DD is now almost 4 months and ebf. She has been a frequent spitter (constantly changing wet bibs) and has all the symptoms of reflux (coughing with stridor - the stridor has since settled, gurgly/wet voice, wet burps, hiccups and lots of silent reflux, unsettled often during feeds...popping on and off, coughing lots and making throat clearing noises). She is also a frequent feeder and seems to pass gas and have fairly explosive, wet bowel movements. I think I had an oversupply problem in the early days, which resolved with attention to feeding longer on one side before switching (3 hours) and has since balanced out....however the reflux symptoms didn't really change. She seems to be a relatively happy baby, but seems to be in pain somtimes - arching her back, frowning, fussing (I think her temperment is easygoing in general) and is following her growth curve. She has never slept well....not at all on her back, and only on her side in bed with me. We tried elevating the head of her bed, swaddling, etc...but nothing helped her sleep in the recommended position for SIDS prevention. So, alas, I gave in a few weeks ago and started putting her down on her tummy for naps (supervised) so she could get used to the position. And no surprises: she actually started napping for longer than 10 minutes! Anywhere from 25 min - 2 hours (though usually they are shorter) and she was coughing less in her sleep. Once she seemed used to the tummy sleeping, I started doing this at night in the crib (firm mattress) right next to my bed. She had previously been only sleeping with me (snuggled up and suckling all night)....however, my back/body is in pain from the sleep position and I really wanted her to sleep in a crib so I could have a little bit of time to myself in the evenings and was less nervous about her being alone in an adult bed. We get anywhere from 30 min to 4 hours in her crib at night before she wakes...and then finishes the night in bed with me.
So - that's some of the history...
For her reflux - since the spitting seemed to make her a bit irritable (plus the cough/stridor concerned me) I thought it was worth doing a dairy elimination diet. I lasted 3 weeks total. Initially I thought it "might" have helped a little bit (she had an eczema rash which cleared soon after....but then she got a cold and the hand/foot/mouth disease and her reflux got worse. Once she was over the viruses than I gave it another week of no dairy in my diet (I was strict other than consuming some products that had a cross-contamination risk,eg dark chocolate). When I reintroduced the dairy, I honestly couldn't tell if she was worse or better. Initially she seemed worse, but then she improved. It was sometime after this that I noticed her spit up had a brown tinge on a couple occasions - but that stopped. Then a week or so later, I noticed a bowel movement that had a bright red streak. Then a few days later another one was full of small brown spots (she had had some explosive ones the day before, followed by a very long sleep at night). The day before was also the day I introduced a dissolvable children's vitamin D tab (put on my breast) that has a lactose base (SISU brand). Upon closer examination the dark spots definitely looked to be spots of blood (not bright) and they were mixed with her usual high amount of mucous. A couple other times I've noticed dark spots. The colour is otherwise the typical mustard. I haven't given her that vitamin D supplement since. It's the only thing I have every introduced into her gut besides my milk. I didn't even try gripe water for that reason....
Re. her reflux and the blood, I have twice taken her to our family physician (who has an interest in pediatrics) - (in BC, Canada, pediatricians are referred services, not primary care providers). She was not concerned about the blood or mucous in the stool. She thinks it's just an anal fissure. She also doubted dairy allergy, saying it is extremely unlikely in breastfed babies and didn't think another elimination diet was worth it, and figured it was just coincidence that it happened after the vitamin D tab. She didn't think medication was needed for the reflux. Her only concern seemed to be that my baby followed her growth curve and had her vaccinations...and that we should follow up in 4-6 weeks to ensure she is still growing well. I have no concerns with growth/development and am perfectly capable of assessing that myself - so I'm tempted to skip the next checkups because I feel it will just be the same thing again....check growth, listen to chest and rush me out the door.
What do you think? Dairy allergy? Reflux that should be treated? Or just normal physiological reflux and nothing to worry about? It's going to get worse when solids are introduced....so I'm almost tempted to delay that just so her spit-up remains lower acidity and has a lower chance of causing esophageal irritation. I certainly can eliminate dairy again...but it is definitely a big challenge as my other daughter and husband both eat significant amounts, e.g. cheese, yoghurt, etc. and there is always the risk of accidental ingestion/cross-contamination. If I don't have to, then I won't.
I'm not sure what to do as I'm not convinced my doctor has really taken a careful enough history to make a judgement. We are in a rural area, so referrals to allergists or pediatric GI's are pretty much not an option (reserved for very severe cases). Our one and only pediatrician has the worst bedside manner with parents I've ever experienced and has questionable clinical judgement - many of our town's residents refuse to see him. My baby looks healthy (although a tiny bit pale, which maybe could be her normal colour?) Thanks so much for any insights you can offer!
Edited by dot1 - 2/14/12 at 10:33pm