16 week old refusing to feed - does he hate breastfeeding, has he reflux ????

[Trimum2]

My LO is 16 weeks. need some help!

1. Refusing to feed much during the day.

Despite no breakfast, he is taking very little at 10.30-11.00, post lunchtime and even no much at tea time, I think. He feeds well for first 4-5 mins then comes off the breast. Then lots of crying / arching /unsettled behaviour.

After winding or attempting to..... Have tried to put him back on breast but that just makes him cry harder and he pulls back with all his might. (don?t want to try putting him on again and again with him crying so hard as don't want to give him aversion to it).

Is refusing to go back on the breast common? and does it mean anything??

Sometimes swapping sides seems to help and he begins again before same thing happening again. I have ended up swapping sides even if I have only fed from one side for less than 5 mins.

• He is definitely still hungry because I had topped him up then and he gobbles down at least 3 oz .
• Plus I have had him weighed today and although on the 50th centile he has lost weight over the past 3 weeks which ties in with this bizarre behaviour (at least its not my imgaination he is not feeding properly)
• Sometimes I've thought that its because he is frustrated because breasts empty/low but the last few days they have been quite full and had to express to relieve the pressure. Then thought... well at least he will be hungry next feed only for the same thing to happen again!
• Am thinking it could be silent reflux as there is the arching of the back and then he starts off the crying. Plus it seems like something comes back up because he moves his tongue as if he is tasting something. He also shoves both his fists in his mouth mid feed. Also he drools a lot (could be start of teething but also seems to be listed as reflux symptom)
• or maybe he just hates bfeeding and wants bottles?

Overall - feeds are taking 50 mins or so with only about 10 mins of actually feeding (if even that)

2. Nighttime munching means no breakfast. BF at 6-ish and then 3-4oz of EBM top up as he heads to bed around 7.30 or so. Then dream feed of 6oz ish of EBM. Then... seems to feed A LOT from 4am to 6am. Then takes virtually no breakfast. 5 mins max.

• I am puzzled that none of the day time refusal behaviour happens with bottles in the first part of the night.
• Also puzzled that he feeds happily from 4am to 6am on the breast. Does this rule out reflux as the cause of his day time problems?
• As a result of huge feed from 4am-6am he is virtually refusing breakfast. Obviously, I would prefer to try and get him to eat breakfast rather than feed at 4am and drop his breakfast feed. Should I be trying not to feed him at night?

Sorry for the long post. But I am feeling very stressed by his refusal feed properly and am worried that my milk production will start to go down as a result. And have just had to deal with mastitis due to his not eating very much. Thanks

Hi,

You poor thing I can sympathise as I have had similar sounding problems recently with my 23 wk DS. I got v stressed (as did DS)with it all as it didnt quite fit diagnoses described on websites. Although he has always had excessive possetting and I used Gaviscon for posssible reflux in the past I couldnt work out whether it was reflux as he seemed to take some feeds well. However eventually most feeds were accompanied by back arching ( actually a wrestling match usually) screaming/crying, fingers down throat and hand chewing. I discussed the symptoms with a number of NCT breastfeeding counsellors who went through a check list of "breast refusal reasons" such as oral thrush, ear/throat infections etc. gradually every feed was a problem. Even his sleepy 11pm (all feed times approx!)feed became traumatic. I tried Gaviscon again which can be prescribed by GP but he wouldnt take it from spoon/bottle and got constipated and I was not able to express much to disguise the taste.

I tried expressing and bottles seemed to be ok for a while but gradually he began to cry after a bottle too.

I went to my GP who was a bit dismissive but who actually witnessed a feed and agreed to refer me to a paediatrician who prescribed Zantac (anti acid medication). After 1 week he has settled down considerably although the 10am and 2pm feeds are still stressful.

