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Thread: How do I breastfeed my baby with Reflux?

  1. #1
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    Default How do I breastfeed my baby with Reflux?

    I have been through so much with my little one. She is now 5 months and this has been an ongoing issue. She has reflux and is on ranitidine. At 4 months I started to wean her due to her refusing feeds both formula and breastmilk via breast and bottle. Offering formula due to sheer desperation, a constant screaming baby and poor weight gain.

    She has always been slightly fussy at the breast due to tiredness from jaundice and then anaemia, so we have defiantly not had it easy. In the last few weeks, she has started to reject food as well as breastfeeds. Please tell me how to feed my child. I have tried everything from feeding little and often to positing. I have done everything anybody has suggested and what I have read. Nothing actually works. My midwife and my heath visitor have been useless and don't seem to have any advice to offer other than lets see how she goes. After waiting 5 months, things still haven't got better and i'm hitting breaking point. I really want to continue breastfeeding but don't know how. HELP!

  2. #2
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    Default Re: How do I breastfeed my baby with Reflux?

    Hi mama! I'm so sorry about the difficulty with your baby's feeding and weight gain. It might be helpful if you could post a full weight history- birth weight, lowest weight, weight at each check-up. Also, can you describe her feeding patterns? Before this strike, how many times per day did she nurse (in general)? How many bottles per day did she get (in general)? And when you say you started weaning her at 4 months, do you mean that in the British sense, i.e. introducing solids, rather than the American sense, i.e. ceasing to nurse?
    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!"

  3. #3
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    Default Re: How do I breastfeed my baby with Reflux?

    Yes mommal has good questions. We can't tell if baby is nursing now, bottled fed, combo? It's unclear. How are/were bottles given (have you tried paced bottle feeding?) and how much is in the bottle? Also, how often are solids offered, how are they offered, and what are you giving your baby to eat?

    Also how are the meds working? any improvement after starting those? How was reflux diagnosed?

    When you say nothing works...what do you mean? Is baby not gaining weight? Losing weight? Literally not eating anything? Eating only sometimes? Or eating, but not as much or as often as you have been told she should? etc.

  4. #4
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    Default Re: How do I breastfeed my baby with Reflux?

    Sorry, I think my post was sent with haste of sheer desperation. She has continually gained weight but very slowly. She has never lost any weight but her weight gain hasn't been what health visitors/midwives would like. She regularly falls off the centiles of where she should be at but as I say has always gained. She was 3.340kg at birth and is now 5.875kg at 22 weeks, she did loose weight after birth, which I am told is normal which was 3.170kg. She doesnt really have a feeding pattern as I demand feed, she did used to nurse for an hour or two and then maybe go an hour in between.

    Before the strike she had baby rice 3 times a day, Breakfast, Lunch and Dinner and would feed as and when she wanted which was usually in the morning before breakfast and before and after meals and then two main feeds between Breakfast and Lunch & Lunch and Dinner. These particular feeds would last approx 30mins maybe more and the lesser feeds 15mins.

    Sorry when I say weaning, I mean in the British sense, a little baby rice or porridge with breastfeeding. My baby was combined fed with formula and breastmilk as my supply started to decrease however since I have started taking Fenugreek and Donperidone this was no longer a problem and formula stopped. She tends to have a small bottle to feed her medication and the rest fed by breast. I would prefer to breastfeed her but obviously will give whatever she will take.

    She has been much better since meds, alot more settled and defiantly doesn't cry as much. Reflux was self diagnosed and brought to the attention of health visitor/doctor/consultant who all agreed.

    She's hardly feeding from the breast and taking food is hit and miss. Sometimes she takes it no problem then other times she will just cry when the spoon comes near her. When she is at the breast she is either on off or fusses and shakes her head.

  5. #5
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    Default Re: How do I breastfeed my baby with Reflux?

    Ok, first, you asked how to help your baby want to nurse. The best source for info on that, imo, is this article: http://kellymom.com/bf/concerns/child/back-to-breast/

    Ok, I have to convert everything to pounds and ounces, so after converting, I am getting a gain of about 6 pounds in 5 months?

    Yes, that is slow gain overall. Typical gain in the first 3 months (after the initial loss which is normal) is ~ a pound (or a little less) every two weeks. But after 3 months, weight gain rate slows down quite bit, and slows again a few months later. What pattern is your baby following with gain?

    You mentioned anemia. Any chance this has not been resolved? I think that severe iron deficiency causes a lack of appetite.

    Ok. Sorry, I still don’t understand quite want is going on right now.
    If baby will not nurse and will not eat, what is baby living on right now? Is baby getting dehydrated?

    I am not sure what the recommendation in the UK is, but in the US, the latest recommendation is that solids of any kind are not suggested until 6 months. However, some doctors (notably Jack Newman who is Canadian) do think that some solids earlier are ok instead of formula IF baby is not gaining well on the amount of breastmilk available. But this would probably not be needed if baby is able to get enough breastmilk. You might want to read his thoughts on this subject.

