to be upset by what the paediatrician said?

[frakyouveryverymuch]

I took DS (3 weeks) to the paediatrician today because I suspect he has silent reflux. I know I'm not a doctor but I also know his levels of distress aren't normal for babies and he's got most reflux symptoms bar the projectile vomiting.

Apparently because he is gaining weight he can't have reflux. TBH I'm sceptical about that because I think he's sucking for comfort, and therefore getting milk, because he's refusing a dummy - but why would he have silicone when he can have a mummy-dummy! When I said we'd tried a dummy (against my preferences but if it helps, it helps) and that he was feeding frequently but only taking small amounts she told me that I'm causing his reflux by 'giving in' to frequent feeds, I have to wait at least 2,5 hours between feeds and 'if he cries, he cries', and I have to make him get used to a dummy.

Now I'm not one to whip out a boob when DS squeaks. I check to seee whether he's hot/cold/needs changing/etc unless it's been ages since the last feed and he can go up to 4 hours at night without waking for a feed but during the afternoon evening he can cluster feed for ages and daytime feeds are more like every 2 hours.

She might have a point but AIBU to be upset by the way she said it? Please be honest because if I am BU or oversensitive we'll keep her as our paed - she comes recommended by friends (who have quite different parenting styles admittedly) - but if I'm not I want to find a new one before DS's next scheduleed checkup.

It was a bit of a nightmare when i think back. I have 3 and she was the only one who suffered with it. She was also the greedy one who polished a bottle off in record time

Trina that's an excellent question

I've decided I definitely don't like her, regardless of whether she's right or not about the reflux or the feeds. We tried spacing feeds out yesterday and it was hideous and heartbreaking, and I only lasted 10 minutes before feeding a whole hour before I 'should' have according to her, by which time DS was so distraught he could barely latch and guzzled so quickly he was pulling off and screaming.

I was in tears to my unsympathetic mother over the phone, although she did tell me I had to be kept upright after feeds and would only sleep on my tummy but almost never spat up so I wonder if there's a genetic link? According to MIL DH had such bad reflux she had to stop BFing him and add gelatine to his bottles to keep the milk down. Thankfully she didn't have the nerve to suggest I do that

Some of the stories you've shared are heartbreaking :( If DS does have it I suspect it's only mild because we can get by although it hurts so much when he screams and I can't help, all I can do is cry with him. I just want to know and if he does have it catch it early - IME babies who are diagnosed early do better because it's managed appropriately.

Betty he's always had a high rate of respiration and he sometimes makes funny rasping noises. I put it down to a blocked nose but could it be something else? He occasionally does this scary thing where he stops breathing for a couple of seconds and then makes a noise when he takes a deep breath in as well.

LadyGolden, you are just plain wrong.

It sounds as though your lo had colic, hence it stopping at 3 months, my dd1 had the same it was horrible and nothing we tried stopped it.

However it was totally different from ds, who was diagnosed by hospital paeds with GORD at 10 weeks. He screamed and cried nearly all the time, struggled to feed (breast or bottle), would only take tiny amounts each time. His weight went up and down, but sometimes he would overfeed (this is typical of silent reflux).He didn't vomit copiously but would dribble small amounts of curdled foul smelling milk. He hiccupped all the time, couldn't lie flat, would only sleep being rocked in our arms. He made lots of rasping, grunting noises, because of the acid coming back up.

Gaviscon made no difference (as this merely thickens the feed to stop it regurgitating. Ranitidine has kept it under control, as this neutralises the acid.

Ds has a lot of medical problems, and every dr and paed we have seen say that the first thing a good dr should do is listen to the parents, as they know the child best, and often if they have a gnawing worry that something is wrong, it should always be taken seriously.

frak, crossposted, the breathing thing sounds just like ds. It was this that alerted the paed to reflux, it can also be related to sleep apnoea.

I sympathise, my dd, who is now 13 weeks has reflux, I'm pretty sure, although none of the two GPs and three HVs I've seen have bothered to get a proper diagnosis. The bog standard attitude seems to be "if child is gaining weight, no problem." Its irritating and patronising. My baby's reflux is actually easing now, thanks partly to age, partly to infant gaviscon and she was never a big screamer so I'm happy not to push it further now. But if its making your life hell, I'd demand to be referred to a gastro specialist. I know for a fact that several hospitals have them and they are pressed into service in cases of severe reflux but I think that GPs are reluctant to refer you to them unless the reflux is very bad (i.e. baby not gaining weight.) But if you put your foot down they should refer you.