I did wonder if I had less milk as he was often only feeding for 2-3 minutes and if you dont use it....This would then compound the frustration as he would be in pain and not getting much! I hired a hospital grade double pump and have been expressing an evening feed 6+ oz in 15 minutes so at least know I have some in there! My previous Avent pump would take 1hr or more to do the same.

I found it very difficult to feed in public and frustrating as noone seemed to know what was going on.

Things have still not settled down completely and his 2pm feed today involved swapping sides constantly.However he does seem relatively content between feeds. He has put on about 7oz this week previously 2-4oz in the previous 4-6 weeks.

Sorry I havent discussed all your questions but would suggest speaking to a breastfeeding counsellor who can discuss all the posible causes of breast refusal with you.

God - no apologies needed. Sorry for my long outpouring in the original post.

Anyway, you have saved my sanity!!! Its EXACTLY that description in terms of his physical response.

And its the gradual worsening of the condition and each feed getting more and more difficult that was puzzling me.

The lack of weight gain in the past 3 weeks gave me some confidence in my belief that there was something up.

But your post has given me the extra boost not to be fobbed off by the HV. Cos I know you can explain the hands in the mouth by just early teething or whatever.

interesting your comment about feeding in public cos it was only when I sat in the feeding room in PeterJones that i realised.. eh... why is my baby fighting / arching etc. and everyone elses isn't!!!! I haven't fed in public since it was just too stressful.

I am particularly worried about giving him breast feeding phobia due to the struggling / battle which is why I am keen to try and get it sorted as like you its starting to affect almost every feed at this stage. We are still ok for the 11pm so far. Am about to express and feed him that now so fingers crossed.

Many many thanks for taking the time to reply

ps - is the zantac need to mixed with bottle or are u still bf

Hi Trimum,

My DS (19 weeks) had silent reflux, but was like this pretty much since he was born (took us a while to work it out). Eventually got referred to a paediatrician after Gaviscon didn't help, and he immediately diagnosed reflux and prescribed Zantac (Ranitidine). Just about seems to be better now.

I'm not sure about reflux starting at 16 weeks.. maybe do some research on the internet and find out if this can happen? Otherwise the symptoms sound very similar. For some reason my DS was terrible during the day and pretty much ok at night.. not sure why. Also worried about low milk supply etc. and still am - not sure what to advise on that front.

Sorry can't be much more help. To be honest, we were just lucky as GP thought it might be reflux only after DS threw up all his feeds for about 2 days (was prob. just a bug).. but at least we got there in teh end.

Sorry for rambling as well.. late.. DS v bad sleeper at the moment!

Thanks all.

Just to add re the symptoms. He is scratching his head also - particularly when when arching his back. Not sure if he just likes the feel of his hair (!) but it looks like it could be part of trying to stretch.

Naturopath - the symptoms have been around for since birth a bit. Lots of hiccups. And a bit difficult to feed. But I thought he was just v.v. windy. I guess most unusually, he had choking / apnea from the day he arrived but that has stopped. Horrible horrible experience and it happened more than once a day. He would stop breathing for less than 10 seconds but it felt like forever and made an awful choking sound. Nearly gave my MIL a heart attack when she was in the room when it happened. GP didn't offer any insight, but now having read a bit I think that was reflux.

Maybe i am imagining it, but I think sometimes gets a kind of a startled look on his face as if to stay - what the hell was that just in my mouth.

starlight - I hear what you're saying. I will try to be a bit more relaxed! Sorry - just being a worrier. Its just BF was a complete disaster first time around and this time i thought we were doing so well (I probably cursed it by thinking that) and am thrilled to have been able to BF and was really enjoying it. I guess thats why i am panicking that its all going t*ts up and keen not to let it get to the point where I give him some kind of phobia against feeding on the breast as at the moment during feeds he starts to cry as I pull him closer to latch him on... as if to say Nooooo. And I know he is still hungry because when this has happened... I have expressed and he gobbled all 4oz.

wow- my DS does that too (the head-scratching). Have just worked out that I think it might be excema - the two often go hand in hand I think..

