If you or your child’s other caregiver have ever thought, “I think my child has reflux” then I recommend that you explore that thought a little. Do some research (your off to a good start by reading this article) and trust your instincts. I was the doubting Thomas; however, luckily my wife was all observation, instinct, and research.

During those sleepless nights of my son constantly waking and crying inconsolably she scoured the web. At first my son’s symptoms did not fit textbook GERD; he rarely vomited. But my wife was observing Lex closely and she detected something more and I think I even heard something too; and so she kept digging. Eventually she discovered that there was something called Silent Reflux which rarely resulted in visible vomiting. After she explained this to me I detected it happening to my son. Vomit came up and then he swallowed it. In fact, it made sense; neither my wife nor I have vomited more than 5 times in our entire lives. Maybe Lex inherited that super power.

Well, somewhere along the way, I think before I completely accepted that there might be something wrong I got my son an appointment with a specialist. Even though at the time we had a PPO and we did not require a referral to see a specialist this was not an easy task. Firstly our pediatrician consistently told us that it was normal or that we needed to change my wife’s diet. We gave up on that route and we started going down the list of Pediatric Gastroenterologists on our insurance and in our area. Some were booking 3-4 months out (or more) and others required a referral from a pediatrician.

Regardless we found one that seemed qualified and had availability. Dr. Fernando Navarro, MD, saw us rather promptly and he took us very seriously. He listened to our concerns and observations and sent us away feeling relieved and with lab test orders. Now if you have to go out and find your own doctor I highly recommend that you credit your pediatrician with the referral. This smoothed things for us during the initial visit and during their communications later.

The testing was a nightmare that I never want to relive. My son was feeling so bad with his reflux that he was eating ever moment there was space in his tummy. He was very used to feeding every 2 hours, but they wanted him fasting for 3 hours before they placed the pH probe in his esophagus. This requirement was a little difficult, but when we showed up for the probe placement they could not get it calibrated. They spent what was about 1.5 hours trying and it felt like a lifetime. We were furious and Lex was in pain and very upset with us for not giving him his bottle. He was less than 2 months old then. It literally broke my heart. Now I why parents act as they do when their children are in pain, such the characters in stories and films like “John Q.“.

Anyway, to get to the point the probe was placed. Lex sneezed a lot, but slept well enough in the strange hotel room. He was very pleased to get the probe out. He also took a barium swallow test with video x-ray. It was cool to watch and he made me proud sucking down all that barium solution so effortlessly!
Anyway, the tests came back shortly and the doctor saw us immediately. The tests confirmed that Lex had “severe GERD”. We never felt so validated, especially my wife and we did all but beat our pediatrician over the head with the report.

The doctor gave us a prescription for Zantac which worked well for Lex for about one month. This comes in an off-the-shelf prescription solution. The problem is that for some reason most kids’ reflux stops responding to it after a short while. My wife was again researching away and discovered all this was normal and that many parents were having luck with Prevacid. He got so bad he went on a hunger strike on a weekedn and landed us in the Emergency Room because of suspected dehydration. He turned out to be OK, but the visit was a major improvement because the doctor on hand switched Lex to Prevacid.

Lex is still on Prevacid Solutabs (more than 16 months later) but this is not the original prescribed form. The problem with this prescription was that is was for the little pellet packets. Luckily our insurance couldn’t process it right because my wife has read that administering it was a nightmare. The Pediatrician switched the prescription to a compound of Prevacid and this worked at first, but it was a big hassle because the compound was only viable for 2 weeks and our insurance required manual processing and rejected more than one submission per month.

My wife dug in again and discovered Prevacid Solutabs. We ran it by the pediatrician and they checked with a specialist who blessed it and said that these were quite common. Back then somewhere between 3 and 4 months Lex was on half a 15 mg tablet twice per day. The Prevacid Solutabs are artificially sweetened and flavored (strawberry) and Lex took them willingly. When we was younger we had to hold them in his cheek until they dissolved, but now he just takes it right on his tongue. Lex is on 15mg twice a day now, but that is not two 15 mg Prevacid Solutabs. Doing that was two expensive and the insurance was a major pain. Finally we switched to a 90-day supply of 30mg Prevacid Solutabs, half a tablet twice a day.

I know that cutting pills is not an exact science, but precision is not necessary in this. More important is the timing. 45 minutes after food or drink and no food or drink for 30 minutes after the dosage. Stick to this and you will see a happier child.

Now Prevacid was not the only medication that Lex started back then. He was on some weird colic medication that we eventually stopped because results were inconclusive. But Dr. Navarro recommended something his colleague was testing as a treatment for Colic, probiotics. Specifically he recommended “Lactobacillus GG” which is commonly sold by the “Culturelle” brand. We started giving this to Lex more than a year ago and we still do. We don’t give him the the capsule and hope he doesn’t choke, but rather his first bottle (and now sippy cup of “juice”) is spiked with a capsules worth or about 10 billion bacteria cells. Seriously this stuff is worth a try. It is “the most clinically researched strain [of probiotic] and proven to improve digestive health”. We took Lex off of it, well it sort of happened, and then he ended up with all kinds of digestive problems. Was Culturelle’s Lactobacillus GG keeping his healthy? Who knows, but it was the only thing we changed. So he is back on it indefinitely now.

