Okay moms I really, really need your help and expertise. I am a nanny to a wonderful, adorable 6-month-old little boy who is the light of my life. He has suffered from acid reflux since about 2 weeks old. Because of the severity of his reflux, he has developed what is called an oral aversion to the bottle. In other words, he connects pain with the bottle and screams and fights you if the bottle gets near him. We (mom, dad, and I) have been able to get him to start sucking and actually drink 5-6 oz of formula after he falls asleep but for the last 2 weeks that is not even working. Yesterday from 7:30 am to 6:30 pm he only drank 6 oz of formula.
We have taken him to a pediatric gastroenterologist when he was 4 months for the reflux and it is now greatly improved. He referred us to a pediatric physical therapist but she was little to no help. But we still have this bottle aversion issue. Has anyone else experienced anything else like this? The PT suggested we try distraction, sippy cup, sweetening the formula with apple juice or applesauce and none of that has helped.
I am hoping someone has some ideas. I took him for his 6 month checkup yesterday and basically we are on our on our own to try to figure this out. No one is really too concerned because he is gaining weight and is 50% for his weight. We thicken his formula by using more powder to water so that gives him more calories and we feed him while he is sleeping. That is the only reason why he has continued to gain weight. I have been taking care of infants for years and have never run up against a problem like this. HELP! I have never seen a baby that will not take a bottle.
Thank you, thank you, thank you to everyone who responded. I really felt your love and concern not only for my very precious charge but for me too. Not much to report really but I will add a little that I left out. The family lives very near Stanford as both parents are resident doctors. When I previously said the baby had been to a physical therapist I was incorrect, he has been to an occupational therapist. It was very little help. He has been on Zantac for his reflux since 3 months old and from 4 months to a couple of weeks ago (he is now 6 months) he was doing pretty well. Still had the aversion to the bottle but we could get him to suck and drink when he was totally relaxed and almost asleep, sometimes awake too but seldom. He has been on solids for two months and does very well with solids, thank God! For the last week his reflux seems to have reared its ugly head again and he totally will not take any liquid of any kind by bottle or sippy cup, even when he's asleep. We had him to the pediatrician last week (6 months checkup, good timing) and back to the pediatric gastroenterologist last week too. The plan is to feed him solids 4 times a day and add whatever we want that is high calorie to his food (cereal, formula, butter, etc.). This was suggested by a nutritionist that came in and talked to us while at the GI office. Thanks again for everyone's response. It was very helpful.
Hi C.,
My niece's little girl has a bad case of acid reflex also. What she found was after feeding her was to have her sit upright after she eat or drank anything. She was actually loosing her breath and unable to breath. My niece's sister in law had a son that had the same problem and told her the food has to go down so far for them to digest it or they will have problems breathing.
Good luck
Jennifer is right on the money. He definitely needs special help and it is up to the parents to INSIST on that help immediately from the pediatrician. This little guy needs help and now.
Re: thickening his formula with more powder and less water - that can be very, very dangerous. By doing this you are giving him too much concentrated formula and not enough water. This can easily lead to other health issues because his body is having to work extra hard to process the food without the necessary hydration. I strongly recommend you stop now. I am a Lactation Consultant and feedings are my specialty. The PT who suggested adding juice and applesauce advised you quite incorrectly - those are not safe either.
Listen, I deal with Peds who don't listen all the time. It sucks and it is WRONG. But this is where the parents need to insist on getting help and if the current Ped won't help, file a formal complaint and get another one who will listen. Go outside their health care system if they have to...DEMAND assistance. Feeding issues are nothing to mess around with and you are right, just because he is gaining or is in the 50th percentiles doesn't mean what he is going through is normal.
I wish you much luck on this...but please stop over concentrating the formula - it isn't actually putting weight on him...but it can definitely cause other health related issues.
J.
Feed him solids. He is old enough for rice cereal, and stage 1 foods. Also try a sippy cup with the formula. He is old enough to drink from a sippy cup. Also, at target, the first years makes plastic cups in assorted colors that come with spill proof lids and straws. He may do well with a straw. So, do the rice cereal mixed with formula and sippy cups, or cup and straw. You can also use a regular cup and slowly let him drink from it while you hold it.
Hi C.,
I'm the mom to six kids, five of which had severe reflux and two who still have oral aversions. The mom who said you need an evaluation by an SLP is correct. It would also be beneficial to have an occupational therapist do an assessment for sensory issues. The PT can help because a lot of reflux can be caused by a child being low tone (not enough muscle tone). Usually once babies start walking the reflux goes away because they've developed enough muscle tone to keep the food down. That being said, I still have two three on reflux meds because even after walking it didn't stop.
I would recommend contacting your county education office and ask to speak with someone at their Infant Program. The infant program is part of the school district and yet they do service kids under the age of 3. In fact that's what they are specifically there for. You need to tell them you have an infant with severe oral aversions and need a speech and OT evaluation. Ask if they have a speech therapist that specializes in feeding therapy. Some do and some don't but must SLP's can work with kids with oral aversions no matter what. In case the family is paying for the PT through their medical insurance or privately, the Infant Program can cover the PT and all of these services are free of charge. Even with the state running out of money next week, these services will not be affected as they are federally funded not state. So there shouldn't be any problem with getting him taken care of.
Hope this helps.
L.
Try conspicuously dipping your finger in a cup, stick your finger in his mouth so that he can taste it. Once you see that he is enjoying the taste, then try giving him a taste from the cup without a lid.
At six months, your little one probably won't be able to figure out the fancy no-spill sippy cups, but the cheap ones with a simple opening might work.
My little one wouldn't take a bottle after 3 mos. It wasn't too much of an issue since he was breastfed and I was at home with him, but it made it difficult to leave him for more than a couple of hours. We figured out that he would drink from an open cup and then moved to sippy cups very early.
