Reflux & what to do...

Forgot to add my doctor said that when i was able to get EBM into her diet earlier on better to give her one full feed of that if possible rather than top up with formula as she didn't seem to tolerate the two at the same feed.

a little light reading for you.... http://www.refluxbabies.co.uk/information/lactose-intolerance.php?cat=2 http://www.refluxbabies.co.uk/information/overactive-letdown-reflex.php?cat=2 http://kellymom.com/bf/got-milk/supply-worries/fast-letdown/

Not too sure if this will help but DD has always been a happy chucker until about 7 weeks when silent reflux kicked in and clear stomach acids were coming up so we embarked on sorting this out. Dr guided us to try all non-medication options first. - Nan 1 - she loved but reflux happened even with sitting up 20 minutes after feed; sleeping on wedge and effectively having a wedge under her anytime she was playing on her back - AR formula worked wonderfully but was too thick and her appetite halved and weight gain stopped/slowed - Nan 1 with gaviscon - worked well but she got constipated - Comfort Aptimal with gaviscon - not as good on controlling the milk spill but none of that clear reflux anymore (so back to happy chucker) and constipation is no longer. Dr said this is a reduced lactose formula (still has similar calorie/nutrient profile to Nan 1) and her appetite has improved greatly - she is almost back up to the recommended volumes for her size. As she is now 16 weeks and we are hoping she will grow out of it at about 6 months (according to Dr) we are happy to live with the happy chucker as it is only milk and laundry. BTW I also have an allergy to lactose

right, so he was miserable when just BFed and is also miserable when just fed EBM by bottle? All I can think of is lactose overload then, I know you can give (lactase?) drops which help break down the lactose in the milk, not sure how you get your hands on them? Maybe try the pumping for 10 min then BFing (and ditching the pumped milk as it will be the highest in lactose) and see if it makes a difference, and the just feeding from one side, so long as he is not still visibly hungry (although reflux babies do sometimes overeat to try and soothe the pain, which unfortunately results in more refluxing). I would go back again to Dr Delphine and discuss whether you might have oversupply or if there are other things you might try eliminating. (a dairy-free diet can take up to 3 weeks to show results but as I said there is no point in a dairy free if he is ok with and still having, formula) He will def be greatly improved reflux-wise by 12 weeks but I would persevere in the meantime with trying to find the cause. A final thought with the tounge-tie, did she check for an upper lip tie? My son had his mild tongue-tie snipped at 2 weeks but only when he upper teeth came in with a large gap did I click that he actually had an upper-lip tie which was likely a big factor in him taking so long to latch well (his top lip would get sucked under instead of flanging out). Hang in there!

Ok well if you are sure that there is a def improvement with the formula over your BM (unusual since normally reflux/gas is much worse on formula) Then you can forget about trying a dairy-free diet. A dairy free diet will remove any cows milk protein that is in your BM, the formula you are giving may be lactose free but will still have cows milk protein so clearly that is not the issue. (I would try a whole day of just BFing, a whole day of EBM (no formula) and a whole day of formula (expressing and setting aside for later) as time of day can make a big difference in both your milk and in reflux/colic type symtoms in general. It could be something else in your diet, possibly gluten, spicy foods etc, unfortunately you will not see an overnight difference in an elimination diet. My first though was a latch issue, possibly tongue-tie etc causing a lot of air to be swallowed but if the EBM is the same then I'm def wondering about lactose overload. It is extremely uncommon that a baby be truly lactose intolerant (the carbohydrate in BM IS lactose and your baby needs this) but with lactose overload basically there is more lactose than your baby has enzymes for, leading to similar symptoms to lactose intolerance) Lactose overload tends to happen when the breast is very full before a feed, and the milk has separated (tends to happen the longer the gap between feeds) so the baby only gets to the foremilk. You can try only feeding/pumping ONE breast per feed and making sure the feed lasts as long as possible so the breast is fully drained. You can achieve the same thickened effect with BM as the AR formula by giving locust-bean gum by spoon after a feed, I had a friend with a refluxer who found this very helpful. You can also try and get your hands on some infant gavison which again can be given by spoon with a BF. Zantac and losec will take a few weeks to really make a difference, they will not stop the spilling but rather should stop the pain (which is obviously more important) Crying tends to peak at 4-6 weeks anyway, even if you change absolutely nothing you will notice it seems worse around this time and gets better from the 6 week point, unfortunately that makes it a little difficult to figure out if any diet changes and meds etc are the reason for improvement. Have you been giving formula since birth, before contemplating giving up breastfeeding I would be pretty tempted to take away ALL formula for a week or more just to make sure its not actually a reaction to the formula after all. (simply because a reaction to formula is vastly more common than a reaction to BM and sometimes reflux symptoms appear quite a few hours after eating the trigger food so if formula and BM are being alternated it could be co-incidence when you notice symptoms are worse) If after all that you really feel that formula is the solution then frankly, thats nobody's business but your own and don't feel bad about it, but assuming YOU do want BFing to work out, I would work through all the other options first, for your own peace of mind. <em>edited by kiwispiers on 26/04/2012</em>

sounds like what you have been eating is causing his reflux. check your diet OP. :) <em>edited by shjbelle on 26/04/2012</em>

