Reflux-and not sleeping

[pippa]

Hi,

My litlle man is mearly 8 weeks old and just been diagnosed with reflux. He is currently on Omeprazole, 2mg twice daily. He doesn't vomit but just get really bad pain, with screaming, crying and back arching after feeds (not after every feed) and at other odd times of the day.

He is also cat napping during the day and can sometimes go 2 hourly between breastfeeds overnight. I am trying to work out ways to get him to sleep during the day but arn't having much luck. He just seems to get himself so overtired at times which then obviuosly if he gets upset triggers his reflux.

Can anyone give me any hints onto how to get him to sleep longer than 5-40mins at a time during the day.

Cheers

[RISA]

Hi Pippa,

Congratulations on the birth of your son, but my goodness, it sounds like things have been really difficult for you in the last 8 weeks. I’m really pleased to hear that your doctor has been able to diagnose reflux so quickly and that he is already well on the way to find a treatment that is effective for him.
When you say ‘just been diagnosed’, how long ago was that? It can take a while for the medication to start working, though for some it seems to work remarkably quickly. For others, it may take several weeks, or even more, before you notice any difference.

I’m sure with the various issues he is displaying, you must be stressed and exhausted. I can remember that age, and dealing with issues like that was just so demoralising too (especially as everyone thought it was something I was doing wrong, including myself).

As you’ve worked out, as he gets more overtired, he will get more upset, which will trigger his reflux. Being overtired on its own can flare the reflux, and the fact that he is getting so upset as well, of course makes it worse.

Are you able to recognise his tired signs? (such as jerky limb movements, clenched fists, yawning or eye rubbing) If you respond to them quickly, that can help get him to sleep. If he goes beyond that, you have a much smaller chance of being able to settle him. It can be tough to get into a routine- really tough, but the better the routine, the better he may settle.

Are the feeds going well? Are they also a factor for you, or is the distress after feeding and the issues he has with sleeping the most worrying aspect? It isn’t unusual for reflux babies to also have problems with their feeds as well. Some will want to snack rather than feed properly, others may refuse feeds, while others want to feed quite frequently. These can contribute to the sleeping issues as well.

Without knowing how his feeds are going, I would just say to try to make sure you do have a good routine with the feeding. Feeding too frequently can cause more reflux as it may lesson the chance of the tummy ever emptying. (I may be totally off the mark, but I just wondered, I suppose, because my son sounded very similar, and he/I fell into the trap of feeding him way too often (every hour at times), which only made the situation worse.)

It’s really important, with any sleeping issues, that you trust your instincts too. A lot of people (I know from personal experience) will tell you to let him cry and not to pick him up too much. If your gut feeling is that he is in pain, you need to do what is right for both of you, whether it is to pick him up to comfort him, or to try to settle him.

Have you tried elevating the head of his cot? That may or may not be helpful, but may be worth trying. Other suggestions you could try are
- try giving him a relaxing massage, bath, or lots of skin on skin contact, which may help soothe him
- wrap him securely
- try carrying him in a baby sling during the day (making sure he doesn’t slouch in them)
- leave something in his cot/bassinet that has your smell on it (eg a breastpad), or maybe try putting one of your t-shirts over the mattress, which he may find comforting as well.
- Because they can be woken easily, keep all noise to a minimum. Use white noise in the background, such as that from a radio, CD with music or lullabies, or a repetitive noise like vacuum cleaner, air-conditioner or washing machine.
- Try putting him to sleep in his rocker, tightly wrapped
- Try using a baby hammock or gentle baby swing, or any other device that can gently rock baby; there are quite a few on the market you may like to look into.
- Put him in the pram and go for a walk and
- If all else fails, let him sleep upright on your chest.

Its also important that you are able to have some time to yourself. Are you getting any support? Getting a break once in a while to recharge your own batteries or get some much needed sleep? It is important that you get that, which will in turn help you care for your little man. I can imagine you need some help right now, and I really hope your family and friends are being supportive.

If you continue to have problems, or have any concerns, then please go back to your doctor. There are times that no matter what you do, if the reflux is causing too much pain or other problems, the doctor may need to adjust the medication dosage, or change it to something else. Please keep in touch with your local doctor, and let him know if things don’t improve.

