Another reflux question - hysterical baby

[Mellymoo]

Hello

I have a 9 week old daughter. For quite some time now, she regularly has intense crying after feeds.

She will have a feed, and when I see the tired signs, I will wrap her and put her in her cot. She will be okay for 5 minutes, then she'll start crying. Everything is tried before we pick her up - dummy, patting etc etc.

As a last resort we pick her up to see if she has wind. She rarely does. We put her back in the cot after she has calmed down.

Then a few minutes later she is c rying again - but it gets worse and more intense. Again we pick her up - all efforts at consoling her are fruitless - being rocked, being pushed around in the pram - the only thing which seems to calm her for a while is being held bolt upright. As soon as you put her back down she goes bananas. The crying is hysterical.

I took her to my GP a few weeks back and he basically told me all babies cry, and to get over it. I asked him if it could be reflux and he said probably not, but gave me a presc ription for Zantac - she has 1ml twice a day.

But she still has these crying fits - yesterday AND today she has been inconsolable. She doesn't have a fever or pass wind. If I hold her bolt upright, she might burp, and it's a very sour smelling burp, and also smells a bit like the Zantac.

Now I don't know if the Zantac is making her worse or not. It seemed to be working for a while - perhaps it was just coincidence ? But now she is acting just the way she was BEFORE the Zantac.

I am taking her back to a different docor in a couple of days but wondered if I could get some advice in the meantime - it's awful when baby is hysterical like that and nothing much seems to help. And she's like this all day when she is like this, not just the evenings.

I have tried to prop up her cot at the top with telephone books, but didn't seem to make much difference.

Any advice ??

[RISA]

Hi,
Thanks for contacting our organisation, and congratulations on the birth of your baby. It sounds like things have been really tough though, and that she sounds like she has a lot of pain.

What you have described is very classic reflux signs without the vomiting, so you have done really well to get help for her (especially given your doctor wasn't so sure it was reflux). It is worth mentioning that other conditions can present similarly, so it isn't always reflux, even if it looks like it.

Zantac is usually pretty well tolerated, but for some it can cause problems. Given that she did show some improvement once the Zantac was started, it does sound like you are on the right track. It may actually be something you can help with, as Zantac is a weight related medication. Generally, as bub puts on weight, the dose of Zantac needs to be increased to keep in line with the same amount/kg. Essentially, as she has put on weight, she is getting less Zantac, which is quite possibly why you have seen her worsen just recently. I'm gathering she has put on weight though. When my son was on Zantac, he needed to have his dose increased every 2 weeks, though he seemed to put weight on pretty quickly.

There are other things that can flare reflux, and at her age, I wonder if she has recently had her vaccinations. That is something that often flares reflux, as can lots of other things, such as an illness (even just a cold can flare it), being out of routine, over tired, really hot weather (and depending on where you live, it has been a lot hotter the last few days), and even teething.

All those things can contribute, and can make life really difficult for you all. It is good that you are getting a medical opinion, as it sounds like it could very well be reflux that's still a problem. It's also good to check to make sure she doesn't have an infection or something like that.

Her Zantac dose does sound low, and most doctors will start with a low dose and increase as necessary, to prevent them being on a higher dose than they need. Perhaps that is part of the problem too.

In the meantime, has the doctor let you know if you are able to use Mylanta or Infant Gaviscon? That may help as well, so just check if they are okay with you using it. Perhaps the pharmacist can help with that.

Because she does much better while upright, are you able to carry her around more? A lot of parents resort to using a baby sling or pouch to achieve that, though it isn't always practical. Perhaps you can find other things to help keep her upright too- like a baby swing or rocker, which might help.

Try to ensure there are no tight nappies or elastic waistbands, and ensure she doesn't slump, no matter what position she is in. Both these can put pressure on the tummy, which can cause reflux.

