4 week old arching off breast, screaming - reflux, allergy, something else?

[redrum29]

I know this topic has been raised a number of times, so apologies for bringing it up again.
My four week old has in the last few days become very fussy at feeding times, arching off the breast after about five minutes, or grimacing as she takes nipple in her mouth, only to start crying hard. I initially wondered if it might be my let-down, but she seems ok in the initial part of feeding, it comes on only after a short while. I was wondering if it could be reflux - she spits up quite frequently, more than my first child as far as I can recall - or an intolerance. I read that one sign of an intolerance is a rash, and she has a cluster of red spots on her face since about 2.5 weeks old, which has at times extended down her chest and upper back.
Feeding is exhausting, and it means that she doesn't go that long between feeds, and is constantly waking up during the night, and is then hard to settle. I have resorted to taking her into bed to sleep, as getting her down in her Moses basket is a trial at 3am.
If anyone has experienced the same and could give some pointers, I would be hugely grateful. I am thinking of going to a new doctor, as the one I go with my older daughter is very anti medical intervention of any kind, but I feel sure my baby is in pain. When she is not feeding or asleep, she is usually crying.
Sorry for the long post - and thanks in advance for any advice.

Hi redrum. My 9 week old dd has been doing exactly the same for the last few weeks. I was convinced it was silent reflux (she rarely brings anything up) so I went to the GP, who prescribed infant gaviscon. It seemed to work slightly but is a complete pain to give when breastfeeding (as it has to be mixed with sterile water and given after every feed). I also felt that she needed something stronger so I went back to the GP and asked for liquid ranitidine. This has REALLY helped. She started at the basic dose (1mg per kg 3 times a day) but we have doubled this with the GPs approval. She could still have a third more as a maximum dose if necessary. It is very easy to administer with a syringe 3 times a day. I try to make sure the doses are given before a feed as this seems to help.

Something I also realised is that sometimes when she's crying on the breast she's simply tired. I put her to sleep straight away and then she'll wake 30-90 minutes later for a feed. It's like she just needs a little sleep to get over the tiredness in order to feed. This might not be the same for your dd.

Something else that has helped is sleeping her on her side. I know it's not recommended but she has never been happy to sleep on her back. Even with the ranitidine she's still not happy so she stays on her side. This is against professional advice though as it's not 'officially' as safe as back sleeping but we had no other option with her.

If I think of anything else i'll let you know.

Thanks Crepe. I had her sleep on her side last night, and she went for a mammoth 4.5 hours from start of previous feed! But still in my bed though..
The tiredness definitely strikes a chord, particularly yesterday which was a bad day, and she seemed inconsolable. But she also had very little sleep which must have contributed..
Will try see dr tomorrow, and will ask about the ranitidine. Thanks for the advice.

My dd (now 21 months) had exactly the same issues with reflux. We used ranitidine for months and was fantastic. Once it got into her system her whole routine seemed to settle and her feeding was much more effective. I bf her too and it was much less stressful trying to get it into her than gaviscon. Good luck with the gp

Any luck with the GP redrum?