You should def. persist with the reflux suggestion to your GP and if possible, try to see a paediatric gastroenterologist asap and/or try to get Ranitidine prescribed (after trying Gaviscon). Rantidine is a medicine given with a syringe-dropper thing - DS much preferred the taste to the Gaviscon anyway.

As soon as we got this sorted he was like a totally different baby - feeding fine, hardly crying and put good weight on.

oh, also, should try to work out whether he has a problem with processing cow's milk proteins - could be the cause of the problem. You should prob come off all dairy products completely for about 3 weeks and see if there is any difference. Can then test it properly be reintroducing it.

God that will be a challenge. i am a yogurt, cheese, hot chocolate and chocolate freak.

Good point though. Also read that caffeine makes reflux worse also.

Not sure what there is left to eat or drink in my diet now!

That makes me sound like such a bad mother... I guess everyone is thinking no wonder her baby has problems if thats what she eats.

Hi,

Glad to hear my experiences of help. Unfortunately we have been wrestling/crying with most feeds today....serves me right for saying things improved! Generally though he has been much more settled on the Zantac (Ranitidine) I was interested to hear that someone else had similar probs as no-one else I know has seen this. Thought I was going mad too.

I have been quite stressed by the last 4 weeks+ as we had a rough time establishing BF for the first 9 weeks or so (weight issues, sore breasts, latching probs etc etc). However had had about 10 weeks of feeding relatively well with only a few top ups of EBM. So to seem to go "backwards" was difficult. I have struggled to BF due to this in "public" and after every feed became a battle I got tearful watching a Mum happily feeding her LO at a class. It was the complete opposite of a "bonding" experience and very upsetting for both of us. He also vomited copious amounts after a feed which when you battle to get it there in the first place is very difficult to cope with.

I contacted the NCT breastfeeding helpline- have used them a number of times and they are very helpful. I went through all their suggestions for fussing and breast refusal. They do have some helpful suggestions which are useful to exclude simple things. I tried relaxing, baths, skin-to-skin etc with little improvement- but at least tried (repeatedly). I agree that stress can affect let down etc but I have really tried relaxing and at other times that he fed well I could feel stressed!. I had a feed observed by a counsellor who had little to suggest that I hadn't tried. I really enjoy BF when it works and had intended carrying on for some time. It had though become almost impossible to consider carrying on. Thats when I hired a "super pump" as I thought I would try at least expressing milk rather than use formula. I express after some feeds and find there is milk there. I wondered if as he was fussing and ?not draining the breast I might be producing less milk so he would get more frustrated. This may have helped but not sure.

If there is any chance of reflux contributing I would suggest discussing it with a sympathetic GP. Ask for a referral to a paediatrician and to try Gaviscon. i believe anything "stronger" than Gaviscon has to be prescribed by a hospital consultant and that often the only real way of working out if it is reflux is to trial something which will supress acid and await results! You can always cancel the specialist appt if things improve. I was lucky to only wait 13 days to see a specialist but am sure it could easily be longer. In the meantime you could discuss with breastfeeding counsellors/ this website.

There are so many things that could potentialy affect feeding that it is impossible to discuss them all here. Every baby/mother is different and what works for one may not work for others. Sometimes I wonder how the human race has survived so long!!

I tried no caffeine, low dairy food but with no success ( most say lactose or milk protein intolerance also give diarrhoea in addition). I await teeth so I can say Yesss it was teething but nothing yet...I have read up on breast refusal/ fussing/ reflux extensively and am still unsure why I have had these problems.

As his weight has still been going up (although slowly) I often just stop and walk around the room calming him (and me) down. He actually does often settle and can be content between feeds. Once he has got worked up trying to latch him on again just seems to worsen things. Obviously if your LO has weight issues that may not be sensible. One of the things I found out was that breast milk can be an antacid and I wondered if EBM might somehow "settle" his symptoms. he will greedily take a bottle- which makes me feel very needed! I don't know about breast aversion as my DS keeps going for it but can often pull away at the last moment!

