a sensitivity developing. (Gluten can cause gastro-oesophageal reflux disease! Author: Dr Rodney Ford).

© Gastric Reflux Association for the Support of Parents/babies (GRASP) and Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) 2005. Used and edited with permission by Roslyn (Roz) Ballantyne (RN), Regional Coordinator, GRSNNZ (in consultation with Dr Rodney Ford, Paediatrician) May 2005.

www.cryingoverspiltmilk.co.nz

Page may be printed or reproduced for personal use of families or health professionals, as long as copyright and Crying Over Spilt Milk's URL are included. It may not be copied to other websites or publications without permission and acknowledgment. This information (unedited) was also provided (by GRASP) to health professionals in New Zealand to use “to continue to support and inform families with babies/children with Gastro-oesophageal Reflux."

Page last modified 02-Sep-2007 by Roz (Website Manager, Crying Over Spilt Milk).