Reflux and overfeeding - HELP

[oikopolis]

My son arrived at 34 weeks gestation. As of today, he's 3 weeks, or 37 weeks adjusted. Despite this he has done amazingly well. He is breastfeeding very well and gaining weight very fast.

He has some typical preemie challenges. For one thing he has silent reflux which causes him some discomfort. Also, I have massively strong letdown in my right breast, which has choked him frequently. (I've now learned to pace him by unlatching whenever he sucks too long without taking a break -- that's helped.)

I shared my concerns about his discomfort with the NICU team's feeding specialist. She told me I had too much milk and too strong/frequent a letdown, that I was overfeeding him at the breast, and told me I needed to limit him to no more than 20 mins at the breast every three hours. She told me that his rooting is likely just a manifestation of his need to suck, not of hunger, and that I should give him a dummy if he's still rooting after 20 mins. She said that he's not cueing when he's full because he's premature and doesn't have the satiety switch that a term baby has.

So I tried this approach last night hoping it would make him more comfortable.

It was hell. I cried, he cried, I wanted to jump out of the window, he probably did too. He wailed and wailed. He spat out his dummy 500 times. Eventually I offered him the breast again but by then he was hysterical and so was I.

I don't know. Is he crying because he's hungry? Is he crying because he's having reflux? Is he crying because the extra breastmilk would calm his reflux? Does he feel less pain when overfed?? Is that what it is?

I never want to go through last night again. I felt like I was torturing my child. Should I just ignore the advice of the NICU people and demand feed, and overfeeding be damned? Is is really a massive issue that he's eating more and gaining more than he's "supposed" to? I am so tired and confused that I can't think straight about this anymore.

Sounds like an awful night
I don't have any expertise, but it sounds like he was hungry and if he is gaining weight and thriving then I don't think there is anything wrong with feeding on demand - trust your instincts. Babies also nurse for comfort - I would have thought this is even more important for a prem baby.
Can you let your milk run into a muslin until the flow has slowed down so it is less likely to choke him?
I also wind dd mid-feed to prevent her struggling with wind and this might also help your ds with his discomfort.

Hi oikopolis watching this with interest as just about to start an almost identical thread!
My triplets were born at 34weeks and are now almost 3 weeks. One of them sleeps on her back fine most of the day and feeds well, but in the evening/ overnight is very unsettled. If I put her down on her back she writhes around grunting and occasionally screaming. As soon as we pick her up she starts rooting for food. She is settled when feeding or for short periods lying on our chests. She is pretty sicky, especially after these epic feeding sessions. I can't work out if she is cluster feeding, has reflux or colic. Would go to gp, but suspect they would give generic advice and not seeing paediatrician for another 3 weeks.

My DD was full term but when she was 4 weeks she was diagnosised with silent reflux and the consultant said I was overfeeding her and that she was a greedy baby! I too had a lot of milk and a powerful let down. I felt awful that my feeding of her had caused her pain via her reflux. I think my DD would comfort feed as well and some of the time probably was only getting a little milk.

I was advised to feed on one side at a time only - before DD got both sides at each feed. This worked fine but I think DD basically just fed more often - at one point it was every hour whereas when I feed with both sides it would be every 2 hours or so. I did demand feed. On reflection I am not sure about the whole greedy baby and only feed on one side, but it did work even if it meant a lot more actual feeding time. When she got older and stronger and the reflux was under control I went back to feeding with both sides and the gap between feeds widen again.

She was also put on gaviscon to help with the reflux. Is this an option for you?

Is he crying when you are holding him upright but not actually feeding him? When my DD was a couple of weeks old she would stop crying only when I was feeding her - except if she was held upright - I think it stop the reflux.

We tilted her moses basket up and she slept on her side (as advised by consultant).

I hope it gets better for you - it is awful listening to a new baby crying and crying. What I would say is trust your instincts. Before my DD was diagnosised with reflux I knew she was crying in pain, not hunger, I just didnt know why and medical professionals just said that what babies do but I knew she was in pain.

I had overfeeding issues with DS2 (not premmie tho) & had similar advice re the breastfeeding timing, however I dragged the feeding time out to 40mins absolute max at the beginning of a 3-4hour cycle. Some of the horrendous crying can be due to overtiredness & unfortunately with overfeeding they can't get the rest they need cos it increases digestive discomfort (reflux, also regular gas pain, having more frequent bowel movements, etc) & if you give a top-up feed it can actually give them a little boost of energy so they feel awake for a bit but then the crash down after is even worse.

Try the 3-4hr feeding/sleeping cycle, if this is indeed what you have been advised & hopefully babe might benefit from getting more rest if this is contributing to the problem It can be hard to believe they are not in severe pain as the screaming is so bad (& of course it could be due to pain so you can't rule it out) but they really are so young their neural pathway system (can't think of the proper terminology) just gets overloaded as it is not yet mature enough to handle what is going on. I was also told that even if you get some joy on a 3-4hr cycle, you still might have one horrendous session a day & one whole horrendous day about every week.

thanks everyone who replied.

i ended up going to the GP out of sheer desperation. he prescribed Losec (omeprazole) for silent reflux and I was so relieved.

unfortunately it now seems this poor child is suffering constipation as a side effect of the medication. straining and screaming and crying with very little to show for it... i am at my wits' end.

on the bright side he is feeding better and showing a little less discomfort now that i'm feeding less, on one breast a session, and unlatching him as soon as he seems sleepy (rather than letting him feed indefinitely - or feeding by the clock iyswim) and i do think that his reflux has become slightly better already. it will take a week to see a proper difference apparently.

sigh.

I guess you know all the things to try for encouraging a bowel movement, like tummy massage & leg cycling? The "frog" position is one I hadn't heard of before DS2 where you place babe on tummy with legs up by their front preferably slightly inclined like on your bent knees, heaad up, so they look like a frog from above, & try to massage tummy with knees. Myself & DP got pooed on several times doing this, luckily with a towel over us!