5mo crying during feeds, reduced weight gain, green poo

[SamN]

I've had conflicting advice re. ds2 and I thought mumsnet might help.

He's always had predominantly green poo (i.e. most times I change his nappy his poo is green, but sometimes it's greeny yellow or sometimes it is actually yellow). I thought it might be due to something I was eating but there is no clear pattern. (I am particularly aware of this possibility since ds1 has a cows milk intolerance.)

He also usually feeds for a very short time on the first breast, then pulls off and screams, and it's hard work to get him back on either breast. He often screams a lot before going to sleep too, and sometimes he's screamy inbetween but other times he's a little darling.

I wasn't too worried about either of these until his weight gain started to really drop off. His birth weight was between 25th and 50th percentile but he's now on the 2nd percentile line. His screaming seems to have got a lot worse too and I suppose that's the more worrying thing.

I've had various suggestions including checking our positioning, expressing before each feed to get rid of some of the 'fore' milk so he has to work for the fatty 'hind' milk, getting him checked for reflux, starting formula, starting solids.

I'm particularly averse to the last two suggestions because of problems with ds1 and a belief that introducing anything other than breastmilk will just confuse the issue rather than solving the problem.

I also suspect that when I go to see the GP they will be very quick to prescribe infant Gaviscon (as they did for ds1, who we later realised didn't have reflux after all) and as ds2 is exclusively bf I'm not looking forward to the faff of having to give him Gaviscon before each feed - but I will do if he really needs it.

I should add that he's going through all the developmental stages pretty much as expected. He's also had to deal with thrush, two colds (from ds1) and being rather interested in what's going on around him - all of which I'm aware could lead to low weight gain for a temporary period.

Any suggestions as to what is going on and what I can do? I'd love his weight to go up again as I'm fielding frequent suggestions of solid/formula feeding from dp.

Sam, what happens when he comes off the first breast? What would happen if you took that as the end of that particular feed? I am just ruling out the possibility that he has actually had what he needs after a short time, and is objecting to being put back on again...though other stuff in your description wouldn't back that up.

Glad you're around, tiktok!

When he first comes off, he cries a lot, but if I put him back near the breast he usually opens his mouth wide as if he wants to go back on. Sometimes he will go back on and maybe even suck for a bit more, but then pulls off again.

That does sound like distress/discomfort, Sam.....I know reflux is sometimes overdiagosed (in some areas it's permanent flavour of the month ) but maybe ask the doc to check him out?

Is the return of thrush a possibility? Colds and blocked noses sometimes interfere with feeding, too.

Reflux sounds like a small possibility to me too. Is he sick though?

I wanted to wait till 6 months before I weaned DD, but she was hungry, so I started at 5 months. If he is losing weight and not being sick then I really think he is probably gasping for some solids. Maybe you could give in and just keep him on baby rice for a few weeks.

Green poo is normal, it just depends on what you are eating.

This sounds just like ds1. He'd suck for moments (5mins max) and then scream his head off. Fretting at the breast, few sucks then off and screaming again. I read somewhere that predominantly green poos may be a sign that ds is getting only the foremilk rather than the hind milk, which I felt might have been the case with my ds. And its supposed to be a "windier"cocktail than if baby suckles for a good feed. I was cinvinced that my problem was a productivity one. I never had a strong let down reflex, I found it really difficult to express any milk, despite using an industrial strength electric pump, there never seemed to be more than a couple ounces in either breast, ever. DS1's weight went from 50th centile to 9th centile by about week 12-14, when there was a complete plateau of gain for 8weeks. He didnt put on a thing. I ended up giving him nanny goat formula as he had a cows milk intolerance (eczema +++). Weaned at 18weeks(4yrs ago now so advise re weaning has changed somewhat), but with little success. He just was an awful feeder. He's maintained a constant 2-9th centile line for his weight ever since. It was an extremely stressful time, so I send lots of cyber hugs of support. Have little to suggest as help sadly, but perhaps rule out reflux with the appropriate med staff. Are you on dairy whilst bf, maybe thats causing ds some distress, esp with a family history of dairy intolerance.
I wish you well and hope things get easier.

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Hi SamN

Are there any signs of teeth in your DS's mouth? (Stupid sentence - where the heck else would there be teeth other than in his mouth - it's late!).

Can you try putting a bit of teething gel on his gums before feeds? Might settle him enough to get to the hindmilk - green poo suggests too much foremilk to me.

xxx

Hi there, thanks for all your messages and your goodwill.

I have a couple more questions so I'll put these at the top of the message!

If this is reflux, is there a way to get rid of it without using medication? (Having been given Gaviscon myself while pregnant, it appears to me to be treating the symptoms but not the cause. In my case, I found that changing my diet was a far better long term solution.)

Is it a good idea to try feeding on one side only, and if so, for how long? I'm torn between trying to get as much milk as possible into ds2 - therefore offering him the second breast quite early just to see if he will take a bit more - or trying to encourage him to get more hindmilk, therefore repeatedly trying to latch him on to the same breast. I have heard this can work well if you have an overactive letdown. (I did post a while ago about having too little milk but I think that was a temporary problem as most of the time my breasts spurt all over the place.)

I'm going to the GP tomorrow to see if they think it's reflux, and I have to admit I'm tending towards that possibility myself now. Having read around the subject, he's showing lots of signs like being sick (not always, but often) arching his back, preferring to sleep on his side with his head slightly raised, and being pretty windy.

I can't see any sign of thrush coming back. The cold and teething might make everything worse but I think the underlying problem was there before they both started. (Thanks for the suggestion about gel, hunkermunker, have bought some from the chemist today.)

