View Full Version : Struggling With Bottles
In recent weeks my DS has been struggling with his bottles. He has been diagnosed with reflux since he was about 4 weeks old and has been on .25ml of Zantac 2 times per day since but this is a recent problem. Basically he'll be sucking away on his bottle and if he comes off or I have to burp him I can't get him to take it back no matter how much he's taken. It's usually not until it's time to put him to bed that he'll take it back. He isn't a huge vomitter - it's more the stomach acids coming up and him gagging on it - which doesn't happen that often anyway.
My local MCHN said that the half bottle thing is quite common for reflux babies. So if this is the case is there anyway I can help him? I've tried slow and fast flow teats. But it can happen with either. He also in general is very sporadic with his feedings too. Two days ago he had 5 feeds totalling 650mls for the day which is where he averages but yesterday he had 8 feedings and just over 1000mls! If going by his weight he should be having 1050 but that never happens until yesterday. He is putting on heaps of weight regardless so at least I don't have to worry about that.
Is this all to do with the reflux or is he just a fussy unsettled baby? It took us 5 hours to get him to sleep last night as he was just constantly hungry but wouldn't take much at a time.
Please help. I'm at my wits end.
:(
Hi Pebilz,
It sounds like things are quite tough right now, and it is certainly very common in reflux babies. I’m sure you are both exhausted!!! Have you been back to the doctor to have him reviewed, just to make sure there is nothing else going on (like an infection of some kind)? While the chances are it is his reflux, it is important to remember that any issues aren’t always due to that. Even though his weight isn't a problem, that doesn't mean his reflux isn't a problem either! (though it can sometimes be harder to get the attention you need because of that as they generally look so well)
There are probably a lot of things you can do once you do ascertain that it’s his reflux. From talking to lots of other families, ‘fussy, unsettled babies’, especially those ones already diagnosed with reflux, tend to have not well controlled reflux, and life does improve once the reflux is better treated. Please try to remind yourself that this isn’t your fault and you are not doing anything wrong! It’s often a matter of trial and error until you find something that helps, and since things aren’t great right now, it just means that you haven’t found all the answers yet.
I would recommend talking to your doctor about the possibility of increasing his Zantac, as that may be helpful. Zantac is a weight related medication, so as a baby puts on weight, the dose of Zantac needs to be increased to keep at the same level. You don’t mention it has been increased, so I gather it hasn’t? It also sounds like the dose is quite small as well, though there is a large range of doses that doctors do use- it just may give you some options to discuss with the dr. Also, there are other medications taht are used as well, which can be more effective for reflux babies (eg Losec, Zoton)
The fact that his Zantac dose would have been progressively getting smaller as he put on weight could explain why he has been struggling with his bottles lately. Also, reflux can flare in a lot of situations- this really hot sticky weather we’ve been having is a common trigger; and at his age, many refluxers also tend to be worse (they are still on fully liquid diets, are becoming more active, but can’t make meaningful movements like sitting themselves up- which means they tend to slosh the milk around more and can reflux more). Also, things like teething, any infections, even colds; overtiredness, a change in routine, or vaccinations can flare reflux (all pretty hard or impossible to avoid).
It may also help to know that reflux can cause problems with their sleep and their feeding. The fact that he wouldn’t take much of a feed, but was constantly hungry, sounds like very classic reflux. While some babies do refuse feeds with their reflux, others want to snack frequently. Those who refuse work out that feeding is causing problems and you can’t convince them to drink. Others comfort feed because they work out that while they are feeding, they feel better, so often will demand small amounts quite frequently, which sounds like what your son was doing.
The problem with that, is that it never gives their stomach a chance to empty, and a full tummy is more likely to cause reflux. It’s a vicious cycle because when they are refluxing, they demand a feed to ease the discomfort. They have a little bit, because they aren’t really hungry, but want to feel better. Their tummy is full so they reflux more easily, and so they demand another feed. While that cycle is very hard to break, if you can get the feeds back to a more regular routine, it may actually help lessen the reflux. Talk to your doctor or pharmacist, as using an antacid to help here might work.
