Thanks again for your advice everyone.
DD has silent reflux and takes Losec, Motillium and Zantac. She has been on Losec for two weeks and all her reflux symptoms have pretty much gone away since she started taking it. I'm sure this means she isn't cured but the main thing is she takes her milk, is putting on weight and has stopped screaming and crying after her meals. We have almost weaned her off the Motillium per the doc's advice.
The Neocate was recommended to help manage what the paed thought was a milk protein intolerance. She has been on Neocate for five weeks now and we started mixing in the Aptamil Comfort about 2.5 weeks ago.
I've put in a call to the paed to check in with him and I will be quite direct and ask him why he specifically suggested the AC.
I don't know much about formula, but I would agree with LD below and wonder about a few points
1) Neocate is completely hydrolised, all the others are not, basically what this means is the milk protein is broken down so her body won't have a reaction to it. From what I have heard Neocate is THE ONLY ONE that is like this, I have also heard that it has quite a different taste, and it is hard to switch an older baby to it, so as LD says better to keep baby on it now so that when she is older and more set in her ways she will still accept it rather than experimenting now and having to switch back to it later
2) If your Ped says you should switch formulas so much, why has he told you to wean off Neocate after only 2 weeks? if her only reaction was constipation, vs the other reactions to other milks, then wouldn't you stay on it for longer and see if that righted itself after a while?
I suspect your Ped doesn't actually think your LO's problem is a milk protein allergy, and is possibly not being 100 % open with you, perhaps for fear of offending you and is instead suggesting the comfort milk, which I think (could be wrong) is a thickened milk, to help prevent refluxing without explaining why?
Thickening feeds is somewhat contraversial, as some say although it relives the spitting up kind of reflux it results in silent reflux which can be worse, but others think it works well. Rather than a special thickened formula I know some people thicken feeds by adding a separate thickener like locust bean gum which you can buy in some European countries, or a pre-prepared thickener like this one http://www.epharmacy.com.au/product.asp?id=34893v, (no idea about availability in this part of the world sorry). So maybe you could look into thickening the Neocate, although it sounded like maybe it was fine by itself.
hope you figure it out soon, and perhaps you need to see a reflux specialist if possible?
Thanks for all the advice ladies.
Lemondrops - DD has no issue drinking her milk, she has been on the bottle since day 5 as I couldn't BF. Based on your advice below, do you think I should try the other formulas now rather than waiting for the 4 month mark? I could try mixing it in with Neocate just in the same way I am doing with Aptamil.
It's good that she's drinking now, but like I said, drinking at this age is more reflexsive, than proactive, once babies hit the four month mark, drinking becomes more proactive, i.e. they decide whether they want to drink or not, and if they've begun associating drinking with pain/discomfort that's when the refusal kicks in.
This is my advice, but if I were in your shoes I would go back to the neocate for at least two weeks (that's the minimum amount of time required to get the offending milk proteins out of her system), then if you want to move her to another formula do a trial with that. If that fails, then switch back to neocate and try another brand in another two weeks and so on. If you keep switching from brand to brand, you're not going to really know which sits well with her becomes sometimes it can take up to four weeks until she's comfortable again. And if she's being continuously subjected to formulas that make her uncomfortable, she might start resisting.
And given you suspect both MSPI and reflux, then I think a consult with a ped GI is warranted. He might even prescribe for you something that would help with the constipation, because there are a lot of safe options out there.
Lemondrops said"When you are ready to switch formulas move to a hypo allergenic formula; the milk protein is not as digested as the elemental formulas but should be enough to help manage most MSPI issues. Aptamil comfort is NOT an HA formula; I have no idea why your ped recommended that. Apatimil does make an HA brand however."
I was wondering this, too. I believe that Aptamil Comfort is a partially hydrolyzed formula (I could be wrong), which may be helpful in milder cases of milk protein allergy but more severe cases in formula-fed babies would typically be treated with elemental formulas (such as Neocate), or else fully hydrolyzed formulas. If the elemental was not working out, perhaps you could discuss with your doctor moving to a fully hydrolyzed formula? Trust your mummy instinct. Your doctor is not with your little one 24/7, and you are.
*Hugs* hope you work things out soon. It is truly miserable seeing our little ones in distress, and can be very stressful for you.
xx
Thanks for all the advice ladies.
