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Can A 4-months Infant Get Symptoms Of Silent Reflux?
Question: Hello Doctor, I am first time mother currently in the UK (I am from XXXXXXX originally). I am 34 years old and my daughter was conceived after IVF with my own egg and my husband's sperm.
My baby daughter was born at 38 weeks with C-section and birth weight was 2.960kg. Since birth she could not latch on my breast easily. I consulted many lactation experts but nothing worked so I started pumping milk with electric pump and gave to my baby with bottles.
First two and half months were ok. She was gaining weight but at slower pace. Urination and pooping were acceptable. She had eczema episodes 2-3 times in last three months which were controlled by mild steroid cream.
After two and half months she started rejecting the bottles while she was awake. Few days she consumed less than usual. We were so much engrossed in her feeding issue that I could not pump enogh and my breastmilk supply went very low. From three months of age she is on formula milk.
At three months she was still rejecting the bottles most of the time. She would arch back, push her tongue out, cry, turn her head away etc. Interestingly she would take feed during sleep state.
My baby was not vomiting and only brought her ingested milk (small amount) back very few times.
We consulted few doctors but none was concerned. They said babies do that. One suggested it could be silent reflux and advise to start Renitidine. We started it and seen some improvement after a week. She rejected bottles less than before but still not fully accepted.
She does not ask for feed herself, I mean she does not seem to be hungry after few hours. I have to keep tracking her feeds and amount so I can give her next feed if 3-4 hours have passed since last feed.
Today she is 4 months and 2 weeks old. Her weight is 5.250kg. She urinates about 8-10 times a day and poo about once a day (in large quantity). She is exclusively on formula milk now. She takes about 650ml in a day in 7-9 feeding, from 60ml to 120ml at a time. She is active, sleeps well and plays well.
Since last few days she has started to reject bottles completely in awake state. If she is sleepy or in sleep she would take 100-120ml if 3-4 hours have passed from last feed. I have to make her sleep sometime to feed her so she does not go hungry and get dehydrated.
My concerns:
1> Are her feeding volume is sufficient for her age and weight? She takes about 650ml in a day. She was taking the same amount about a month ago.
2> Can she really have silent reflux or are we just giving her Renitidine unnecessarily?
3> Our current feeding schedule is: Offer her bottle every 3-4 hours. If she takes 100ml or more wait upto 4 hours. If she takes 60-80ml wait upto three hours for next. If she does not take at all wait one hour and offer her again. Try to make her sleep if she has not taken for long time.
Before sleep around 10.00pm she usually takes 120ml in half sleep state. We then let her sleep about 4 hours and then give her feed in her sleep. She usually takes about 50-60ml. then next feed is in morning about 7.00am.
Are we doing it right? as I said she does not demand feed herself by crying or rooting etc.
4> What is the reason for her rejecting the bottles? This can not be normal behaviour. We tried different milk, different bottles but nothing has worked.
5> What your suggestion is to make feeding easier for everyone?
6> This feeding issue has become real stressful for all members. I am sure she will go hungry for long if we do not keep track of her feeding. Why she is reluctant to demand feed?
7> She does not appear gassy or constipated. She does not look in pain. She plays well and sleeps well.
8> Is her weight gain acceptable? She was on 25th Percentile chart at birth and now on 02nd Percentile line. She is following 2nd percentile line from last three months.
9> Three weeks ago her blood test was done. Renal function, Liver function, blood count, calcium, para thyroid hormone were in normal range.
Any further advise will be appreciated.
Thanks.
My baby daughter was born at 38 weeks with C-section and birth weight was 2.960kg. Since birth she could not latch on my breast easily. I consulted many lactation experts but nothing worked so I started pumping milk with electric pump and gave to my baby with bottles.
First two and half months were ok. She was gaining weight but at slower pace. Urination and pooping were acceptable. She had eczema episodes 2-3 times in last three months which were controlled by mild steroid cream.
After two and half months she started rejecting the bottles while she was awake. Few days she consumed less than usual. We were so much engrossed in her feeding issue that I could not pump enogh and my breastmilk supply went very low. From three months of age she is on formula milk.
At three months she was still rejecting the bottles most of the time. She would arch back, push her tongue out, cry, turn her head away etc. Interestingly she would take feed during sleep state.
My baby was not vomiting and only brought her ingested milk (small amount) back very few times.
We consulted few doctors but none was concerned. They said babies do that. One suggested it could be silent reflux and advise to start Renitidine. We started it and seen some improvement after a week. She rejected bottles less than before but still not fully accepted.
She does not ask for feed herself, I mean she does not seem to be hungry after few hours. I have to keep tracking her feeds and amount so I can give her next feed if 3-4 hours have passed since last feed.
Today she is 4 months and 2 weeks old. Her weight is 5.250kg. She urinates about 8-10 times a day and poo about once a day (in large quantity). She is exclusively on formula milk now. She takes about 650ml in a day in 7-9 feeding, from 60ml to 120ml at a time. She is active, sleeps well and plays well.
Since last few days she has started to reject bottles completely in awake state. If she is sleepy or in sleep she would take 100-120ml if 3-4 hours have passed from last feed. I have to make her sleep sometime to feed her so she does not go hungry and get dehydrated.
My concerns:
1> Are her feeding volume is sufficient for her age and weight? She takes about 650ml in a day. She was taking the same amount about a month ago.
2> Can she really have silent reflux or are we just giving her Renitidine unnecessarily?
3> Our current feeding schedule is: Offer her bottle every 3-4 hours. If she takes 100ml or more wait upto 4 hours. If she takes 60-80ml wait upto three hours for next. If she does not take at all wait one hour and offer her again. Try to make her sleep if she has not taken for long time.
Before sleep around 10.00pm she usually takes 120ml in half sleep state. We then let her sleep about 4 hours and then give her feed in her sleep. She usually takes about 50-60ml. then next feed is in morning about 7.00am.
Are we doing it right? as I said she does not demand feed herself by crying or rooting etc.
4> What is the reason for her rejecting the bottles? This can not be normal behaviour. We tried different milk, different bottles but nothing has worked.
5> What your suggestion is to make feeding easier for everyone?
6> This feeding issue has become real stressful for all members. I am sure she will go hungry for long if we do not keep track of her feeding. Why she is reluctant to demand feed?
7> She does not appear gassy or constipated. She does not look in pain. She plays well and sleeps well.
8> Is her weight gain acceptable? She was on 25th Percentile chart at birth and now on 02nd Percentile line. She is following 2nd percentile line from last three months.
9> Three weeks ago her blood test was done. Renal function, Liver function, blood count, calcium, para thyroid hormone were in normal range.
Any further advise will be appreciated.
Thanks.
Brief Answer:
Unfortunately, there is no short cut here!