Of course when their feeds are problematic, they don’t tend to sleep well either. This can make for a very overtired baby, who of course refluxes more as a result!
Have you had a look at our website, to see some of the management suggestions? Are you able to keep him upright for feeds and for some time after? Are you having any success in keeping him upright through the day? Some mums use a pouch (being careful they don’t slump in it, as any pressure on the tummy can cause reflux). Others use products such as baby seats, bouncing seats, baby swings, hammocks etc with some success. As with all aspects of reflux, it’s a matter of trial and error until you find something that works, so there are no ‘right’ answers. It’s about trusting your instincts, trying things that you feel comfortable with, until you find something that suits.
Sometimes a dummy/pacifier can be helpful too. That may help with his need to constantly feed, but dummies can also help with reflux (if he will take one).
I hope too that you are able to take some time out for yourself. Dealing with a reflux baby can be very stressful and overwhelming, and it’s really important you look after yourself as well. Do you get a break? Even if it’s just some time out, it’s better than nothing. It can help you feel more able to cope with the situation, and can help you feel more in control.
I hope some of that information helps, but if you would like to know more, please continue asking questions.
Glenda
Hi Glenda
Thank you for your respsonse.
My son's Zantac hasn't been increased but I will be taking him to the paediatrician this week so hopefully he can change the dosage as it doesn't seem to do anything at all for him. Can you explain what the difference is between the Zantac and an over the counter antacid? The thing is he never seems to be in any pain at all. The only symptoms I seem to notice are the stomach acid and him not taking the bottle back regardless how much he's had.
As for keeping him upright it can be difficult especially if he needs to sleep - which very often happens after he's finished his bottle as putting him the sleep is usually the only tactic I have in getting him to eat!!
He doesn't use a dummy and it's not something we want to introduce but he does constantly want to suck his hands. I would let him do this when I put him down to sleep but he won't fall asleep unless he's wrapped - not that he thinks that though constantly fighting to get out.
So would you recommend trying to put him on a feeding routine - say 4 hourly? I know my daughter was 4 hourly at this age and would always have the same amount at each feed. Can you suggest a way to do this without starving him if he constantly snacks?
As for timeout well I'm lucky to get half an hour to perhaps an hour during the day IF both kids are asleep at the same time but I usually have my lunch then and will put my feet up if I can but it's not usually the case.
Thanks for your help. Any suggestions you can make would be wonderful. I'll check out your website too.
Hi,
It sounds like it’s a good plan to take him back to see the paediatrician. Having your child reviewed when you aren’t sure whats happening is a good idea, and so is continuing to let the doctors know that his problems are still an issue. (if you don’t go back, they don’t know that).
He doesn’t necessarily have to have a lot of pain to be refluxing or for it to be affecting his feeds- and they need to determine the reason behind why his feeds are so difficult (and if it isn’t reflux, then what?). Sometimes too, children can show pain differently, and from your previous letter, you mentioned he was fussy and unsettled. That may be his way of showing you he’s in pain, though for others, they may cry or scream to let you know. They are all different; they all present differently and they all respond differently. They also respond to treatments differently, making Gastro-Oesophageal Reflux one of the most difficult conditions to grasp, in my opinion.
Given his weight gain recently, the paed may consider increasing the Zantac to keep in line (and it will be interesting to hear what he has to say. He may even change it). Zantac suppresses acid production in the stomach, which provides a constant level of relief. It is given regularly to maintain that control throughout the day. An over the counter antacid such as Mylanta neutralizes the acid it comes into contact with. It can offer relief quite rapidly, but the effect is very short term (maybe a couple of hours). It is generally used when there are only occasional symptoms, or at times to offer relief when the regular medication needs a bit of a boost. Sometimes, if you are having problems with the feed, if the paed is happy with you giving an antacid, you could give a dose. It may be enough for him to feed well, and break that cycle of only having ½ a feed. (might be worth a shot). It may also be enough to show you that he is uncomfortable, and you are on the right track to help him feel better.
Any of the suggestions people give you are ideas, like keeping him upright, especially after feeds. You still have to work out what works for you, and if anyone gives you ideas, and it doesn’t fit in with what you feel comfortable with, or your beliefs, it is fine to listen, and either follow, or discard. While it can help to keep them upright, it may not always be possible. It may still be preferable to hold him upright for that period of time even if he is asleep, but it is totally up to you to decide what works best for you all.