Sometimes sucking on something can help too, and a lot of refluxers seem to want to suck. If she will take a dummy, that might help, or offer her a clean finger- it makes more saliva, and saliva is alkali which can help neutralise any acid and it encourages them to swallow, to wash it out of the oesophagus if there is any there.

Try to lay her down to change her nappy and also for tummy time before a feed, rather than after.

Keep her upright for a feed as much as possible, and for at least 1/2 hr after a feed (the longer, the better). You may also find slightly smaller feeds slightly more often may work better too- all this can put less pressure on her tummy.

Keep in mind these are all just suggestions. I'm sure you have lots of people telling you what you should be doing but that can be confusing. Try to trust your own instincts as you have been doing, and do what feels right, and what you feel comfortable with, and I'm sure you will find the answers you need. It is basically all trial and error, which makes it pretty hard, as nobody can tell you exactly what it is you need to do!

I hope you find the new doctor supportive, and that he/she listens to you, so your bub can feel much more comfortable.

HTH

Glenda

[Mellymoo]

Hi RISA / Glenda

Many thanks for your advice.

Can you read this thread I posted in the Bottlefeeding forum :

http://www.bubhub.com.au/community/forums/showthread.php?t=90938

I haven't had her weighed for the last few weeks, just haven't had a chance.

No one has been able to tell me this, but I am wondering if there is a link between reflux and big babies, or potentially overweight babies.

She doesn't really like her dummy and as I put in the above thread, I'm pretty sure I'm doing everything I can before I give her a bottle.

She is having 6 x 140ml bottles a day, which I didn't think was excessive for her age and she has it all, she could probably have more, but I am conscious of the fact she was born a big baby and is still a big baby.

Is there a link between weight and the reflux - am I making sense ?

I mean, if she's having a 'reflux episode' I don't just shove a bottle of milk in her mouth - I try a dummy and other settling issues and if she's real bad, I try water.

I will only give her a bottle if she is 'due' for a feed and if nothing else works.

Can you enlighten me on this ? None of my doctors can give me an answer (GP)

The paediatrician told me at her 6 week checkup that he didn't think it was reflux - I guess because at that stage the Zantac was working and she wasn't showing any 'reflux' symptoms.

Also : I have noticed that when I give the Zantac to her, she seems to hate the taste and you can hear her stomach gurgling when the Zantac hits her stomach. SHe cries and arches her back - does this mean she shouldn't be on Zantac - should she be on something else ? Wondering if this is making her worse all of a sudden - I'm surprised that it seems to have been working in the past and then all of a sudden we are on our 3rd day where out of the blue, she is hysterical a lot of the time.

Thanks

[RISA]

Hi :)

Re the Zantac- have you tasted it?? It is a really strong flavour, and not at all nice, and I'm not surprised she objects to it. IF you think it is causing problems, and want to try something else, then please talk to your doctor about it. There are other options. One of them is to increase the dosage to one that suits better. It may just be it's not high enough and it hurts when she swallows. Another one is to use the effervescent tablets- made up to the correct dosage and then measuring off the right amount. The GP can give you a script for that.
The other option I can think of is to use a different medication- Losec is most frequently used, and can be a lot more effective. It can be given by dissolving a capsule (do not crush the granules as they are enteric coated), or by being made up into a suspension by a compounding pharmacist- it costs a bit more though if made into a suspension.

Re the weight gain and reflux- yes it can be related. If your bub is putting on heaps of weight, that may be another reason why the doctor isn't really paying attention to your concerns, as many doctors seem to be taught that reflux is only ever a problem if the child is failure to thrive. Unless they've had experience with it, they may not realise that a child can have severe reflux, yet put on piles of weight.

While some bubs refuse to feed because of their reflux (tend to be the failure to thrive bubs), others learn that feeding is really soothing, and want to continue doing that- some even comfort feed and ask for feeds well before they are due. These bubs tend to put on heaps of weight. My son was like that, and he wanted to feed often. I really don't think he knew what hunger was, and although he was telling me he was hungry, I think it was more that he had figured out that feeding was soothing, which is what he needed.

