Fussy feeds - is this silent reflux?

[Mamakath]

Hello all.

DS is 3 months now and I'm still bfing - it's been a long struggle and his latch still ain't great, but I'm finding it manageable. (Thanks to those who gave me advice and support on here!) Now that things aren't too painful my main problem is that he is fussy and agitated for some of his feeds - arches his back, pulls away/ moves his head from side to side (without letting go of the nipple - ouch), grunts, kicks and wriggles, occasionally actually comes off and cries, but wants to continue feeding straight away. This has been happening regularly since around 3/4 weeks, and I thought the most likely thing was nipple confusion, and/or my supply wasn't great and he was getting annoyed with the slow flow. (I had to express and bottle feed for a while early on, and gradually go back to bfing directly.) But recently a BF counsellor has suggested that it might be silent reflux - the milk is coming back up as he feeds and making him uncomfortable. She suggested I cut dairy to see if it helps, which I'm now doing (too early to tell if it makes a difference yet though).

Any opinions on this? What strikes me as strange is that this only happens for 1-3 feeds per day, and never when he is relaxed/ sleepy. If it were reflux surely it would happen no matter how sleepy or awake he is?? I'm beginning to think he just doesn't like feeding that much, and (ridiculous I know) I've somehow scarred him by crying/ screaming through feeds in the hellish early days :(

[beckieperk]

Oh bless you. That sounds horrible. My ds is very similar and was recently diagnosed with reflux and prescribed gaviscon. Night feeds are very calm and normally successful....(shouldn't have said that, probs jinxed myself!!)....daytime feeds are a different kettle of fish. Not pleasurable at all most of the time....he is a big boy and constantly pushing against me to arch backwards! Nice!!
I'll keep my eye on this thread too in case anyone has any suggestions.
Good luck OP.

[highheelsandequations]

So sorry you're finding the feeding so stressful and really hope things improve for you. My DD is also acting similarly just now, I've wondered if it's wind making her uncomfy as she's had some enormous burps and will sometimes feed better after one of these. Sorry I've no advice to offer but will be watching with interest.

[narmada]

mamakath sounds a bit stressful :(

Like beckieperk says, refluxers often feed best when they're sleepy or asleep, so what you're describing could be reflux. I think the BF counsellor is right to suggest cutting out dairy first though. You need to do it for at least 2 weeks to see if it works. Watch out for whey powder, which is in everything, and also avoid any other mammalian milks - e.g., goats' and sheeps'.

Has your baby been checked for tongue tie, high/ bubble palate, and thrush? If not that's something you may want to check, given what you say about the ongoing niggles with latch.

You mention nipple confusion - is your DS getting supplements with a bottle or is he having a dummy?

[Mamakath]

Thanks for your replies! Beckieperk how are you getting on with the Gaviscon? We're at the doctor's tomorrow for jabs and I'm wondering if I should ask for a prescription. Highheels sorry to hear you are suffering too. DS does get a bit of wind, but normally brings it up quite easily - I don't think this is the problem in our case.

Narmada DS had a tongue tie which has been snipped twice and I think is now resolved (he can move his tongue pretty well, in any case). He does have a high palate and tight frenulum on his upper lip meaning he doesn't flange his lip out like I see other babies doing. I'm a bit at a loss as to what more I could do to sort his latch out; I've spoken to BF counsellors galore and I'm doing all the right stuff technique-wise, but it seems it's just never going to be easy for us... still feels a bit rough and pinchy, IFSWIM. We've been treated for thrush as well as the HV thought this might be the problem - didn't make any difference.

DS had mostly EBM via bottles for several weeks while we were struggling to get his latch sorted. He now just has one bottle per day (for his dreamfeed, which my DH does). To be honest though if things don't get better soon I'm going to start mix feeding - I really wanted him to be EBF but it's just getting me down struggling like this.