Detailed Answer:
Hi,
I am really sorry that your daughter is having such problems with her feeding.
In the first instance, I think both you and your partner and the rest of the family (you haven't actually indicated how many adults are in your household, but I imagine there are others apart from your husband) are doing a great job being patient and trying your best to resolve the entire situation.
First of all, please tell me which milk she is currently on. You have told me the quantities. Normally, if a child is feeding well, they should get about 120 - 150 ml for every kg weight. This means that for her weight of 5.25 kg, she should be okay with about 700 - 800 ml in 24 hours. I guess she is just below this, but you could maybe go up every feed about 10-15 ml and she will get her required amounts.
I am okay with the weight that she is on. I am also okay that she has maintained her weight on the same, albeit lower, 2nd percentile. It is likely one of the parents - either you or your husband - was similarly slim in infancy.
Do not stress about the fact that you lost breast milk in early infancy of your child. What is done is in the past. Let us not dwell on this now.
I think I would agree that there is a silent reflux situation going on. Please consult her paediatrics doctor to see if any increase is possible in the dose of ranitidine. There is an acceptable range of doses that we can go up to and the doctor will help you optimize the dose.
I would like to suggest that you try giving her the milk without using any bottles at all, but with a cup and spoon. This may initially be a little troublesome, but, believe me, after a while, the baby will adapt herself to it easily and make your troubles vanish.
When you use the word "demand feed", you are usually referring to a baby that is up to a few months old. After this, most babies would develop some sort of a routine - the most common one being one feed every 4-5 hours and about 5-6 feeds in a 24-hour day. However, many infants about 4-5 months of age are already down to just one night-time feed, with the majority of feeds taken during the day. This, I think, is also the case with your daughter, so I wouldn't worry about that one feed that she does take in sleep.
Actionable points:
1. Stop worrying.
2. Try giving her milk without using a bottle.
3. Do not keep changing the milk or the bottles.
4. Gradually teach her to stop taking the night feed. It can be a problem if she feeds without even waking up for it. In any case, the amount she takes at night is negligible, isn't it?
I will await a further response from you. Do rate my answer if satisfied.
Unfortunately, there is no short cut here!
Detailed Answer:
Hi,
I am really sorry that your daughter is having such problems with her feeding.
In the first instance, I think both you and your partner and the rest of the family (you haven't actually indicated how many adults are in your household, but I imagine there are others apart from your husband) are doing a great job being patient and trying your best to resolve the entire situation.
First of all, please tell me which milk she is currently on. You have told me the quantities. Normally, if a child is feeding well, they should get about 120 - 150 ml for every kg weight. This means that for her weight of 5.25 kg, she should be okay with about 700 - 800 ml in 24 hours. I guess she is just below this, but you could maybe go up every feed about 10-15 ml and she will get her required amounts.
I am okay with the weight that she is on. I am also okay that she has maintained her weight on the same, albeit lower, 2nd percentile. It is likely one of the parents - either you or your husband - was similarly slim in infancy.
Do not stress about the fact that you lost breast milk in early infancy of your child. What is done is in the past. Let us not dwell on this now.
I think I would agree that there is a silent reflux situation going on. Please consult her paediatrics doctor to see if any increase is possible in the dose of ranitidine. There is an acceptable range of doses that we can go up to and the doctor will help you optimize the dose.
I would like to suggest that you try giving her the milk without using any bottles at all, but with a cup and spoon. This may initially be a little troublesome, but, believe me, after a while, the baby will adapt herself to it easily and make your troubles vanish.
When you use the word "demand feed", you are usually referring to a baby that is up to a few months old. After this, most babies would develop some sort of a routine - the most common one being one feed every 4-5 hours and about 5-6 feeds in a 24-hour day. However, many infants about 4-5 months of age are already down to just one night-time feed, with the majority of feeds taken during the day. This, I think, is also the case with your daughter, so I wouldn't worry about that one feed that she does take in sleep.
Actionable points:
1. Stop worrying.
2. Try giving her milk without using a bottle.
3. Do not keep changing the milk or the bottles.
4. Gradually teach her to stop taking the night feed. It can be a problem if she feeds without even waking up for it. In any case, the amount she takes at night is negligible, isn't it?
I will await a further response from you. Do rate my answer if satisfied.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you doctor for your reply.
We are four members at home, my husband, my mother, me and my mother-in-law. All play their part in raising my daughter.
She is on standard infant's first formula milk since three months of age. The brand name is "Aptamil" which is very popular in UK. It is based on cow's milk. We buy it ready made bottles. The powder version is also available but we prefer ready made bottles as it is less time consuming. Other options are lactose free milk, protein free milk, thicker formula for reflux, comfort formula for constipation and colic etc but we have not tried those.
We had tried different milk (that means different brands). We tried different bottles previously but there was no improvement so we are now using same bottles since last month.
I completely agree with you that baby should develop pattern of eating 4-5 hourly feed. I tried to wait 4-5 hours but what happened was that one time she took 120ml but next time only 50ml. My worry was that if she does not take enough after 4 hours then she will not go through her required amount of around 700ml in a day. Therefore I started feeding according to what she had taken in last time and when. This way she does 650ml in a day.
The night feed is small amount but still significant for her daily total. Without it she will even go below 650ml in 24 hours.
Renitidine was started with 0.33ml and after three weeks it was increased to 1ml 3-4 times a day. As I said it made little difference but not as much as I would have liked.
1> Are you confident that she does not have any major health problems? I am worried whether she may have some gut or other problem.
2> we will try cup and spoon and will see how it goes.
3> Do you advise to start semi-solids from now or wait till 6 months of age? One had suggested that it could do good for reflux babies if started at 4 months.
Thanks.
We are four members at home, my husband, my mother, me and my mother-in-law. All play their part in raising my daughter.
She is on standard infant's first formula milk since three months of age. The brand name is "Aptamil" which is very popular in UK. It is based on cow's milk. We buy it ready made bottles. The powder version is also available but we prefer ready made bottles as it is less time consuming. Other options are lactose free milk, protein free milk, thicker formula for reflux, comfort formula for constipation and colic etc but we have not tried those.
We had tried different milk (that means different brands). We tried different bottles previously but there was no improvement so we are now using same bottles since last month.
I completely agree with you that baby should develop pattern of eating 4-5 hourly feed. I tried to wait 4-5 hours but what happened was that one time she took 120ml but next time only 50ml. My worry was that if she does not take enough after 4 hours then she will not go through her required amount of around 700ml in a day. Therefore I started feeding according to what she had taken in last time and when. This way she does 650ml in a day.
The night feed is small amount but still significant for her daily total. Without it she will even go below 650ml in 24 hours.
Renitidine was started with 0.33ml and after three weeks it was increased to 1ml 3-4 times a day. As I said it made little difference but not as much as I would have liked.