    One reason solids are potentially a problem prior to 6 months (and even after, if introduced too quickly or in high amounts) is the baby fills up on lower calorie solids rather than high cal, high fat breastmilk or formula. So when solids are introduced to increase gain, it might make sense to choose solids that maximize the healthy fat and cal content. While of course every baby is different, I think 3 meals of solids a day is a lot of solids to expect a baby who is barely at the age of introduction to take in, and this amount would be likely to interfere with breastfeeding.

    But since I gather gain was always slow, was breastfeeding ever assessed, baby assessed for issues causing poor transfer? Any idea what caused your low production? Or was low production just assumed due to the slow gain, and formula started? or Was the slow gain blamed on reflux alone?

    One thing about reflux is that while the pain from reflux might cause avoidance of eating in its most severe form, it does not usually cause a baby to nurse less. Because breastmilk is soothing, babies with reflux often nurse more often than average.

    The problem is, at this point, you may well have low production because of the formula and the solids. On the other hand, if you feel your production is normal great. Is this based on pump output?

    The introduction of bottles and solids may be creating breastfeeding issues. Why baby won’t eat I of course cannot say. But generally, a baby won’t nurse because either they cannot,(there is some unsolved latch or sucking issue) or they have been trained, perhaps inadvertently, to eat from a bottle rather than the breast, and/or trained to comfort with a pacifier, rather than the breast, or they are full from other foods.

    A book that may help you is My Child Won’t Eat by Carlos Gonzalez, a pediatrician. It is not a book about making children eat. Instead, he explores the issues around food intake (starting with breastmilk or formula) weight gain, growth, charting, and child nutritional recommendations and growth expectations and whether they are accurate, helpful or realistic etc.
    Last edited by @llli*lllmeg; August 1st, 2014 at 09:10 PM.

  6. #6
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    Default Re: How do I breastfeed my baby with Reflux?

    I'm just going to back-convert this to metric.

    Quote Originally Posted by @llli*lllmeg View Post
    Typical gain in the first 3 months (after the initial loss which is normal) is ~ 0.453 kg (or a little less) every two weeks.
    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!"

  7. #7
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    Default Re: How do I breastfeed my baby with Reflux?

    Have you considered seeing an IBCLC to assess your breastfeeding? Usually this has to be done privately and not on the NHS in the UK

    As said above baby rice can hinder weight gain tho some HV's still push weaning and esp baby rice at month 4 they are not supposed to and if they work in an area with or working towards it's unicef baby friendly award it is frowned upon and in my area at least it is worthy of disciplinary action if they are caught doing it. Unfortunately most mums don't know this I said this because I am aware you are probably doing it because you were advised to.

    As above mashed higher calorie foods are preffered over baby rice if food is recommended.

    Are there any LLLI groups in your area or peer support groups? They might be able to help also.
    Last edited by @llli*bsua65; August 2nd, 2014 at 11:36 AM. Reason: Mispell

  8. #8
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    Default Re: How do I breastfeed my baby with Reflux?

    When you say pattern do you mean Centile? She is currently on the 9th.

    Its probably better if I give you a history of Charlotte, she was born with rhesus incompatibility to me. She was born extremely jaundice which meant she couldn't actually feed as she would just sleep. I did everything to wake her up but nothing would work. I was lucky if she got a 5 min breastfeed, so I would express and give her that and then supplement with formula as guided by doctors. This was a no choice situation as when she didn't feed well her billirubin levels would rise and it risked her hitting exchange and ending up on special care but still I continued and fed her when I could and when I couldn't I would cry and go with the above. As her jaundice improved she would feed from me for longer but as she got tired a bottle top up would be offered. This was suggested by all medical professionals as she needed her rest to. I was advised to feed for no more than 40mins. In addition she would also required medication which she would only take mixed with milk, as she still does now.

    Once this eventually settled down her blood started to hemolyze which caused the Anaemia. Again she was very sleepy with this, although she did feed better and I was able to got to solely breastfeeding with a few top up feeds which tended to be late in the evening. This was until she didnt sleep at all and cried 24/7 was fussy as the breast would make wheezy sounds, occasionally be sick etc, all reflux issues which was when it was discovered.

    At 4 months Charlotte completely refused to feed breast or bottle therefore weaning was introduced. I am aware of the 6 month issue however, I had no choice and as I had no help from any professional. I had to make a decision as a mother. Weaning began beautifully, it was introduced very slowly and she loved it however as I said earlier its hit and miss sometimes she eats little and sometimes she refuses it completely. My question was more aimed at the advice of getting her to breastfeed. She is either on off or thrashes in refusal. She isnt getting dehydrated as I offer her milk/water regularly from a bottle which she will take bits of, but obviously I am concerned for her next weight check due to her refusal to eat. The fact is I know she is still hungry by her ques but she wont take any more food or breastfeed and what little she does take, I do not feel its enough to sustain her.

    Anaemia is still a slight issue however she is only slightly anaemic now and her doctor is no longer concerned about it and blood tests have just been stopped.

    Breastfeeding has never been assessed no, but midwifes and healthvisitor has seen me feed her and found no issue. My low production was noticed by myself in her hunger and through the amount I was getting from the pump. During this time she was topped with formula. Slow gain hasn't been blamed on anything, it has been accepted due to the issues she has had including colic in the early days and no before you ask this wasnt reflux masking itself. It was genuine Colic and was confirmed by docs.

