To ignore GP and health visitor advice re/ reflux

[Woodlandwalks]

My 10 week old daughter was weighed yesterday by the health visitor who said she's not happy with her weight gain and referred us to the GP. She is gaining but slowly and has dropped from the 91st centile to the 50th since birth. She's exclusively breastfed and she is very sicky. She spits up quite a lot after most feeds but is doesn't bother her and other than a bit of a pain due to the amount of outfit changes, it doesn't bother me. She's not distressed, she's happy, chatty and doing everything I would expect her to. She's perfect. The GP has prescribed her Gaviscon to see if it improves her weight gain but honestly I'm just not buying that there's a problem with her weight. I think she's am average sized baby who was born big and is now finding what's more natural for her. I measured her length myself and plot her as being on the 50th centile for length too and she looks very proportional to me. She wees and poos for England. She drains the breast, comes off by herself, is content after a feed. Theres literally nothing else to suggest there might be something wrong. I don't want to medicate her if I don't need to so thought I might just not use the Gaviscon and keep an eye on her weight myself. Or am I being stupid to ignore the GP? I've heard that Gaviscon can cause constipation and whilst it would be nice for her to be less sick, is it really that much of a problem?

When my baby was born they put the blanket on the scale and then forgot to zero it before putting him on. They were very worried about the amount of weight he lost because of it until we figured out the problem. If you're happy then don't worry but obviously keep an eye. However, Gaviscon won't do any harm so why not just give it a go? Worst case scenario if you give her the Gaviscon then she's had unnecessary Gaviscon...

I thought I was going to completely disagree with your post until I read it.

No I personally would prefer not to be giving a 10 week old gaviscon for weight gain. At the 50th she is bang on average.

If it’s to help with the spit ups then that’s a little different. Perhaps monitor the situation over the next few weeks/months and make a decision then? She’s just ten weeks. There can be a perception of GPs “fobbing people off” when they tell them to see how it goes, I wonder if that has an element here.

I personally wouldn't ignore the advice if it came from my gp. Gaviscon won't do any harm, so honestly I'd just try it. She could just be on the smaller side. But no harm in giving it for now.
My daughter is still now at 17 months classed as underweight however her paediatrician isn't worried as she thinks it's just her frame and all children are difficult.

Have you considered cutting dairy out your diet to see if it helps?

Mine had reflux and stomach issues until we got her onto a dairy free formula.

Also we had tried gaviscon, ranitidine and omeprazole. Ranitidine helped for a while. Other 2 did not!!!!

It sounds like your baby’s doing well to me, although I’m not a medical expert. I’d be tempted to follow your instincts - if she continues to wee / poo well and is happy and healthy then I’d probably leave the Gaviscon for now. But I’d keep a close eye on her weight yourself to make sure she’s not dropping any more. You’re right about the constipation - I’ve used Infant Gaviscon for a time on both of my babies and it constipated them both as well as being pretty ineffective. Good luck with it all!

I think you’d be unwise to ignore it, but totally justified in getting a second opinion before you try the gaviscon. Her dip in weight might not be due to reflux - she could have another medical issue, or an allergy, or a feeding issue. Or as you say she may be fine.

Can you see a different GP for an opinion? Or perhaps it might possible to agree to weigh her in a couple of weeks and try it then if her weight isn’t satisfactory?

I think it would be a really bad idea to just ignore it and assume it’s fine, you could miss something important

If you are happy to monitor, as you know your child best then go for it. That's a good thing. Could be that the 50th centile is her line . As long as you know where to ask for help if required later.

I would disagree with pp who say it’s easy to give gaviscon.
Not to a baby that is being bf on demand

How do you feel about her weight? It sounds like you aren't concerned (not a criticism). Is she dc1? And is she happy, alert and mobile/energetic generally? If she's fine apart from the weight I wouldn't be worried about it at this stage.

How often does she poo?- I ask because both my ds were ebf and by 10weeks did fortnightly poos (not constipated). If I'd had them weighed immediately after I would've been worried.

Thinking about the reflux/spitting up (in case you want alternatives to gaviscon):
What position is she in after a feed?
My Ds2 was quite spitty (very grumbly with it) and I found having him upright in a sling or whatever helped after feeding.

We didn't really have issues with weight gain; both Ds1 and Ds2 started on the 25th and dropped to the 9th centile where they stayed for ages. I have had HVs misread the weight charts and start telling me how concern they were about slow weight gain; do check they've plotted things correctly.

Was she overdue, did you have a drip during labour and/or a c section? All these can make the baby weigh more than it should do at birth.
Mine lost weight within days and then has tracked the same centile exactly for 2.5 years. I do think they find their natural weight in proportion with their height.
To stop the sick reflux have you just tried propping her up eg a folded towel under the head end of the pram mattress or holding her upright for half an hour after feeds. It sorted ds’s slight reflux?

It’s a bit tricky to give gaviscon to an ebf baby, and it does firm their poos up considerably in my experience so constipation is a risk. My baby was on it briefly when I suspected reflux, but it is really a stepping stone to ranitidine.

Did your baby drop down the centiles, but is now following the 50th centile (not too worrying), or are they still falling down the centiles (much more worrying)?

