My baby sleeps. Does this mean she can't have silent reflux?

[BecAndAlex]

My daughter is 8 weeks old and suspected that she may have silent reflux.

She is my second child. I have a 5 yr old son who always fed well and was content after a feed.

Problems with me daughter seemed to start at around 3.5weeks old. She would fuss over all her feeds. She would take the first few ounces fine and then struggle. She seemed to push the bottle away, but then get frustrated because she still wanted to drink. She would arch her back and seemed very uncomfortable. She would look at me with worried eyes like I was poisoning her. She would sleep on me, and when I put her down, although she would stay asleep she would squirm quite vigourously, spit, squeak and grunt, before evenytually seeming to relax into sleep. She feeds ever 2.5 to 4 hours.

When she was 3.5 weeks old she was admitted to hospital with an unidentified infection which was treated with iv antibiotics. I put the change in her feeding behaviour down to this, but by 7 weeks there was still no improvment. I never felt she was satisfied. She constantly exhibits signs of hunger ie, tongue out, finger sucking, crying etc, even very shortly after a feed.

She only ever relaxes when over your shoulder, and when lay down always wakes and cries. HV said colic, but I was sceptical. Have since discovered that if I get her to sleep over my shoulder in day, and then lay her on her tummy she stays asleep.

At night I give her a warm bath, feed her upstairs and put her in her cot on her back. She squirms and spits as mentioned above but then settles into sleep. She will generally go from around 8-9pm and 2-3am, then back down to 6-7am. She has no trouble at night, just in the day.

HV advised to change to Aptamil comfort which I am now using. It seemed to work but now she has started to fuss again and frowning. She only poos every 2-3 days and this milk is making her wind stink...its vile. Aparently thats normal?

An overview of her symptoms are:

Very windy. Can feel and hear it popping.
Difficult to wind (although Dentinox has improved this)
Doesn't like to be flat during day (except in moving pram or on playmat)
Spits / drools (milky deposits round mouth)
Wants to suck constantly (always exhibits signs of hunger)
Arches back and looks uncomfortable after initial few ounces.
Fusses and have to feed bottle in bits to get her to drink it.
Always gets hiccups
Sneezes lots every day
Doesn't seem satisfied after a feed. Is very unsettled.
Is very hoarse.

It was another mum who mentioned Silent reflux, but I assumed that as she will lay flat on her playmat, and at night in her cot, that it is unlikely to be that.

Just wondered what other peoples experiences are. At the GP for 8 Wk check next week and don't know whether to bring this up, as a lot of GP's don't seem to know much about Silent reflux anyway.

Any replies would be greatly appreciated.

thanks

[Iggly]

It could be she doesn't tolerate cows milk very well hence marginal improvement with the comfort milk. I'd be asking to try hydrolysed formula (it's on prescription).

It sounds like silent reflux but that can be caused by cows milk intolerance so if you fix that her pain goes away.

As for sleeping - many reflux babies are so exhausted from poor naps that they crash at night time after a long day.

[omama]

If she's spitting it could well be regular reflux rather than silent. Silent is where the acid rises in the throat & burns causing discomfort, but doesnt come up so far as to cause spit up.

Agree with pp though it could be the cows milk thats the underlying problem & aptamil comfort wont help that, you need aptamil pepti or similar, (available on prescription only). I would suggest a trip to your gp, to discuss whether she may need reflux meds or a trial on a hypoallergenic formula to see if dairy is the problem.

She sounds so very similar to my ds at that age, we were initially fobbed off with 'he'll grow out of it' but his discomfort & distress during the day got worse (our nights were also fine), then we got gaviscon which reduced the spit up but he was still fussy, constantly demanding milk, oh & covered in eczema. When he started solids it got worse still & the doc finally listened & prescribed aptamil pepti when he was 8 months & i excluded all dairy from his solids. Within a couple of weeks he was a different child, eczema free, spit up stopped, fussing stopped, his feeeds reduced & he was so much happier. Hth.x

[BecAndAlex]

Hi

Thanks for the replies. I suspect it may be lactose intolerance too. I am lactose intolerant although not allergic, so I still do have it in my diet although not a massive dairy fan anyway.. I know it can be herediatary so may mention to the doctor.

I suspect that is why she sleeps well on her tummy too as if the milk is hurting her belly the pressure will help.

We are at the doctors on wednesday so will write a list of things and take it with me. Hopefully he will be helpful.

Thanks again.

[omama]

My ds is cows milk protein intolerant not lactose intolerant, 2 different things.
make sure you discuss both possibilities with gp Good luck.