1> Are you confident that she does not have any major health problems? I am worried whether she may have some gut or other problem.
2> we will try cup and spoon and will see how it goes.
3> Do you advise to start semi-solids from now or wait till 6 months of age? One had suggested that it could do good for reflux babies if started at 4 months.
Thanks.
Brief Answer:
Please read a detailed reply below.
Detailed Answer:
Hello,
I currently work as a Paediatric registrar in the U.K. and the milk brands are very much known to me.
First of all, babies tend to follow a certain percentile trajectory and will generally stay on this for a considerable time and then, in some cases, cross a percentile upwards. Not all will, though. The beauty of it is that even those that follow a lower percentile have the potential to grow as normal adults as long as they do not dip further downward, say, due to an infection or some other illness.
I am not able to say 100% that she has no illness or an underlying gut problem since she is still very young and only on milk. Some illnesses like, say, coeliac disease, would only manifest after a child starts having cereals like wheat, rye or barley. However, the balance of probabilities at this stage does favour my thinking that she is essentially normal, and will get there to the higher growth percentile eventually.
I am glad to learn that you will try out spoon feeding. Just give it a fortnight of trial before passing any judgement on it.
Coming to the last part of your question: Yes, you could try semisolids after 4 months of a baby's life. Jars containing baby foods are readily available at stores all over the U.K. Brands include Knorr's, Nestle and others. Be aware that these jars are expensive but highly safe for the babies as the British governmental checks are pretty good and no manufacturer will risk plying goods that have artificial colours, preservatives or chemicals.
This introduction, however, can also be done with other forms of weaning foods. I can suggest baby rice, softened banana, mashed boiled potato, and similar foods such as the ones XXXXXXX families give to their children. (I am assuming that you are an Indian-origin family, but even if you aren't, it doesn't matter, because these foods are time-tested and safe for babies as they are home-made and also free from any harmful ingredients.)
You are already giving her a good dose of Ranitidine and I don't think you should increase it for now. There is always a variation in response from one patient to another, whichever medicine is chosen for comparison. This is because our bodies are different from each other and processes medicines differently from others.
I hope these tips help. Do revert for more information and I will be happy to discuss it further.
Thanks.
Dr Taher Kagalwala
P.S. I can see that you have been visiting this site and asking questions quite often. I think that you are possibly not very confident of her family physician and/or her paediatrician. Is this the right impression? If so, why is it so? The answer to this will help me formulate the right strategies for you, as, of course, I am not seeing your daughter in person.
Dr Taher
Please read a detailed reply below.
Detailed Answer:
Hello,
I currently work as a Paediatric registrar in the U.K. and the milk brands are very much known to me.
First of all, babies tend to follow a certain percentile trajectory and will generally stay on this for a considerable time and then, in some cases, cross a percentile upwards. Not all will, though. The beauty of it is that even those that follow a lower percentile have the potential to grow as normal adults as long as they do not dip further downward, say, due to an infection or some other illness.
I am not able to say 100% that she has no illness or an underlying gut problem since she is still very young and only on milk. Some illnesses like, say, coeliac disease, would only manifest after a child starts having cereals like wheat, rye or barley. However, the balance of probabilities at this stage does favour my thinking that she is essentially normal, and will get there to the higher growth percentile eventually.
I am glad to learn that you will try out spoon feeding. Just give it a fortnight of trial before passing any judgement on it.
Coming to the last part of your question: Yes, you could try semisolids after 4 months of a baby's life. Jars containing baby foods are readily available at stores all over the U.K. Brands include Knorr's, Nestle and others. Be aware that these jars are expensive but highly safe for the babies as the British governmental checks are pretty good and no manufacturer will risk plying goods that have artificial colours, preservatives or chemicals.
This introduction, however, can also be done with other forms of weaning foods. I can suggest baby rice, softened banana, mashed boiled potato, and similar foods such as the ones XXXXXXX families give to their children. (I am assuming that you are an Indian-origin family, but even if you aren't, it doesn't matter, because these foods are time-tested and safe for babies as they are home-made and also free from any harmful ingredients.)
You are already giving her a good dose of Ranitidine and I don't think you should increase it for now. There is always a variation in response from one patient to another, whichever medicine is chosen for comparison. This is because our bodies are different from each other and processes medicines differently from others.
I hope these tips help. Do revert for more information and I will be happy to discuss it further.
Thanks.
Dr Taher Kagalwala
P.S. I can see that you have been visiting this site and asking questions quite often. I think that you are possibly not very confident of her family physician and/or her paediatrician. Is this the right impression? If so, why is it so? The answer to this will help me formulate the right strategies for you, as, of course, I am not seeing your daughter in person.
Dr Taher
Above answer was peer-reviewed by :
Dr. Kampana
Thank you doctor for your reply. Glad to hear that you have understanding of UK system and products. Makes it easy to explain to you.
We have tried spoon/cup feeding for two days but she did not take it. We are now planning to start semi-solids with UK and XXXXXXX recipes and some fruits banana, apple etc. Lets see how it goes.
We think that baby has become more worse in feeding. Few days back she was taking feed in sleep but last three days she could not complete his 650ml even in sleep. She starts taking it and wakes up in the middle of the feeding and starts rejecting it. We were worried about dehydration etc so we took her to private consultant pediatrician.
She recommended we start 1.2ml of renitidine, additionally omeprazole and change the milk to Neocate (Amino acid based - cow's milk protein free). She thought baby is having cow's milk allergy and reflux. She also recommended to start HiPP organic rice, bananas and apples.
She took baby's poo sample and we are awaiting for the result.
Yesterday baby did not take any feed for almost 9 hours and cried cried a lot even in consultant's office. She finally took 100ml after 9 hours because she was like starving and did not have choice.
1> Do you think the above plan should work and my baby is really having cow's milk allergy and severe reflux?
2> I read on internet that sometimes baby develop aversion to milk or bottles due to previous bad memory. Can my baby have case of aversion to bottles or milk? If yes, are there any ways to reverse it?
3> You are right in assuming that we are not confident in our GP. My GP and my baby's GP are same. She is very very very reluctant to prescribe anything at all. We had been to her many times for feeding problem but everytime she says "Babies do that" and just check her and let us go home. We asked her to prescribe renitidine but she said she has to consult pediatrician and finally she gave prescription of minimal dose (0.33ml) of renitidine instead of current dose of 1ml.
She still thinks that my baby has no problem at all and weight gain is absolutely fine. She does not take us seriously at all. She does not see that whatever the baby is taking daily is with too much struggle and stress. Without us being on her feeding all the time she will not take enough. We had asked her to refer us to NHS pediatrician but initially she did not and after requesting so many times she referred after a month. NHS pediatrician was similar to GP and just put us off by saying baby is healthy and nothing new to be done. no tests needed and continue renitidine. She also did not listen that baby is struggling to get her needed amount with ease. It is much struggle.
