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Thread: reflux help please!

  1. #1

    Exclamation reflux help please!

    My daughter is 18 days old today and I have been exclusively breastfeeding since day 1. After a day or so, she was able to latch on and my milk came in. She would burp randomly on her own. By day 5 or so, I noticed that she would cough/gag on my milk - I figured out that I had an overactive letdown. I started block feeding (I am now just feeding from one side every feed, unless she's cluster feeding), hand expressing when needed, and trying to recline back and keeping her somewhat upright when feeding her. This has helped with the gagging/coughing/wheezing.

    However, now there are other problems. Regardless of when or how many times we burp her, she will spit up. Sometimes it's a normal baby spitup amount, but other times it's the whole feed and she'll cry and/or look like she has a bad taste in her mouth, grimacing. She'll also randomly cry out in her sleep and grimace, and this morning she was fussing in her sleep for 2 hours, arching her back, stiffening, curling to the side. She spits up in her sleep almost every time she sleeps. I wasn't so concerned before, but now she is crying out more, fussing longer, and grimacing after burping/spitting up. It is rare for her to burp without having anything come up. I'll nurse her, she'll fall asleep, I burp her, she cries and wakes up, I put her back on my breast because that's the only way she'll calm down, and either she'll fall asleep on me and I leave her on me, or I try to burp her again so she'd be more comfortable, or I'll just place her in her crib. She rarely burps when we try to burp her like this, and if she does, it takes a long time. If we don't get a burp out of her and just place her in her crib, she'll spit up pretty soon after, fuss, and wake up again. The only way she seems comfortable is if I let her sleep on my chest or stomach, but then she'll spit up the moment I lay her down in her crib or to change her. Oh, and the spit up is sometimes mixed with mucous, and other times it's mixed with curdled milk. She also hiccups rather frequently. Some days are better than others.

    We saw the pediatrician today, and he didn't seem too concerned since she gained about 20 oz in a week and a half. We are to follow up in a week though, especially since I mentioned that she recently began to refuse to latch on at times, having my breast in her mouth but not closing her mouth onto it.

    - Should I wake her to burp her when she falls asleep while nursing?
    - Should I burp her every 3-5 minutes while nursing? When I try that, she'll spit up the first burp, and the subsequent burps sometimes never come. She then gets sleep and will not try to feed again.
    - Do you think she has reflux? I mean, I know all babies have some degree of reflux, but should I try zantac?
    - What about simethicone?
    - Any other suggestions? Thank you!

  2. #2
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    Default Re: reflux help please!

    My guess is all the spitting up is from the forceful letdown. This can take several weeks to resolve and is not a problem in and of itself as long as baby is gaining well.
    Keep doing what you are doing. It is perfectly normal for a baby to prefer being more or less upright laying on the chest of a trusted adult. Keep doing all the strategies for ffld esp. nursing very frequently and one side at a time. If it gets no better after a time you can try block nursing to reduce production but that is tricky so I suggest wait a bit on that. If you have. It read the kellymom.com article on forceful letdown, that is good info. I have had overproduction and oversupply with all
    3 of my kids it gets better I promise!

  3. #3
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    Default Re: reflux help please!

    What LLLMeg said.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  4. #4
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    Default Re: reflux help please!

    Agreed with the above. I'm only 3 1/2 months into this gig but here's my experience with both OALD and reflux---I guess! I keep going back and forth on the cause of all this spit-up and feeding fussiness in our case. It drives me crazy not knowing for sure but I think the key here is just dealing with whatever the day brings and keeping baby happy. It's good your LO is gaining weight so well--that takes a lot of the pressure off when she isn't feeding as well as you'd like.

    I've tried the OALD management techniques since the oversupply showed up, but could have been a lot more consistent with taking baby off before the letdown. Right now it comes and goes and when I know it's going to be forceful, I make sure always to take her off and let it spray into a towel before she comes off coughing, because it really makes her unhappy for the rest of the feeding---sometimes impossible to continue. It's weird because that wasn't always the case. For a few weeks she seemed minimally bothered by the gagging, but eventually she reached a point where it regularly started making her mad, so I realized I needed to be more consistent.

    Lots of people suggested to me that going off dairy was worth trying to help the reflux, so I did a couple rounds of no dairy, then reintroducing a little, and I *still* cannot tell you whether it made a difference. I thought so at first but there are so many variables at work here. (My current compromise is to restrict it as much as possible without going crazy reading labels, since it seems a total elimination diet is really only called for if you suspect a real *allergy* to cow's milk protein, not just intolerance that causes some reflux.)

    I have also looked in vain for a link between the days when OALD is not so bad and an improvement in the reflux, but that isn't always the case either. When we traveled for Thanksgiving I had been mostly off dairy for a couple of weeks, my OALD was more under control than ever before, and still, much to my dismay, I had to pass her around to family with a burpcloth and a warning attached because she was spitting up SO much those few days we were visiting, and was very restless/fussy after feedings. (Another case of not being sure which causes which--does the reflux hurt her and so makes her fussy, or is she fussy for another reason and all the thrashing around causes more reflux??) Frustrating.

