Diarrhea, increased reflux and fussiness at the breast

[@llli*juneflakes]

Hi Ladies,

You all helped me before with nipple pain, which by the way I *think* is getting better finally after 3.5 months!

3 weeks ago he had his frenulum clipped for a 2nd time. I think that's finally stretching out and getting better.

During that time period, even before the clipping - he had started being really fussy while feeding but still wanting to feed all the time. I thought it was due to fast flow/let down, but it would continue through out the feeding.

He has always spit up a lot and also seemed to have reflux at night making it hard for him to go to sleep an stay asleep- he makes grunting, gurgling and squeeling noises. But starting about 2 weeks ago, it's even worse! He wants to nurse constantly because sometimes that provides releif for a few minutes, but other than that he seems very irritated with the reflux. He'll start screaming and make sad faces how can I help him?

Also about a week and a half ago, he got water stools and was having them every half hour. He was screaming in pain and had major diaper rash. Took him the ped, they recomended some pedialyte and not to use any formula to supplement (I had been doing 1-2 bottles due to the nipple pain) So I went on breast feeding and supplementing a liter/24 hours of pedialyte (which he loved) for a few days. I have him 1 oz of formula last night for the first time in awhile because he was getting so mad trying to breastfeed but either the flow wasn't right or something. He litterally smiled ear to ear when I gave him the syringe of milk (trying to avoid bottles in case we have nipple confusion) The formula didn't seem to cause reflux like my breast milk so maybe it's something I'm eating?

He now still has the reflux and the diarrhea. Could the two be connected?
Also he pulls and fights with my breasts at most feeds. I love dream feeds because he's calm and even his morning feed is great. But noon, afternoon and evening feeds and all in between he is tugging, screaming, crying, turning his head sideways!

One other thing, I was wondering if the way milk comes out of my nipple is "normal" If I mannually express, I have about 5-6 streams that spray milk. Often towards the end of a feeding, there are just 2 or 3 streams and they are shooting in crazy directions! Straight up, backwards to the left, sideways crossing each other. Is this normal??? This has always been this way.

I'm going to Seattle Childrens in a couple days to get a wedge fitted for sleeping but just curious what you all think of this.

Sorry for the long post, I look forward to hearing any advice.

[@llli*LLLKaren]

bumping

[@llli*lllmeg]

The behavior at night sounds like reflux to me. Had that with both sons. I have to be honest I found the sleeping wedge not much help, baby just slipped down it. But mine was from babies R us maybe this is something different? Anyway, what did work was changing the position I nursed in (so baby was more up and down-head well above bum, when nursing) and also holding baby upright (head well above bum-could be leaning on me or in a sling etc.) for 30+ minutes post feeding. Some nights baby never successfully laid flat and slept on my chest while I reclined on pillows. We went the meds route as well but with the positioning and feeding changes not for long. In our case, OALD definitely worsened the reflux, so working on lessening that also helped.

I do not know what to make of the diarrhea. In my experience, what a mom thinks is diarrhea is almost always just normal breast milk poop, and the frequency of pooping could be from oversupply maybe? A virus could cause diarrhea but that would be temporary. In any case I am not a fan of giving a breastfed baby pedialyte, breastmilk is way better when baby is ill. See article linked below.
Can you describe in more detail the 'watery' poops?

Food allergies via breastmilk are very rare. When they happen, dairy is public enemy number one. I do not know if it would cause diarrhea but it would cause blood in the stool, green stool…so it makes sense? Of course, if it is dairy that is what most formula is made of. Another usual suspect is soy, so again, a soy based formula could make things worse. I would suspect the formula over breastmilk if it IS from something baby is eating. After all, baby would be getting much more dairy or soy from formula than your milk. It could be from something else you are eating, of course-but again, this ia a rare occurance. See article linked below.

As far as baby having less reflux from the formula, that could be due to the delivery system- again, OALD (which would only happen at the breast) can make reflux worse. In my experience, the symptoms of forceful letdown can happen throughout a feeding.

