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?

My baby spits up a bit of milk after most feeds. Isn't that what babies do? I'm ebf and if she dozes off I'm not going to wake her to burp her. However when she wakes she will usually spit up when you sit her up or hold her. She doesn't cry or look in pain, she's totally oblivious to it, so my thinking is she's fine. Only you can judge how your baby is OP.

My oldest dipped around a bit on centiles over his first six months ( ebf) . He was born at 98th but was overdue and I was induced had fluids . He now tracks on 91st now for weight and height. He also spat up a lot, no allergies.

My current baby was born on 75th now on 91st for both weight and height too. I think this will resolve once sitting unaided more confidently and weaning onto solid stuff. I've tried a few purées and they seem to be as easy to spit up.

For 50th centile I wouldn't bother. My baby is on gaviscon and has been almost from birth. She's on the 10th centile and was always very sicky.
Gaviscon causes constipation and she is in distress which has to be relieved by taking lactulose.
My GP's opinion is that no baby has ever died from reflux so just put up with it. It was the hospital that insisted my baby take gaviscon when she was in for 2wks. After we left they prescribed omeprazole which we refuse to use as I'd rather her take the gaviscon. My GP also advised against omeprazole.

Also be aware that there is a shortage of gaviscon at the moment and we are really struggling to get any. So if you start your baby on it, you may end up with a patchy supply which wouldn't give you the result intended.

My baby was put on gaviscon, it made an amazing difference. She became a happy healthy baby.

Ohnoherewego62 The OP says the baby is exclusively breastfed. Does one of your tits do dairy and the other dairy free? Twist the nipple once for semi skimmed and twice for skimmed?

The OPs diet!

If it aint broke, don't fix it.

Gaviscon is not harmless, it can change the way the baby's digestive tract works... change micro-flora, constipation.

Why would you? I agree babies can be born big, then settle into their size. She may even go under the 50centile, but if it's matched in height and weight, maybe she is destined to be less than average height.

Trust yourself.

Totally agree, you sound intelligent and rational to me. With my dc21, everyone around me seemed to have a baby with reflux, everyone went the gp, every one prescribed ranitidine. I just dont buy it. Not saying reflux doesnt exist but think its way too over diagnosed. Based on rational observation (fwiw I'm a vet so my job is to diagnose in non verbal patients) I dont believe either of my two had reflux in the early days (when they had witching hours) so I never took them to gp, knowing i'd walk away with antacid prescription!

Just wondering, were you on fluids for the birth? That can make a baby artificially heavy for the first couple of days

@redbigbananafeet- what??? Too much gin????

Dairy can known to give newborn babies reflux. Reflux and being sick can be symptomatic of ! dairy intolerance. Certain formulas can trigger this. Same with breastfeeding, if mother is consuming dairy this can be passed on to babys system and cause an upset stomach, reflux, rash etc etc

Everydays a school day

It’s interesting how different midwives in different areas react to things. My DD was born on 91st centile. I was a first time mum and watched with horror as she quickly dropped to the 21st. No one batted an eyelid - I was the one stressing so much about how much she was or wasn’t eating (she was EBF so couldn’t visually see) she loved to mess about on my boobs and would stop eating to have a good look around the room whilst milk went everywhere. I got myself in such a tizz about it I gave up breastfeeding, which with hindsight I bitterly regret.

The point I am trying to make is really, you know best as their mum whether they’re meeting milestones and producing wet and dirty nappies. I think you need to take the lead from them. X

Hi, my dd was born on 75th centile and dropped to 25th and hv wasnt concerned at all as she was still gaining just at a slower rate. She said they only worry if the baby actually loses weight. She was bottle fed as well and was rarely sick. The hv said she was just obviously born big and was finding her natural curve. Shes almost 2 now and only weighs about 23lbs and shes petite but me and my partner are both small too so it doesnt worry me in the slightest

I'd seek a second opinion. But the reflux might be causing some discomfort to your baby. Can you return to the GP and explore other options other than gaviscon? Perhaps dietary modifications?

My daughter was born on the 92nd centile and has followed the 50th since she was about a week old. Nobody has ever been concerned about this as she has stayed on that line, but she was never sick.

Although some babies are just sicky for a while. I know plenty of sicky babies and there hasn't been medical intervention.

I think you if you don't give Gaviscon you should decide now when you might. Eg weigh again in 2 weeks and needs to still be on 50th line. Also you should be honest with gp and health visitor what you are doing and why.

Thank you all for your replies. Of course I would give the Gaviscon if my baby was distressed or appeared uncomfortable, but she doesn't and I agree with those that are saying Gaviscon is now 100% harmless. It is known to cause constipation as a very common side effect and that is not harmless so why give it to a baby who doesn't need it. I'm not in any way criticising parents who do use it for their baby because I know reflux can be very distressing for some but my daughter appears completely content and totally undisturbed by hers so the only reason to treat it would be if it's causing a problem. I will monitor her weight, I have another appointment with the health visitor to weigh next week anyway and if I believe there is a problem then I will use it.
I will consider cmpa, thank you. I don't think it is the case for my baby because she has no other symptoms of an allergy but I will give it some thought.