    I'll tell you my experience with deciding to try Zantac. It didn't do anything at all, but this was at the height of the awful feeding fussiness around 6 weeks and when my doctor heard my description of her behavior, including arching away from me screaming, she felt confident it was acid reflux. I was scared the baby was going to develop feeding aversions, as it seemed she already hated nursing, and the doctor also warned me it tended to get worse around the 2 month mark. So I caved. Like yours, my baby gained weight extremely fast (4 lbs in the first month). I should have taken that into consideration when deciding whether this warranted medication--all the doctor had to go on was my description and my distress at how distressed the baby seemed, but---my baby still arches away from me and cries for who knows what reason. Any little thing can set her off while feeding and then if I don't get really creative or change the scene a lot (lying down, walking around), she will continue to cry and arch away from me each time I turn her to try to feed her again. People here will tell you that such behavior is actually common. Babies change all the time, can have volatile moods and nursing sessions don't always look like they could grace the cover of a LLL book! As much as I love good pediatricians (and mine is one as far as I can tell), they are not usually well-versed in breastfeeding behaviors and problems like the LLL leaders and lactation consultants who have had years of experience with their own and others' babies. So they are naturally going to be thinking in terms of a physical cause for the baby acting upset.

    Now that we have been on Prevacid for two months (after the Zantac "failed"), I kind of wish I had gone with my gut and just been more aggressive dealing with the OALD and more patient in doing what it took to keep my baby happy (NOT persisting in trying to feed her when she was worked up, holding/wearing her a lot, waiting out the peak fussy weeks to see if that was a contributing factor). It isn't easy. The roughest part of all this for me was trying to follow the advice to keep her upright for half an hour after feedings even at night, when she was up to eat every two hours for a few weeks. Especially when I noticed that even when I did that we still had the gagging, the puddles of spit-up, etc. What has definitely gotten better is the wakefulness, the random coughing and gagging while sleeping, and finding puddles of spit-up next to her when I go to get her in the morning. No longer spitting up every. single. time. I change her diaper, either, I just realized. But I don't know why! The only sure thing to remember here is that she *will* grow out of it.

    My doctor said gas drops are always worth a try.
    Last edited by @llli*tejana; December 6th, 2012 at 09:22 AM.

  5. #5
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    Default Re: reflux help please!

    I was on my dumbphone so I messed up and forgot a couple things. I meant if you have NOT read the kellymom article yet, read it. In fact, read it again even if you have read it, it's really good.
    Also-burps-As far as I am aware, one burps a baby to prevent/relieve pain from trapped air and not to prevent spitups. If the air is under the milk, whenever baby is burped, or burps on their own, then milk is going to come up with the air-right? Someone please enlighten me if I have this wrong, but I have never found that being aggressive about burping lessened spit up measurably. This may differ for bottle fed babies. Spitting up is normal, forceful letdown or no. But ffld can certainly make it more dramatic in every way.

    My most recent experience is with my four month old. She nurses, and usually there is some spit up shortly after. When the ffld was at its height, it could be a HUGE spit p and forceful itself. Now it's less but still, enough to need to change either myself or her once in a while.

    I never 'try' to burp her. Instead, I hold her upright after feedings for as long as I can. Unless I have to put her down, I don't. She goes in the sling or I just hold her or someone else holds her whatever. But especially when home I will lay her down more as I do stuff, and at this age, she is fine as long as I don't pop her down right after nursing. But then, suddenly she may cry or start to 'complain" and then I pick her up. And then she burps, and then she is fine.

    I am sure experiences vary with this. So....

    I also did various reflux meds with my oldest, who did show continuous signs of true painful reflux, according to the info on askdrsears on this subject. But I knew nothing about ffld at the time, which I certainly had. And since I also tried other things (holding upright longer after feedings, began bed sharing) at the same time I was never sure if it was the meds or the other comfort measures or baby jsut maturing that helped. Also the meds were tried at around 3-4 months old. I personally (my opinion here) would hesitate to do possibly uneeded meds or remedies of any kind at less than a month when much of what is happening (not wanting to lay flat etc.) is simply normal newborn behavior and the infant gut is still so sensitive to anything but breastmilk.
    Last edited by @llli*lllmeg; December 6th, 2012 at 09:56 AM.

  6. #6
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    Default Re: reflux help please!

    Quote Originally Posted by @llli*lllmeg View Post
    Also-burps-As far as I am aware, one burps a baby to prevent/relieve pain from trapped air and not to prevent spitups. If the air is under the milk, whenever baby is burped, or burps on their own, then milk is going to come up with the air-right? Someone please enlighten me if I have this wrong, but I have never found that being aggressive about burping lessened spit up measurably. This may differ for bottle fed babies. Spitting up is normal, forceful letdown or no. But ffld can certainly make it more dramatic in every way.
    I never bothered burping my kids. I tried a few times but it never helped their gassiness and never did anything to alter their spit-up patterns. Especially not with baby #2, who was a world champion spitter due to my forceful letdown and oversupply.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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