I'm not eating any dairy at all because I wanted to avoid the problems we had with ds1 , so the green poo is quite likely due to a foremilk/hindmilk imbalance as he just doesn't stay on the breast for very long (unless he's very sleepy) and so I suppose it's just not long enough to get much hindmilk.

Yurtgirl - I have to confess to having a very similar attitude to you regarding weighings and health visitors. I have only taken ds2 for a few weighings because I didn't want them fussing over little deviations from the curve that even out over the next few weeks. But the combination of the behaviour during feeding, the slow weight gain and the green poo has really got me worried now. Thanks for your hugs, honeybunny, because you're right, it is such a stressful time .

Sorry giraffeski, didn't mean to ignore your comments in my last message. I have spoken to two different breastfeeding counsellors and they were both very encouraging, but I ended up feeling that I had heard too many things that might help and it would be good to try and identify exactly what the problem is. If the visit to the GP is inconclusive I shall probably call one of the counsellors again.

Another good idea is to go to a 'baby cafe' where they have counsellors and hv etc to help you (but its not a weighing clinic!) and you can sit and have a coffee etc. Here is a link so you can see if there is one near you.
My niece had reflux and all they would give was baby gaviscon- didn't do much TBH.

Bump!

Is there any alternative to Gaviscon if he does have reflux?

I would try probiotics before gaviscon. You could even start by taking it yourself if you don't want to give it direct. It might settle down any gut issues which are giving pain, may help with the green poo etc.

I have been to the GP and after examining ds2 he prescribed Gaviscon as well as asking for a urine sample for analysis at the hospital.

I didn't do very well giving ds2 the Gaviscon and I think I'll try mixing it with breastmilk instead of water next time to see if he will actually swallow some of it. I hope it helps him to settle more after feeds but I'm still rather dubious as to whether it will help his behaviour during feeds.

Kinderbob, I had wondered about probiotics, but if I'm taking them, would the live bacteria actually manage to get through my gut into my bloodstream and into my milk?

giraffeINAMANGERski - what a good idea about the baby cafe. There is one in my area but I assumed it was just other mums and health visitors and wasn't sure how much they could help. If there are trained bf counsellors there too then they can see what's actually happening when he feeds and give me help on the spot, so to speak.

Yup, probiotics do get into your milk.

Hi SamN, have only just seen this. What is your feeding routine with ds2? Are feeds every 3hrs-ish or are you trying to fit more feeds in (eg. every 60-90mins) cos you're worried he hasn't taken any during the previous feed? Sometimes they fret when 'snacking' rather than being really hungry for a feed. Maybe try delaying his next feed for a few hours to see if he has more of an appetite?

Also, my ds started to take in really short feeds around 4.5mo and this was mainly due to being distracted. I know it must be difficult with two babes but are you able to feed him in a quiet room and plonk ds1 in front of a video (in a different room)?

Have you tried different feeding positions? Remove the pillows and feed him sitting on your lap, or in a sort-of-upright rugby position? Maybe lying down on his side is facilitating slight reflux?

HTH (PS. Have emailed you about the dvd). Hope things get better for you.

If it is reflux, I would use the gaviscon.. My friends dd wasn't diagnosed till she was about 18mths and she had poor growth because of it. They also went through hell all that time not knowing what was wrong with her.

TBH with reflux you only need to treat the symptoms, as the cause will only get better as your ds gets older and his digestive system matures.

yeah Sam the one near us has a HV but also a few trained bfc who will give you a hand. It's much easier to deal with a latching problem if they can see you feeding (and it might not be of course but if you go along at least you'd rule it out- and if your ds isn't staying on the breast for long then it might be the root of the problem- which would cause the excess of foremilk of course).
good luck!

I believe that the green poo is from the baby getting too much of the foremilk. This can account for the baby not putting on sufficient weight gain. Apparently it is a good idea for the baby to get some of the foremilk but the baby needs to continue to suck longer than 5 minutes otherwise they will continually get the foremilk and not reach the hind milk which can sometimes take up to 15 minutes or longer. I had to put my baby onto a bottle and continue to let the baby feed from the breast as he had lost so much weight. The baby is now over 3 months and I express as much as I can, top up with formula and still let the baby feed from the breast. I find that baby uses it as a comfort to breast feed and will often have a good drink half way in the day and always has a quick drink of foremilk after every sleep. I try to give as much breast milk as I can express and only offer formula if I need to top up or haven't any expressed milk left in the day. I used a cerain type of bottle and teat to feed the baby and haven't had any problems transferring the baby onto bottle and breast. Luckily he doesn't get confused. Whatever you do, keep up your supply of milk it the baby wont feed for longer than 5 minutes then express the milk and your milk supply will dwindle. The baby could be getting upset because the milk supply in one breast is low and wants to go on the other side. Keep up with it and offer the other side.

Hi there, thanks to all for your concern and helpful points. As well as the Gaviscon, I'm trying some new bf positions and although expressing is hard due to a demanding ds1 I shall try to get back into the habit. I have some probiotics in the fridge plus I'm scheduling in a visit to the Baby Cafe next week.

Thanks again for all your help. I'm feeling far more positive at the moment (funny how it comes and goes) and I'm sure we will both get through it eventually.

Sam, I had very similar problems with DD1. I find singing to DD2 during feeds, approaching her at feed times with a great big smile and making a concious effort to relax and not pester her to feed really helps both of us. It's easy to become so anxious about feeds that feed times become miserable. DD2 and I went through a patch where I felt it was on the verge of going the same way as with DD1, but now, using these methods she generally breaks off from feeding for a giggle or smile rather than a cry. I also found laying her down to feed her helped prevent her from feeling any tension (from previous concerns) through my arms and chest.
I'm sorry if this all strikes you as obvious or things that you already do...feel free to ignore ! I really hope feeding becomes more enjoyable again for both of you .