What you are seeing when expressing is milk coming from your nipple pores, which vary very much from mom to mom in number and placement. Each pore that milk comes out of is attached to a milk duct (although everyone has pores that are not attached to any ducts.) Maybe you empty some ducts faster than others. In any case, it sounds entirely normal to me.

Article on when a breastfed baby is ill: http://kellymom.com/bf/can-i-breastf.../baby-illness/
Academy of Breastfeeding Medicine protocol for food based allergies in the breastfed infant. (Beware, lots of medical terminology.)
http://www.bfmed.org/Media/Files/Pro...ish_120211.pdf
Forceful letdown: http://kellymom.com/bf/got-milk/supp.../fast-letdown/

[@llli*juneflakes]

Thanks for the support!

1. Diarrhea : it went away and then came back. It's like green water, no thickness whatsoever and sounds very liquid. Right now it's not as severe, maybe 4x a day. I stopped the pedialite

2. Got a wedge, he sleeps small amounts in it now but hoping will get used to it. It's a custom made one with a place for his bum to rest and straps. I also got a feeding wedge that might help. I'll keep tying to keep him upright.

3. Letdown- I used to have oald but now I'm pretty sure I dont because I way before and after and consists you he's getting just .5- 1.5 ounces.

4. I'm now worried he's not getting enough so I'm nervous to take away the formula. It I'm starting pumping in the middle of the night again so I have a full bottle for when he's really cranky at the breast. I really want to ditch the formula but .5-1 ounces x 12 feeds or so a day doesnt seem like enough and he still seems hungry but for some reason hates my boobs after let down ends. I've tried compressions but he gets even more angry.

I have another therapy apt this week. Apparently his tongue is still not mobile enough even after two clippings. I think the plan is to keep doing tongue exercises, cranio therapy, neck stretching for the torticollis and then if tongue still can't properly transfer milk then a 3rd clipping ugh!!!

I feel like I've encountered so many issues but st least now I have a bit of a plan!

A couple questions: if he is really just getting average of 1 ounce and feeds 12x a day, is it still okay to stop formula?

Could it still be oald even with just an ounce?

Is it normal that the milk comes out in strong high pressure squirts even at the end of a feeding? He seems irritated at the end and i think it's because it squirts out inconsistently since his tongue doesn't work and I'm trying compressions .

He spits up lot and seems so uncomfortable sometimes I just breastfeed more to comfort him, does this make reflux worse?

Luckily my nipples are starting to just get used to all his incorrect sucking but the pulling and big bite downs are really starting to hurt!!!

I think that's it for now thanks for listening!!!

Jackie

[@llli*lllmeg]

OK, I cannot answer everything because some is beyond me but here are a few thoughts...

1) OK that does sound like diarhea. But when you say it is 4 times a day, is baby having 'typical' poops as well, on the same day? Or is it all the green squirts? It went away and came back-what, if anything, changed during that time?
2) OK I remember reading about such a wedge. That is different than the literally slippery slope I tried with my oldest!
3) While it is true os/oald typically causes fast weight gain, I am not sure if low gain before and after weigh-ins are going to rule it out. The signs of oald are many, if you have several of those, I would still consider it a possibility. If not, then that is not what it is.
4) I understand your worry about baby getting enough. And yes, if baby is really getting only 12 ounces a 24 hour day (or less) then that is not enough, the typical amount of breastmilk a baby needs is around 25 oz per day, with some babies needing a few ounces more and some needing a few ounces less.

BUT I am very skeptical of before and after weigh ins. These have to be done on a very sensitive scale. Baby has to not poop or pee between weigh-ins, they have to be dressed exactly the same (actually naked is best) -the slightest thing can throw it off. And the stress of weighing your baby before and after each and every feeding would seem like it would interfere with the natural rythms of nursing for both of you. I assume you are doing the before and after weigh-ins on the suggestion of an IBCLC, who showed you how to use the scale etc? Did more typical ways of seeing if baby is getting enough (weekly weight checks, for example) not work due to the tt issue causing extreme low weight gain and concern?