[FudgeyCookie]

Dd is 4 months and just been diagnosed with reflux as she was spitting up a lot after every bottle. She too takes a while to feed, pulls the bottle out of her mouth then cries, as she is hungry. She is also sometimes difficult to wind, but I find putting her on my shoulder then winding her a little later helped- almost as if the pressure on her tummy helped bring up the wind.

The gp has also given us gaviscon infant to give her for the reflux and she's a lot better - hardly spits up, enjoys being laid flat on her back more, and seems to be a little easier to wind now. I would mention your intolerance to the gp, even if to just rule it out

[stargirl1701]

Hi. I have thread in Children's Health about dd. She has silent reflux. The symptoms you describe seem almost identical. I videoed a feed on my phone to show the GP.

[mummy2benji]

Hi! Yes unfortunately some GPs aren't as clued up as they should be about silent reflux - I'm a GP and my 4yo ds suffered with severe silent reflux as a baby to the point that he refused to drink any milk and kept being admitted to hospital and needing tube feeds. He wasn't sick, slept well at night and between feeds was a happy smiley little boy. Hospital admissions were a nightmare because they took one look at his grinning face and thought he must be fine. I struggled with his weight but it remained just about acceptable solely because I spent 8+ hours a day just sitting with him on my lap in front of the tv (needed something on to distract him) trying to get him to take sips while he screamed and fought me and I felt like I was torturing my own baby. He barely drank during the day but at night I could get him to "dream feed" where he looked asleep but was just awake enough to suck on the bottle, but without him fully realising that he was drinking the dreaded white stuff.

Even the local paediatricians were baffled by his refusal to drink and it was only when we were referred to a specialist in reflux in babies at a big centre that I finally found people who 'got it'. He started off on gaviscon (useless and constipating), ranitidine, domperidone and finally omeprazole. Unfortunately by the time he ended up on the big gun medication his level of inflammation was so high that it hurt him so much to drink he decided he would rather starve himself and chose hunger over pain. This had a knock on effect with weaning as he didn't start to eat solids until he was 15 months old. Now at the age of 4 he still has an eating phobia, a very poor diet and fear of trying anything new - although I am just thankful that he does eat.

In short, the first 15 months of ds's life were hell, and I ended up with PND as a result. I cannot stress enough that if your baby is getting distressed during feeding then prompt treatment can prevent all that we went through with ds. Your GP will probably give you gaviscon first, as it does sometimes help for mild reflux. If it doesn't help within a few days however, don't delay and go back to your GP and ask for ranitidine - if your GP is not familiar with prescribing this (although it is the next step for treatment of reflux in babies according to the NICE guidelines which we all follow) then ask for an urgent referral to paediatrics. I don't want to alarm you unduly - even ds's specialist says that it is very rare for babies to completely refuse to feed as he did, but I am very much of the opinion that even in milder reflux, not delaying treatment will help prevent other feeding problems developing (and also help to preserve your sanity). Hope that helps! x

[BecAndAlex]

Thanks for the reply. I went to my GP who thought that it wasn't true reflux and probably lactose intolerance. She examined dd and said she was very bloated. GP prescribed colief ( DD is also on Aptamil comfort, has been since 6 weeks old) and made a follow up appt for 4 days later. In that 4 days DD fed much better and also pooed daily. She hasn't done that since she was 3 weeks old. I went back and told GP this and she examined dd and said tummy was much softer. I have to say I have noticed a difference is dd tummy and can now see her rib cage. She is definately less bloated. GP told me to continue on colief and they will check her weight in 2 weeks time.If it isn't sufficient they will try a fully hydrolysed milk I.m pretty certain her weight will be fine as she is drinking around 30oz a day. Today however, she has been bad again. I know 2 people who have experience of silent reflux / lactose intolerance with their children, and they have both said from seeing her feed they are certain it is reflux. DD is doing exactly what their children did. I'm feeling like I may have a battle ahead now. I have suspected silent reflux since dd was around 4 wks old but then we would have a good day and I'd think I'd just imagined it and DD was just grumpy. It's been on and off like this for weeks now. DD is 11 weeks today. I think we have just gotten so used to it that now it just feels normal. I suspect DD is so used to being incomfortable that she too is just used to it. We do get smiles etc, but she does seem uncomfortable a lot of the time. My only saving grace is that she is sleeping between 7 and 10 hours a night. I look forward to her first feed of the day as that is the feed she takes the nicest. Also the feed after her bath is nice as she is so relaxed.