The paediatrician told me that the funny noises are caused by breathing through the (reflux) fluid as they are unable to clear their throats. It sounded a bit like a giant kitten purring or a coffee percolator.

The stopping breathing could be down to his age but could also be sleep aponea as hazey said, my DS also has obstructive sleep aponea . You should record it each time it happens, include the time that it happens and how far into a sleep he is. If you haven't already raised it you need to raise it with your GP/HV or Paed. I don't want to alarm you but whilst reading around on reflux there is a theory that there is a higher incidence of cot death in reflux babies.

When you see the paed ask them to look at his tonsils, they will probably say that they look normal but ask specifically if they are on the larger size of average. My DS's are very large and almost meet at the midline. When distressed they cause him to gag/vomit and are the cause of his obstructive sleep aponea. They also cause problems with eating but that's another thread!

I would go and get another paed's opinion, I hated the first one we saw who treated DS like a piece of meat, the second one was lovely, had loads of experience with reflux and discovered the monster tonsils. Tell them everything, even if you don't think its related.

frakyou - you sound just like me and DD - you poor thing

Unlike you, I had a fantastic HV and then GP and infant Gaviscon stopped it in its tracks. In fact, my HV took the view we should try infant Gaviscon to see if it was silent reflux - taking the view that if it was, that would show it up.

Which it did - although it constipated her and we ended up on Ranitidine instead.

Has your GP tried infant Gaviscon?

YANBU my DS is 2.5 years and still has silent reflux. Hi symptoms at 2 weeks old were
-extreme distress the whole time he was awake
-violent hiccups and splashing noises
-slept 20 mins max at a time (was up ALL night)
-the worst was the choking, constant choking which made him stop breathing-he was rushed to hospital with it the first time
-feeding aversions (he hated food and eating, was 16 months before ate proper food, 12 month for stage 2 food)
-vomitting (not huge amounts)
-didn't sleep through the night till 12 months
-screamed and arched his back for hour on end
-I can't put into words the difficulty of those first 6-9 months

He always gained good weight and was breastfed every 1.5 hrs.
Things got easier when he could move around about 11 months but the msin improvement was at 19 months. He still has it but it is more annoying now. He is just coming off the Losec.

I would go back for a second opinion. What helped our DS..
-hammock bed
-music
-jumperoo (weirdly it didn't make the reflux worse, he loved it)
-propping up in the pram and going out for walks

Good luck, hope things get better soon.

I've not read all of the thread so forgive me but.....there is some truth to what the dr. said. Frequent, short, episodes of breastfeeding do not allow the baby to get the hindmilk. The foremilk can cause tummy upsets, which is what it sounds like your DS is getting a lot of (due to comfort feeding). I had the same issues with DS and had to make sure not feed him any sooner than 2 hours apart. He didn't cry for it either and actually rested better in between once we got him on a better schedule. Also, I breastfedd both of my children until 9 months, so hours of lactating under my belt! ;)

If you want to try spacing the feeds out a bit more, then dint head straight for 2h+ intervals. It might be too long. Many 3w babies will be feeding more often than 2-hourly, whether or not they have reflux. Instead try giving him a dummy for a few minutes. If he settles, great. If not, then feed him. You may have to hold the dummy in fir him, newborns often cannot hold a dummy in their mouths and it looks as though they are rejecting it, but they aren't. It's just that the suckling action involves pushing the Tongue forward, which can push the dummy out of their mouth.

A dummy really helps with reflux. The swallowing action helps keep the stomach contents down without filling the stomach further.

You may find that a dummy for a minute or so before a feed helps him to settle inti the feed, rather than gulping frantically at it.

Are you finding that you are tuning in to his signals, recognising his asking-the-breast actions before he starts crying for a feed? Taking action before that point, whether it is by feeding or by giving the dummy, helps.

One last thing - it may sound off the wall, but it isn't: have you considered cutting out all milk and milk products from your diet? That can help, too.

