Downhill Chronic Vomiting – Land of Lloyds

UPDATES after our Pediatrician visit today:

Recommended we see a GI doctor to further assess Henry’s projectile vomiting.

Henry will see the GI next week.

We are trialing a hypoallergenic formula until then, slowing feeds to over 90 mins, and can give MiraLAX to prevent blockages.

If things get bad (weight loss, dehydration, lethargy, etc) we go to the ER at SLC Primary Children’s to see a GI.

In more detail…

Baby Henry’s chronic vomiting took a turn for the worse. When I called the pediatrician, Henry had projectile vomited thin liquid every feed that he was awake, and wasn’t drinking anything orally.

Plus the following worsening symptoms:

A wave of gurgling would come from his stomach and make its way upward in an explosion of vomit.
He’d start choking (that’s new) so we’d watch him even as he slept.
Baby hadn’t pooped in days, which for a formula fed baby is a long time.
He was super fussy when being fed, arching his back and crying in pain the entire feed and after.
Baby was feverish even after the vaccine recovery period ended.

Too many worsening changes; something is obviously wrong.

I’m working with our Doctors and providers on the process of elimination below.

Over-Feeding: No.

I checked with our Nutritionist to see if I’m over feeding him, but it’s the same or less volume as scheduled. He’s taken that same total in the last couple of weeks.

Allergies: Maybe, but Unlikely.

The pediatrician had us try a hypoallergenic formula called Nutramigen until next week to see if it helps and to rule out allergies.

Pediatrician doesn’t really think it’s allergies because after observing Henry projectile vomiting during a feed, the milk doesn’t even appear to make it to the digestive system to irritate it. Nutritionist agrees with this assessment.

Baby seems to be doing better on it than the previous one, but not by much.

GI Issue: Likely.

Pediatrician witnessed Baby during a feed projectile vomiting. He said there doesn’t look like any stomach motility; the milk just pools there in Baby’s esophagus without ever reaching the digestive system then comes right back out. Milk is likely still there in the esophagus after vomiting.

He says this is beyond him, he doesn’t know much about these issues because it’s not his specialty, and we NEED to get in with a G.I. doctor right away. Baby has been losing weight again or just gaining really slowly.

If it takes too long to see a G.I., our pediatrician said that the backup plan is for us to drive straight to Salt Lake City Primary Children’s Hospital emergency room, tell them that the baby is losing weight and needs to see a pediatric G.I., and they would have to send for one.

Thankfully the scheduler at Primary’s considered the urgency and seriousness of Henry’s situation so we got an appointment for next week!

I’m thankful we were able to switch providers and can see a different GI doctor that the scheduler vouched for. That was encouraging!

Constipation: Ask GI.

Almost in a cyclical way, Baby takes days before there’s a buildup of huge poopy diapers. Then it seems clear and he has regular poops, but slows after a few days and then stops again.

Baby’s poop is never hard the way it would be in constipation. Towards the end of the cycle before a huge poop comes, he does strain and pass lots of smelly gas.

Normally this is not a concern, but together with the persistent vomiting and pain it may point to some other issues.

Pediatrician said we can give MiraLAX to keep things moving and prevent blockages.

Pyloric Stenosis: No.

This is usually only in very young infants, so our pediatrician thought it unlikely. Baby does have wavelike ripples on his stomach after feeding, so we checked anyway.

We can rule this out after an ultrasound of the pylorus showed no pyloric stenosis that the doctor could see so far.

NG Tube Position: No.

There’s always a possibility of user error and that my positioning of the ng tube is too far down curling up around the stomach, or too far up and emptying into the esophagus or the lungs instead of the stomach.

An X-ray of the NG tube placement showed that the NG tube is in a great spot, so we know that 26-27cm is a good length and the positioning is not causing this.

Feeding Speed: Sort of.

Baby’s tummy may need a slower rate on the pump so we don’t feed him too quickly. Pediatrician suggested experimenting with the feeds rate and trying to feed slower over two hours or continuous at night. I doubled the time of feeds from 45mins to 90mins.

This is not a long term solution and shouldn’t be a major factor in the cause of Baby’s vomiting, but it could get us through each day until we can see the GI.

2 hours may be too long since the milk is only good for two hours, and if a feeding takes 2 hours plus keeping Baby upright for 30 minutes, then I only have 30 minutes to prep everything before the next feeding.

GERD: Ask GI.

Baby has dealt with acid reflux since his days in the NICU. Pulmonologist prescribed an “anti acid reflux medication”, so Baby is already taking Famotidine to lessen acidity.

We can ask the GI about a PPI, maybe Pepcid (does it have to be oral only to coat throat?) and/or Nexium?

Gastroparesis: Ask GI.

Through a diagnostic test, a GI would be able to diagnose Gastroparesis. This is delayed stomach emptying and has no cure but can be managed. Our friend’s son was diagnosed with it after 2 years of issues. Being on a tiny daily dose of Azithromycin or erythromycin worked wonders for his vomiting.

Our pediatrician may get us a prescription for erythromycin to see if it helps, but there are side effects of giving Baby an antibiotic.

G-Tube: Ask GI.

Our Nutritionist recommended that if it’s a structural gastrointestinal issue, then we may want to talk with our GI about a G-tube button since Baby is now at a severe oral aversion. He won’t touch the bottle, I don’t think he likes the taste of the new formula.

Our friend with a son who has Gastroparesis found that the NG tube exacerbated his oral aversion on top of the vomiting, so we have another recommendation to switch to a G-tube.

The first GI I talked with thought Baby was too young for a G-tube even though babies get discharged from the NICU on them. I’m curious what this next GI will say.

Sigh….. I have realized that maybe I need to be specific in my asking in prayers, and so if you could join us in asking about answers for his chronic vomiting or how we can help him with his feeding issues that would be super. I feel God is answering my prayers to help us find specialists who cares and can investigate these problems so that Henry can thrive.

-Kat