Oh no, you poor thing, I feel your pain! Below is the link to the thread I started up a few weeks ago about this exact thing, it is definitely worth taking a look through the responses on there as there are some great suggestions! http://www.expatwoman.com/forum/messages.aspx?TopicID=176011 Even though she has suffered from it since birth, DD has a mild to moderate case to date (this could get worse - as typically happens with reflux), she is only 'occasionally' bothered by the symptoms - but I do spend a lot of time managing it - as it sounds like you are - which is absolutely exhausting as you say :( DD didn't sleep in her moses basket until she was around 4-5 weeks old - she spent the entire time before that on an incline on my chest I don't have a huge amount of time but wanted to quickly respond with what I have been doing. - Firstly, if you haven't already seen someone, definitely get him checked out - just in case, it is important they confirm it is reflux and not another digestive tract issue, or wind, or reflux (or both wind and reflux for that matter). I would definitely check because you mention nights, and my DD (and all the research I have done) has mentioned that reflux is a daytime problem - not a nighttime one. I still use my reflux remedies during the night to avoid it causing issues during the daytime, but DD is never upset, and doesn't vomit or choke or wheeze during the night. She wakes up, has a quick feed and drops straight back off to sleep (of course I am still up for a good 45 mins holding her upright - so I am still not getting great sleep). Below is what I have tried and am currently doing: - She never lies flat (except when she was in hospital not feeding at all) - she is always on an incline with the reflux wedge in her moses basket, sitting in her bouncer or sitting on me (this is where she spends most of her time) - I feed her sitting upright in front of me (if that makes sense), I try to give her small feeds - I found that if she really guzzles, it seems to get a bit much, and she ends up choking/vomiting/wheezing, whereas small amounts taking her off, popping her on my shoulder giving her a back rub, and putting her back on seems to work quite well. - After each feed she sits upright on my chest for at least 30 - 45 mins - I change her nappy on a incline, I basically have her head resting in the curve of my feeding pillow - I was giving her infacol before every meal - the paediatrician we had last week for her other problem told me to discontinue this as it won't work - so I have, and to be honest, there hasn't been too much of a difference. He has prescribed another anti-vomit drug, which to be honest she had a really bad episode after, so I am going to try it once more in a day or so, and if I get the same result, I won't have her take that either. For her winding (her reflux and wind issues seem to go hand-in-hand): - I alternate between 3 positions, over my shoulder (both arms also over my shoulder - having her arms raised makes a difference), tiger in a tree and having her sitting bolt upright on the nursing pillow with her chin resting on my hand (almost looks like you are choking her) and then patting her back - this seems to be her best winding position - I have given her gripe water a couple of times - this does seem to have worked for when she is in bad pain - I try not to stress to much about 'hearing' a massive burp - apparently you may not always hear them, and I know that if I am being vigilant with my routine for her, I am doing the upmost best that I can to avoid her having any wind issues - but that she still may have problems - I do lots of leg cycling - well, I push her legs (alternating and together) up to her belly - mainly during nappy changing .. she seems to enjoy have her nappy undone when I do it (I still have it covering her bottom, just not fastened). She actually really enjoys having her legs pushed up - I get lots of smiles! Anyway, that is all I can think of for the moment, I am sure there is more, but I have been up since stupid o'clock, so my brain is less than functional and need to get some sleep! I hope it helps though!

Have u check with doctor? it might happen that child is having pyloric stenosis.Check it out asap so baby will not sufer

Have you tried giving a bottle of expressed milk, how is he after that? That would be your first clue as to whether its to do with a reaction to something in your milk or to do with the way he is feeding. If he reacts badly to EBM by bottle and not to formula then you might want to look at things like lactose overload (a higher than average percentage of foremilk, usually due to you having too much milk and remedies by a change in feeding routine and/or pumping off a bit off milk at the start of each feed and discarding it). If you are sure he is not reacting to formula it would seem pointless to eliminate dairy from your own diet. If he is fine with EBM but not with drinking directly from the breast then the issue might be with his latch itself, allowing an excess of air in (by the way what you describe doesn't sound like reflux but rather a gas issue, you wouldn't cycle legs etc to help with reflux and there wouldn't be issues with passing wind). The anti-reflux formulas are thickened to prevent the baby from spilling, is your baby spilling a lot after each feed or just seeming distressed. How old is your LO, have you tired any reflux meds?