But as the Dr's wife answering the door, I would have told you, "this is what happens with small babies, we are off duty,bugger off and let me get some sleepmhope you have a good night"

Is the baby just plain thirsty?

My DS had reflux and was put on baby gaviscon which worked instantly. He had feeding problems from the start but things got worse at 5 weeks, crying half way through a bottle, not wanting to finish, having many small bottles a day and vomiting, not all the time but when he did it was the full bottle back up. We had to have a bath towel to hand just in case!He was putting on weight but I wasn't happy to leave him as HV thought he was fine (the mind boggles) so went to the GP.
Definately get a 2nd opinion and you could try the Gaviscon as if it doesn't work you'll stop using it, no harm done. In the mean time feed on demand, little and often means his tummy won't be full so less likley to reflux. Keep him upright for 20mins after feed and you could try raising the head of his cot/basket or use a foam wedge.
Hope this helps and your DS gets the help he needs. Trees

Angel - doesn't feeding frequently mean the baby gets hindmilk though as they are feeding from emptier breasts? Empty breasts = fatty milk, whereas if the breast is full the milk is more watery.

Angel I'm block feeding (2-3 hours per side) to prevent that rather than switching at each feed.

Pretty I'm allergic to cows milk so there isn't any in my diet. I've considered going wheat free as well to see if that makes a difference. We're learning the cries but his facial expressions are a better cue. Apart from the pain cry he's very 'good' and rarely cries, just fussed a little when trying to poo, wet or dirty.

We've been trying a dummy - thank you whoever it was who said they tried different shapes, we've found one that seems to work short term. I'll try the dummy before feeding approach although very often DH has been trying to give me a couple if minutes to install myself comfortably by proffering a finger, but DS just gets pissed off because there's no milk and that's what he wants!

Latest trick however is throwing up through his nose. I think he gets a mouthful of sick but tries to swallow it down.

Rita - The hindmilk is typically released only after 10 minutes or so of feeding.It takes about 2 hours for your breasts to fill up completely again. This is natures way of building up the milk supply to meet the demands of the growing baby's appetite. As time goes on, the baby's stomach grows bigger which allows more milk to be digested at one feeding, thus your breasts naturally meet this demand. The foremilk that your breasts produce is high in protein, which is harder to digest and can cause digestive issues. Most babies grow out of reflux/colic at around 3 months due in part to their stomachs growing larger and being able to digest a larger quantity of milk and do it more efficiently.
I fed my DC one boob per feeding. I found they both only wanted to feed for about 10-15 min at most, so in order to make sure they got the hindmilk, I let them completely empty one boob and switch to the next for the next feed.

Now, growth spurts are a whole other story as that baby will suck you dry! But again, this triggers your boobs to produce more milk and by the end of the growth spurt, I swear my boobs were another size bigger!
Also, one thing to mention is that, in my experience, when baby doesn't get enough hindmilk, they tend to be generally fussy and not sleep for long or be generally cranky.

Oh Frak :( Absolutely no advice but I would also be ignoring that paed. Do you have some choice to find another one? I don't know what they're like over there but on the mainland I've found some in the medical profession to have some rather odd views (diarrhoea in a bf baby - switch lactose free milk immediately!) so we've found we need to shop around. I hope there are enough around that you can do that.

I hope you find a solution quickly so you can go back to enjoying your lovely DS :)

I'm sorry, Angel, but that's just not right. Breasts dint work to a clock. Some babies are very efficient feeders, and will take a full feed in just 5 mins (though admittedly that would be unusual at this age). Also, breasts do nit empty out and then take a fixed time to fill up again. The more milk is removed, the more milk is made.

Breastmilk, just like unhomogenised milk in a jar, separates on standing. So milk that builds up in the breasts between feeds separates into foremilk and hindmilk, but milk that is made during a feed is 'homogenised'. The longer the intervao between feeds, the more the milk separates. The shorter the interval, the less difference there is between the 'types' of milk and the nore 'homogenised' milk thrre is. Once the let-down has been triggered, and milk has begun leaving the breast, then milk is made continuously throughout the reed and after.

Undoubtedly, some babies benefit from enforcing a gap between the feeds, just as some benefit from very frequent feeds.

If Frakyou's ds is an efficient feeder with a good latch, then short, frequent feeds are unlikely to be the cause of his discomfort.

