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Friday, December 6, 2013
Newborn and Infant Care
How is this medicine going to help my infant
I took my daughter to the pediatrician 3 times because she is congested in the nasal area, she has a terrible cough and has a lot of phlegm. They had her on Amoxycillin and Omnicef. Yesterday they prescribed her with Prevacid. We gave it to her last night and this morning she woke and she is even sicker. How is the Prevacid going to help her get rid of her sickness? She is on cereal with every bottle because of her reflux. She was also on Axid 3 times per day until yesterday. Please help me understand this.
I hear your frustration! I don't know how old your daughter is or when the problems were first identified. From the information you have given, I think the doctor believes your daughter has gastroesophageal reflux also called simply reflux and sometimes GERD. In this condition the food easily flows back into the esophagus, the tube carrying food from the mouth to the stomach. This not uncommon in young babies because the muscle at the bottom of the esophagus and top of the stomach often leaks. It is also possible that your baby may not have the normal pulsing movements of the esophagus that help move food along, but this is far less frequent than a lax muscle at the top of the stomach.
The mainstay treatment of reflux in young babies is to thicken their breastmilk or formula with rice cereal, about 1 Tablespoon per ounce. Secondly, many doctors prescribe medications like Axid and Prevacid to relieve the heartburn that can accompany reflux. When food enters the stomach, it is mixed with hydrochloric acid produced by cells in the stomach lining. When food flows back from the stomach into the esophagus, it produces burning in the lining of the esophagus, causing babies to back arch and cry after eating, making reflux even worse as they tense their tummy muscles crying. Prevacid and Axid both produce the same results, shutting off stomach acid to the relieve the pain of heartburn from reflux and allow the esophagus to heal. I don't know why the doctor changed the medications, other than to say sometimes one seems to work better than another for any given person.
The antibiotics likely were given to treat a presumed pneumonia from reflux of stomach contents into the baby's lungs, one of the most worrisome aspects of reflux. Amoxicillin is the first drug of choice for this condition because it covers the bacteria most likely to cause pneumonia, with it's coughing and congestion, in newborns. It's a narrow spectrum antibiotic and therefore a safe choice for a young baby to prevent antibiotic resistance from developing. Since the Amoxicillin did not result in improvement of her symptoms, the doctor then tried Omnicef, a different type of antibiotic, that works well for children's respiratory infections.
It sounds as though Omnicef has not worked to relieve the symptoms either. I think it is safe to say that your daughter does not have garden variety reflux disease of infancy. Your baby's doctor has tried all of the standard therapies without success, so it would seem appropriate to ask for a referral to a pediatric gastroenterologist and/or a pediatric pulmonologist for a more in-depth assessment to verify that the problem actually is reflux and not perhaps an opening between the trachea, or breathing tube, and the esophagus, or food tube, that is allowing food to enter her lungs and cause the coughing and congestion you are describing. These types of openings are called tracheoesophageal fistulas. They develop early in fetal development when the food tube and the breathing tube divide and separate from each other from a common single tube. Some children do have hard-to-treat reflux, but these specialists can be of great help in finding a treatment plan that works well. Pediatric specialists are located at Children's Medical Centers. In Ohio, these centers are found in Columbus, Cincinnati, Cleveland, Dayton, and Akron.
In the meantime, if you are not already doing it, be sure to elevate the head of your baby's mattress to a 45 degree angle with a pillow or box under the mattress to help keep food in the stomach by gravity. Also hold her or position her in an infant seat after eating for at least 30 minutes to help her feeding stay in her stomach rather than putting her in a flat position. If she develops a high fever or has trouble breathing, call 911 or ,if you live close by, go to the nearest Children's Hospital emergency room for help. They will have the baby-sized equipment to help your child best compared to a general community hospital that cares primarily for adults.
I wish you a speedy resolution of this worrisome problem for your new baby and joyous holidays.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University