I read your other post and I do agree in part to what the other mums say- a hungry baby won't overfeed. The thing to consider though, is with reflux, a baby can overfeed because of the pain issue, so it may be a matter of getting the reflux under control. There may be no point in dropping the volume of her bottles if she is still in pain, as it's not hunger driving her need to drink. (well, that is just one theory, anyway). The other theory is that they are right and she just needs more at the moment. oh, from our experience too, it doesn't matter if the HC is slightly different from length and weight- just so long as she maintains it.

Perhaps when she does have a bad episode, you could find out if it was okay to use Mylanta or something like that. That may give relief, and it may also offer you answers- if it does help then you know why she is so unsettled. (though I have to say it doesn't always help, as it didn't seem to make a difference for my son).

I hope that all makes sense, and I think it's really important you continue to listen to your gut. Your instincts are telling you that she is still in pain, and that things aren't right, and she needs you to continue pursuing it so you can help her feel more comfortable.

oh, I also wanted to comment about not showing any reflux symptoms. What did the paed mean by that? That she didn't show any reflux symptoms when he saw her, or that what you described didn't sound like reflux to him? Reflux can present so differently, and what can make it worse, is when you go out, and esp to a doctor's appointment, they are distracted from any pain, and sit there and happily goo and gaa at the doctor. It makes it so hard, as this may be the total opposite of what they are like at home (it can also play with your head because you then start to wonder if it really is you, or something you are doing wrong).

I hope that all helps, and I hope you find some answers for her,

Glenda

[Mellymoo]

Thanks again for your reply.

It frustrates me that I seem to be doing all the research instead of being told this stuff by the doctors.

And yes, there is a general consensus that if the baby is doing well in the weight department, then the reflux cannot be that bad. And I totally agree with you about doctors making you feel like it's in your head - I walk away from some appointments feeling as though I am over reacting and not everyone can have a perfect baby so stop whingeing, but I know she is in pain and not happy when she cries like that.

They always tell me that she looks happy, and is 'thriving' - "there's nothing wrong".

I just want to fix it, and it frustrates me that I haven't found the solution yet.

It makes me feel so helpless when just about everything I do, is not working, and I just wish a doctor would tell me "Here, this is what you have to do" because they're supposed to know about all this...aren't they ?

Thanks again

[RISA]

Hi,
I know. I so wish I could say or do something that would actually help.

Reflux can be such a difficult and stressful condition, though a lot of doctors seem to be taught that it is simply a bub who spits up occasionally (goodness knows what they are taught about the anxious mother!!). It is difficult though, as it isn't necessarily practical for them to know everything about every condition, though with reflux being so common, you would think there would be more awareness!
It isn't unusual for the parents to do the research- it's what we do- perhaps it's cos we are more passionate about finding answers for our children. I don't know, but hopefully it helps a little to know that it's quite common, and a lot of reflux families seem to do a lot of research along the way (thank goodness for the internet)

I wish too taht they could give you an answer about how best to treat it, but there really are lots of different variables and lots of possible treatments. If they could tell you how to treat it, I'm sure dealing with reflux would be a lot easier. I hope it helps to know though, that you aren't doing anything wrong- it's just that you haven't found the right answer yet. Frustrating, I know, but something a lot of reflux families face.

It may help if you did consider joining the group, as it can help to have support of other families- others who have been through something similar and understand how frustrating it can be- for the lack of answers, for the lack of awareness from doctors and for the lack of awareness from family and friends who can't understand why you are struggling to cope.

It is really important for you to trust your instincts, and to continue to pursue it until you do find the answers you need. Good on you for doing that, and I hope you find the answers you need soon.

Could food intolerances be an issue? A lot of refluxers do seem to have problems with foods, particualrly cows milk protein, so that may be something to consider as well (that, and soy protein as the proteins are apparently similar). I don't know if I mentioned it before, but perhaps that angle will help too.

Glenda