[beckieperk]

Gaviscon worked wonders for quite some time.....the effects seem to be waring off a little. He is sick more often now and its sort of cottage cheese consistency.....sorry tmi. If you discuss with your gp he should Be happy to prescribe gaviscon if thatswhat you want? He has a cold at the moment though too so not sure if this is adding to his troubles.
Let us know how you get on with gp. Good luck. xxx

[Mollcat]

Re the upper lip tie, not sure if you've seen this but it might help: thefunnyshapedwoman.blogspot.com/search/label/maxillary%20labial%20frenulum

[Mamakath]

Thanks for that Mollcat! I had heard that the upper lip tie affected things but had found it difficult to find any research to support this. My local hospital unfortunately won't cut them (or at least, not for breastfeeding related reasons), so it seems there's little I can do about it - plus I'm not sure I want to inflict surgery on my LO.

Beckieperk - got Gaviscon from the GP - it's a bit of a faff, isn't it? Will report back on whether it helps...

[beckieperk]

Good luck mamakath. I'll keep my fingers crossed for an improvement for you.

[Mollcat]

I don't think there is anyone in the UK who will cut them in infants. Apparently they're very liable to regrow anyway (bit like the PTTs they are so often found with!). More info on what they do in the States here if you're interested but I think we're stuck with the funnyshapedwoman's approach.

[Pseudo341]

It does sound a bit refluxy, doesn't have to happen every feed to be reflux. If it's acid reflux you might be able to smell it on her breath, it's a really unpleasant chemically smell.

[theboobmeister]

It's not necessarily reflux - especially interesting that it's only happening in some feeds, and never when he's relaxed or sleepy.

Could I suggest another possibility?

All babies have natural BF reflexes which include head-bobbing, arm-cycling and leg movements. When you are BFing in the laid-back position (you lying back with baby lying on your tummy) all of these reflexes actually help him to attach to the breast really effectively. But when you're feeding in the traditional sitting-up position, these reflexes actually hinder him from latching on - and they look exactly like he is fighting at the breast!

Some babies just have really strong reflexes which take months to settle down, producing exactly the kind of behaviour you are talking about. And interestingly, the two solutions are:

1. Feeding in laid-back position
   
2. Feeding when baby is really relaxed, sleepy or actually asleep - when all these reflexes are dampened down (sound familiar?)
   
   Worth a try before rushing to give medications?

[Pseudo341]

My reflux baby didn't fuss at every feed, she was a lot calmer at night feeds. Not saying it is reflux, just saying not fussing at every feed does not make it any less likely. If he's relaxed then the vomit may bother him less, hence so many parents of reflux babies end up cosleeping, if the baby is disturbed by the vomit but mummy's there they're comforted and can go back to sleep but if they find themselves alone it's all a bit too much so they get upset.

[Pseudo341]

Also it's possible being relaxed in the first place might make the reflux less likely, since I'm pretty sure stress makes it more likely having been thoroughly sprayed several times by a very tired baby who can't get to sleep and is getting more and more worked up.

Interesting idea about the reflexes though, or maybe he's having trouble latching on and getting frustrated. Back arching is a classic reflux sign but I'm wondering if it could also be anger.

[theboobmeister]

I know they say back arching is a classic reflux sign ... that doesn't mean that every back-arching baby has reflux.

I worry that we are all too quick to diagnose reflux, colic etc when there may be other factors at work. Some paediatricians are very worried that reflux is massively over-diagnosed and leading to babies being medicated unnecessarily.

My baby supposedly had reflux (not a clinical diagnosis, I suspect the GP gave us Gaviscon to make me stop pestering her). Needless to say the Gaviscon did absolutely nothing. The puking stopped by itself at 7 months, and later I realised that her other worrying symptoms were caused by hay fever!!

[theboobmeister]

I hasten to add - before I am flamed - I know that some babies genuinely do have reflux, it is a real condition and can be serious ...

[Pseudo341]

I'm not going to flame you, I don't think every back arching baby has reflux either, just that it is one of the known signs. I remember babysitting my nephew at 6 months old and he was arching his back and pushing away from me, I think he was just overtired and couldn't sleep. Anyway it's not reflux that's the big problem, it's acid reflux, and you should be able to smell that, especially if the baby is actually vomiting.