Frakyou, have you gone to any breastfeeding support groups? The sort run by trained breastfeeding supporters, not HVs or midwives. All respect to GPs and paeds, they are experts in their fields, but not in breastfeeding. It is important that your ds is latching comfortably.

It is excellent that you are learning his visual cues, because if you can respond to his needs before he gets distressed then he may reflux less. And also be generally more content and confident. I dont mean you have to jump to it the moment he twitches, but that you can be prepared and modify what you do earlier. Is your dh trying to pacify ds once starts crying, or before?

If you are already dairy-free, what about soya? I don't know whether it, like dairy, is implicated in reflux, but it can cause a lot of digestive upset in some people. I had to cut out chocolate rom my diet when ds2 was tiny, because it upset him and made his reflux worse.

(Sorry about typos. Typing on phone in bed, after dear darling dcs woke me to tell me they were letting me have a lie-in.)

Angel, there is no such thing as "reflux/colic" - they are ENTIRELY different conditions. Babies can grow out of colic but reflux, especially if there's a link to cow's milk protein intolerance can go on for years.

There was some talk recently about Mumsnet having a sort of reflux event. I wish they would - there's so much ignorance around the condition.

Sorry Angel, I also think you're totally wrong about timings there! Different women will have different storage capacities in their breasts so the amount of time to empty/fill a breast will differ - not that a breast ever really empties as milk is made constantly.

Hindmilk isn't a separate milk that is "released" - it's just a term for milk with more fat molecules in it. The milk stored in a full breast has less fat molecules in it than milk made during the feed. A baby feeding for 5 minutes every hour may get more fat than a baby feeding for 15 minutes every 3 hours, so it's impossible to put a time limit on it.

Kellymom, a very good breastfeeding site.

Well guys, in the end what matters is that the baby breastfeeds for as long as possible. Only 36% of U.S. moms will breastfeed exclusively for first 6 months, with even less in the UK.
I fed both of mine for 9 months each with gradual weaning from 6 months onwards. With no problems. Because breastfeeding was explained to me by every health professional and book I came in contact with that concerned breastfeeding.
I wonder if you all can say the same?

(sorry to jibe, but I really hate it when people attack each other on here saying no knows anything just because it isn't what THEY have done or would do).

Angel, wasn't trying to attack you just correct some misinformation which could be damaging to women trying to breastfeed.

Via wikipedia (search hindmilk)

'Foremilk, the milk released at the beginning of a feed, is watery, low in fat and high in carbohydrates relative to the creamier hindmilk which is released as the feed progresses. The breast can never be truly "emptied" since milk production is a continuous biological process.'
Also, take a look at the photographs of the two milk samples. A full breast will release the foremilk first, hence the watery, light color....as baby feeds, the hindmilk is released. You can only get to the hindmilk once the foremilk is exhausted.'

now see site - www.kellymom.com/bf/supply/foremilk-hindmilk.html

'Your breasts don't "flip a switch" at some arbitrary point and start producing hindmilk instead of foremilk. Instead, think of the beginning of a nursing session as being like turning on a hot water faucet.
The first water you get out of the tap isn't usually hot, but cold. As the water runs, it gradually gets warmer and warmer and warmer. This is what happens with the fat content in mom's milk - moms's milk gradually increases in fat content until the end of the feeding.'

Now this is what I originally said 'The hindmilk is typically released only after 10 minutes or so of feeding.It takes about 2 hours for your breasts to fill up completely again. This is natures way of building up the milk supply to meet the demands of the growing baby's appetite. As time goes on, the baby's stomach grows bigger which allows more milk to be digested at one feeding, thus your breasts naturally meet this demand. The foremilk that your breasts produce is high in protein, which is harder to digest and can cause digestive issues. Most babies grow out of reflux/colic at around 3 months due in part to their stomachs growing larger and being able to digest a larger quantity of milk and do it more efficiently.
I fed my DC one boob per feeding. I found they both only wanted to feed for about 10-15 min at most, so in order to make sure they got the hindmilk, I let them completely empty one boob and switch to the next for the next feed.'

Where am I wrong exactly??

Also
On demand infants typically will feed every 2 hours or so....except with growth spurts, then they can be on the boob all day it seems!