Not unreasonable at all, I would do the same in your shoes. Certainly continue to keep an eye on the weight gain and maybe reconsider if she drops further, but I wouldn't want to jump to medication at this point either. It sounds like she's doing fine.

I’m afraid I’d disagree with pp who have said there’s no harm in taking gaviscon if not needed. It can a hinder some uptake of the nutritional value of the milk.
Why not try cutting things from your diet?
I’d agree with @nocoolnamesleft about tracking or continuing to drop. X

Such a nightmare to give gaviscon to a bf baby. Don't think you'll be keen on it OP.

Keep an eye on the weight, any more loss I'd be getting more advice. Can you do any extra feeds, dream feeds etc?

She's not bang on average. She has dropped 2 centiles. Babies generally follow their centiles and when there is a dramatic change, up or down across 2 centiles, the health visitor and GP will wonder why and investigate as it can be a sign that something isn't right. You should be following their advice. They are going by the faltering growth policy.

It sounds like your GP didn’t explore ways to feed that may result in increased gain? If there are queries over gain then that would be the first way to look at what could change. Speak to one of the bf helplines and YABU may be able to help. And that’s if there is a problem as whilst checks are made after a two centile drop most babies are fine and where they should be. Lots of babies are very sicky without it impacting on gain at all.

Hello
I exclusively breastfeed, my daughter was also constantly spitting up and uncomfortable after feeding. Was told it was reflux but as she was my third I thought something wasn't right. So i thought allergies,1st I stopped eating eggs but no difference, then I went back on eggs again and stopped consuming dairy again no difference so the issue continued and at 6 months when I was weening her we discovered she was allergic to eggs and dairy. So I stopped consuming both dairy and egga and she stopped being sick after I fed her. She had what we thought was a birth mark on her lower back, red markings. But they cleared once i stopped consuming the foods she was allergic to. She had an epi pen but luckily out grew the allergies by 4 years but she does not like milk. I would recommend changing your diet. Stop dairy and eggs for a month or two. If no change stop consuming nuts, maybe seeds. Allergies to eggs and dairy are quite common in little ones an many out grow them. I fed my daughter till she was 2 years and just wished I had stopped consuming eggs and dairy sooner. I hope you get it sorted. I think many allergies are passed off as reflux. No harm in changing your diet but do your research and if not consuming dairy make sure you are getting enough calcium and b12 and take a suppliment also. I am not a medical professional though! Take care and congradulations on your baby.

Both my EBF babies were born on the 91st and dropped to around the 50th over a few months. One was sicky, one wasn't, both were feeding well and plenty of wet and dirty nappies. Never occurred to me that anything needed 'doing' about it.

I'd keep an eye on any further drops down the centiles but skip Gaviscon for now, a nightmare to give an EBF baby and not without side effects for newborns esp constipation.

I'll give you my experience. Dd was born 10 days over due, and was on 93rd centile. Six weeks later, ebf, she was on 75th centile at her weigh in, so after that we had fortnightly weigh ins for 12 weeks. She dropped to 50th centile at about 10 weeks and now at 7 months is still bang on that 50th centile. My health visitor (really lovely lady) asked all the things you're thinking about, is she weeing and pooing, pink and healthy, feeding well, sleeping well, alert and interested when awake, etc. As dd ticked all of those boxes, my health visitor reasoned that dd was just finding her level, and would probably settle at 50th, which was spot on. She didn't suggest any feeding intervention, just to keep an eye on her weights and if it hadn't levelled out by about 4 months, or if she showed any other signs of not feeding well or ill health then they would refer to a gp or paeds, but that wasnt necessary.

Dd tends to hold on to wind, and still now sicks up a bit after some feeds, but is right where she should be in terms of weight and development. I was happy with the approach my health visitor took, very much 'keep feeding, wait and see, call us if you're worried'. It sounds like that might be a sensible strategy for you op.

You know that it isn't compulsory to get your baby weighed? You could just 'forget' to get her weighed for a while, trust your instincts, feed her on demand as much as she wants and see how it goes?

I'm always a little struck in scenarios like this, how the baby's comfort isnt mentioned 🤨

It can't be nice spitting up and being sick constantly, if you can try gaviscon to see if it makes a difference and settles her stomach, why wouldn't you?

You can always discontinue if it has no effect, or causes side effects.

No harm in giving Gaviscon?! A. It's a nightmare to give to a breastfed baby and B. It can cause bad constipation (it did for mine).

OP, do check the symptoms of cow's milk protein allergy (CMPA) and consider whether that could be the issue.
www.allergyuk.org/information-and-advice/conditions-and-symptoms/469-cows-milk-allergy
dilanandme.com/2017/01/27/confirm-cmpa/

If it is CMPA, it's obviously much better to eliminate dairy than giving medication.

FWIW, my son had bad silent reflux caused by CMPA. He was suffering so we gave meds as well as cutting out dairy. But the meds didn't make a big difference, he improved once the dairy was out of his system, and was fine when we stopped the meds.

Note
"If your baby is a ‘Happy Spitter’ –gaining weight well, spitting up without discomfort and content most of the time — spitting up is a laundry & social problem rather than a medical issue."
kellymom.com/hot-topics/reflux/