You mentioned hand expression. Are you pumping, besides the one time at night? If you are supplementing that much due to poor milk transfer, it is vital to pump regularly with a good pump, a hospital grade rental if possible. Both poor milk transfer and supplementing harm milk supply so it is really important to pump. If you are hand expressing instead, that may be OK-I really do not know-I would be concerned it may not provide enough stimulation and be incredibly tiring and time consuming for the amount you would possibly need to do. Also, how much milk do you get when you pump or hand express?

I would say do not stop comfort nursing, definitely breastfeed more, if you have any concern about baby getting enough. Letting a slow gaining baby to nurse lots is way more important than avoiding spit ups. reflux babies will sometimes nurse more as breastmilk soothes the pain. Is baby on meds for the reflux?

With the low weight gain I wonder if it could be a food based allergy after all. This is a difficult article to slog through, but it gives a science based protocol for approaching food based allergies in the breastfed baby. Maybe your IBCLC can walk you through the medical terms. http://www.bfmed.org/Media/Files/Pro...ish_120211.pdf

[@llli*lllmeg]

Is it normal that the milk comes out in strong high pressure squirts even at the end of a feeding? He seems irritated at the end and i think it's because it squirts out inconsistently since his tongue doesn't work and I'm trying compressions .

I really don;t know. My instinct is, there is no normal when it comes to this, every mothers anatomy is going to be slightly different. But is baby unhappy when the flow slows, before you try the compression, or when it comes fast when you compress? Or both?

Also he pulls and fights with my breasts at most feeds. I love dream feeds because he's calm and even his morning feed is great. But noon, afternoon and evening feeds and all in between he is tugging, screaming, crying, turning his head sideways!

Since baby is happier at some feedings, the fussy at the breast does not sound like so much an issue of how the milk actually ejects (which would be pretty much teh same at each feeding, probably?) and maybe more some other differences at those feedings-Maybe look at variables such as positioning, babies level of calm at the start of the feeding, baby being sleepy or drowsy, distractions, etc, and try some adjustments to make all feedings a bit more like the happy feedings based on that and see if that helps at all?

[@llli*juneflakes]

Thank you for your continued support :-)

I feel like some things are starting to get easier, we've just been through so much!
I think his tongue is continuing to gain mobility from the clipping and exercises we're doing. We also saw another therapist yesterday that does more mechanical cranial work so we'll see if that helps any.

I think you're right about the level of calm during the night time feedings, so I'm trying to simulate that- basically this means I can't ever feed in public which is a bummer but oh well! Maybe someday that'll come for us although he is already starting to be distracted and want to look at everything everywhere while feeding.

His weight gain was really good for a long time, but I was also supplementing with formula. I bought the scale just to see what was going on when feeding at home because the last couple visits to various health providers, he wasn't getting much during the feedings. I know not to freak out too much because there are many variables.

He still has diarrhea so I'm analyzing my food and supplements. The therapist has recently heard some infants have sensitivity to certain probiotics. I'm going to completely cut chocolate (It wasn't an issue the first couple months but maybe now it is?), stop the probiotics for a few days and then start taking fish oil again because it seemed when I was taking fish oil he wasn't having bowel problems- not sure if coincidence or not.

He's having less of the green poos so I think my work to make sure he's getting enough of the fatty milk is working. Turns out I had a bunch of clogged ducts and I think that was making it difficult to get the fattier milk out at the end. He was mad with and without compressions, so I'm going to keep working on getting the ducts cleared out. It's probably all the reclined feeding I'm doing, which he prefers of course. I see a lot of info on this site about preventing the clogs so I'll work on that. His feeding weight on the scale is now back to 4 ounces yay!

Thanks again for listening and letting me bounce ideas around! BF'ing has been the hardest thing I've ever done but I am glad I haven't given up and I think I'm getting closer to a happy bf'ing relationship!!!

If I have another baby, I'm going to make sure to go back to Dr. O'Hara in Seattle to check for tongue tie immediately so we can get it clipped right the first time (ENT didn't go deep enough) and to do the excursuses right away...