Yesterday health visitor came to our house. Instead of solving problem of feeding she was more interested in how other members are helping, how many times we take baby out, what work do we do etc.. The health visitor said she will type a report then speak to her manager then if necessary she will speak to GP and then they will decide what to do. I thought come on, this will take ages to sort things out.
Because of slow response of NHS, I often take opinion on this website, internet and also used private consultants.
We bought Neocate LCP milk powder yesterday and planning to start from today. This powder is really expensive, £40 for 400 grams. If she likes it and goes well we need to continue her for longer and give her solids as well and we would really like our GP prescribes it.
4> IS THIS MILK AVAILABLE ON NHS?
Because it is for our baby, we do not want to act slow or miss anything which may be wrong with her.
Awaiting your reply.
Thanks.
We have tried spoon/cup feeding for two days but she did not take it. We are now planning to start semi-solids with UK and XXXXXXX recipes and some fruits banana, apple etc. Lets see how it goes.
We think that baby has become more worse in feeding. Few days back she was taking feed in sleep but last three days she could not complete his 650ml even in sleep. She starts taking it and wakes up in the middle of the feeding and starts rejecting it. We were worried about dehydration etc so we took her to private consultant pediatrician.
She recommended we start 1.2ml of renitidine, additionally omeprazole and change the milk to Neocate (Amino acid based - cow's milk protein free). She thought baby is having cow's milk allergy and reflux. She also recommended to start HiPP organic rice, bananas and apples.
She took baby's poo sample and we are awaiting for the result.
Yesterday baby did not take any feed for almost 9 hours and cried cried a lot even in consultant's office. She finally took 100ml after 9 hours because she was like starving and did not have choice.
1> Do you think the above plan should work and my baby is really having cow's milk allergy and severe reflux?
2> I read on internet that sometimes baby develop aversion to milk or bottles due to previous bad memory. Can my baby have case of aversion to bottles or milk? If yes, are there any ways to reverse it?
3> You are right in assuming that we are not confident in our GP. My GP and my baby's GP are same. She is very very very reluctant to prescribe anything at all. We had been to her many times for feeding problem but everytime she says "Babies do that" and just check her and let us go home. We asked her to prescribe renitidine but she said she has to consult pediatrician and finally she gave prescription of minimal dose (0.33ml) of renitidine instead of current dose of 1ml.
She still thinks that my baby has no problem at all and weight gain is absolutely fine. She does not take us seriously at all. She does not see that whatever the baby is taking daily is with too much struggle and stress. Without us being on her feeding all the time she will not take enough. We had asked her to refer us to NHS pediatrician but initially she did not and after requesting so many times she referred after a month. NHS pediatrician was similar to GP and just put us off by saying baby is healthy and nothing new to be done. no tests needed and continue renitidine. She also did not listen that baby is struggling to get her needed amount with ease. It is much struggle.
Yesterday health visitor came to our house. Instead of solving problem of feeding she was more interested in how other members are helping, how many times we take baby out, what work do we do etc.. The health visitor said she will type a report then speak to her manager then if necessary she will speak to GP and then they will decide what to do. I thought come on, this will take ages to sort things out.
Because of slow response of NHS, I often take opinion on this website, internet and also used private consultants.
We bought Neocate LCP milk powder yesterday and planning to start from today. This powder is really expensive, £40 for 400 grams. If she likes it and goes well we need to continue her for longer and give her solids as well and we would really like our GP prescribes it.
4> IS THIS MILK AVAILABLE ON NHS?
Because it is for our baby, we do not want to act slow or miss anything which may be wrong with her.
Awaiting your reply.
Thanks.
Brief Answer:
Please read a detailed reply below.
Detailed Answer:
Hello,
Thank you very much for your continued dialogue. It really means a lot to me. Although I am a registrar in the UK, I have been a consultant for nearly 25 years previously in XXXXXXX I have to say that I appreciate the hard work your in-laws, and you - the parents are putting in.
In the UK, the NHS still remains a viable and good option for over 90% of the patients. It is fund-starved and there is a delay with appointments and so on, but, on the whole, it still delivers. I am proud to be associated with the system, albeit for only over 2.5 years now.
Coming now to the questions you have raised. Yes, Neocate can be prescribed by the NHS paediatricians. I think the addition of Omeprazole may or may not help, but it is fair to try the new doses of ranitidine and the omeprazole for at least a month before passing any judgement on it.
I am a little concerned that the doctor is treating her as BOTH reflux AND cow's milk protein allergy. The first step should have been the use of an extensively hydrolysed cow's milk formula like Nutramigen rather than Neocate. This is not to say that the doctor is wrong. After all, I have NEVER seen your daughter. and perhaps these changes will do the trick. I would recommend you use everything the doctor has recommended for at least a month, then have her weight taken to see what the progress is.
The qualitative differences you are seeing in her eating and feeding habits must also show a positive change. For example, she should start taking interest in feeding - whether it is rice, other cereals, fruit or vegetable. I would say that if she eats well, then the weight is less important. As I previously stated, there are children who grow a little more slowly than others, but they are still normal as long as they develop normally, eat well and are normally active.
The health visitor is obviously a little sceptical about what you and your family are doing. You need to impress upon them that you are actually trying your best to bring up your infant in the correct way. Do not keep complaining to them or they might think you are not being a good parent!
I guess you need to go to the NHS Paediatric consultant and get them to prescribe the Neocate. This is subject, of course, to the results you get with it. If the result is not satisfactory, it would be like flogging a dead horse, would it not?
Please stay in touch and let me know how this turns out. I will be happy to answer your future queries.
Please do visit my profile and send me a rating and testimonials. Thank you.
With warm regards,
Dr Taher Kagalwala
Please read a detailed reply below.
Detailed Answer:
Hello,
Thank you very much for your continued dialogue. It really means a lot to me. Although I am a registrar in the UK, I have been a consultant for nearly 25 years previously in XXXXXXX I have to say that I appreciate the hard work your in-laws, and you - the parents are putting in.
In the UK, the NHS still remains a viable and good option for over 90% of the patients. It is fund-starved and there is a delay with appointments and so on, but, on the whole, it still delivers. I am proud to be associated with the system, albeit for only over 2.5 years now.
Coming now to the questions you have raised. Yes, Neocate can be prescribed by the NHS paediatricians. I think the addition of Omeprazole may or may not help, but it is fair to try the new doses of ranitidine and the omeprazole for at least a month before passing any judgement on it.
I am a little concerned that the doctor is treating her as BOTH reflux AND cow's milk protein allergy. The first step should have been the use of an extensively hydrolysed cow's milk formula like Nutramigen rather than Neocate. This is not to say that the doctor is wrong. After all, I have NEVER seen your daughter. and perhaps these changes will do the trick. I would recommend you use everything the doctor has recommended for at least a month, then have her weight taken to see what the progress is.
