6 week old with reflux - medication? chiro?

[mama anne]

long story short - my 6 weekold daughter has been diagnosed with reflux by a gp. we are on gaviscon 6 times a day and this is really helping with her symptoms though she is still obviously in pain after a feed - i breastfeed her then give her the gaviscon mixed with expressed milk in a bottle after the feed, so she is grizzly for a little while, i'm assuming until the gaviscon takes effect?
we try to keep her upright for half an hour after feeds which also seems to help.

i suppose my question is where do we go from here ... a chiropractor friend spoke to me about how he has treated babies for reflux in his practice, and though it sounds promising i'm a little unsure as to how this works or perhaps how often this treatment is used in other children? also with the gaviscon, it has clearly made her feel alot better, but as i am breastfeeding it is a hassle mixing up the medicine and giving her a bottle after feeding .... i don't mind doing this at all because it is making her feel better, but will this be the routine until she is 6 months and it possibly comes a bit more under control with solids etc?

hope that makes sense!

[RISA]

Hi Mama Anne,
Congratulations on the birth of your daughter, and well done for managing to find answers to help her early. It isn’t always easy to pick up on, and to get that diagnosis, so you’re doing really well.

I have heard of a lot of children undergoing chiropractic treatment for their reflux. Some people do seem to have success with it, while others (like my son) aren’t so lucky. The thing about reflux that makes it so hard to deal with, is there is not one answer that will work for every child; they are all different, and what works for one may not work for another. Another difficult factor is that lots of people will give you advice, and often it is conflicting. Someone will tell you to pick them up every time they cry and someone else will tell you to do the opposite. It all comes down to listening to what they have to say, but following your instincts and doing what feels right for you and your daughter. If a particular treatment sounds like something you want to try, then give it a try, but if you don’t feel comfortable with the idea, then don‘t feel you should do it. It’s hard not to feel guilty sometimes, but you do have to do what feels right for your own situation.

Talk to your friend some more about what the treatment involves, and talk to your local doctor if you’re unsure. Maybe then you will feel comfortable deciding either way.

With the Gaviscon, did your doctor tell you to give it to her after a feed? If he wasn’t specific, then perhaps it would be more effective given before the feed? If your doctor is happy for her to have it then, it may be worth trying. If she objects to that, even part way through the feed may be okay as well. Sometimes it’s worth playing around with the timing to see if it helps. You may also be able to give it from a spoon, which you may find easier than a bottle (though at 6 weeks not necessarily. Some babies do cope just fine with it though)
How long has it been since you have seen the gp? Is he aware the Gaviscon is working so successfully? Gaviscon is a medication that works in the short term only (hence why you need to repeat the dose so often), so rather than continuing to use Gaviscon, your doctor may decide to use one of the acid suppressing medications like Zantac or Losec instead. It can make life easier if you don’t have to hassle with medications quite so often, and she may be even more comfortable throughout the day. I guess you need to find out if he is happy for her to remain on Gaviscon indefinitely, or whether some of the longer acting medications might be better?

It’s hard to judge how long her reflux will cause issues, sorry, and therefore how long she will need to stay on medication- it’s something that cannot be predicted. While a lot of babies do improve at around 6 months (by which time they are often sitting up and on solids), there are still quite a few who do continue to suffer from reflux until 12 months (generally walking), or even longer. I wish I could be more specific, but reflux just isn’t that easy, and they are all so different. We were given milestones, and for my son, he didn't improve at the times we were told, and I found that quite devastating. I firmly believe parents should know that the chances are good that they will grow out of it early, but also be aware it may not happen then either.

Good on you for keeping her upright for half an hour following each feed; that’s often quite a helpful strategy. There are others that may help as well, such as:-

• elevate baby’s head and shoulders during nappy changes to avoid laying them flat on their back, which may cause discomfort due to increased reflux.

• roll baby to the side, and don’t lift legs up while changing nappies.

• where possible, change her prior to a feed and ensure that nappy and elastic waistbands are quite loose around the tummy.

• Try to keep baby upright as much as possible throughout the day, and avoid positions that she slumps in. There are a lot of products on the market that you may find helpful.

• try tummy time before a feed; and perhaps try laying her on an incline/wedge rather than flat on the floor. Even if you only get a few minutes before she starts to squirm or vomit, that’s ok. Try to do it as many times a day as you can.

• Many parents find the use of baby pouch helpful while others use a baby swing or baby seat.