One more thing thatl may be worth mentioning, is that there are some reflux babies who do have problems with cows milk protein, and if you are having any, it will go through your breastmilk. If you do ever want to consider that possibility, please seek medical advice about it as it's important any changes in your diet are done under medical supervision. Not all reflux babies do have this problem though, but I just thought I would mention it. In case things don't improve you may like to consider it at some stage.

I hope that helps, but please let us know if there is anything else we can do, and if you need any further information, please ask,

Glenda

[pippa]

Hi Glenda,

Thankyou so much for your reply. He was diagnosed last wednesday, I have noticed the signs on and off for the last few weeks but wasn't quite sure if it was reflux. Then the two days before we had our 6 week checkup with our paed he played up big time. So we told our paed and thought it was definatley reflux so started im on the omeprazole.

I know it will be trial and error to see what works for him. I think that the omeprazole has made a bit of a difference but is still not working to it's full effect. I am wondering if anything i'm eating could be affecting him so i'm just trying to see what he reacts badly too and try and minimise eating those things.

My partner went back to work today (he had 8 weeks off) so during the day I will mostly be on my own, but I do have some very good friends who I can call on if I need to and a mother in law (if I'm really desperate).

Today he hasn't been too bad. Now with the hot weather it is a chore keeping him cool. I keep overwrapping him I think and then he gets hot and upset. We have air conditioning which I have turned on and i just gave him a nice bath which helped him to settle (he is now asleep) cross fingers for a while.

I just feel sorry for him because he doesn't seem to sleep much during the day. He does fall asleep in our arms but we find that sometimes (mostly during the day) as soon as you put him down in either his rocker or his bed he wakes up and then you have to start again. We are really worried about getting him into bad habits by constantly letting him fall asleep in our arms and not being able to go off himself. But I know that maybe we will have to do it because of his reflux.

What your theory on soft drinks and reflux. My only vice is that i have 1-2 cans of coke a day. I don't drink tea or coffee so this is my caffiene boost. But I have read that I should avoid them????

Cheers

[RISA]

Hi Pippa,
It’s probably not great that he had a rough few days before you saw the paediatrician, but I have to love your little guy’s timing!!!! How perfect- before the day so you haven’t just had the appointment and then things turned rotten, and not too far ahead so that he started to improve again and you wondered whether you should mention it or not!!!!! I may just have a funny way of looking at things, but it was probably good if he was going to have a few really rough days, that he did it when he did!!!

I think it’s good that you have noticed that the Omeprazole has made some improvement already, but it can still take a while longer to be more fully effective. If you are still concerned though, please get in touch with your paediatrician again.

It can be REALLY confusing if you factor in some of the things you could be eating. I mentioned cow’s milk as that is a fairly common problem one for refluxers, though of course not all. If you need any help figuring that out, or you do have strong suspicions diet plays a role in his reflux, I would recommend you speak with a dietician.

Oooh yikes, with your partner going back to work. I hope that your friends will be supportive of you. I always hated Monday when my hubby went back to work (after the weekend off), but after 8 weeks, that would have been tough, I’m sure- even without the reflux. It is important that you do continue to look after yourself too, so ask friends for help if you have to!

I hope the bath and the aircon helped him settle, and I should have mentioned too- really hot, sticky weather like we are starting to have, can be another flare factor for refluxers. It’s hard to create that happy medium though, of not too hot, not too cold, everything just right!!!! I hope he had a great sleep!!! And you caught up on some too if necessary.

With the worry about getting into bad habits because you have to let him fall asleep in your arms- sometimes it comes down to having to do what you have to do- if you find something, anything that works, then go for it. My philosophy was always if you do create problems, then down the track, when the reflux is more controlled, you can sort out any other issues. Often, it doesn’t seem to make any difference what you do, but if the reflux is not controlled, then nothing much will work. If nursing him to sleep during the day is working for you at the moment, and nothing else is, as you say, you don’t have much choice! Try not to feel guilty about it either, as it can be a matter of getting through the day the best you can.

It would probably be ideal if you were able to avoid your cans of coke, even with them being your caffeine boost. It doesn’t sound fair though, does it, as it’s your only vice!! It is totally up to you, of course. Caffeine apparently relaxes the oesophageal sphincter, even further increasing his chances of refluxing. You need to decide whether it makes enough difference to you and not enough difference to him, and decide whether it is worth it.

All the best

Glenda