[narmada]

I am not so sure reflux is over-diagnosed and over-medicated for. I know a few people whose babies suffered from this (I also have one) and they had to fight like nobody's business for any treatment at all.

While I am not for medicating uneccesarily, severe reflux left untreated can lead to FTT, food refusal, eating phobias and malnutrition.

[narmada]

Not meant as a flame theboobmeister, in fact, I agree with almost everything you said. Parents generally know when there's something more than normal baby behaviour going on I think - you can just tell.

[Mamakath]

Wow, thanks for your input everyone! Some interesting ideas here. Feeding in the laid back position has never quite worked for us (probably because due to all our issues I'm not that laid back!!). We do feed lying down sometimes and this doesn't seem to make much difference to how he behaves - the key thing seems to be sleepiness.

As for the silent reflux diagnosis, I'm still not sure. We've had a few days on the Gaviscon but I'm struggling to get it into him and haven't managed more than 3 doses a day (won't take it via bottle before a feed as he wants boob, won't take it after because he's full, spits it out if given via syringe). It seems to be doing little other than thickening his poos. In the meantime DS has been getting more and more distressed, and sleeping less and less (I had about 3 hours last night and ran a red light on the way to the supermarket earlier - not good). He WILL NOT go back down on his back after a night feed atm, which makes me think it is indeed reflux; on the other hand I can't smell anything acidy on his breath. Saw another GP this morning to discuss again and see whether there is anything more bf-compatible they could prescribe, and he said DS has signs of thrush in his mouth and it's probably that - argh!!! Our normal doctor didn't spot this and I thought we had ruled thrush out weeks and weeks ago - and if it is thrush he (and I) have probably had it for ages, pretty much since he was born (he had antibiotics in hospital which is the probable source).

So, for the time being I'm doing the thrush treatment AGAIN and sticking to the non-dairy thing just in case. I'm in two minds about whether to keep persisting with the Gaviscon just in case it is reflux, but as others say don't want to medicate unless it's actually going to help. Any views?? I guess by treating for one thing at a time we will at least get to the bottom of what the problem is.

(As an aside, the GP this morning told me that if it was indeed reflux, the solution would be to start bottlefeeding and then I could give him Gaviscon with no problems!! )

[theboobmeister]

Blimey sounds like that GP doesn't know what he's talking about! Formula-fed babies have loads more problems with reflux than BF ones.

The Gaviscon should work immediately if it's going to work at all - that's because it physically thickens the feed in his tummy. Sounds like it's doing that effectively, but the upshot is a less happy baby?

It does sound like things are pretty confusing for you now Mama. I'm not sure if I'm going to help much throwing in a load more things into the mix, but here goes - this is a helpful piece with lots of other suggestions.

And please do also consider other possible non-medical causes ... loads of babies hate being put down to lie on their backs because they'd rather be in their mum's arms. Some are just very, very demanding and will behave as you describe unless they are carried around and held 24 x 7. Inconvenient and worrying, but normal, sadly ...

[Deliaskis]

Mamakath sorry you're going through this. DD was a silent reflux baby, and TBH, Gaviscon didn't help as all it does is thicken the milk, does nothing to neutralise the acid. DD was better when on acid supressant meds, which she is now weaning off.

Sorry can't really help with your OP but thought it was worth mentioning the Gaviscon given that you are already in two minds about it.

D

[beckieperk]

Hi again everyone. Just wondering if anyone has noticed their LO only falling asleep while feeding? My Ds does this and as soon as he notices the milk has been taken away he fusses and wakes. He will settle again straight away when milk is back in his mouth. I'm pretty sure he's not hungry.....could this just be a comfort thing because of the acid? Or Growth spurt? Ds is 11 weeks today - but was 2 weeks after due date. I've tried dummies (several kinds) and this doesn't trick him for long.....and he can't keep it in his mouth anyway. As soon as I let go it falls from his mouth. Any ideas on this too?
Any Help or advice is greatly appreciated.

[theboobmeister]

beckie I'm assuming you're BFing? It sounds like typical behaviour of a normal healthy baby that age ...

What happens when you give him back the boob? Does he eventually wake up and start to feed again?