C.,
I can't really offer too much help with this, but I wanted to offer big hugs of support to you and your young charge's mom. I have a 13-month-old who has severe reflux too and had to see a specialist as well and was given medication and a specialized formula. It can be hard to deal with and hearing a little one in pain is enough to make any mom cry. But I hope the little one that you care for grows out of it eventually. If it gives you any hope, ever since my little boy was 11 months, his spit ups have lessened considerably and he may be able to go without medicine in three more months!
I agree with those moms who said to seek out an SLP. I don't know too much about them, but I do know that my husband's brother was told that if he'd seen one when he was young, he wouldn't have the swallowing and texture issues he has now. (My husbands family all have severe acid reflux, but it wasn't diagnosed until the sons were in their 20s.)
One more thing that may be of (a different kind of) help: If the dr. prescribed a special formula, such as Alimentum or Neutramagen, please tell the mom about Apria Healthcare. Those specialized formulas can get really expensive and Apria worked with our insurance to get us a monthly supply of formula at no cost to us. (No, I am not affiliated with the company, they just did such a wonderful job of saving us a LOT of money.) You can find their Web site here: http://apria.com/home/
You sound like a wonderful nanny to be so concerned. Good luck to you, the little boy and his parents!
D.
Hi C.,
Is it possible the little boy still has reflux and it is still painful to eat? Have you ever considered getting him acupressure/acupuncture? i know a wonderful pediatric acupuncturist. let me know if you want her contact info!
Good luck to you,
G.
How about starting him on baby food?
My daughter wouldn't take a bottle from about 4 months to about 6 months because she wanted my breast milk so when I wasn't around sometimes she wouldn't drink her bottle. We started a sippy cup early and that seemed to work. They have ones with straws too. I would try a couple different kinds. We introduced the bottle again at dinner time when she started eating more solid foods and she liked playing with the bottle and finally realized she could get milk out of it. She finally liked taking a bottle and then we moved to only a sippy cup by her 1st year.
Good luck!
C.
Hi there, i am a mom and also a Speech-Language Pathologist. SLPs work with swallowing disorders from infants to elderly. While this child may not have a problem with actually swallowing, it is still within our scope of practice to work with feeding aversion issues. what you need is an SLP in the medical field (hospital or clinic based)that has special training with pediatric swallowing issues. You mentioned that the child saw a PT but was of no help. PTs, from what i know, dont work with this kind of problem. Its possible that pediatric OTs do (Occupational Therapists). Check with this child's doctor and ask for a referral to an SLP with pediatric feeding issues. I work in the adult/geriatric population and address swallowing issues daily. Sometimes you have to go a little further away if that is where this professional works. but i know the sacramento area must have someone who can help. You can also go to ASHA website (American Speech-Language and Hearing Association) at www.asha.org where there will some help there or referrals there. i dont know what area you are in, but i know there is help out there. you just need the right professional. Good Luck. and let me know what you find out. sincerely, J.
Hi C.,
Is the little guy drinking any water? There is a filter that makes alkaline water that will help him with his reflux. The acid reflux comes from the body becoming slightly acid. When you change the body from acid to alkaline the body goes back to normal.
If you would like more info email me and I will share,
Have a great Sunday.
N. Marie
One of my girls had acid reflux. We got a prescription for Zantac when she was 1 month old which eliminated that problem within 10 days or so. She outgrew the need for Zantac by about 6 months.
We also had her sleep at an angle -- usually in her infant car seat -- and more frequent feedings where she would eat only a few ounces at a time ... too much food in the stomach can exacerbate reflux.
If he still has the reflux, maybe you need to deal with this more aggressively. Once that pain is gone, then the negative association will go away.
Good luck!
My daughter had the same issues and became a "sleep feeder" meaning she would only take a bottle when she was sound asleep. While this was harder on us, we chose this route instead of a feeding tube. She is 33 months and we still give her two bottle a night to help her gain weight. You can change the formula/water concentration to get more calories in, as we did it for two years. Check with the pediatric GI specialist as to the correct formula. We were switched to Good Start and was able to mix it up to 40 calories per ounce, again under the doctor's recommendation. Good Start formula is much easier on the tummy because it breaks down easier and faster than other formulas. There are higher calorie formulas available, some you need a prescription. It will take quite a while for him to over come his oral adversion and it may continue once he starts on solids. Feel free to contact me if you need other suggestions. Good luck. By the way, there are two pediatric GI doctors in the Sacramento area that are wonderful: Dr. Yinka Davies and Dr. MacDonald with Sutter.
I would not "thicken" his formula. This can be very dangerous.
Have you tried feeding him smaller, more frequent meals with a syringe (no needle of course)? He is also old enough to start solids.
Hi C.:
I also have a child with severe GERD/reflux and am part of a website called PAGER. There are many articles and information you can obtain about feeding issues and I too can send you some information but it has to be direct from private email rather than from here because you cannot do attachments to responses. If you are interested, email me at ____@____.com you feed this boy after he is asleep is it via tube or oral feeding. If so, does he lay prone? A big thing is to keep the child upright when feeding and at night put at 30-45 degree angle to help with the refluxing. Also, not being put immediately to bed for at least a 1/2 hour is a good idea. Gravity helps a lot.
If you are using tube feedings, maybe upping the amount per hour will help.
Bottle aversion and pain is a definite issue with GERD. The key is to show him that when he does use the bottle that it won't hurt and he won't throw up and have reflux pain. So whatever methods you are doing right now, change immediately. I'll pull some documents and as soon as I hear from you, I'll send them to you.
Good luck and check into the website too. It is www.reflux.org.
T.