Other things which have been helpful (sometimes) are to feed before he gets very hungry or if still sleepy. massaging the breast (I have to grip mine as largish) to improve flow and to take it day by day.

Anyway am going on a bit now and reading this it seems a bit negative. I had a pretty good day yesterday with the feeding- honest! Hope it is more a helpful post than depressing?

Best of luck.

Trimum, I hear what you're saying about the dairy - it's a bit depressing to watch others around you gaily enjoying their cappucinos, hot chocolates (god, I wouold kill for one of those!!!!!!!!!!!!), cheese, etc., but believe me, if that is part of the problem, the improvement in your lo will be so worth it (for your sake as well as his). I haven't had dairy for quite a while now, and it is a challenge but at least I can enjoy my day with very little crying and frustration from DS.

DAvidsmom is right re the consultant - you should ask to see one asap as my GP said it would take about a month to get an appt. (unless you go private).

The more I think about it, the more I think you should look into the excema / head-scratching thing as well. Our Ds's excema has got really bad now, and I think I might have been able to do something about it earlier had I really paid attention (and not just thought, how weird, he's scratching his head again!)

Also, if you're worried about low milk flow, make sure you get as much rest as possible, eat really well, drink loads etc. I'm sure you know, but it's good to be reminded! (Just reminding self in the process.. as I wake up from my 2-hour nap!)

and if you do go off dairy you should prob have to take some additional calcium - tablets or something. I have Rice Dream with added calcium.

Its exactly as you describe. Most days (not all - days when I've had to wash up with him in the baby bjorn cos he won't be put down at all) he reasonably settled between feeds, its the getting worked up latching on again that is really bad. I know he is hungry. Like you this happens even if he has calmed down and is not crying... then I think... I'll try to sneak him on for another few seconds. sometimes he latches on for 10 seconds or so, but mostly when I even START to put him back into position (after settling) he starts to cry again.

Anyway, spoke to DH about idea of asking for referral - which I think is the right path as you suggest. Even just to get a dr.s view on whats happening. I always worry that they will tell me that i am fussing over nothing!! Anyway, turns out we have insurance cover for LO with his job. I am on the phone tomorrow!

Thanks for the encouragement re the dairy / caffeine. I tried to be a better eater today. didn't have two bars of chocolate... so guess thats a start! just a few chocs after dinner. (sorry - small steps!!!)

I think part of the caffeine problem is that I've just got bored with water and am now drinking fizzy drinks (primarily lucozade and coke) and hot chocolate or coffee to relieve the boredom of water and to give me energy. Like anyone after 4 months of not getting more than 3 1/2 hrs at night I am shattered. And so am surviving the days buzzed by caffeine. But as you suggest Naturopath I am going to try and rest more... during the day.

will let you know re dr appointment!

Intrigued by all of all this, as my ds, (nearly 6 mo) has been exactly like this from about 3 mo ; arching back, scratching head, fists in mouth, and much worse when feeding in public !
He went a whole week recently refusing to breastfeed in day, but luckily still woke in night to bf so kept my supply up, and now is back to liking bfs, but still occasstionally stops andscreams etc ...usually it is trapped wind, and hes ok once a big burp comes up. He does this less with bottles.
The head scratching thing is interesting as eczema runs in our family, and dd2 suffers very badly.
Ds has lots of little scratches on his head where he constantly grips it and scratches.
Anyway, good luck !

great that you have insurance - should be able to get an appt. in a day or two then.

I also found that when I have fizzy drinks it gives DS wind (I could be imagining it so don't take my word for this!), so basically just stick to water (and v little caffeine as well). I'm really not that boring, but have/will try anything to get DS happy (and me in process).

I get dairy-free chocolate by the way - couldn't live without chocolate! I would try to cut out dairy completely as even a little bit would send DS screaming...