Lex also started taking “Bethanechol” at about 3 or 4 months of age. This is a simple compound (necessary for administration to a young child). CVS and Rite Aid have agreed to make it for us after a little discussion (and they don’t usually do compounds). The drug is a motility agent that helps get food out of the stomach sooner. We have stopped and restarted Bethanechol many times. Presently Lex is still on 1.5 ml twice per day. The concentration is 1mg per 1 ml. Anyway, those are his medications. They keep him from pain and as a result happier than he would be without them. They require some timing (Bethanechol can cause nausea so not right before or after food), but once we worked this into our routines there was not too much disruption.

The power of a routine, a specific set of actions executed in the same order and fashion, was never fully understood by me until my son was born and we all learned a few. The most important and powerful became the bedtime routine: dinner, bath, getting dressed, bottle, bed. However, the routine of quiet time, counting, and ascending stairs quickly became equally important and powerful. Still other routines followed have been very helpful in other occasions, such as when eating at a restaurant.

Where does the miracle come from

I think the miracle in routines comes partly from the the comfort in knowing what comes next. This knowledge can help a little one who may not yet be able to understand all of your other communication methods. This removes surprises. The other part I think comes from the self-fulfillment of knowing what comes next. Initially this may seem like the same thing, but I propose that this feeling can be likened to that a child feels when they are able to “predict” occurrences in a film before they happen because they have already seen the film many times. It is something between confident pride and a feeling of familiarity. I think my son feels this when we initiate a routine. Additionally I believe the routine invokes a kind of conditioned response; prompting subconscious reflexes.

A routine is sort of like a family tradition. It is something that may seen novel the first few times, then ridiculous the next 10 times, and finally become a part of your culture after another 50 times. Yes, this means that the routine might not catch on so quickly. The bedtime routine is the easiest. Other routines may not be so effective because of the lesser significance of event they preclude. However, I submit that they are less effective because we as parents, and especially fathers, do not uphold the routine consistently. Routines require consistency in order to have any power at all.

For example, leaving the house to go outside and play should follow the routine or changing the diaper, putting on appropriate clothing, and putting on shoes. This partly worked in the winter. Somehow when it was colder the clothing and shoes part was very consistent because there was always a jacket to put on. In the summer; however, my son often has no need for a change of clothing. He sometimes needs sunscreen and half the time he needs a hat (he is very fair skinned). These variations have made going outside a guessing game. Sometimes Lex acts as if he has no idea we are going out. Other times he is very confused about what we are doing. I could probably fix this if I were to brings some more consistency to the routine. For example, I could put just a small amount of sunscreen on if it is not needed.

An Investment with an Excellent ROI

When the routines are established I have seen them work miracles. I have seen Lex switch in one minute from a very unhappy little boy throwing a tantrum to a quiet little man drinking every drop of his bottle and then resting sweetly on my shoulder as I took him to his crib. I’ve seen a little boy who resisted with all of his physical force and tears being placed in his crib at bedtime or naptime, turn into a sweet angel who nearly leaps out of my arms into his crib when that part of the routine comes along. It was not easy, but it has definitely been worth it!

As a father who wishes to participate more in your child’s upbringing here is a place to shine. If your child’s primary caregiver has already defined a few routines learn them, practice them, and perfect them. If the routines are not completely established or you feel another should be able speak up, consult with the other caregiver (if any), and implement your new routine. Remember to watch your child; she will help you mold the routine best to her needs and expectations. Keep in mind that a good routine is an investment that pays off very well in the future.

As much as I’d like to think so, I do not have a great singing voice. I love music, but I can’t carry a tune. Oddly enough I always found women with good singing voices to be quite attractive. So it’s of no surprise to me that my wife sings like an angel. She’s sung professionally on and off throughout her earlier years and I’d like to think that you could have given any Diva pop or R&B star a run for their money. When my son was born, she gently advised me not to sing to him for fear my out-of-tuneness might rub off on him.

An Alternative Contribution

For the most part I have avoided singing to him. Simple, fun songs like “The Wheels on the Bus” are about as far as I get. But when he was just an infant it was clear to me that he responded very well to my wife’s lovely lullabies. Striving to be a responsible father I wanted to contribute to this soothing. My wife, however, made it clear that I should leave the singing to her. After some deep pondering I decided that I could offer him a rhythm and a lyrical lesson that did not involve singing.

So what did I do? I just counted in a slow, steady, and sometimes extra deep voice from one to ten. At first it began as a method to soothe him while I walked him up and down the stairs trying to help him fall asleep. This was great exercise for me, but it wasn’t effective for very long, the stair climbing, that is. Nevertheless, the consistent repetition began to function as an indicator to my son that he was preparing to go to bed. Before long if either of us were carrying him and we counted he would fuss or put his head on our shoulder to indicate disagreement or submission to the imminent nap.
 

The Triumph of Active Fatherhood over Tone-deafness

Even into his second year my son expects the counting. It became so effective my wife now does it exclusively. Consistency was the key to making it a success, but it started with a good idea for an alternative to singing lullabies. In fact, now when he hears someone counting he actually responds to “one” with a swift “two”. Counting may not be everyones thing, maybe the alphabet, or maybe a spoken favorite rhyme or lyric. If you can sing lullabies you could go with that, but if you don’t want to, or your spouse doesn’t want you to, or you want to try something else then you now have a good alternative that might end up becoming a standard.