Breastfeeding, reflux and water?

[Downbytheocean]

Need some advice please, ds2 is 3wks old and breastfed. We have been to see a cranial osteopath who has advised that his lack of sleep is due to reflux (diagnosed due to gag reflex being so pronounced on his left side of mouth). She said that this explains the constant need to feed at night as he is uncomfortable lying down. He is waking every hour at night and desperate to be latched on. I feel like I've been feeding all night again. I'm exhausted.
Osteopath recommended that I give an oz of cooled boiled water as a way to neutralise the acid. Is this sound advice? Has anyone tried this? She said it may avoid need for medicine. I am unsure, might it be better to see doctor?
Ds2 is settled during day and sleeps for a couple of hours in car seat or pram but nights have been dreadful. He often possets or throws up in bed and makes choking noises which indicate he is uncomfortable. He will settle for an hour in bed if I let him sleep on me. We cosleep and i feed lying down mostly as a way to get a bit of sleep myself. I am exhausted and unsure whether to try water, see doctor or ride it out and assume this will pass. TIA

Hello!

Not sure about water, maybe some knowledgeable person will come along shortly.

I would recommend a quick visit to the GP just to make sure you are not missing something.

My DS2 is now 14 weeks. He was very similar to how you describe your DC. We were given gaviscon but found it impossible to get in a newborn breastfed baby without giving him lots of wind which was worse than the vomiting!

Have you tried putting a couple of books under the feet of your bed at the head end to tilt the bed a bit?

My DS & DD took a bit longer than 3 weeks before they could successfully feed lying down without vomiting or getting excess wind. DD was about 7 weeks and DS still struggles now( 14 weeks). He's quite a windy baby and tends to need winding after feeds which I guess gets forgotten if I was lying down and already asleep. Could you find a safe way to feed sat up whilst you are propped up enough to be able to doze?

Good luck!

Just an after thought...
My 14 week breastfed DS used to vomit massively. (I mean massively- would involve complete change of everything both of us were wearing, vomit all over the floor, etc, horrifying passers-by!) GP said it was reflux but he was still gaining lots of weight (75th centile), which isn't normal for reflux babies to thrive so well. Was feeding every 90 mins ish (birth to 12 weeks).

Whenever anyone other than me was holding him they would end up with rows of bruises on their arms from him sucking on them constantly.

My mum suggested a dummy, I reluctantly agreed. It's worked wonderfully! Turns out he was the exception to the rule where breastfed babies take the correct amount of milk. He's a gready boy with a big need to comfort suck.

He's now feeding 3-4 hourly and hasnt vomited for 2 weeks, he's less windy as he isn't overfeeding. He has his dummy for sleeping in between feeds.

I always hated dummies but obviously my DS loves his and is much happier with it. So maybe dummies arent so bad after all!

Thanks for your reply graciegirl. We've just had an hour sleeping propped up on pillows.
I've been careful to wind ds for last 24hrs but it's made little difference.
Its such a small amount of sick compared to what you have experienced and hearing the difficulties getting a breastfed baby to take gaviscon I think it may be a case of riding it out. Ds2 is gaining weight well, 11oz in a wk and must be 11lbs now.
I am reluctant to try dummy as his feeding seemed to be going well and the weight gain told me he needed to feed. Ds1 had a dummy and huge sleep issues ensued. I would have to go to him 5 times a night to replace the dummy, despite him holding one in each hand. If it will help short term then I could give it a go.
I will try books under the bed too, thanks.

I would rather try water than a dummy or gaviscon if there is anything to suggest it works. I'm not sure whether I am meant to give it at night to try to stop him feeding every hour. I fear I'll end up with a screaming baby rather that a sucky baby...

I don't have expert advice, only not to give such a little baby water... It won't help reflux, even if that is what he has, and will just fill him up with un-nutritious fluid!

As my year 7s will tell you, you need an alkali to neutralise an acid, and water is neutral.

See a doctor, get some gaviscon (mix with a little expressed milk and give from a spoon or syringe after feeds).

It worked wonders for DS. I wish we'd insisted when we suspected at 8 weeks, rather than being fobbed off till we saw a lovely doctor at 4 months. The poor thing had been in pain all that time

Please see a doctor. Reflux is surprisingly common in babies.

No you should never give water to a breastfed baby. Especially one so young.