Good luck with dr.!

chankins, what do you do for the excema?
Nothing's working at the moment as DS is currently waking up about every 20 mins throughout the night scratching and rubbing his face and head. Have put on loads of cetraban / diprobase but he still seems really bothered by it.

(am seeing dermatologist by the way, but haven't got appt set up yet).

Hi Trimum2,

Just wondered how you are getting on with your LO.

I am still having fussing and some screaming (even with EBM in bottle) but the arching has only happened a handful of times since starting the Zantac.

Have been a bit busy and not kept up with recent postings.

PS LO has also developed excema and scratches/ constantly rubs eyes!

Didnt think motherhood would be easy but wasnt expecting all these "medical" things

Hello!
Was trying to figure out how to contact you. wasn't sure whether just posting at the end of this was going to get your attention! Thought not, but I was wrong!

Went to consultant last Friday. i thought I would have to convince him or something. but I had hardly started into the description when he said it was pretty clear he has reflux. He used to stop breathing / had gagging episodes from when he was born (this apparently, consultant said this was acid coming up). He has had a chronic stuffed nose since early days (another classic sign!)

most interestingly he said that it can be "episodic" which I said was the most confusing for me as we had good days and bad, which made me think it wasn't reflux. But he said that was normal even in severe cases.

So we are now on Gaviscon to start with but will go onto Zantac if there is no improvement. So far I haven't noticed much change with the gaviscon to be honest.

Have you thought about weaning? I think I will go onto baby rice and solids etc. ahead of the 6 months now to see if that helps.

Will keep you posted. I think we will either have to up the dose of gavison (we are on one sachet not the two) or move onto zantac.

Hi all,

Sorry to jump in on your posts, but I'm in a similar situation and don't know what to do. Long story short (I have a sep post up)....had real problems b/f so DS has been f/f since about 8 weeks. He's now 14 weeks and all going great, happy, relaxed, healthy and absolutely no probs . Anyway, on Sat he totally unexpectedly refused his 6pm ish feed and just screamed and screamed. He's been like that Sun and Mon but has at leat got some food down him. Today he has barely eaten at all, just cries and cries and cries. Only other symptom is hand chewing. My HV says it could be reflux, but has never seen it present so late. Mr Dr is completely dismissive that anything is wrong at all.

Is there anything at all you can suggest as a first stage to getting him eating again?

Hi JHelenA,

Sorry to hear of your problems-What's the thread in your other posting- shall I reply to you on that so as not to cross ?Talk.

Hi Trimum2,

Glad to hear you got to see someone and to get somewhere. It is a relief to actually have someone take it seriously and potentially have a treatment which might help.

I found that I had to go for the double sachet of Gaviscon before it would help (when symptoms first appeared and were much milder at about 8 weeks) I found it difficult to get it into him without mixing with EBM and when I did he got v constipated and colicky. I have heard from some people using it regularly that the usual constipation remedies are helpful such as orange juice (pure not squash) 1 part with 10 parts water is helpful. another person gives her 4 month old warm water which helps the constipation. I have tried neither and cannot vouch for their usefulness or safety!! It sounds like your LO's symptoms are severe enough to warrant the "proper" dose- I presume LO is over 10lb? You know them best though.

I was told that if the Zantac didnt work in a week it wouldnt be helpful- by day 4 it had helped.

Really interesting to hear about the episodic symptoms being typical- my LO had the same- thought I was going mad as I couldnt see a pattern until it was virtually all the time. Then there could be the occasional feed that went ok.

I have a number of allergies as has my husbands family so wanted to BF til at least 6 months. As there are food allergies I was prescribed Nutramigen hypoallergenic formula if I felt I had to supplement because he was refusing the breast. Unfortunately he wouldnt take it!! Finally hve found a temperature he is happy at so planned to keep on the fluids. However in the meantime he really needed more and was trying to grab food from every plate etc. So started on some baby rice and sweeet potato- no problems at all Yum Yum..!!I have heard that babies with reflux can have problems with pain swallowing food especially lumps. He does gag on even small bits in the puree but I think many do.