    There is nothing I can say regarding reflux causing her to nurse less except that this is all anyone can put it down to.

    My low supply was not because of weaning or formula as I pump regularly to maintain a supply and in fact should have an over supply however I am never more than a day in front with milk storage and this is usually on days she does not feed.

    I don't feel she has been trained not to nurse as there are occasions, rarely where she nurses without a problem. I dont know what goes on with her, its been a very long and hard road and we have had nothing easy, even feeding.

  9. #9
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    Default Re: How do I breastfeed my baby with Reflux?

    Quote Originally Posted by @llli*bsua65 View Post
    Have you considered seeing an IBCLC to assess your breastfeeding? Usually this has to be done privately and not on the NHS in the UK

    As said above baby rice can hinder weight gain tho some HV's still push weaning and esp baby rice at month 4 they are not supposed to and if they work in an area with or working towards it's unicef baby friendly award it is frowned upon and in my area at least it is worthy of disciplinary action if they are caught doing it. Unfortunately most mums don't know this I said this because I am aware you are probably doing it because you were advised to.

    As above mashed higher calorie foods are preffered over baby rice if food is recommended.

    Are there any LLLI groups in your area or peer support groups? They might be able to help also.

    What is a IBCLC? How do I go about doing this? I would be extremely interested if it can help.

    She does have porridge as well as baby rice but tends to take the baby rice better. She refuses other foods, so I am restricted. Any ideas are welcomed.

    Not that I have noticed. I would love to go to some kind of group to help. There is a breastfeeding support woman at my local surestart centre but I have found her useless and all she does is praise me which is lovely as I haven't been told anything positive from anyone, however no advise is ever offered even when asked for.

  10. #10
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    Default Re: How do I breastfeed my baby with Reflux?

    Ok. First I want to say that discussions on the internet are difficult and I am sorry if anything I said or how I have put my questions are off putting. I understand you are very worried and want to do what is best for your child. You have had a difficult few months and I really do understand that. Yet your child is gaining and I assume, developing normally, or else (Again I would assume) your hcps would have more concerns than they do. If how I have phrased things have made you feel defensive, I am sorry. I am asking the questions I am asking because I am trying to make sense of your situation in the hopes I can help. When a mom is looking for answers for issues that perhaps began much earlier, I feel I must look at the entire picture to give my best answers. It is not about assigning blame, it is about finding the answers, or at least trying to. Because sometimes, if you know what caused the problem, that gives you a path for solving it.
    Here are some reasons I am asking the questions I am asking.
    many, many moms are told they have low production when they do not.
    Many moms think they have low production when they do not.
    Many moms are told to supplement with formula when it is not needed especially in the early weeks
    Even when supplements are 100% necessary and appropriate, they can STILL be harmful to breastfeeding. This does not mean don't supplement or that it was wrong to supplement in the past. It means, there will possibly be consequences even when supplements were/are needed.
    Reflux is frequently misdiagnosed and/or the effects overstated
    Growth Charts and percentiles are often misleading.
    Pump output is a poor indicator of milk production
    infant behavior is a confusing indicator of milk production
    While pumping is a good idea & important if supplements are given, pumping is not the same as nursing and is, in some cases, not going to keep production where it needs to be. Plus, it is a very hard thing to do.
    You don't say how much you are able to pump or how much baby is taking in with the bottle?
    Solids are introduced at an early age for many reasons, usually ones for which there is no data or proof of effectiveness, such as for slow gain or as a treatment for reflux. But, as I noted above, according to Jack Newman, a breastfeeding expert, early solids are, in his opinion, an appropriate choice in some situations.


    I do not have any ideas for encouraging a baby to eat more solids. For understanding that issue better, I again suggest the book My Child Won't Eat.

    For encouraging nursing, I again suggest the ideas in the kellymom article. For encouraging baby to take a bottle, I would suggest trying paced bottle feeding which allows baby control over the flow and may be more relaxing for baby. Here is information on this: http://www.llli.org/docs/00000000000...astfedbaby.pdf and http://www.bing.com/videos/search?q=...FD00534CAAC56E OR, maybe seeing if baby would like a sippy or open cup better.

    Have you checked your expressed milk for signs of excess lactase? It gives expressed milk a soapy smell. The smell usually happens after the milk has been refridgerated or frozen. The milk is fine, but some babies object to the smell and will not drink it.

    I am still very confused about how often your child nurses or takes a bottle, I thought you said she has not nursed or taken a bottle for a month, which I guess is not the case, but this is why I was wondering about dehydration. Also, water- If baby will take a bottle, does it matter what is in it? If baby will drink anything, probably best to have that be formula or breastmilk. Both contain plenty of water so there is no need for additional water. It does not sound like baby is taking a lot of water, but if baby is quenching thirst with water that also may cause a baby to not nurse/bottlefeed as much as normal.
    Last edited by @llli*lllmeg; August 2nd, 2014 at 03:15 PM.

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