The qualitative differences you are seeing in her eating and feeding habits must also show a positive change. For example, she should start taking interest in feeding - whether it is rice, other cereals, fruit or vegetable. I would say that if she eats well, then the weight is less important. As I previously stated, there are children who grow a little more slowly than others, but they are still normal as long as they develop normally, eat well and are normally active.
The health visitor is obviously a little sceptical about what you and your family are doing. You need to impress upon them that you are actually trying your best to bring up your infant in the correct way. Do not keep complaining to them or they might think you are not being a good parent!
I guess you need to go to the NHS Paediatric consultant and get them to prescribe the Neocate. This is subject, of course, to the results you get with it. If the result is not satisfactory, it would be like flogging a dead horse, would it not?
Please stay in touch and let me know how this turns out. I will be happy to answer your future queries.
Please do visit my profile and send me a rating and testimonials. Thank you.
With warm regards,
Dr Taher Kagalwala
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you doctor for your reply.
I do appreciate NHS and have no complaints about it. NHS has treated me and my husband nicely previously. It is just because this is matter of my first and very little baby and I do not want to miss any diagnosis which may affect her health if left untreated for longer time.
In my last appointment with private consultant she had done poo test. The result came today and shows inflammation of bowel. The reading of faecal calprotectin is 75 ug/gFec (normal range is <50). She said NeoCate is necessary.
I am worried again by this readings. Is this something to worry about or is it related to milk allergy only?
Do you think any more tests are needed?
Please reply as soon as you can.
thanks.
Further to my previous notes I just got email from the private consultant that I should contact my GP immediately for referral to local paediatric department to look into this further by doing scans and investigations. Also she recommended that I should ask for referral to speech & Language therapist also dietician to help start solids and drink milk without pain. She also recommended referral to paediatric gastroenterologist.
They can do all this privately but will be much expensive.
I am very stressed that what happened to my baby. Can this be resolved quickly?
Thanks.
I do appreciate NHS and have no complaints about it. NHS has treated me and my husband nicely previously. It is just because this is matter of my first and very little baby and I do not want to miss any diagnosis which may affect her health if left untreated for longer time.
In my last appointment with private consultant she had done poo test. The result came today and shows inflammation of bowel. The reading of faecal calprotectin is 75 ug/gFec (normal range is <50). She said NeoCate is necessary.
I am worried again by this readings. Is this something to worry about or is it related to milk allergy only?
Do you think any more tests are needed?
Please reply as soon as you can.
thanks.
Further to my previous notes I just got email from the private consultant that I should contact my GP immediately for referral to local paediatric department to look into this further by doing scans and investigations. Also she recommended that I should ask for referral to speech & Language therapist also dietician to help start solids and drink milk without pain. She also recommended referral to paediatric gastroenterologist.
They can do all this privately but will be much expensive.
I am very stressed that what happened to my baby. Can this be resolved quickly?
Thanks.
Brief Answer:
I think you should see a Paediatrician in the NHS.
Detailed Answer:
Hello,
Let me not for a moment think that you are wrong in whatever you have been doing. First, though, my apologies for keeping this answer waiting for this long. I was on nightshift and therefore unable to write the answer for you.
An elevated fecal calprotectin is a surrogate marker for bowel problems like inflammatory bowel disease, coeliac disease, and other problems. Your child's level is only marginally elevated, and, perhaps, a repeat testing may turn out different and not concerning. However, at the present time, your GP should refer you to an NHS Paediatric unit for further testing and rule out these conditions.
I can tell you for sure that an elevated fecal Calprotectin should not be present in a child with milk allergy. I am not sure why your private consultant said that Neocate is necessary. Neocate is an extensively hydrolyzed cow's milk formula milk that is used in children with severe cow's milk protein intolerance. This would have nothing to do with the abnormal test result. It is, however, true that Neocate would be more easily digested than the usual formula milk.
I would suggest first pursuing that abnormal result. A referral to a dietician is not a bad idea. I am not certain the speech and language specialists should be involved right away, as there is not much evidence to show that there is a swallowing difficulty here. However, this can be considered as part of an overall plan of action through the NHS.
I am fairly certain that things will move more swiftly now that there is an abnormal stool report and the erstwhile reluctant NHS Paediatrician is now more likely to take cognizance of the result and speed up the work-up on your daughter. Do keep in touch with me and let me know how this turns out.
Regards and best wishes for your daughter.
Dr. Taher
I think you should see a Paediatrician in the NHS.
Detailed Answer:
Hello,
Let me not for a moment think that you are wrong in whatever you have been doing. First, though, my apologies for keeping this answer waiting for this long. I was on nightshift and therefore unable to write the answer for you.
An elevated fecal calprotectin is a surrogate marker for bowel problems like inflammatory bowel disease, coeliac disease, and other problems. Your child's level is only marginally elevated, and, perhaps, a repeat testing may turn out different and not concerning. However, at the present time, your GP should refer you to an NHS Paediatric unit for further testing and rule out these conditions.
I can tell you for sure that an elevated fecal Calprotectin should not be present in a child with milk allergy. I am not sure why your private consultant said that Neocate is necessary. Neocate is an extensively hydrolyzed cow's milk formula milk that is used in children with severe cow's milk protein intolerance. This would have nothing to do with the abnormal test result. It is, however, true that Neocate would be more easily digested than the usual formula milk.
I would suggest first pursuing that abnormal result. A referral to a dietician is not a bad idea. I am not certain the speech and language specialists should be involved right away, as there is not much evidence to show that there is a swallowing difficulty here. However, this can be considered as part of an overall plan of action through the NHS.
I am fairly certain that things will move more swiftly now that there is an abnormal stool report and the erstwhile reluctant NHS Paediatrician is now more likely to take cognizance of the result and speed up the work-up on your daughter. Do keep in touch with me and let me know how this turns out.
Regards and best wishes for your daughter.
Dr. Taher
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you doctor. I wish our GP or Paediatrician was as concerned as you are.
We have been to our GP today. As expected she still believes that our daughter does not have serious problem. Everytime GP says our baby is putting on weight so nothing to worry.
GP said she has spoken to local Paediatrician and appointment will come within next 5 days. GP also mentioned that Paediatrician was also not concerned by this elevated fecal calprotectin. We almost begged our GP to take some quick action but she said she can not do more than referal to local Paediatrician. We requested she refer us to feeding clinic or dietician or Private hospital (where we had been going). She just refused it saying she can not refer to anywhere else. Local Paediatrician will decide.