PS had orange sick with the sweet potato! Stained most of his bibs. Perhaps need to get colour coordinated bibs for different foods.

hi Trimum2 just wanted to say I hope the Gaviscon works for your lo, but don't wait too long to try to push for Zantac if you think the Gaviscon isn't working. You also need to let the doctors know whenever the baby puts on a fair bit of weight, or if the medicine seems to stop working. The doses are very sensitive to the baby's weight, so they need increasing regularly, but also the body can stop responding to one kind of anti-reflux drug and need changing to another. In my experience the doctors will assume everything is fine unless you repeatedly tell them it's not. (my experience was that ds2 had severe reflux and was on drugs until 2yo - but most kids should have grown out of it by then, so don't despair too much)

But also, please don't hurry to introduce baby rice. Baby rice has been suggested to people who have refluxing babies for a while but research has shown that it doesn't really help with the reflux, only appears to, because it is heavier and so the mixture doesn't come up so far the oesophagus. It is quite dangerous for two reasons - one is that there is more danger of the rice going down the windpipe instead of the oesophagus, the other is that if the acidic milk/baby rice mixture is going up and down the oesophagus instead of coming out as vomit, there is a far higher risk of acid damage to the oesophagus which can cause lots of pain for the baby.

Plus if your baby is taking a small volume of food (milk) anyway, you want the stuff they are feeding on to be nutritious, and baby rice doesn't really have much in it except carbohydrates and added B vitamins. It's certainly far less calorific than either formula or breastmilk.

i hope this doesn't sound too preachy, just based on what i found out when I went through all this with ds2. Incidentally it wasn't until he was about 8 weeks old that we started to suspect reflux, and he wasn't on Gaviscon until about 5 months old. But I completely agree with Davidsmom about the experience with feeding in public. I used to think I was a very bad advert for breastfeeding, as he was always writhing around and pulling away and I had to swap breasts frequently to get him to take anything - far from discreet!

Hi mummypig,

Yes quite agree about not introducing food too soon. My LO was about 24 weeks and there were other signs. I have stopped as the v occasional bottle of formula is now taken well and takes the pressure off me sometimes when he wont feed and have to express.

Interesting about your experience that the meds can stop working- I found the Zantac great for the first 1-2 weeks but he is starting to fuss again although not much back arching he still pulls away a lot exposing everything! Going to see paediatrician next week and was considering trying Omeprazole.

Bit worried about meds in the long term though as in adults taking these meds can reduce the absorbtion of calcium. has anyone mentioned this to you? Am going to ask at next visit. On balance though it was so bad I would continue with the meds unless they could cause real problems.

Oh.. thanks mummypig about the babyrice. I am under pressure from DH to wean. Because of reflux DS is basically a nocturnal feeder and so the amount of sleep that I am getting is not very much. But to be honest, I am so thrilled to be able to breast feed this time around that while I am tired, I don't really mind too much. Yes, I would prefer he slept through, but if he needs to feed at night because its more comfortable for him then so be it.

When did you start, did you wait the full 6 months?

Re the doseage. We are only on 1 sachet. And at the moment its not every feed. I am supposed to give it before the feed (rather than after as the instructions say) because he is refusing to feed so early on. BUt I can't always manage to give it every feed as sometimes he is crying out in hunger and I feed him (e.g if we are out or just back from being out). And the doc said just see how bad things are and give it when its needed. So he is not maxing out the dose. But what he has had so far as made no difference at all... and if anything has made him bring up more sick (although maybe I am imagining that bit, seems odd that he would be more sick on gavsicon than not surely!!!!!!!!!!!)

So, I would say its flaming useless, but I guess I should max out the dose before saying that... he he