My HV yesterday said you give my DS cooled boiled water to help him poop. He's 36 weeks old, is she wrong?

(sorry OP to crash thread) :)

we suspect reflux one DS so we have raised the head end if his cot slightly

breast milk will sooth the acid reflux that's the reason why they want do suck so much. Have a look at the Kelly mom website if you have already and sees if the systems fit for reflux.

Thanks all. I did fear that the osteopath was wrong. I even said that it isn't recommended to give such young babies water but she said at his weight he shouldn't be feeding all night long. She's not a bf expert hence posting here. I just wanted to be armed with facts as to why I haven't followed her advice as we have another appt on Monday.

I will definitely call doctors today then and see if I can get some gaviscon.

Feeding frequently is common in reflux babies as BM is an antacid (it soothes as it goes down and if inhaled BM is less likely to cause aspirational pneumonia). Exceptionally good weight gain can result from this soothing feeding or the vomiting may negate the extra milk taken and the baby may still have faltering weight gain.

Water is NOT a good thing to give to a baby who is not yet on solids and it wouldn't neutralise the acid in the stomach (water is pH neutral it's not a strong alkali which is what would neutralise hydrochloric acid in the stomach) but it would mean baby was less hungry and less likely to bf as much as he needed to. Giving water can also throw the body's electrolytes out of balance even in fairly small 'doses' given the size of the baby's body.

At 3 weeks old your baby definitely does need nightfeeds if he is waking for them, plus it's good for your milk supply to not go so long between feeds (if he was sleeping all night by himself without any encouragement from parents/swaddling/sleep training and was over birthweight then there's not much you would do apart from enjoy! His stomach is still only small (around 80mls or so) and breastmilk is easily absorbed so he will be hungry. He's trying to double his birthweight by 6m and that's not going to happen if he's restricted to eating during the day. Night weaning isn't really recommended until baby is over 12 months (if not 18m or not at all!) so your osteopath is showing her lack of knowledge in the infant feeding arena.

Gaviscon isn't the only option (just the cheapest IIRC!) and it doesn't neutralise the acid either it just makes milk thicken in the stomach which makes it harder to be sicked up. There are other drugs which can neutralise the acid in the stomach or speed up gut transit so milk isn't in the stomach so long making vomiting it up less likely. Your GP will be able to advise on the suitability of medications though.

In the meantime, keeping baby as upright as possible after feeds, carrying in a sling (wrap/ring sling type), sitting baby in bouncy chair, gentle handling (no playing 'horsey' just yet), propping the head of the cot up or putting a folded up towel under the mattress at the head end to raise it, limiting time spent flat on back (you can get quite adept at changing a nappy while baby is sitting upright!) can all help limit vomiting and refluxing.

Lots of good stuff already here, but would add my irritation with therapists who pronounce on feeding and other babycare issues without knowing the first thing about them. The same thing can occur in HVs and midwives and docs, I know...:(

But meds such as gaviscon and omeprazole mean giving 15ml water to ebf babies. How come that's okay then?

!

I agree about the incorrect advice from the osteopath being infuriating as I could have taken her word and gone ahead with water. She was only suggesting that ds2 should manage 4 hours sleep between feeds, rather than 1.5 hours that he goes at present. I have no expectation other than wanting a little more sleep, I wasn't expecting that he should be sleeping through. Ds1 was 3 before that happened!

The gp felt there is no need for medication and said it's all it the scope of normal newborn behaviour. I am trying feeding sitting up rather than lying down tonight.

Downbytheocean - four hours sleep between feeds is too long for most babies of 3 weeks (though some will do it occasionally).

pomme - gaviscon can be mixed with expressed BM (and administered by spoon, etc.) - we did this, it took a weekend (and a whole box of the stuff) to get to grips with it, but we had a different baby by the monday!

Down - keep an eye on things, we were told the same at 8 weeks, but by 4 months DS was clearly unhappy and uncomfortable - I wish we'd persisted with the doctors earlier.

What TruthSweet said. DS2 suffers from reflux and for us careful handling after feeds and keeping him upright work better than Gaviscon (giving an extra 15ml to a full baby almost guarantees vomiting for us). And finally, at 3 months, it seems to be improving: have just had 48 hrs without vomiting!

underwater - but omeprazole can't as milk is alkaline.

