Wednesday, January 22, 2014

If there was no puke in my life...

...I'd be a much happier lady.

Dylan has had reflux forever and that may be a factor in the puke, but I don't think it's necessarily the answer.

There are two main pukes:

1) Immediately After Bedtime Bottle Puke

2) Middle of the Night Puke

The Immediately After Bedtime Bottle Puke consists of mostly "milk" (Pediasure or formula at the moment) but also has nice little chunky bits of dinner.  It's really convenient that it happens immediately before bed...right when Dylan is super sleepy.  Usually when I'm transferring from the rocker to the crib.  When I'm lucky, I get all of the puke on me so I can just strip off my clothes, get another bottle (he always eats after and has never thrown up a second time) and we move on.  The lights stay off...not too bad.

But on other nights Dylan pukes all over the rug.  Or on one night, all the way from the rug in his room to the kitchen sink.  On those nights, lights come on, I have to find a spot for Dylan to chill in while I clean puke off the rug or strip his bed, etc.  Then we repeat the bottle and bedtime is just pushed back a half an hour or so.  (Or the carseat pukes....those are probably even worse.)

The MOTN Puke is the more worrisome and baffling.  Google says it could be low blood sugar, or a brain tumor....or reflux.  Don't worry; I'm not going off the deep end, I'm sticking with reflux as the most plausible answer for now.  Dr. S (The Ped) thinks that his ear infection caused most of the MOTN puking.  (This puke is orangey-yellow, full of bile, with some partially digested food sometimes.) D has only woken up crying during one of the MOTN pukes and so in the morning we find him, with his hair plastered to his head and a pukey bed.  (So sad and upsetting as a parent!)

But then last weekend he puked in the middle of the day!  It was after a bottle as I was putting him down for a nap, but come on!  That wasn't part of the routine.

I'm finding that my mood is set by whether or not Dylan has puked that day or not.  It's horrible to spend so much time making sure he's getting enough calories and then see them all come right back up.  (And even more horrible to know that your baby is sick in the MOTN : (.)

So I took him back in yesterday and this is the new plan:
1) Up his Prevacid dose.  Most babies outgrow reflux by 6 months, then the rest by 1 year.  I guess we are part of the lucky few where it persists.  But we're hoping he grows out of it by 18 months.

2) We are switching from Pediasure to Whole Milk with added whole milk powder.  The puking really started with the Pediasure.  It may just be an ingredient in it.  Or it may be that he can't process the 30 calories an ounce. I don't know.  But it's artificial and expensive so we are going to see if whole milk works.

3) We are adding a probiotic.  Maybe the Amoxicillin wiped out too much bacteria in his gut (but the puking started before the Amox.)  Can't hurt to try.

*     *     *     *     *

The hardest thing for me is working through all of the different variables to figure out how to fix the problem!  Is it what he's eating? When he's eating? How he's eating?  And how am I supposed to switch to a sippy from a bottle when we are so concerned about his overall calories (I'm working on it!)?  It drives me bonkers and brings me back to the days when we were trying to get out of the NICU.

But Dylan is slowly gaining weight (he's at 17 1/2 pounds now - 12 months adjusted, 15 1/2 actual).  That's still not on the growth chart but we're getting closer and closer.  He eats lots of different foods, just not huge volumes.  Recent favorites are casseroles and cottage cheese.  And the best, best thing is that he has no lung issues.  If we can just get through this flu season (which just exploded in CA), we will be in a really good place.  The doc would just like to get him to 20 pounds and then maintain that weight.  Then we can relax a little.

It's amazing in the wide world of the internet how it can sometimes feel like you're the only person dealing with a particular issue.  Anyone else have a problem of the puking variety?

When he's not pukey, he's really happy!

Enjoying his Adjusted Birthday Celebration cake.  He knows what to do with it now!


  1. I have NOOOOO idea about preemies, but let me tell you, if I am full, I often feel like puking. What would happen if he skipped his before bed bottle? I know you have orders from a doctor, but are there any dieticians with preemie experience you can consult?
    So awful! I have had to deal with the overnight vomit before (sometimes fresh and sometimes old and sticky) with my little one. Blah!

    1. We are trying to limit the volume of the evening bottle, but sometimes he really wants it! Like last night he ate a ton and still woke up in the middle of the night hungry (which isn't common so we definitely think it was hunger). My ped does consult the dietitian in the NICU and has sent us to GI and the Dietitian...but no one has figured it out yet.

    2. Hmmm...I hope you get some answers. It must be so hard on everyone.
      Whenever puke hits the floor at my house, the dog RUNS to the mess and starts clean up. So gross!!! Just thought I'd share that detail!

  2. Your new plan sounds good. Keep trying new things and hopefully you will find the sweet spot. We don't have puking issues but there is a lot of gagging. C has a sensitive gag reflex and often when he eats solid foods I think he is going to puke. Usually he doesn't but I can totally imagine what it must be like to have that to deal with all the time. Poor D.

  3. Hi, my daughter was on Prevacid for reflux until she was 21 months old. She most often puked at night or when she was tired. She was born full term, but was still on the small side (6 1/2lbs). At a year old she was 19lbs, and we really struggled to feed her all day to make sure she got to that weight. We saw a major change when we switched her from whole cows milk to Lactose free while milk at 16 months. Now she is 26 months old and thriving. She eats okay, and is gaining weight without us stressing about her food intake 24 hours per day. I highly recommend trying Lactose free whole milk, I'm so glad that we did.

  4. Poor kiddo! One of my nieces was a preemie and has struggled with reflux her whole life (now 8). No tips, just hope you find a fix or he grows out of it soon!