This is what I was talking previously about NHS. Our GP knows that we first reported to her this feeding issue about THREE months ago and still she is taking matter easily because our baby has not lost weight and otherwise seems healthy. But she is not considering that how much effort we have to make so our baby can take her milk. She does not take any milk during awake state. So we have to wait until she sleeps or make her sleep so we can feed her. Lately she has even reduced the amount she takes in sleep as well. So situation is not improving but getting worse.
The paediatrician our GP has reffered to is known to us. We had met her about a month ago and that time she said our baby is healthy and nothing to be done. Just continue Renitidine. We had asked her can you please arrange some tests to be done to rule out health problems. She replied back to us by asking "You tell me What tests you want me to do?". We were not happy with her response. We are not doctors, she is. She should think about what is necessary. That is why we are not sure whether she will do anything more this time?
We tried Neocate and then SMA Althera and Aptamil Pepti 1 but my daughter has rejected all of them. Even in sleep she starts and does not swallow due to their tastes. Because she rejected all these and I was worried about her going dehydrated, I gave her Aptamil (her usual milk) and she took it.
1> Do you think she really has milk allergy?? She had 3 episodes of eczema during her five months of age which were controlled by e45 cream and mild steroid cream. Her stool and urination is acceptable since birth. She has only vomited 3 times in last five months. Few times small amount of milk came out (not vomit). She was between 9-25th percentile on weight chart at birth and after a month dropped to 02nd centile but since then followed same 2nd centile line on weight. She has not lost weight so far. She is alert, playful, recognise people now, cry when stranger comes near her, does not cry unnecessarily.
2> She is on Renitidine 1.1ml (she is 5.5kg and 4 months 3 weeks old) and since last two days also on Omeprazole twice a day (5ml each time). Do you think she may still has silent reflux?? If yes, when do you think omeprazole should help? because renitidine has not improved her situation over last one month.
Does Omeprazole suppress appetite? I think that she has taken little less milk (not very less but 50-100ml less) since starting omeprazole.
3> If you were treating my child, what next would you do? Would you order stool tests, ultrasound, allergy tests etc?? Please let me know this so at least I will have answer this time when we meet local paediatrician and if she asks us again "What tests would you like to have?"
4> Our GP said we can give her small amount of water in between feeds if we think she has not taken enough milk so she does not go dehydrated. Some advise not to give water until six months. Whats your advise on water?
5> On advise of private consultant we have started to give her solids. We started ready made fruit purees and baby rice. She took couple of time fruit purees about two tea spoons and baby rice about two tea spoons. We try to give her twice a day, one in morning and one in evening. She does not how to eat it like adults but she interestingly licks it and try to suck it like milk bottle's teat.
If she continues to take solids 2-3 tea spoons each day, do you think we should relax on her milk intake volume if she takes little less that day?
6> At one stage I was thinking to take my baby to XXXXXXX for proper treatment or quick investigation. Do you think I should travel for this feeding issue? My baby is turning 5 months next week. I am from XXXXXXX (Mehsana city) and closest big city is XXXXXXX (100kms from my town). If yes, would you be able to recommend any good paediatrician?
Apologies for lengthy response but I am so desperate for quick help.
Thanks and Regards.
We have been to our GP today. As expected she still believes that our daughter does not have serious problem. Everytime GP says our baby is putting on weight so nothing to worry.
GP said she has spoken to local Paediatrician and appointment will come within next 5 days. GP also mentioned that Paediatrician was also not concerned by this elevated fecal calprotectin. We almost begged our GP to take some quick action but she said she can not do more than referal to local Paediatrician. We requested she refer us to feeding clinic or dietician or Private hospital (where we had been going). She just refused it saying she can not refer to anywhere else. Local Paediatrician will decide.
This is what I was talking previously about NHS. Our GP knows that we first reported to her this feeding issue about THREE months ago and still she is taking matter easily because our baby has not lost weight and otherwise seems healthy. But she is not considering that how much effort we have to make so our baby can take her milk. She does not take any milk during awake state. So we have to wait until she sleeps or make her sleep so we can feed her. Lately she has even reduced the amount she takes in sleep as well. So situation is not improving but getting worse.
The paediatrician our GP has reffered to is known to us. We had met her about a month ago and that time she said our baby is healthy and nothing to be done. Just continue Renitidine. We had asked her can you please arrange some tests to be done to rule out health problems. She replied back to us by asking "You tell me What tests you want me to do?". We were not happy with her response. We are not doctors, she is. She should think about what is necessary. That is why we are not sure whether she will do anything more this time?
We tried Neocate and then SMA Althera and Aptamil Pepti 1 but my daughter has rejected all of them. Even in sleep she starts and does not swallow due to their tastes. Because she rejected all these and I was worried about her going dehydrated, I gave her Aptamil (her usual milk) and she took it.
1> Do you think she really has milk allergy?? She had 3 episodes of eczema during her five months of age which were controlled by e45 cream and mild steroid cream. Her stool and urination is acceptable since birth. She has only vomited 3 times in last five months. Few times small amount of milk came out (not vomit). She was between 9-25th percentile on weight chart at birth and after a month dropped to 02nd centile but since then followed same 2nd centile line on weight. She has not lost weight so far. She is alert, playful, recognise people now, cry when stranger comes near her, does not cry unnecessarily.
2> She is on Renitidine 1.1ml (she is 5.5kg and 4 months 3 weeks old) and since last two days also on Omeprazole twice a day (5ml each time). Do you think she may still has silent reflux?? If yes, when do you think omeprazole should help? because renitidine has not improved her situation over last one month.
Does Omeprazole suppress appetite? I think that she has taken little less milk (not very less but 50-100ml less) since starting omeprazole.
3> If you were treating my child, what next would you do? Would you order stool tests, ultrasound, allergy tests etc?? Please let me know this so at least I will have answer this time when we meet local paediatrician and if she asks us again "What tests would you like to have?"
4> Our GP said we can give her small amount of water in between feeds if we think she has not taken enough milk so she does not go dehydrated. Some advise not to give water until six months. Whats your advise on water?
5> On advise of private consultant we have started to give her solids. We started ready made fruit purees and baby rice. She took couple of time fruit purees about two tea spoons and baby rice about two tea spoons. We try to give her twice a day, one in morning and one in evening. She does not how to eat it like adults but she interestingly licks it and try to suck it like milk bottle's teat.
If she continues to take solids 2-3 tea spoons each day, do you think we should relax on her milk intake volume if she takes little less that day?
6> At one stage I was thinking to take my baby to XXXXXXX for proper treatment or quick investigation. Do you think I should travel for this feeding issue? My baby is turning 5 months next week. I am from XXXXXXX (Mehsana city) and closest big city is XXXXXXX (100kms from my town). If yes, would you be able to recommend any good paediatrician?
Apologies for lengthy response but I am so desperate for quick help.
Thanks and Regards.
Brief Answer:
Please read a detailed reply below.