Lemondrops - DD has no issue drinking her milk, she has been on the bottle since day 5 as I couldn't BF. Based on your advice below, do you think I should try the other formulas now rather than waiting for the 4 month mark? I could try mixing it in with Neocate just in the same way I am doing with Aptamil.
u can try S-26 LF (green bottle) formula, i tried it on my son for a while when he was unwell, and it was ok. Although i switched back to the normal S-26 formula. I have used S-26 for both my kids and they loved it, no problems at all.
<em>edited by jhea123 on 27/09/2011</em>
As a mother of a reflux refuser, here's my advice:
1. Go back to Neocate, and if possible stay with Neocate until your LO is well over 4 months and you're not dealing with bottle refusal issues. Your ped is right in that switching to too many formulas could make matters worse, but as your LO has clearly failed the Aptamil comfort trial you need to bring her back to what you know her system cn manage. Plus, If you move from Neocate and mess around with different formulas only to find out that in the end you do need to return to Neocate you're going to find it much more difficult getting your LO to drink it due to taste as well as other things. The four month mark is an important milestone because your LO's eating moves from being reflexsive to proactive. So if she starts associating feeding with pain/discomfort you could be dealing with a refusal issue as well as the reflux and right now you want to avoid that at all costs.
2. When you are ready to switch formulas move to a hypo allergenic formula; the milk protein is not as digested as the elemental formulas but should be enough to help manage most MSPI issues. Aptamil comfort is NOT an HA formula; I have no idea why your ped recommended that. Apatimil does make an HA brand however.
3. Ped's are useless when it comes to reflux and feeding issues; if you're not comfortable with the advice he's giving, don't follow it. Question everything you're being told.
4. A few resources to help you with dealing with your LO's reflux. This website happens to be great, you can even post a few questions, the advice will be US centric so they won't know what formula brands you're dealing with, but the essence of the advice should remain the same.
http://community.babycenter.com/groups/a3937145/surviving_reflux_dealing_with_the_other_colic---reflux_mspi_and_other_gi_issues
what HAK said, you are her mother and you know her better than anyone and know whats working best for her too. My DD gets Aptimal and we had similar experiences (not to the same extent as your wee one) when we moved from stage 1 to stage 2. I would try a different brand of formula imo, you know whats best for your wee one. Good luck
oh, hun... what a horrid situation! One thing though - you know your baby better than any paediatrician ever will, and if you know that this is causing her discomfort, then that's that. I've never given formula to either of my two, so can't help on that front, but yes... you know what needs to happen. Tell the paediatrician that he needs to advise something else.
Hi Ladies
DD is 13 weeks today and has silent reflux which is being managed by medications. A few weeks ago we also discovered she may have an intolerance to cow's milk protein. At the time, we had tried SMA Gold and Lactose Free and her paed recommended Aptamil Comfort. She immediately developed watery stools and a lot of gas to the point where she would thrash her legs around all the time and find it difficult to sleep. Even when in our arms, she would wriggle around so much and cry whilst trying to pass gas.
The paed eventually suggested Neocate. DD responded quite well to it but went the reverse way and had constipation. After 2 weeks on Necocate, the paed suggested we begin weaning her off it by re-introducing Aptamil Comfort. We have been mixing up her formula at every meal. Initially we started with more of the Neocate and less of the Aptamil in the mix but have now got to the stage where we are supposed to be giving her more Aptamil than Neocate. For example, in a 180ml feed, she should be having four scoops of Aptamil and 2 scoops of Neocate.
But, in the past three days where she has been taking more of the Aptamil, the symptoms she had previously have returned, this time with a vengence. She basically cannot sleep without being held. When held, she wriggles so much that sometimes I'm afraid I'll drop her. She thrashes her legs and cries a lot more than before. Whereas she had been sleeping through the night from 10 weeks of age, now it's a battle to get her to even close her eyes at night time let alone get her to settle for a sleep. Hubby and I are exhausted.
The trouble is our paed insists we continue with the Aptamil and I am not sure why. I have asked him about switching to another brand (several times) and he says we shouldn't change formula too often and need to give it time to settle. Clearly though, DD is not responding well to Aptamil Comfort and we need to do something about it as it has been more than 3 weeks that we have been trying to get her to adjust to it.
I've read through previous threads and it seems as though HIPP Organic and S26HA are two formulas we could try. I would be grateful for any other suggestions you ladies may have.
Many TIA.