Going to get an appt with GP tomorrow if I can to discuss further, but really feel like they will just fob me off....Not really sure if I believe myself now and that I'm just hung up on a diagnosis because 2 people have mentioned it and said it is, so Im assuming they must be right and doctor is wrong.....Its so hard isn't it.......Even thinking that when dd was admitted to hospital at 3 weeks old with an unidentified infection (wasn't urinary as they checked that, and she had lumbar puncture and blood tests), that it may have been related to the reflux.

Its so hard isn't it......Never had any issues with DS so not used to these constant doubts and niggles!!!

I'll let you know how I get on.

thanks

[BecAndAlex]

Okay. Went back to the GP today and they have said it could be silent reflux and have given me some gaviscon to trial. Fingers crossed it works. How long does it normally take to work?/
thanks

[mummy2benji]

Gaviscon is just a feed thickener so it works pretty quickly. I would give it a few days however as if she has had silent reflux for a while she may have some inflammation of the oesophagus (oesophagitis) which will take longer to settle. When ds was a few months old he had blood tests which showed platelet and white cell count - both markers of inflammation - were sky high. So while the gaviscon will work quickly, it may take a little longer to know if she is responding to it or not. In my experience, only about 50% of babies with reflux respond to gaviscon. If she shows no improvement whatsoever, this doesn't mean that you are wrong and that she doesn't have reflux. The next step in treatment for reflux is ranitidine. GPs vary in how comfortable they are in prescribing this, unfortunately - some may insist on referring dd to a paediatrician first. This is largely because the doses needed by a small baby are tiny - less than 1ml per dose (2 or 3 times a day) and this freaks some GPs out if they are not used to prescribing it. You can tell them that ranitidine is in the NICE guidelines for the management of reflux in babies - that might help. I'm always happy to prescribe it, but then I have a special interest in reflux and feeding problems in babies, given what ds went through. If you can't get ranitidine, ask for an urgent referral to paeds - it needs to be urgent as it will take way too long if routine.

I have to say from what you've described that it sounds like reflux - the initial willingness to feed followed by fighting the bottle and getting really upset is quite typical. She may well also have lactose intolerance or dairy intolerance so the response to colief doesn't rule out reflux. Hope you can get it sorted soon x

[BecAndAlex]

Thanks for the advice. Its really helpful. Its interesting how much different advice you can get depending on who you speak to. I am at a surgery where they have 6 different gp's. Last time I went I couldn't get in with the GP I wanted, who I know has more specialist knowledge in babies. This time however, I got an appt with her and she seemed much more knowledgeable about silent reflux and how it can minifest itself. Fingers crossed the gaviscon works, but if it doesn't I'll know which GP to ask for next time.

She had very strong antibiotics for 4 days at 3 weeks old when in hospital as they treated her as if it was meningitis due to her age and symptoms, until all test results came back. It wasn't meningitis thankfully but they never did find out what it was. Not sure what her white cell count was like (they did a CRP test which was 42, don't know if that looks at white cells???), but it responded to antibiotics. I think this could have caused a temporary intolerance to the lactose as it strips the enzymes out of the gut (or so I was told) making it hard for the body to digest. If so I don't know how long it would take for the gut bacteria to replenish itself?? She is on comfort milk with coleif, but have been told that if using colief and gaviscon that first milk should be fine? If the gaviscon does work, I'll try her on the first milk again.

Thanks again

[anotherbitofcake]

God this could be me! I'm at wits end with my 10 week old. Now thinking maybe it's silent reflux. He started fussing around 3 weeks old and hasn't stopped. He got thrush around 6 weeks then in hospital at 7 with a fever. So battled with that first. No improvement now. Just had his tongue tie snipped and he actually seems worse. He cries most of the time when awake. Generally just seems whingy though sometimes it's a full on scary screaming session. He feeds ok to start but then screams at end and afterwards. Arches his back, bangs on me with his fists etc. he's a really quick feeder - about 10 mins. He gets annoyed when initial fast flow gone and has to be swapped to other boob quick. I've been to see a bf specialist who said he is putting on enough weight (she did the clever weighing him pre and after feeds) she suggested snipping tongue tie which I've done but no help. He does sleep ok - usually 7,11,3,7 with some settling needed to get him back but generally ok. He doesn't possett much at all. He hates being put anywhere really so I can't tell if its being laid flat or not. Do you think this is silent reflux? I'm so confused and worried I'm sinking into pnd. He is putting on weight but just enough not loads. I do have some days which he seems chilled out but I have to work so hard for those. I could never just leave him to chill on a playmat!