Is this reflux?

[jaq]

Hello,

I've been reading through the posts and your answers here, but am still not 100% sure whether my newest daughter has reflux, or something else. So forgive me if some of this is repetitive!

Sofia is six weeks old tomorrow. She was born four weeks prem, so is quite small, though gaining weight very fast (born 2.7kg, currently weights 3.7kg).

She is a particularly avid eater, breastfeeding every three hours during the day and four hourly at night.
Sometimes she acts hungry well before the three hourly mark, so I suspect she might be looking to comfort feed. Because of wind/reflux problems, I'm trying to stick to a minimum of three hourly feeds.

She seems to get a lot of lower wind pain, which doesn't ease significantly when she burps or farts (very explosively!) Poos are explosive and obviously painful. They have ranged from very frothy pale mustard colour, through dark green and curdy, and now back to mustard and liquidy, though not frothy. There is rarely much volume, just near constant liquid farts, really.

Lower wind pain seems to have reduced somewhat (she isn't writhing in pain so much now) since I read about foremilk/hindmilk imbalance and now only give one breast per feed.

Which leaves the refluxy symptoms. She frequently falls asleep on the breast and will then go down into the cot quite happily. Half an hour later, she wakes up screaming, and I pick her up to hear obvious gagging or gulping noises in her throat. She is not much of a posseter, but one or twice a day milk will come out, but more often than not it doesnt. She does the screw up her face thing and cries more after a burp/gag than she does before one.

During the day, its bearable enough (she often feeds and sleeps well before lunch) but after the 4pm and 7pm feeds, she will not generally go to sleep at all, and will often have long periods of screaming and obvious pain. Her entire body goes stiff as a board, legs out, and then she draws them up; she claws at herself with her hands and screams herself hoarse, with a funny trilling noise in the back of her throat.

Her discomfort is worst when she's lying down, on the change mat, her playgym, or in bed. I have angled the cot 45 degrees off the vertical, but it doesn't seem to help much. The only thing that will get her to sleep before 10pm or so is the Baby Bjorn.

I haven't tried any reflux medications yet (wanted to be sure that's what it was) but have been using the Brauer's Colic Mixture to see if that helped the wind. Is it true that this can make reflux worse?

Are there any homeopathic or at least, vaguely gentle reflux treatments that might give her some relief? I am a bit reluctant to charge into using heavy medications if there's a more natural alternative available, and would be keen to try dietary, homeopathic or physical therapy methods first.

I am due to see my paed next week so wanted to have as much info on this front as possible on the offchance his reaction is to reach for the prescription pad.

Look forward to your thoughts!


Jaq
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DD1: Annika (cheeky monkey) 12/07/05
DD2: Sofia (cuddly possum) 29/03/07

[RISA]

hi Jaq
Congratulations on the birth of your beautiful daughter. She sounds like she has put on a lot of weight since her birth, so shes obviously thriving (though sometimes that means you get less attention if weight isn’t an issue for them). You don’t actually say, but have the doctors diagnosed her with reflux, or are you just wondering that yourself? Prem bubs do often have reflux, and while she does have signs that fit in with the reflux picture as well, I can’t comment on that aspect, sorry- it still has to be diagnosed by a doctor. THat's really important because there can be other conditions that present similarly.

It does also sound like she may also have colic, which makes it even more difficult to figure out. I’m glad you have an appt to see the paed as that would have been my first recommendation, and especially to determine what exactly is going on. (never easy to figure out as they are all so different!!) It sounds like she needs that, as she is getting so distressed at times, poor little mite! It must be hard for you and your other child as well. Are you getting much support?

You’re right, some colic remedies can make reflux worse, especially if they relax smooth muscle- but as with other reflux treatments, it doesn’t necessarily mean it will be worse for every baby. It may be worth trying, if you are comfortable with the idea, and if it helps, continue with it, and if not, then at least know you have tried. It just depends on what your instincts tell you. Ask your pharmacist as well, as they may be able to give more detailed information.