Pomme - Gaviscon has sodium in it (it has a warning against those on a low sodium diet) so it wouldn't affect the electrolyte balance in the baby as much as pure water does.

DD2 at 3y had gaviscon & omeprazole (and then lansoprazole as the pins and needles from the omeprazole got to much for her) when she had gastritis following treatment for arthritis and we mixed the omeprazole (as Losec MUPS and originally as opening up adults capsules!) with custard or yoghurt as it was the only way to get her to take it - this was cleared by the pharmacist and by her rheumatologist. Obviously you can't give a under 6m old baby custard or yoghurt so BM or formula could be presumably be used instead as the dispersing agent.

I really have too many drugs at home so I must go to the pharmacist to dispose of my stockpile of old drugs (I have packs of all sorts at home - useful though to check for things though!).

Thanks truth - that makes sense about gaviscon. That's interesting about the omeprazole too - seems to contradict everything I've read on the packet/internet.

Can I ask about switching and the lansoprazole? Did switching work? How did you know it was pins and needles in dd2? We are waiting to see a aped in a month time and GP is being utterly rubbish. I asked if we could swop as dd2 just does not sleep with omeprazole but she refused.

Sorry OP for hijack!!

DD2 could be sitting with her legs outstretched on the sofa/lying in bed/sitting in her pushchair and her legs would go tingly and she would get distressed (she was in a fair amount of pain due to the arthritis so didn't need anything else to cause pain!).

I looked at the side effects on the PIL and pins and needles was one of them so the GP agreed to swap to lansoprazole which did the same job but with out the distress of pins and needles (they would go on for ages as moving about was difficult for her).

I have just googled 'omeprazole milk' and found it shouldn't be taken together as it can cause milk-alkali syndrome!!!! DD2 has some of the symptoms of M-AS - excessive urination, fatigue, nausea, and pain in her lower back! Why the heck were we okayed to give her omeprazole in custard and yoghurt if it could cause a serious illness?

Anyone reading my above comment (10.04) about omeprazole and milk based products please ignore and seek a professionals advice (just not my local pharmacist or rhematologist!!!)

Grrr, OP, sonds like you've been peddled a load of old codswallop by the osteopath. Grrrr again. I don't think artificially increasing the content of the stomach by giving water is going to do anything for reflux (if it is that...) and certainly it is not good from the perspective of neutralising anything!

Have you thought about visiting a breastfeeding support clinic or baby cafe? Do you know if there's one around you anywhere?

I am not saying that it's definitely not reflux, but I think if it was you could probably expect the unsettledness to be occuring in the day too, and especially around feeding times.

pommedechocolat I don't think the small amount of water given with omemprazole is going to do much harm. Hope not because DS had it for months. I'm more worried to be honest about the possible effect on bone density, which I only learned about recently .

truthsweet I am in no way medically qualified but I wonder if it's OK to take milk with omeprazole because omeprazole isn't actually an alkali like common acid-neutralisers? I think it works in a different way - e.g., by turning off the proton pumps in the stomach that make acid, rather than neutralising the acid that's being produced.

Was this the page you were looking at? Cos if so, it seems to be talking about omeprazole in some sort of alkali-containing buffering solution . Unless I am mistaken, omeprazole in the form of LOSEC mups doesn't contain a buffer, does it?? Could be wrong about that tho.

One reason for not giving omeprazole with milk (or any other food) is that it doesn't work as well. It's supposed to be given on an empty stomach (or as empty as possible).

Narmada - for a while we didn't have Losec MUPS, it was just regular adult capsules which I opened and sprinkled the granule bits into yoghurt/custard. I don't know if the adult capsules have sodium bicarbonate in them.

The adult capsules I have at home (they were prescribed to me for stomach protection while taking NSAIDs) don't have sodium bicarbonate in them and the dosing recs. for children say to mix with yoghurt or juice and feed to the child immediately. I don't recall the brand that DD2 was prescribed as this was about a year ago that she was on them.

Thanks Narmada, I plan to see a breast feeding counsellor on Monday. I did some baby massage yesterday and spent a long time winding throughout the day. I did all feeds sitting up and last night ds slept so much better. He was still grunting but didn't seem as uncomfortable and wasn't latched on all night. I know everything could change again but I feel so much better for two and a half hours solid sleep.