Same with the dummy; if you prefer not to introduce a dummy, then that is fine. It is important that you also follow your instincts and do what feels right for you. There are also plenty of bubs out there who refuse to take a dummy, and after having one child who loved one, I do understand the pitfalls too :)
I guess with the routine you mentioned, often 4 hours is a bit too long for a refluxer (mostly they do better with slightly smaller feeds more often.. say, 3 hours)- BUT, for some they do better the opposite. If you want to try doing that, then I would say follow your instincts and give it a try. Rather than doing it suddenly, which would possibly be very traumatic for him, AND doom it to failure, could you try to draw the feed out just a little bit each day? Even if it is a slow process of 15 minutes at a time, it might work.
You may find if/when his reflux is better controlled (if that’s whats causing the problem), feeds won’t be such an issue and he may actually resort to a decent routine without a lot of preempting.
I;m sorry you aren’t getting much of a break. What about your partner? Are you able to get a break when hes at home? What about on the weekends? Are you able to get him to share in the chores so that you can have some all important time to yourself? It isn’t a selfish pursuit by the way, if that’s what you are thinking. It is really important to look after yourself- not only are you important too, but you have to ask the question- whose going to look after them if you fall apart? Sometimes thinking like that can help you be more creative at findng ways to get some time to yourself, and recharge your batteries. Are you able to leave them with a friend while you go out, or perhaps go to a gym class (or something way less strenuous) and put the kids in care for that time? A lot of places have childcare as part of the service so the mums can have some time out for themselves.
Anyway, I hope you get some answers with the paed, and good luck trying to sort his feeds out.
HTH
Glenda
Hi Glenda
I took my son to the paediatrician today and he suggested two things - that I take him off Zantac and that I start him on solids. His reasoning being that the Zantac isn't doing anything and the solids will fill him more.
I'm not sure about this. He's putting on weight so that isn't an issue it's just the fussy bottles (him not wanting to finish his bottles until I put him in bed)
What do you think of this?
Thanks again
Hi,
Thanks for letting me know how you went with the paediatrician. How do YOU feel about what he has suggested? Are you comfortable with trying it?
One of the most difficult things about reflux is that there is no ‘RIGHT’ answer. There are lots of possibilities, as what works for one may not work for another. Sometimes, it is a matter of trying a few different strategies until you find the one that works best for your child. So, do you feel comfortable trying what he has suggested? It’s important that you follow your instincts, and if you’re happy to give it a go, then do so.
If you’re not terribly happy with the suggestion, then you have every right to question it. Did you get a chance to discuss that with the paed at the time? (sometimes I know that can be a bit awkward or difficult). Perhaps you could discuss it with your GP if you didn’t, or contact the paed again and discuss it. Sometimes a simple phone call will suffice.
Quite possibly, with the weight gain he has had since being started on Zantac (with the equivalent dose (per kg) being so small), it really isn’t being effective, like he said. Perhaps that is why he suggested you take him off Zantac; if you made no changes other than that, it’s possible you wouldn’t notice any difference in him at all.
As for his other suggestions, sometimes solids are introduced early with refluxers, and sometimes this can make a dramatic improvement. Sometimes though, it doesn’t help at all, and other times, it makes things worse. The only way you are going to tell is by trying- but it does all come down to your instincts, whether you are happy to try it or not.
If you do give his suggestions a try, then be very watchful, and if you have any concerns, don’t hesitate to contact your paed and discuss it. Did he give you any other options? If you did try this and it didn’t work, then what else do you have to try, or did he just say to come back if you had any problems?
Sorry- not very helpful, I know, but you know your child best. What do your instincts tell you? Are you happy to try it, or not? Has he guided you on any way of introducing solids if you do introduce them now? What suggestions did he make regarding that? I can perhaps offer some suggestions if he didn’t cover that.