The health visitors basically have a script/process to follow for any baby who goes up or down 2 centiles. My first baby went from 25th to 75th and I was asked about overfeeding her, although she was EBF. She has stayed on that centile ever since (now 3 years old).

My friends baby dropped from 25th to 0.4th centile, also EBF. Was recommended to give formula and eventually referred to paediatrician and nutritionist. They saw her at 7 months, crawling around the room, bright and aware and clearly doing fine and discharged her. She is also 3 now and still following the 0.4 centile line. Some babies juse take a bit of time to find the right line, if you know what I mean.

I would say go with your instincts but keep an eye on it. Maybe buy some baby scales so you can weigh her occasionally, since health visitor clinics arent running at the moment.

Please don't take this as patronising, but have you tried winding her before feed, between boobs and at the end? Starting gently then more vigorous to really get everything out. My boy used to spit up a bit and I worried initially that he might have an allergy, but then figured out he just needed a lot more winding than some babies. He's an amazing farter as a toddler now. For extra trapped wind, gentle clockwise tummy rubs send it in the fart direction rather than spitting up. He also did well with a little gripe water, it seemed to help him fart rather than spit.

You've mentioned her weight and centile, but not how stable she's been. Some babies work up or down to a centile that works better and stick on it, that's fine. DS weighed heavy initially because I had a caesarean, and in the initial weeks I had a dreadful midwife really worry me about his weight that he wasn't gaining enough and suggesting I should supplement his feeds, happily my health visitor rolled her eyes and said you just keep feeding on demand, gaining is gaining and breastfed often have slightly lower weight gain early on then catch up later. He then stuck to his newly chosen centile so he's just naturally tall and slim (lucky kid, wish I was!). If you decide to look at allergies instead then dairy, egg and wheat seem to be the most common that need to be cut out. If she's still losing ground proportionally then you'll have to consider gaviscon etc.

I think you sound very sensible OP and should follow your instincts on this. She's obviously doing well. Have you read about catch-down weight?

My DD was a chunky 4kg at birth and she fairly quickly went down to an average weight. I never weighed her because I didn't want the stress that I felt with it with my DS (he didn't have problems, but I worried a lot about the numbers and had him weighed frequently). I trusted myself to spot problems over a pair of scales. She was squishy and happy and fine.

Both DS and DD were pukey babies. Both breastfed. I found around 14-16 weeks they figured out the art of not eating when they were full already. They naturally are less frequently and puked up less often. I think when they're little they puked a lot simply because they had over-full stomachs.

Keep an eye on things, but trust yourself and your baby.

I used to have to wind my bf baby quite a bit to stop them spitting up. My other thought is that shes over sucking at the breast and taking in wind - comfort sucking even though she doesnt need the milk

Ended up using a cherry dummy to stop over sucking at the breast

I wouldn’t jump to medication so quick either.

Regarding bringing so much milk up - could you feed her little and often or wind her in between?

I would echo the previous poster who said it's not essential to get them weighed. Weight isn't the only marker for health (although HVs seem awfully hung up on it).

My DD is 6.5 months old and hasn't been weighed since she was ten days old. I've no idea what she weighs, she's a bit smaller than her brothers were at this stage, but she's in the appropriate size of clothes and seems healthy and well. My middle child I also never got weighed, and I never really thought about his weight because he was healthy and well.

This was after my first baby who I took to get weighed religiously every week and became a bit hung up on the whole thing. Now I trust myself that I know my children well enough to spot if they aren't growing or healthy and well.

All of mine have been sicky, it's pretty standard for babies and a lot of GPs seem in a hurry to diagnose 'reflux' when really spitting up is fairly normal.

Of course follow medical advice and I'm not saying you shouldn't, but try not to fixate on weight (it sounds like you're not anyway) and look for signs she is well instead.

Dietitian here - for a lot of babies it takes the first 6 weeks to "find their line" so it could just be that 50th is where she should be. Would you expect her to be more like a 50th or 91st baby based on you/her fathers build? It doesn't always follow but gives an idea. I wouldn't personally start gaviscon if she is a happy. You could call and discuss this with GP - they are generally supportive of allowing you to follow your intuition so agreeing to monitor her weight over the next few weeks and make a decision then. In terms of other advice, I would contact your local breastfeeding support service. Checking that she is feeding efficiently can rule out any possible reasons for the drop. Do you have a fast let down? That can be another cause of spitting up a lot. Lying back while feeding should help, as well as having her more upright while she is feeding- look up the koala pose. It is unlikely to be an allergy, not impossible but very rare. I wouldn't advise cutting anything out of your diet at this stage!

Had very similar babies and once they became more upright and started solids the sickyness stopped. Was also told this by a gastric surgeon. Gaviscon probably won't stop sickness because it's just an antacid which prevents the burning affect from reflux. As she's not experiencing distress why give it? It won't help with weight gain unless it stops actual spitting up, as in keeps more milk in her stomach, and that's unlikely because the spitting up is a mechanical problem.

Reflux seems very 'fashionable' at the moment, but if your baby isn't in distress then why bother? The muscle around the top of the stomach (sphincter) is probably still maturing, and the spitting up is probably just a little excess milk. Why medicate when what she's doing is totally normal?

Just have plenty of bibs!