Reflux or...? Help wanted with sick baby (LONG POST)

[Maursh]

I have one DD who is 3.5mths and EBF. She has been diagnosed with reflux and prescribed domperidone (Motilium suspension). My niece had reflux, she is now 14, and that consisted of projectile vomiting and bouts of inconsolable crying. My DD is nothing like this. There is no projectile vomiting, it?s more like she suffers from a bit of wind and then throws up and is a ?happy chucker?, apart from the odd occasion when there is clearly a bit of acid burn,. If she is moved too soon after a feed a fountain of milk will generally come out. She is also very windy and wriggly and often when burping her a whole load of sick will come up with the burp, or without.

Apart from being a laundry problem, since we last saw the doctor the sickness seems to have got worse and I am concerned with her hydration levels in the hot climate. At the last appointment she had been gaining a consistent 150g/6oz per week, but I am sure that this is largely down to me being able to feed her very frequently since we are alone all day in Madrid.

My question to you all is, what can I do to stop her being so sick? I don?t think that it is serious (something that she won't grow out of) but I am not convinced that it is reflux either because:

1. the domperidone hasn?t worked, in fact it appears to make her more sick

2. I have also tried Infacol since she seems to be a particularly windy baby, but this doesn?t seem to have been effective either

3. She doesn?t appear to suffer at night times. In fact she wakes once or twice a night, guzzles a boob and then falls asleep and will go straight down on her back, all within the space of 15mins.

4. Frequently she is sick quite a while after she has been fed eg 90mins.

5. Some days she is not sick at all, other days she is nothing but sick all day. It seems to be a bit random. Also if she is sick in the morning, that generally sets the tone for the day ? eg she will be sick all day

6. I can feed her lying down without any particular problems so long as she is not moved.

7. She has runny green pooh a lot, although I gather this is probably nothing to worry about/might be caused by additives in food I am eating. I block feed to avoid fore/hind milk imbalance issues. I have also dropped all medicines since I didn?t know whether it was an additive in them that was causing the nappies (such as saccharine)

8. I have tried cutting various things out of my diet such as dairy, acidic fruits and windy vegetables but nothing has been a roaring success.

We see the doctor again this Wednesday. If anyone has any bright suggestions of questions to ask or ways to limit her being sick, they would be appreciated.

Hi Maursh, my DD was sick loads when she was little, but was never diagnosed with reflux. I am no doctor but to be honest I think it was because she used to guzzle down too much at once (she's still a greedylittle thing ). So what I used to do which wasn't easy was to feed her less but more often, and also let the milk settle a bit before winding, plus try and get her to be more upright when I was feeding her.

The greeny poo may be an indication of too much foremilk and not enough of the richer hind milk. If your DD is gaining wait as normal and having plenty of wet nappies, it could be that she is just getting too much milk for her tummy to take and she just upchucks the excess!

If the weight gain is normal and loads of wet nappies try a few days of expressing and getting rid of some of the foremilk and see if it has an effect - feed 3-4 hourly (or as you normally would) She could also have a weak muscle that closes down once milk is in the stomach. This improves as the baby gets older. Second migs suggestion that DD may just be greedy (or just likes the sucking) and overfull. Expressing some foremilk may also reduce this.

You could be describing my two at that stage. As you said, it seemed miraculous that they could gain weight whilst sucking up so much of each feed!

I don't really have any answers. I found Dentinox Colic Drops betters than infacol for bringing up wind (and I liked that Dentinox is given post feed if there seems to be a wind problem, rather than infacol, which I think is preventative and given pre-feed?). I have to say I just used lots of bibs, muslins and towels!

I did find they improved a lot at about 4 - 5 months (or I got used to it!) and then improved again on when I started weaning at 6 months (though they're still fairly sicky, just less. And of course post-weaning sick isn't just milk ...).

I didn't see anyone about their sickiness - like your baby, mine were 'happy chuckers', and not worried by the sicking up as long as they could get the wind out (which was sometimes a struggle, so Dentinox helped).

Good luck with all the washing!

Thank you so much everyone for the replies

@migs: I might be wrong, but I think that if she was taking loads of milk / being greedy that she would be gaining more than 150g per week (?) even after chucking a lot up. The Paed told me that they expect weight gain of between 150-300g / week so she is very much at the lower end of the weight gain scale. Actually this is why I was going regularly to the doctor in the first place: she was slow to regain her birth weight and they wanted to monitor it. He made the diagnosis of reflux after asking me if she was ever sick.

@sneezecakesmum: I will try expressing some of the foremilk as you suggest, however the weak muscle that you described, I think is the thing that the domperidone is meant to strengthen (amongst other things). Also on very sicky days, the number of wet nappies does decrease so I don't think that she is getting enough fluid. During the day she wants to feed every 2 hours. I can stretch her out to about 2.5 before she gets the screaming heebee-geebees. She typically will not take all of one side in a single feed so I block feed so not to have fore/hind milk imbalance.

Perhaps this is one for the breastfeeding forum, but does anyone know if it is possible to have a fore/hind milk imbalance at a production level (ie I am making the wrong balance of milk)

@HappyAsASandboy: it's nice to know that there is light at the end of the tunnel. Thanks for the tip on Dentinox, I have never heard of it.

certainly try the breastfeeding forum as its not quite straightforward. Your fore/hind milk should not be out of balance, nature made it so that its right for the baby but as DD is still very young the balance may not have been found yet. The domperidone won't strengthen the muscle (cardiac sphincter?) at the base of the oesophagus, it physically cant do that. It is an anti sickness med which acts in a way to reduce nausea and vomiting. ? by calming smooth muscle and make it less likely to contract and expel the stomach contents. Unfortunately I cant see how this would effect a weak sphincter except by making the stomach less contractable. It may be worth asking a pharmacist how the med works.

My son had (ebf) similar issues and would crawl - puke - crawl - puke etc until he stood up and it all stayed down!