Reflux advice needed

[JoJoMart]

My baby boy has been showing signs of reflux for a few weeks now. It mainly happens after a breast feed as I feed him mainly horizontal but even if he's on an angle he will sometimes pull of the boob, screaming and arching his back up as if in a lot of pain. He also vomits some of it up again, then screams again. It's very distressing. He will also sometimes do it when I give him formula (he gets both as I don't have a strong milk supply) but because he's more upright when I feed him it's not as bad.

Other symptoms are hiccups, sticking his tongue in and out like he's tasting something he doesn't like, snorting and grunting noises, screaming and kicking his legs and arms flying everywhere, throwing up in his cot (not a lot). The main symptom is the crying which sounds like he's clearly in pain.

I went to the GP last night who said a lot of babies have reflux and there isn't a lot you can do, a lot of the drugs don't work and to try the Mylanta which seems to help Liam a bit. I find it very distressing and dread feeding times sometimes because I don't want to see him in pain.

Liam gets partially breast fed (offered the breast first) once emptied if he's still hungry gets formula top up and some feeds are just formula.

Any advice would be appreciated.

[RISA]

Hi Joanne,
I am so sorry I haven't been able to contact you before now. It sounds like things have been pretty awful for you all, although it sounds like you are doing well. You are doing the best thing you can for him, and that is to trust your instincts. That is the best piece of advice I was ever given when it came to reflux, especially as there are so many times I doubted myself.

It does sound like your bub is in a lot of pain, and that is borne out with the fact taht he responded to Mylanta. There are a couple of different medications that are used that may be effective (and sometimes can make an enormous difference to the child). While they don't always work, for some children it can be the difference between being in pain, and being pain free. You may like to talk to your doctor about using one of them, especially givn the Mylanta helped. The drugs commonly used on reflux bubs are Losec, Zoton and Zantac. Losec and Zoton are generally more effective. If your doctor is happy to prescribe them, we can help with administration tips- as it isn't always easy to give them, esp to a bub.

You are doing the right thing by holding him upright to feed. Can I ask how you know if he is still hungry after you;ve given him a breastfeed? It can be really hard to tell with a reflux baby, as crying and being unsettled doesn't always mean hunger. Does he tend to cry or vomit more often after he has been topped up with a bottle, or does it not make any difference? How is his weight? Does he have any problems with putting weight on?

(sorry, I have a lot of questions for you).

Sometimes topping up a feed can have the opposite effect, as an overful tummy is more likely to reflux. Unless weight is an issue, the recommendation if a bub vomits after a feed, is not to feed them again until they are due for the next feed, to avoid the possibility of relfux. There may also be other things you can do, like ensuring there is no pressure on his tummy- so no tight nappies, or elastic waistbands; no vigorous bouncing; keeping him upright as much as possible throughout the day; using a dummy (if you're happy with that idea) or letting him suck on a clean finger etc.

That brings to mind something else that's important to mention. Lots of people offer advice, and especially when it comes to reflux, it can be extremely confusing. It is important to listen to advice, as you never know when someone may say something helpful, but if you aren't comfortable with the idea, or don't feel it's right for you, then it is okay to discard the idea. A lot of people can put pressure on, and make it difficult, but ultimately, you are the parent, and you have to do what feels right. Everyone seems to have something different to say too, and you simply can't follow everyone's advice anyway.

Well, I hope those things help, and please keep pursuing it with the drs. A mum's instincts are almost always right, and if you are concerned he has pain, well, he is relying on you to help him. Good luck with finding answers, and i hope that helps

Glenda

[JoJoMart]

Thank you for your advice, Glenda. I've booked a paediatrician appt for Tuesday because I want some help and I also want to get the right diagnosis (hopefully).

In answer to your questions. I only seem to be able to satisfy Liam with one feed a day that is purely a breast feed. I've had supply issues from word go and I have had help from a lactation consultant etc so the main advice I have been given is to breast feed him first, then if he is still hungry top him up with formula. They advised to do this mainly in the afternoon or evening when my supply is lower.

You are right as it is quite hard to tell the difference between being unsettled and hunger. How I tend to tell he is still hungry after the breast feed is generally how full my breasts were to start with and whether I feel he's fed well. Also, if he takes the bottle like he's really hungry then I know he's hungry but sometimes I've topped him up when he's a bit slow on the bottle which says to me he wasn't that hungry after the breast feed. His weight is fine (in the 50th percentile).

Liam does vomit but not at every feed and not a huge lot. I've noticed closely him gulping as if trying to keep something down and then his face goes really red and he screams.......I think that's the silent reflux??

Breast feeding has caused as much problems as formula (in fact sometimes more) because I find it really hard to position him in a totally upright way when BF and I notice it comes up easier (mainly because it's more watery?). He will often cough and gulp then start crying which I've found very distressing. Considering the problems I've had with BF this hasn't helped! This morning he was okay though and the last feed he wasn't too bad, so these things don't seem to happen at every feed.

In any case, the hardest thing with all this is combining both breast & bottle and not knowing if I've overfed him or not........however, he has reacted badly half way through a bottle feed (when he's not received any breast that feed), say after 50ml so sometimes he reacts when his stomach isn't full too.

I will see what the paediatrician says, but I hope there's some way of helping him so that feeding times are more pleasant for both of us.

Thanks for your advice!

Joanne

[RISA]

Hi,
I wanted to wish you all the best for your paed appt tomorrow. I hope he/she is able to help, and that you will be able to enjoy those feeds rather than being a time of stress and concern.

I agree that the coughing/gulping/crying/screwing face up sounds like reflux, and the fact that he is so uncomfortable with it would make me wonder if the paed will recommend medication for him.

It is hard to feed more upright while breastfeeding, and yes he may reflux on the more watery breastmilk, but it is more quickly digested as well, so he won't reflux for as long either. Some mums get around the upright breastfeeding issue by standing up and holding them upright to feed; others use a baby sling, with the straps adjusted so bub's head is level with their nipple. you could also possibly try sitting on a seat, with him facing you, but sitting beside you on the same chair (your arm supporting him). That's a really hard one to explain, so i'm not sure if that makes any sense.

You could perhaps try giving him a spoonful of thickened milk prior (during or after) to a feed , so that he isn't able to reflux the feed up quite so easily. I used to breastfeed my son, and would give him a spoonful of thickened milk following a feed- while it didn't stop him refluxing, it did seem to help and he wasnt quite so bad. That may be worth trying as well.

Thickened feeds themselves don't always work, though for some bubs they are great. It generally only reduces the amount of vomiting though, rather than the reflux, so there are no guarantees with that (as with any suggestion).

Anyway, I hope you get the answers you need; and good on you for persevering.

Glenda