Detailed Answer:
Hello,
Please note that I cannot answer perfectly as I am not your daughter's doctor. Legal limitations do exist on an online reply.
Having said this, I have said myself to you that a small elevation in the faecal calprotectin level is not something I would be alarmed with. This is because inflammatory bowel disease is not a condition seen in infants but in older children; coeliac disease is not a common condition in children of XXXXXXX origin, although it does occur rarely. However, its symptoms would not manifest until after a child is on a wheat/rye/barley-based diet. Hence, both these conditions are out.
Yes, she could have a reflux - but it seems unlikely as she is not losing weight, and she is not vomiting much (just three times in her life, you said.) I think the eczema points to a possible cow's milk protein allergy, and I would possibly think of changing her milk rather than giving her ranitidine and omeprazole at this point.
I am not convinced that she needs more testing. I think now that the omeprazole has been started, we should give it a fair trial of between 2-4 weeks to see if it helps. You wouldn't expect this medicine to improve her milk intake, though. It is NOT an appetite stimulant, if you know what I mean.
It is a good idea to gradually reduce her intake of milk in favour of baby foods. No doubt about this. However, milk is still necessary for an infant, so I wouldn't go the whole distance with this. Please continue to use Neocate. I am hoping that the Paediatrician will help you get the Neocate prescriptions from NHS,
I think that the suggestion to give water must have come when the person who made the suggestion was getting worried that if your baby did not get enough fluids, she would get dehydrated. From that point of view, and from that point of view alone, it might be okay to give her a little water. However, the water is not going to replace any nutrition, isn't that correct? It is true that we normally do not recommend water to a baby below the age of six months, but this is especially true for a breastfeeding baby. It does not apply to a formula-fed baby, because such a baby is getting water anyway through the formula which is made with water!
I do feel that you are getting a bit caught up with all the advice you are seeking and it just might be that the baby will catch up on her own if she is left alone with a little tweaking of her nourishment options rather than going down the route of testing and re-testing. Remember that every human being has some flaws and some ways of managing themselves despite those flaws. Your baby is the perfect baby, of course, for you, but in the larger scheme of things, she is an individual herself with her own set of organs, intellect, physiology, metabolism and so on.
Some times, we have to just accept that and carry on with our lives.
In the end, I confess I have never met an analysing parent such as yourself. You have certainly made me think a lot and have helped me crystallise those thoughts into a coherent opinion. I am not working as a private paediatrician, otherwise it would certainly have been a pleasure to help your baby in person.
Please let me know what happens after you have met the Paediatrician.
Forgive me for not being absolutely clear in my opinions previously or on this occasion. Some ambiguity is reasonable, since we are talking online and I have never seen your child personally.
Hope this helps.
- Dr Taher
P.S. I am a Gujarati too, but that is only because my mother-tongue is Gujarati and our family originally hails from there.
- T
P.P.S. You did not share your daughter's name.
Please read a detailed reply below.
Detailed Answer:
Hello,
Please note that I cannot answer perfectly as I am not your daughter's doctor. Legal limitations do exist on an online reply.
Having said this, I have said myself to you that a small elevation in the faecal calprotectin level is not something I would be alarmed with. This is because inflammatory bowel disease is not a condition seen in infants but in older children; coeliac disease is not a common condition in children of XXXXXXX origin, although it does occur rarely. However, its symptoms would not manifest until after a child is on a wheat/rye/barley-based diet. Hence, both these conditions are out.
Yes, she could have a reflux - but it seems unlikely as she is not losing weight, and she is not vomiting much (just three times in her life, you said.) I think the eczema points to a possible cow's milk protein allergy, and I would possibly think of changing her milk rather than giving her ranitidine and omeprazole at this point.
I am not convinced that she needs more testing. I think now that the omeprazole has been started, we should give it a fair trial of between 2-4 weeks to see if it helps. You wouldn't expect this medicine to improve her milk intake, though. It is NOT an appetite stimulant, if you know what I mean.
It is a good idea to gradually reduce her intake of milk in favour of baby foods. No doubt about this. However, milk is still necessary for an infant, so I wouldn't go the whole distance with this. Please continue to use Neocate. I am hoping that the Paediatrician will help you get the Neocate prescriptions from NHS,
I think that the suggestion to give water must have come when the person who made the suggestion was getting worried that if your baby did not get enough fluids, she would get dehydrated. From that point of view, and from that point of view alone, it might be okay to give her a little water. However, the water is not going to replace any nutrition, isn't that correct? It is true that we normally do not recommend water to a baby below the age of six months, but this is especially true for a breastfeeding baby. It does not apply to a formula-fed baby, because such a baby is getting water anyway through the formula which is made with water!
I do feel that you are getting a bit caught up with all the advice you are seeking and it just might be that the baby will catch up on her own if she is left alone with a little tweaking of her nourishment options rather than going down the route of testing and re-testing. Remember that every human being has some flaws and some ways of managing themselves despite those flaws. Your baby is the perfect baby, of course, for you, but in the larger scheme of things, she is an individual herself with her own set of organs, intellect, physiology, metabolism and so on.
Some times, we have to just accept that and carry on with our lives.
In the end, I confess I have never met an analysing parent such as yourself. You have certainly made me think a lot and have helped me crystallise those thoughts into a coherent opinion. I am not working as a private paediatrician, otherwise it would certainly have been a pleasure to help your baby in person.
Please let me know what happens after you have met the Paediatrician.
Forgive me for not being absolutely clear in my opinions previously or on this occasion. Some ambiguity is reasonable, since we are talking online and I have never seen your child personally.
Hope this helps.
- Dr Taher
P.S. I am a Gujarati too, but that is only because my mother-tongue is Gujarati and our family originally hails from there.
- T
P.P.S. You did not share your daughter's name.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you doctor for your prompt reply. My daughter's name is XXXXXXX XXXXXXX My name is XXXXXXX and this account is under my husband's name XXXX
Well, I am worried about my daughter and hence I do not want to miss any diagnosis which might be affecting her. XXXXXXX was conceived after so much difficulties and I may have become over protective but that's motherhood, isn't it?
I accept all what you have to say. I am worried only because I do not want to hear from health professional in future that "your baby's condition is critical and you should have done something sooner. Why did you ignore her symptoms etc?".
My whole worry is what if she is suffering from serious illness and hence refusing milk. So far there is no suggestion of it but can it be?
1> I know you have not seen her personally and only give advise on what I describe. You said earlier to pursue abnormal stool report again. Now you believe it may not the diseases you mentioned earlier bowel inflamation or coliec . Then why Calprotectin was elevated? I mean what else could it be?
2> She did not like Neocate LCP or other hydrolysed milks. Do you have any suggestion how we can make her take these milks? Can we add something to milk? We tried cocktail of her regular and Neocate but she rejected.
