Dear Sharon, Another great case you describe that raises many questions!!! First let us look at the history you gave us. The baby seems to be term and well grown (7 13 at birth). The spells he was having certainly are compatible with reflux and posssible aspiration. I doubt in view of term baby that this is related to immature respiratory center (or central apnea) as it is in premies. One red flag is that this baby did not regain BWt until 8 weeks. He was sleepy and nursing poorly. Altough he may have been influenced by the meds, poor feeding can stem from many other reasons. A few I would think about are:1. Poor technique (pos, latch..) leading to poor intake and decrease in mom's supply. 2.Baby not growing because of Reflux, in this case prob secondary to imparing his breathing. 3. Excess losses due to reflux. It seems though that after the baby was treated and supplements introduced this baby did well. According to the weights you gave, his speed of growth has been normal from 8 weeks to 5 months, I know, he is below the 5 percentile. Remember that 5% of babies are normal and below the 5 percentile. Usually we do not worry if the velocity is normal as in this child. To answer the question about medication. One I wonder why this baby is event on theophylline. Usually used for central apnea in immature babies and not for secondary obtructive apnea from reflux. Usually the doses used are very small (about 1/3 of what you would use in athsma). Many physicians think that theophylline increases metabolic needs of infants and overfeed them. I studied this question in adult and infant rats during my fellowship. We looked at 24 hour metabolic rates in rats before and during theophyllin. We gave it for 3 days. There was an increase in metabolic rate primarily due to increased activity but not to basal metabolic rate of about 20%. Interestingly, this increase was more marked on the first day and decreased to no significance on the 3d day. We therefore felt that the rats adapted to the effects just like coffee drinkers adapt and feel very little effect after using caffeine for a while. Hopefully this will help you in answering this mom's questions. One more point is that this baby may have some underlying athsma problems. I remember one patient I had who didnt nurse well and lost weight around 2 months, without a good explanation. After intervention, using sns and increasing mom's milk supply, she never quite caught up but has been groing at normal rate along 5th percentile. So we were pleased. Mom is a thin person and baby looked like her. Between 6 months and 1 year she developped a chronic cough and runny nose. Was worked up by pulmonologist and reflux was ruled out. Never wheezed. Finally, started empirically on athsma meds and picked up quite a bit on her wt. The kiker is now she is a butterball but another factor is that this 2 year old nursing toddler just had a baby brother and is going to town on additional nursing!!!! So who knows exactly what did it!!! Good luck Maryelle