Whatever you decide, I wish you all the best, and hope you find something that will help him feel more settled. (I’d also like to know if it did help too, if that isn’t a problem? Thanks)
Glenda
Hi Glenda
In regards to the Zantac he suggested to take him off it. However if things turn for the worse then put him back on and go and see him again. Which I'm quite happy with.
As for the solids he suggested farex/rice cereal. This I'm not too sure about as I think it's a bit early. I struggled getting with my daughter and solids and so wanted to delay this process as much as possible. I've read so much info too in that starting early can make them not want different kinds of food (not sure why but I had this problem with my daughter even though I waited till she was six months) and also have read that it can make them more inclined to be obese (not sure how but he is already 7.5kgs and not even 4 months yet!).
I guess I just don't think he needs solid food yet and if he would take his bottles properly he would be so much happier.
Another bubhub member suggested Brauer's Stomach Calm. Have you heard much on this? The pack states from 6 months. The pharmacist suggested gripe water but he doesn't seem to have gas - just the stomach acid.
Thanks again for your help Glenda.
Hi again :),
Did you discuss this with your paed: The reasons why you aren’t comfortable starting him on solids yet? As I said before, I really believe that its important a parent follows their instincts (and looking back on things, the times that I didn’t follow mine, when I allowed someone to talk me out of whatever it was- they are the times I regret, because each time I was proved to be correct! Mums just seem to ‘know’ things)
I can understand your concerns, and I think it would be prudent to discuss them with either the paed or your GP. It’s then up to them to either give you peace of mind, or discuss other alternatives with you (that’s my view on it, anyway). I can imagine some doctors wouldn’t be too impressed with you taking the opposite view to theirs, though :/
As with the gripe water, I can’t see that Brauer’s stomach calm would be helpful, but who’s to say it won’t be (just as giving solids early might be the answer). It can be so hard trying to work out what works, so you need to follow those famous instincts, and give those things you are comfortable with a go, and not worry about the things you aren’t comfortable with. What about Marina Infant Formula? (I’m not recommending these products- just offering suggestions you may like to research)
What about, as an alternative to giving solids, offering him a spoonful of thickened milk before a feed? Or even after he has pulled off the bottle and is refusing to go back on? Or in the bottle itself? I wonder if that would be helpful with his feeds. If it is a reflux concern as to why he is fussing so much, it may work (again, no promises unfortunately). I did this with my son, and while it didn’t stop him refluxing, it did help his milk stay in his belly and he was less troubled by his reflux.
Have you tried using Mylanta or Infant Gaviscon before a feed? Would that be worth giving a try (if your doctors are okay with you using it)?
Does he get distressed if you try to force him back on the feed? Since his weight is okay, and he will take the bottle when he’s going to bed for the night, could you perhaps not worry quite so much about the other feeds (easy to say, I know), and then make sure he gets a decent feed at that time? Have you discussed that option with the drs at all?
I have given you various ideas, or options, but it does come down to you and what you feel comfortable with. Lots of people will give you advice, whether they know anything about reflux or not, and it can become terribly confusing.
I know too, with reflux, you can start to doubt yourself and your decisions, and you can start to lose confidence in yourself. Please try to keep in mind all the things you are doing right- all the things you HAVE found answers for, as this can be really helpful as you try to cope with things.
It may help to consider that if you knew what would work, the chances are you would be doing it. The fact that you aren’t doing it (yet), just means you haven’t yet figured out the answers! Stay strong; you are doing the best job you can for your child!
Hope that helps
Glenda
Hi Glenda
Thanks so much for taking the time with all your info in your replies to me. I'm starting to think though that reflux may not be the problem any more. If I said to you that these were symptoms of my DS would you think he has reflux or that it's possibly something else. I'll list them for you
1. Not feeding properly in that he will only take his bottles in short stints of 20 to 50mls at a time and can take up to two hours to eat
2. If I don't offer a feed he can go six hours between them if he is in the pram/car
3. Will only finish a bottle in one stint in the middle of the night and is asleep/falls asleep on it (during the day I can take him into the quietest room with no distractions to resemble this but it won't help any)
4. Doesn't appear to be in any pain and very very minimal stomach acid being brought up if any at all.
I'm going to take him to my GP tomorrow to get some advice but thought I would check with you also considering your extensive knowledge.