• using an upright position to feed baby –try feeding in the twins position or even standing up to feed so you can keep her more upright.

• try giving her smaller, more frequent feeds but try not to overfeed ie – 3 hourly for breastfed babies, the idea being that it takes this long for the stomach to empty, but if they want to feed constantly as quite a lot of reflux bubs do, their tummy is never empty and this can cause pain due to increased reflux.

• if she vomits her feed don’t feed again right away

• a dummy is helpful for a lot of babies. Saliva helps to neutralize acid, and using one may help to encourage swallowing. It can also wash out any acid in the oesophagus as well.

• Although research has not shown that slightly elevating the head of the cot to be of any benefit (while the baby is positioned on their back), it may be worthwhile to try as it may provide your baby with a certain amount of relief. If you do find that elevating the bed is helpful, it is recommended that you discuss this with your Doctor.

I hope some of those ideas are helpful, and I hope I've answered your questions. If there is anything else, please feel free to contact us again,

Glenda

[mama anne]

thankyou for the quick reply :)


It isn’t always easy to pick up on, and to get that diagnosis, so you’re doing really well.


i knew that something was different as her personality totally changed within a week and she was clearly in pain .... the gp said to me "it's either reflux or colic, if the gaviscon works then its reflux"
so it wasn't the most reassuring thing at the time, but now we know what it is i need to go back to him and tell him about her improvement (we saw him on thursday).
whilst he was sympathetic, i'm not completely convinced he took me seriously ..... so the next question is, any strategies for my next appointment .... do i request medication? how proactive should i be ith regards to her treatment .... i'm new to being a mum and also to dealing with doctors for anything other than regular type things.

also ... i feel quite helpless when she's in pain, like i should be able to help her because i'm her mum. i also worry (perhaps due to ignorance about this on my part) that developmentally this will hurt her, due to limited or a lack of time on her back/tummy playing/batting at things .....

anyway just random thoughts really. thankyou in advance for any possible insight :)

[RISA]

Hi Mama Anne,
It’s hard when you aren’t exactly convinced your doctor is taking you seriously, but perhaps he will seem more supportive for your next visit when you let him know how successful the Gaviscon has been. As you say, he has proven the reflux diagnosis, so that may be enough for him.

If you still don’t feel happy that he is getting the whole picture, then there may be a couple of things you can do. Keeping a written record of her day, or take your partner or family member/friend with you to back you up. If all else fails, video any behaviours you are concerned about and show him.

To prepare yourself for your next appointment, sit down and think about all the things you want to discuss. Write them down if you think you will forget (and it’s not easy trying to cover everything when you are stressed and have a baby with you). Think about what you want to get out of the appointment, and be as proactive as you like. She is your baby and you need to follow your instincts, and try to do what’s right for her. If you aren’t happy with something, ask for clarification or an explanation. If you want to know about a particular treatment, then ask.

You will need to be guided by your doctor, so ask him whether she would be better on a longer acting medication (such as Zantac or Losec). I wouldn’t be at all surprised if that is his plan, but if he wants her to stay on Gaviscon, let him know how inconvenient it is for you. That may impact on his decision as well. Clear communication is the key to helping you get what you need out of the appointment.

All those emotions you have right now are very normal. As a parent, when our child is in pain, and nothing we do helps, it’s terrible. We’re conditioned to think that as a mum we can comfort our child, so when we find we can’t, it can tear us apart. I can remember feeling so inadequate (I really felt like a failure and that I wasn’t cut out to be a mum). If it all gets a bit overwhelming, try to focus on the things you have done right, rather than what is going wrong at the time (things like recognising something was wrong, getting her the medical attention she needed, and getting the diagnosis, learning about reflux and some strategies). In the few weeks you have been a mum, you have already achieved a lot so don’t be too hard on yourself. Remember too, when she was born, you didn’t suddenly become an expert on babies, or on reflux, and it is a really steep learning curve. Just continue following your instincts and if you are concerned, continue to seek medical advice.

I also think a lot of parents worry about their bub’s development, and especially reflux families; I can remember discussing that very issue with our specialist. He said that sometimes they may be slower in some areas, but often they are more advanced in others. They will eventually get there though, and you can only do the best you can do. Because she is doing so well now on Gaviscon, hopefully her reflux will be well enough controlled that none of that will be an issue anyway. Add that concern to the list of things you want to discuss with your GP; he may be able to allay your fears in that regard.

I hope that helps
Glenda