Reflux

[Thaleia]

Hi,
Can someone explain "reflux" to me? Is it if a baby is feeding but brings up a lot again, even without pain or crying?

We struggle to stay on the 9th line and I've tried Infant Gavison, now I'm told to do a trial of Neocate and off breast milk for one week. I am pretty sure if the trial fails I won't be able to continue bf as it takes me 20mins to pump 1oz.

I'm just not sure if it is really reflux or if I just think we're having it bad with lots & lots coming up.

Thanks, Thali

What is your baby doing that makes the doc think it is reflux? Is it just that they are bringing milk up again? And if so, how much - is it just possiting, or actual vomiting? And how old is your baby?

My DD who is now 8 months old, was diagnosed with silent reflux when she was 4 weeks old - silent reflux being all the symptoms of reflux, just without the milk coming back up again - she was arching her back, writhing on the breast and generally a very difficult feeder. Does your baby do any of those things? She was prescribed gaviscon which did nothing. I then decided to cut dairy out of my diet and bingo! When I ceased BF the doctor prescribed both neocate and nutramigen, neither of which she would touch as they taste absolutely foul - fish food mixed with marmite is the best description I can come up with. She is now happily on Aptimel Pepti - super hydrolized cows milk formula so the protein is broken down to virtually nothing and she has been thriving on that ever since (3 months now) but is on a strictly dairy free weaned diet.

Also - what breast pump are you using? It is unusual to take that long to only get an ounce out so perhaps look at changing your pump? I was using the Tommee Tippee for a few months and had the same problem - moved onto the Medela Swing and I could express 5 oz in about 5 minutes. It is expensive, but worth the money.

I think my little one has reflux, he's currently minus 2 (38 weeks, born at 30) :) he hates being laid flat, writhes about in agony, as soon as you put him down he spits up, or vomits a small bit of milk, then an 90 mins after feeding when asleep he'll cry, moan, and even scream sometimes and then bring up milk.

As soon as you hold him so he's more vertical then he stops crying and is fine, but his discomfort is getting worse and worse and the neonatal nurses think it might be the refulx causing inflamation, so we're off to the doctors tomorrow to see if baby gaviscon will work.

My breast pump experience yours Thaleia, it takes me an hour to pump 50mls and it's never been any different even using the hospital grade pumps in NICU. I have the Medela Swing, and it works I just don't produce that much milk very quickly. I have found breast compression along with pumping helps though.

12 weeks today and yes, it's just the bringing up lots, and actually only the day time feeds, at night he's fine. He has no other symptoms, likes lying on his back on the play mat, isn't crying a lot and has some periods when he sleeps for 4 - 4.5hrs.... So essentially, it's the poor weight gain.

I'm trying to cut out cows milk for 1 week now and it hasn't made much of a difference if any.

Did you get the Aptimel Pepti over the counter? If possible, I would like to top him up before ff feed him & it might not even work.

I use the Avent pump. Generally speaking I don't need to pump a lot anyway it's just to mix in with the medication, that's all. I know I have got milk as I can see it on the floor & all the wet cloths I have to wash ....

Are you winding him well? My DD writhes if she needs a good burp after feeding. She has a bit of reflux but gaviscon has really helped and so did cranial osteopathy.

If you don't express often then that might be why you are not getting much as your milk supply will adapt to what is needed by your baby. If you have swapped a BF for a bottle feed try expressing when you would have breast fed as the supply should be there then. We get the aptimel Pepti on prescription, apparently it is not available over the counter. I went into my doctors and specifically asked for it as a friend had recommended it following great success with her reflux boy. They were reluctant to prescribe it as apparently it is very expensive but when I said DD would not touch neocate or nutramigen due to the taste there was no other option. Since seeing her thrive on it (she is on the 75th) they signed her off for repeat prescription until a year old.

I also think cranial osteopathy is a very good idea.

There are other meds that can be prescribed for reflux and you can still bf along side them if you want to.

DD1 had reflux as a baby and her weight gain stalled until she started losing weight (went from 50th to 2nd%ile). Gaviscon was prescribed but that did nothing except constipate her so she was swapped to domperidone which actually worked.

She bf through out this (she was initially bottle fed formula & some expressed BM for her 1st 8 weeks but still had reflux even on bottles) and carried on until she was 3y 6m. She is an enormous 6y now!

On the dairy front it can take 2 weeks or more for symptoms to subside and it has to be all dairy not just the obvious milk, cheese, butter, yoghurt and cream but whey powder, partially reconstituted whatsit, and all the other derivatives of milk products.

Have you been in contact with a breastfeeding counsellor to see if there is anything that could be tweaked to improve bfing? It would be worth a shot before stopping bfing all together (or trying to maintain a supply with pumping).

Can I ask a couple of questions and might then be able to help further?

Is it a paedeatrician that's recommended you cut out breastmilk in favour of neocate, or alternatively a GP or breastfeeding professional?

Reflux can be caused by a mechanical issue (e.g., underdeveloped digestive system that usually gets better in time) or can be the result of a cow's milk allergy - if you are really unlucky both can be present at the same time.

Usually doctors don't think it worth treating babies with 'mechanical' reflux nless they are really failing to thrive or are in obvious pain and discomfort.

I think a crucial thing here is whether your baby has always been at or near the 9th centile or has progressively dropped down the charts week on week.

I'm pretty sure it's not a classic or event silent reflux as DS isn't in pain, sleeps on his back, is not fuzzy, doesn't cry an awful lot. It's just the weight gain of now ~30-50gr per week (he needs to have 100gr to stay on the 9th).

