Fussy feeding... what's the cause? Can't work it out!

[lbandrb]

11 WO DS regularly feeds fussily, and I just can't work out the reason as he doesn't exhibit the same symptoms all the time, and doesn't always feed fussily. I've considered: silent reflux, occasional proper reflux, lactose and soya intolerance (have cut out both from my diet but not sure it's helped), intolerance of something else I've eaten, simple wind, forceful letdown (pretty sure I have this on one side and occasionally both), oversupply, and I've just come across posterior tongue tie. He wasn't like this in the early days.

Key symptoms (not always shown) are: he loses his latch easily, can refuse the breast crying (but can this just mean he's not hungry?), coughs and hiccups (suggesting silent reflux), and can seem uncomfortable after feeding. He doesn't seem excessively windy at all.

The GP diagnosed silent reflux a few weeks ago but as soon as that happened he started to feed a lot more calmly so I didn't persevere with the faff of Infant Gaviscon, which he hardly takes anyway. But he's been having some on-and-off fussiness again.

This may just be a developmental thing, but he also doesn't tend to feed himself to sleep anymore unless he has already just been asleep.

My main question - if he doesn't feed fussily on every occasion, would that mean that some of these (e.g. silent reflux, posterior tongue tie) are out of the question? What might the cause be? Or is this just normal baby behaviour?!

Can defo still be reflux. My lo had lots if issues, couldn't feed at all sometimes, moved head away from breast (and later bottle), then suddenly would feed fine, normally when the in laws were around, proclaiming they didnt see the problem!
Eventually he had blood in his poo and we had to see a consultant ASAP. Ranitidine helped for a bit, but the battle continues.
I think that it burns them, but under the right conditions feeding doesn't necessarily hurt all the time.
For s the other symptoms included hating his swing, pram, car travel (anything moving), and very very poor sleeping where he was tired, would sleep upright on me no worries, but would wake up every half an hour in his cot.
Hope it helps - I know nothing of the other conditions, but definitely try the gaviscon, if it doesn't help, go back to gp and make them listen. Good luck. Xx

It's hard in this sort of situation, isn't it? My DD (5 mo) has gone thru many fussy periods. She is tongue tied, which has definitely been the culprit on some ocasions. But I've also slowly realised she gets very fussy when overtired and feeding (like a combo of not having energy to deal with feeding and frustration at it making her sleepy). But I came to accept that I probably won't know why she's fussy half the time.

Have you tried cranial osteopathy? It could be your DS is in discomfort for some reason. It's helped DD to feed with her restricted tongue.

Thanks, both. I will persevere with the Gaviscon. It's just such a dreadful faff and it really bothers him to be offered it. If it's not working out I'll go back to the GP and ask them about Ranitidine. I'll also look into cranial osteopathy.

Oh, in terms of the waking every half hour - he's started doing this quite badly over the past few days (35 mins is the norm). He's usually quite tricky at keeping asleep for daytime naps, but nighttime has become a huge problem over the past few days too. But that's a whole other complex challenge which could have other factors involved (e.g. we're away from home; possible growth spurt). But he definitely has some sleep challenges and I am convinced feeding issues are strongly related.

If hes reacting to something in your diet his fussiness will vary as to whether you've eaten it recently or not. You say you're restricting soya and lactose. But what about all forms of dairy? Breastmilk contains lactose and a lactose intolerance is v rare and normally the result of bowel damage. Cows molk protein intolerance is getting incredibly common right now and the symptoms do sound right though. Dietary elimination and ranitadine or omeprazole can really help.

I spent weeks thinking the sleep probably wasn't due to reflux. Within 2 weeks on ranitidine he suddenly slept 7-5 with 1 waking. Different baby, it was that dramatic. He never really fed much overnight though so I wasn't too worried about it being about hunger, I knew there was something else going on.
The pattern of waking every 30-60 minutes is classic reflux though. Apparently its the acid building up and causing them pain like heartburn. Elevating one end of the cot helps some babies so they are not flat, and holding them upright for 30 minutes after a feed. For some babies these combined with gaviscon is enough, for others not.
I would say to trust your instincts though on what you think and don't let your gp fob you off. If you think he is in pain (arching back and turning away from nipple) then do what you need to do to get it sorted. X

So helpful everyone, thank you! More convinced about the reflux now.

lem31, did you find the reflux symptoms were lesser overnight? My baby's night sleep is usually quite good, even if he seems refluxy during the day. At night I can tend to feed him to sleep then he feeds in a relaxed way during the night. During the day I tend to try to feed him more upright and keep him upright after a feed, as you allude to, but at night to get him to sleep and during the night usually feed him lying down and this tends to work. [His night sleep is not great right now, but it doesn't seem clearly related to reflux].

have a read of this there is a list of symptoms relating to tongue tie further down.

DS1 was tongue tied although I didn't figure it out until he was 5yo. He was a dreadful sleeper, many tied kids are.

Some of the things you describe are classic tongue tie behaviours.

Also, ties can cause reflux type symptoms because sometimes a lot of air is swallowed (aerophagia) and it comes back up along with the stomach contents.

Article here from Dr Kotlow who is a leading expert.

My dcs struggled more at night than day with reflux, so I think babies can all be different, and definitely had good nd bad spells. There is the living with reflux site on the web which might be useful but also the reflux group within cows milk allergy support group on Facebook. (CMPA support).

Yes, better feeding at night. Not always his evening feed, but his overnight ones were generally fine. Someone told me its cos they are more relaxed, but no idea. X

That's what I figured, Lem31 - that night feeds are better as they are more relaxed. I'll investigate tongue tie more, but I'm inclined to suspect it's less likely as a cause. But who knows?! In terms of dietary elimination, I am trying to be really rigorous about eliminating all sources, but have probably had some minor slip-ups.