3> Do you think if I only offer Neocate when she is hungry, she will eventually start taking it. I mean should I behave like "Take neocate or else you will get nothing". I know I can see her hungry but should I be strong and do this even if she does not take 300ml in a day??
4> I know omeprazole is not for improving appetite but if reflux is under control, she should start enjoying milk and take what she needs to take, I mean around 750ml (she had taken this amount on couple of occasions previously so she has this appetite for sure).
5> Our GP's idea about water was for avoiding dehydration but also to aid digestion. She said water will aid digestion and clear her digestive system.
6> Do you think if we believe she has bottle aversion then all the history will make more sense instead of finding whether she has something medically wrong?? I read on internet many times and most things XXXXXXX does is related to bottle feeding aversion. We tried cups, spoons but sometimes she takes it sometimes rejects it and it is very messy. We will pursue cup/spoon feeding more and will see the benefit. As I said she does not take bottle in awake state so we try cup/spoon while she is awake. She takes bottle in sleep mode so we give her bottle as we can not feed her with cup/spoon in her sleep.
7> In the end I will have to accept that XXXXXXX has her own personality and she will do what she likes as long as she remains good on growth chart. I just did not want to miss if she had something medically wrong with her.
8> Eczema episodes were at 4 weeks old (severe), at 2 months (mild) and at 3.5 months (mild). She was mostly on expressed breast milk until 3 months of age but we were giving her formula when we could not take breast milk with us on appointments. I would say she had formula 2-3 times in first month, 4-5 times in second month and 6-10 times in 3rd month. After three months of age she is on formula Aptamil 1. Do you still think milk allergy is possibility? If yes, what tests are there to be sure?
9> Yes, would have been nice to meet you in person. We are in London.
Any advise from you would be appreciated until we see how paediatrician meeting goes.
Xxxx
Regards.
Well, I am worried about my daughter and hence I do not want to miss any diagnosis which might be affecting her. XXXXXXX was conceived after so much difficulties and I may have become over protective but that's motherhood, isn't it?
I accept all what you have to say. I am worried only because I do not want to hear from health professional in future that "your baby's condition is critical and you should have done something sooner. Why did you ignore her symptoms etc?".
My whole worry is what if she is suffering from serious illness and hence refusing milk. So far there is no suggestion of it but can it be?
1> I know you have not seen her personally and only give advise on what I describe. You said earlier to pursue abnormal stool report again. Now you believe it may not the diseases you mentioned earlier bowel inflamation or coliec . Then why Calprotectin was elevated? I mean what else could it be?
2> She did not like Neocate LCP or other hydrolysed milks. Do you have any suggestion how we can make her take these milks? Can we add something to milk? We tried cocktail of her regular and Neocate but she rejected.
3> Do you think if I only offer Neocate when she is hungry, she will eventually start taking it. I mean should I behave like "Take neocate or else you will get nothing". I know I can see her hungry but should I be strong and do this even if she does not take 300ml in a day??
4> I know omeprazole is not for improving appetite but if reflux is under control, she should start enjoying milk and take what she needs to take, I mean around 750ml (she had taken this amount on couple of occasions previously so she has this appetite for sure).
5> Our GP's idea about water was for avoiding dehydration but also to aid digestion. She said water will aid digestion and clear her digestive system.
6> Do you think if we believe she has bottle aversion then all the history will make more sense instead of finding whether she has something medically wrong?? I read on internet many times and most things XXXXXXX does is related to bottle feeding aversion. We tried cups, spoons but sometimes she takes it sometimes rejects it and it is very messy. We will pursue cup/spoon feeding more and will see the benefit. As I said she does not take bottle in awake state so we try cup/spoon while she is awake. She takes bottle in sleep mode so we give her bottle as we can not feed her with cup/spoon in her sleep.
7> In the end I will have to accept that XXXXXXX has her own personality and she will do what she likes as long as she remains good on growth chart. I just did not want to miss if she had something medically wrong with her.
8> Eczema episodes were at 4 weeks old (severe), at 2 months (mild) and at 3.5 months (mild). She was mostly on expressed breast milk until 3 months of age but we were giving her formula when we could not take breast milk with us on appointments. I would say she had formula 2-3 times in first month, 4-5 times in second month and 6-10 times in 3rd month. After three months of age she is on formula Aptamil 1. Do you still think milk allergy is possibility? If yes, what tests are there to be sure?
9> Yes, would have been nice to meet you in person. We are in London.
Any advise from you would be appreciated until we see how paediatrician meeting goes.
Xxxx
Regards.
Brief Answer:
Let us wait for the consultation.
Detailed Answer:
Dear XXXXXXX (it feels nice to know you a little better),
I think we have gone over all the questions in detail. I think we should wait for the consultation before we take this further. Of course, I understand that you are Prachi's mother and it would be a shock to learn one fine day that everyone missed something serious. However, panic is not going to solve anything. We do know that she is generally doing well. So, we must be a little patient.
I still think that milk allergy could be a possibility. Unfortunately, the tests for confirming milk allergy are not usually done in such a small baby. Removing the offending agent (in this case, cow's milk) is easy and will resolve the issue - even if there is no confirmatory test. Once she is a bit older (over a year), skin testing for milk protein allergy can be done.
Please go back to my first few answers. Try feeding her with a cup and spoon. Try reducing her dependence on milk with the weaning foods 1-2 times a day (I think you are already doing this, so that's sorted!).
A slightly elevated calprotectin can be a false positive result or the consequence of some other inflammation not specific to the major conditions we have listed. A repeat test may help some time after 3-6 months.
Good luck on the consultation. We will talk again after that. And yes, do speak to the consultant to request appointment with a dietician.
Let us wait for the consultation.
Detailed Answer:
Dear XXXXXXX (it feels nice to know you a little better),
I think we have gone over all the questions in detail. I think we should wait for the consultation before we take this further. Of course, I understand that you are Prachi's mother and it would be a shock to learn one fine day that everyone missed something serious. However, panic is not going to solve anything. We do know that she is generally doing well. So, we must be a little patient.
I still think that milk allergy could be a possibility. Unfortunately, the tests for confirming milk allergy are not usually done in such a small baby. Removing the offending agent (in this case, cow's milk) is easy and will resolve the issue - even if there is no confirmatory test. Once she is a bit older (over a year), skin testing for milk protein allergy can be done.
Please go back to my first few answers. Try feeding her with a cup and spoon. Try reducing her dependence on milk with the weaning foods 1-2 times a day (I think you are already doing this, so that's sorted!).
A slightly elevated calprotectin can be a false positive result or the consequence of some other inflammation not specific to the major conditions we have listed. A repeat test may help some time after 3-6 months.
Good luck on the consultation. We will talk again after that. And yes, do speak to the consultant to request appointment with a dietician.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
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