He dropped from 91st all the way down. The paediatrician was fine when he was around the 25th as some babies are born bigger than they are meant to be and it's ok to drop lines as long as the baby is ok.

I feel it's actually getting worse with every day and I feel more and more depressed about everything which doesn't help. It's just heartbreaking to see the whole soup on the floor when I know he needs it. I tried to work out how much it is and would say it's between 30-50ml. Doesn't matter - could be 20 or 100ml as he's not getting enough.

The main part comes out 30-40mins after the feed and I treat him like a raw egg up till an hour after the feed & I follow all the guidelines for feeding reflux babies (upright etc.)

The paediatrician did not say I had give up breastfeeding but that I would have to stop for one week whilst he's being on Neocate. Effectively, that is giving up bfeeding as I know I can't keep the flow whilst not feeding for a week.

Just went to Boots and bought the Reflux Aptimil Powder, maybe if I top him up 3 feeds a day it'll be enough to keep him on the line?

Could it really be an allergy or an intolerance? Why no other signs?

It could really be dairy intolerance: my DS was dairy intolerant and his main symptoms were vomiting, screaming, vomiting, more screaming and eventually feed refusal. He also had omeprazole/ lansoprazole during his early months.

I think it is sensible

I really don't see the logic of giving up BF in favour of neocate for a week, but I am nervous about contradicting your paed because he or she is qualified and I am not. Are you also excluding soy and ALL mammalian-based milks from your diet for the dairy-free trial? If not, could you speak to your paed again and see if he/ she thinks this would be worth doing before going down the neocate route? It's just that soy is sometimes also an allergen for babies with Cow's Milk Protein Allergy (CMPA). Goats' milk, sheeps' etc - same goes for them, you would need to exclude them from your BF exclusion diet. You also need to scrupulously read labels for things like soya leicithin, whey powder, etc etc etc. It's a bore and a chore but might be worth doing.

Like you say, going onto neocate for a week would indeed make things difficult for you and your baby if you are just someone who finds it difficult to express (many people do). It might be you could come back from this after a neocate trial if it didn't work, but this would be tough on you I think. One thing to bear in mind is that Neocate is FOUL. It tastes awful. May be your baby doesn't care, but some who've had breast or normal formula won't touch it unless it's flavoured. Aptamil Pepti tastes better.

Has your baby been checked for tongue tie by someone who really knows what they are looking for (e.g., a lactation consultant who is trained in this area?) It's just you mentioned sore nipples and along with the poor weight gain then this may just be a possibility. Warning - doctors, even eminent paeds can miss tongue ties and many believe them wrongly to be always harmless. Not true - some benign-looking 'minor' ties can cause huge problems, and vice-versa.

Sorry, that should have said 'I think it is sensible that CMPI is excluded before going down the reflux medications route'.

Can you see a lactation consultant? they may be able to provide a different perspective.

Im dairy & soya free for DS & his reflux. He hasn't ever really cried in pain or anything like that.

I wasn't sure the dietary changes had made much difference tbh until I inadvertently ate dairy a last week. He's been pretty pukey since & at almost every feed.

It may be worth cutting Dairy & soy out for longer. I think it can take 2 weeks to get out of your system, then 2 weeks to get out of theirs.

Kellymom has some good info on my phone but hope the links work!

kellymom.com/health/baby-health/food-sensitivity/ and www.kellymom.com/store/freehandouts/hidden-dairy01.pdf

Is it possible for the babes to have sometimes symptoms and sometimes don't? My night feeds are ok, no spitting up here and I've tried a full formula feed tonight at 6pm and again, nothing came up BUT he went straight to sleep as he had his jabs today and is pretty much knocked out.

I'm just confused why days are shit and nights are good ... for that reason he probably hasn't lost yet, just not gained enough.

Could it be to do with positioning during feeding? Do you feed lying down/semi reclined at night and feed differently during the day?

WHat formula did you give him before bed? Was it the aptamil pepti one?

Hope you get a better night.

Truthsweet's point's a good one. If you try and feed him lying down in the day, what happens?

My DDs feeds where fine at night but a nightmare during the day, perhaps they are more relaxed at night so symptoms lessen? Also not wanting to contradict your healthcare prof but from experience, cutting all dairy out of my BF diet worked, meds didn't. Some GPs are very quick to prescribe without really looking into the problem and when it is allergy related reflux I think the solution needs to start at the source not be masked by meds.

On the off chance, have you while BFing or baby ever been on antibiotics? My DDs dietary paediatrician thinks the antibiotics I was on whilst feeding her at 2 weeks old following post birth probs were the cause of her allergies....

Hi Thaleia... i was reading this thread as my 16 week old sounds very similar to your little one. I still haven't figured it out yet, so can't offer advice. Just wanted to quickly comment to say DON'T use Neocate... I tried it for 3 days and she became very very constipated! She ended up passing a completely rock hard solid poo days later... it was awful!! She was crying in pain and pushing like she was giving birth, so sad!!

bex good point, maybe we/ I am more relaxed at night ... And yes, I had to have a cs and was on 3 sets of antibiotics as the scar got infected. Oh no!!

I've spoken to a different GP today again and she said, as long as he's hanging on to his line or only slightly drops, it's fine and that I probably have to wean him earlier at 4.5 months.

So at the moment I try to stop being anxious about it whilst wiping the floor + lots of washing ...