Thanking you once again.
Marissa
Hi Marissa,
I am happy to help in any way I can. I just wish I could do more. It is so hard to say whether a particular child has reflux or not, and they can all be so different. Some of them can have signs so vague it can be almost impossible to tell. Others can look to be classic cases of reflux, yet may have another issues (one of the big reasons why it is important we take our children to doctors to make sure!!)
What I think- if you asked me if it is possible he has reflux, I would say yes. If it is reflux, I don’t know, sorry. They really can present so differently; many reflux babies refuse to feed. Many also seem to get quite distressed, but not all of them.
When you say he has “very very minimal stomach acid being brought up if any at all” can you explain what you mean by that? If a child has silent reflux, they may not have a lot of obvious signs at all, and its possible you may not notice him refluxing much at all. It doesn’t mean he isn’t though. Pain is difficult to interpret as some bubs will cry and scream, while others may just refuse to drink. They handle it all in very different ways. It’s great that he is putting on weight okay- though you may find the dr doesn’t understand your concern of him not eating enough because of that. If so, it might help to keep a written record of his bottles- what he drinks, how much, how long it has taken (and whether he is asleep or very drowsy at the time) (and his corresponding behaviours and activities). It can also help if you take someone else in with you, who will back you up that this is a big concern, and that getting feeds into him is always a struggle! Sometimes that seems to help- likes its more than a neurotic, overly anxious mum then!!
I wonder if he may have a food intolerance too, which may deter him from feeding. I have heard of some bubs who have problems with cows milk having feeds like that. They don’t like the way the milk makes them feel, so prefer not to, thanks. (and I have reflux myself, and I know that when it is flaring, if I force myself to eat, especially if I don’t want to, it makes me feel much worse, and I always wish I hadn’t. if a baby doesn’t know they HAVE to eat, and it makes them feel like that, why would they?)
I hope you are able to get some answers, and I think it is a really good idea to talk to the doctor about it all. Perhaps write a list with all the questions you have as well- there’s nothing worse than getting out of the appt and remembering something you wanted to ask! Remind yourself too, of what a great job you are doing. Every feed (bar perhaps the night time one) is a struggle, and you have to get so creative to get him to feed (not to mention patient). The fact that he is happy and healthy, and his weight is so good, is a reflection of all the care and attention you provide.
I hope that helps a bit to think of that, and please keep following your instincts- that’s what they’re there for.
Glenda
Hi Glenda
What I meant by stomach acid - or what I believe is stomach acid is when he "throws up" clear liquid that is speckled white. It used to happen every so often but it has stopped now.
I have consistently written down what he takes every day and it usually averages around the 750ml mark. I'm not at all concerned about how much he has as he obviously is thriving. It's the manner in which he takes it. I think that's maybe what the paed didn't understand and therefore suggested solids??
Anyway you have been a great help and I'll be going to the doctor tomorrow so hopefully she might have some answers/suggestions and this will be the last you will hear from me!!!
:fingerscrossed:
Hi Marissa,
LOL I don't mind you messaging at all, but I have my fingers crossed for you. I think you're right that the paed didn't understand waht you meant about his feeds (probably not until he had to do a feed himself would he get it). It would be interesting to see what the GP figures this time too. I hope he can shed some light on it, and I wonder if giving an antacid prior to a feed would make any difference at all.
Glenda
Hi Glenda
It's me again!
I just wanted to let you know that I took my DS to my GP yesterday and she also suggested the rice cereal. I decided that I might as well give it a go even though it wasn't something I was 100% about. So anyway I know it's early days yet but the feeds that he normally fusses on I have given him a few tiny spoon fulls before his bottle (not sure how much he is actually swallowing :)) but he hasn't fussed one single bit. It's been great - perhaps a fluke but you never know.
:fingerscrossed: he keeps this up!
Thank you!
Hi,
I'm glad you decided to give the rice cereal a try, but also that you checked further into it with another medical opinion- especially as you felt so unsure of the idea. I am also soooo glad it seemed to help, and I too will keep my fingers crossed!! It's definitely an exciting start!
Thanks for letting me know
Glenda
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