Hello. Thank you for posting your query at DoctorSpring.com
I understand your concerns. You seem to be in a difficult situation. I ll try to be as frank with as I can for the benefit of your baby. Regarding your child's problems, it appears that we are diagnosing things too empirically and too rapidly without adequate clinical evidence/ laboratory back up. It is a new born baby and it is not right to experiment with his feeding.
You mentioned that your child has several red spots on his face. Did you know that there is an entity called the 'Six-week rash' that occurs in many infants around this age and is totally benign? Your description could fit into that. Similarly there is 'Erythema toxicum' that is also considered BENIGN. We are assuming that his rash is due to allergy. At one month of age, it is unlikely that he has MILK allergy. We do not have anything to suggest that.
Secondly, many infants have fussiness and some regurgitation that is considered physiological for this age. Infact, he could be having 'Evening colic' which can manifest around the same age with prolonged episodes of unexplained crying especially during evening/night. This requires no treatment and subsides on its own as the infant grows up. So assumption of 'GASTRO-ESOPHAGEAL REFLUX' is also without basis. Even if we were to assume that it is GER, it is unlikely to be unresponsive to Omeprazole (proton pump inhibitors) which are the first line of medical therapy for GER worldwide. Why would your baby have GER unresponsive to Omeprazole? Unlikely again.
We need to look at his weight gain and growth parameters over the first month of life. If he is truly having a pathological GER, he is unlikely to have gained weight adequately.
To assume that everything is due to his formula and to keep changing the formulas based on our whims and fancies is entirely unjustifiable. I would strongly recommend BREASTFEEDING in your infant. The best way to feed your baby is breastfeeding. Obviously everything else is inferior to breastmilk. If after diligent attempts at establishing lactation, if you are still unable to breastfeed, the you may use the routine infant term formula. Both lactose free formulae and soy-based formulae are to be used only with medical prescription. Using them empirically based on empirical reasoning and without any evidence of underlying disease can be more harmful. Kindly use SIMILAC Advanced formulae/ total comfort if you cannot do without full formula feeds.
Consult a pediatric gastroenterologist at the earliest. PLEASE do not go by whatever you read on the internet.
Feel free to discuss further,
Dr. Saptharishi L G
Patient replied :
Thank you for the in depth response. I am unable to breastfeed and the lacatation department was not helpful in providing information related to formula feedings. He will see a gasto specialist week. I was advised at the ER to give him pandol for pain and irritability related to irritation from acid in his throat. I was told to give 0.8ml. How often can this be given and for what duration? He has a clear liquid that builds in his mouth when he is resting and sometimes bubbles, is this related to his dx of GERD.
Thank you for the follow up.
I can imagine your situation with inadequate help from medical services. It is definitely the duty of the lactation specialist to help you with the initial phase of feeding a young infant.
Pandol is 'PANTOPRAZOLE', which is a proton pump inhibitor (belongs to the same class as omeprazole) and may help in GER. However there is no rationale to give both omeprazole and pantoprazole. However, I am not sure of you are referring to PANADOL, which is paracetamol and can be used for pain-relief in young infants.
Building up of clear liquid in one's mouth due to reflux is known as WATER BRASH. I do commend your keen observation. It is a well described symptom of GERD in older children/adults. However, I have to acknowledge that this is the first time that am hearing such a description in infants as young as yours.Let us, for a minute, assume that he has GERD. There are non-pharmacological ways to help your child.
1. Use thicker feeds of smaller volume, by increasing the frequency of feeding and decreasing the volume per feed.
2. Use adequate burping after each feed ( at least 10 -15 minutes)
3. Use a propped up position and do not put him in supine position immediately after feeding
4. Avoid top feeds if possible. At least minimise it by combining with breast feeding.