Today a 6 month old with irritability and reflux came to the office. He is most irritable after large feeds, when laying down. Mom says he doesnt sleep for more than two hours at a time. He arches his back when irritable and in pain.
He takes 32 ounces of formula a day. He gets one teaspoon of oatmeal in 6 ounces of formula.
In the last 10 days he cries during feeding. He seems to have an aversion to feeds. During burps he spits up. He cries for 1-2 hours secondary to gas. No bile or blood in vomitus. Mom has noted thick clear spit up.
He is uncomfortable and arching his back at night as well. . He is not comfortable during a nap time during the day.
He is on nutramagen. When taking soy, he vomits worse.
He presently gets 6 ounces of formula every 4 hours 6 times a day for a total of 32 ounces a day
MY SUGGESTIONS TO HER WERE AS FOLLOWS-
To treat infant reflux, and irritability:
Food is better tolerated than liquid
Add one teaspoon of oatmeal to each ounce of food-
4 ounces would equal 100 calories
Needs 800 calories a day for growth
will get 100 calories from thickened food ( 4 ounces)
Then he needs- 4 ounces formula with one tablespoon and one teaspoon of oats
give 4 ounces of the above mixture every 3 hours 7 times a day.
SMALL THICKENED FEEDS are a treatment for reflux-
it keeps the food in the stomach
Upright at least one half hour after feeds, one hour is best.
Head of bed elevated 45 degrees.