It sounds like you have done a lot of research on this, so good on you. It’s only natural to want to find answers, but it’s not always easy to find them. I am happy to offer suggestions, but of course it very much depends on whether your paed or gp agree she has reflux (and/or colic), or whether they think it might be something else.

Since you haven’t noticed a huge amount of improvement with elevating the head of her bed, then it’s probably not necessary to continue with it. It works for some, but not for others, unfortunately. Lots of people will recommend thickened feeds, even though you are breastfeeding, but please keep in mind thickened feeds are often more successful for those refluxers who vomit. It may not actually improve reflux at all, though often will reduce the amount of vomiting. Having said that though, I used thickened milk after breastfeeding; I would give my son a spoonful of thickened milk after a feed, and while it didn’t stop him refluxing, it did help.

Apart from medications and thickened feeds, there may be lots of different things you can try
- keep her upright to feed and for at least half an hour after a feed.
- keep her upright for as much of the day (and night) as possible, and if it is do-able for you, then perhaps carry her around in the Baby Bjorn as much as possible too. A lot of parents seem to have success with the Baby Bjorn, and I think that may be because they don’t tend to slump in them. Just make sure she isn’t slumping if it isn’t the type I am thinking of.
- sometimes gentle massage can help- there are lots of Australian sites that can offer you information on how to do it for reflux bubs
- some mums are able to help settle their bubs by rubbing a spot on their heel. I’ve no idea if it works, but may be worth trying
- a lot of reflux/colicky babies have food sensitivities, with cows milk protein being the most common. On top of that, lots of bubs who are cows milk protein intolerant are also soy intolerant, so swapping any milk you drink, for soy milk, may not help at all. Diet is a really tricky area, and not easy to figure out. if you do want to consider this angle, then it’s best to talk with a dietitian experienced in food sensitive babies- small mistakes can matter a lot, especially as you are feeding for two. (and of course it’s worth mentioning that not all unsettled babies are food sensitive- though lots are) The fact that she is clawing at herself is one thing that made me wonder about dietary issues too.
- ensure there is no pressure on her tummy, so no scrunched up positions, no tight nappies or elastic waistbands
- change her nappy before a feed rather than after, so her tummy is empty when she is lying down
- offer play time on an empty tummy, when she is less likely to reflux
- use whatever equipment you can find that will help you keep her upright- baby swings, baby bjorn, rockers, bouncing seats- as age appropriate.
- some bubs find warm baths really soothing and settling
- some bubs really need to suck, so using a dummy, your clean finger, or allowing suckling without feeding, may be soothing- it helps them swallow, and also make saliva, so that it helps neutralise any acid and helps wash it out of their oesophagus too.
- some bubs do better with small feeds slightly more often than usually recommended. Going 3 hrly is okay, but I found that particularly difficult to keep to. my son also wanted to feed frequently, (and at one stage was down to hourly feeds, which I didn’t know at the time was making things worse). Some bubs do better with slightly larger feeds slightly less often- if one doesn’t work, try the other, or try the opposite.
- avoid spicy foods, fatty foods, chocolate, caffeine and carbonated drinks
- avoid cigarette smoke
- go outside and get some fresh air- can be distracting for you and her

The thing about reflux, is they are all different, and it’s a matter of trial and error until you find what works. It means being able to trust your instincts and doing what feels right, and what you feel comfortable with. If you try something and it doesn’t work, then try something else. If you want to explore natural therapies first- chiropractors, naturopaths or homeopaths etc, then make sure you research that too; ensure the therapists have appropriate qualifications and experience with reflux children, that you know what to expect from treatments, how many they think will be necessary and what the total cost may be. Some families have great success, and others not so great, so there are no right or wrong answers, just instincts to listen to.

Sometimes it’s also worth pondering the impact of NOT medicating, as reflux can cause a lot of pain and distress to the child and the family. It may be worth discussing all your options with the paed, so you can come up with a plan of action that is suitable for your family.

I hope that information helps, and I hope you get the answers you all need.

Glenda