Reflux and allergy/intolerance confusion

[@llli*kam09]

My son is 4 months old and has been vomiting since birth. He was diagnosed with relux at 6 weeks. I have now reached such a state of confusion over what is causing his reflux, that I am unsure what to do!

For the first 6 weeks he vomited, screamed and had explosive green poo. At first I thought it was an oversupply issue so I tried block feeding, but he was constantly hungry and always wanted the second breast. Then I tried eliminating dairy products from my diet thinking that it might be a temporary lactose intolerance issue. This definately helped and his poo turned yellow within 24 hours. The screaming also stopped, but the vomiting continued.

At 6 weeks the Dr gave him ranitidine, which seemed to calm him down but did not stop the vomiting.

At 9 weeks I wanted to introduce a bottle or two of formula a day. At this point the Dr told me that the reflux was connected to the lactose intolerance and gave me lactose free formula milk. I continued with a dairy free diet.

When the vomiting didnt improve the Dr suggested it could be a cows milk protein allergy. But the formula has cows milk protein in it and I have never noticed my son have a reaction to it. In contrast I feel he vomits more after the breast milk- so I dont think it can be a milk protein issue. I started to take a small amount of milk into my diet as an experiment- and it doesnt seem to have an effect on him anymore.

So at the moment I am breastfeeding 4-5 times a day and giving the lactose free formula once or twice a day.The vomiting contiues on a daily basis.

He typically has a reflux 'flare up', once or twice a week usually lasting 24 -48hrs. This starts during the night when he would want an extra feed or two. By the morning he is gassy,unsettled and doesnt really take his morning feed. The day then goes on with him unsettled, crying, vomitting and passing wind and wanting a feed more than usual. I have tried keeping a food diary and have noticed that I once or twice I ate peanuts before a big flare up. Other than that I cant find a connection.

Im feeling totally lost. What should I be eating or not eating? Is it a breastmilk issue- do I have oversupply problems? Should I scrap the lactose free formula now and give the normal stuff? I hate seeing him in pain. Any advice would be appreciated.

Kam x

[@llli*esthervegan]

The first thing that comes to my mind by your description of your lo's "vomiting", is
1. Are you calling spitting up vomit? vomit is different from spitting up in force, smell and what the cause is.
2. Does you doctor agree that your LO is vomiting everyday?

some babies get relief from reflux/gas/ fussiness by smaller feeds through out the day.
rather than feed 8 times a day, nurse 10-12 times a day but use one breast per feeding and encourage comfort sucking.
do not encourage baby to overfeed on the bottle, or if possible eliminate the bottles altogether and encourage baby to nurse for comfort.
the cows milk protein is a troublesome molecule, if you can avoid milk your LO's symptoms might improve. But there are no guarantees.
Some babies are troubled by digestive issues irrespective of what the mother eats.
I know some people feel that pacifiers are no-no's but some babies benefit from comfort sucking to help digest what they have eaten.

[@llli*LLLKaren]

I have one of the same questions as esthervegan -- is your baby vomiting (forceful and projectile, may travel several feet) or is he spitting up (the milk coming back up doesn't travel far or forcefully, but just dribbles or gushes out of baby's mouth)?

Lactose intolerance is extremely rare in babies. When it does occur, it causes life-threatening diarrhea and dehydration.

Cow's milk protein intolerance is far more common, occurring in 2% to 5% of newborns, and frequently goes along with reflux. So that's a more likely cause of the symptoms you're seeing, although, as you've found, it can be hard to find the root of the problem.

Here are a couple of articles from kellymom.com that might have some useful information:

Spitting Up & Reflux in the Breastfed Baby
Dairy and other Food Sensitivities in Breastfed Babies

Another resource you could check out is the Food Allergies and Sensitivities forum here. There are a number of moms who are very knowledgeable about food allergies and breastfeeding.

[@llli*24.hourmilktruck]

DS has had a dairy, soy and egg intolerance since he was about 1.5 months old (we are about a week away from hitting 6 months!) so I have quite the experience with this. Bloody stools.. Extreme fussiness.. A LOT of gas...

He was also prescribed Zantac to be used on an "as needed" basis although when we used it we never really saw an improvement. Therefore we didn't really feel the need to medicate if it wasn't necessary. From about 3 - 5 months we went through a bad spit up phase. He would spit up a lot (not necessarily a lot volume wise.. but a lot as in frequently throughout the day) and he just started to grow out of it. He still does it on occasion but not very often. We saw an allergy DR and he recommend the Similac Expert Care Alimentum for if/when I decided to stop breastfeeding. I'm happy to say he has been EBF But it's worth a shot to try that one. It's expensive but it may help. The proteins are completely broken down so babies don't have issues with digesting it.

Oh and good job at the food diary. I've had a food diary for months now and it is SO helpful. Keep up with that - it really helps. Also, read ingredient labels on EVERYTHING. Items you wouldn't think have dairy, end up having dairy in them.