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Reflux or no? - Tongue/lip tie revision on 4/12

post #1 of 16
Thread Starter 
I'm starting to get concerned about my baby. I don't want to jump too fast into saying that he might have reflux, because that almost seems like it's starting to be a "trendy" diagnosis, but I don't want to just pass off all his symptoms as something else if it IS reflux.

He was three months old on 3/31. At his two-month appointment, he weighed 11 lb 6 oz on the doctor's scale, and I *think* it was right after a feeding. His birth weight was 9 lb 6 oz. Yesterday, I weighed him on my postal scale at home, and he was still 11 lb 6 oz. I can't remember the timeframe of how I weighed him, whether it was before or after a feeding, but it seems like it was before a feeding at yesterday's weighing. Length is hard to measure on babies that just want to keep their legs drawn up like they were in the womb, but I did measure his length this morning and he's up about an inch from a month ago. He's also gained a quarter-inch in head circumference.

He has a nurse-only visit tomorrow (where I assume that he would be weighed at because of the nature of the visit). Wednesdays are also when the IBCLC associated with the office has a lunchtime meeting open for nursing and/or pregnant mamas, so I'm going to go to that as well, and then make a dr appointment if either one of them suggests to. I had a weight gain issue with my other son as well (he only gained 2 oz between his 4 and 6 month appointments) and when I saw the LC for him, she wanted me to count my calories, and it turned out that I was not getting enough, and once I was, DS gained about half a pound that first week. Prior to that, I thought he had reflux, too, and he was even on Prevacid for a while, but his was just normal spit-up. (My daughter, older than my son, had normal spit-up as well). Both my older son and my daughter were petite babies, not doubling their birth weight until they were a year old (DD was 15 lbs then and DS was 17 lbs).

My three-month-old spits up ALL the time. I made a post a week or so ago asking when the spit-up would end, and only got a couple of "my baby does this, too" replies. The consistency of the spit-up varies from a creamy-looking emulsion to curdled and partly digested. Sometimes it just smells like breastmilk, and sometimes it's REALLY sour, making even his breath stink like spoiled milk. The volume varies as well, but is usually no more than a tablespoon or so. It doesn't matter if he burps after a feeding or not. He'll still spit up several times over the course of time between then and the next feeding. Even as a newborn, he was "gaggy," where he'd gag and then repeatedly swallow, like the spit-up only came up to throat level and then he was swallowing it back down.

He does some neck arching and back arching, which could be developmentally normal, or again, it could be yet another sign of reflux. He even does it while nursing, on occasion. The other day, I was sitting on the couch, attempting to feed him in a cradle hold, and his back was arched to the point that his body was straight out perpendicular to mine, nestled between my thighs. And when I'm carrying him upright, he pushes away from me to lean back.

His latch is also weird, almost an "open" latch, like he doesn't really want to eat, even if he is hungry. This is partly b/c he arches and pushes way while I'm trying to latch him, too. Becaise of the arching, it's hard for me to het him close enough to me to have a proper latch.

I've thought about it being a food sensitivity, but I'm not really leaning that direction since my older DS had eczema REALLY bad (tomatoes affected him the worst), and this baby just had normal newborn acne that went away after a time.

He is having the appropriate number of wet and poopy diapers. He has a large poopy one about every 3-4 days, and his wet diapers are probably 10 or so a day.

He sleeps all night most nights, but his daytime naps aren't in any sort of regular pattern. All afternoon, he will sleep for about 30-45 minutes at a time and then wake up crying, seemingly hungry and in pain at the same time. And during his awake times, he's not a fan of being horizontal. He arches his back even then, trying to look behind him, and that's when he's in a "good" mood. Sometimes when he's horizontal, he just cries. He does smile, and he's even laughed once, but he's in a good enough mood to smile for maybe a total of 10 minutes every 24 hours. The rest of his awake time he's either chilling, eating or crying.

I don't know what to do. greensad.gif
post #2 of 16
Thread Starter 
I checked his weight on the pedi's scale, and he gained 1.5 oz on that scale from being weighed on it a month ago. I also weighed on the IBCLC's scale and will weigh on hers again in two weeks. She wants me to eat some milk-producing foods (when I was having issues with B three years ago, she loaned me a book called "Mother Food" or something like that, and I have since bought my own copy) and also feed him in an upright position, facing me on my lap. I tried that while there in the group but he just wanted to still lay down, so I had to alternate holding his head and giving my breast compressions. He ate for about 7 minutes and after the feed, weighed 1.7 oz more than he did before. I tried to offer him the other side, but he was too tired and he just fell asleep instead.

She did ask me if I was opposed to medication for him (for reflux, if he has it) and I said I was not, if that is his issue, but she said that at this age, he definitely should be gaining a lot more than he is. I left a message at my doctor's office asking about the weight gain in combo w/ the spitting and the nurse is going to call me back in the morning after she talks to the doctor.

So that's today's update.
post #3 of 16
Is that a photo of this baby as your profile pic?

Has this baby been checked for tongue tie, especially posterior tongue tie? The symptoms of that can mimic or be associated with reflux.
post #4 of 16
Thread Starter 
No, that was my DD.

I have not had him checked for tongue tie but am seeing the IBCLC again on the 17th and will let him see how he latches (she has an open group at lunch and since his weird latch generally starts at 2:00-ish in the afternoon, I'll probably take a video to show her what he does) and see if she has any advice for me.
post #5 of 16
IME, soooo many IBCLC and peds don't know how to check for a tongue tie. This video http://www.youtube.com/watch?v=5opSbXvL7yQ has a good demo about how you can check for yourself. When you press under the tongue on either side, it should not pop up like that and if you can feel a "piano wire" feeling frenulum under the tongue, you have an anterior tie. If you feel that there is something going on, there is a good fb group called Tongue Tie Babies Support that has a good list of knowledgeable providers who can assess the need for revision.
post #6 of 16
Thread Starter 
Yep, I've joined that FB group and am going to call one of the local dentists in their files on Monday and get an appointment for an evaluation.
post #7 of 16
Thread Starter 
Eval will be this Wednesday afternoon, and I went ahead and scheduled the procedure for this Friday just in case he needs it.
post #8 of 16
Thread Starter 
He does have a tongue and lip tie, grade 3 (where 4 is the worst). His release procedure will be on Friday morning.
post #9 of 16
I'm so glad you figured this out!
post #10 of 16
Thread Starter 
We are home now from our UTT/LT revision this morning. He didn't nurse immediately after the procedure, but I think it was for two reasons. One is they offered me an unused dental exam chair to nurse in, and the whole area smelled like a dentist's office. The other is that he was still a little cranky from being messed with. I wanted to feed him before we left because we had a long drive home, and I didn't want him to be hungry all of a sudden on the way, so gave him a paci and waited in the waiting room for him to calm down, and he finally did calm down enough to nurse.

I didn't realize that nursing him had been painful until it suddenly wasn't. smile.gif

I also met with an IBCLC this morning after we got home, and Josiah is going to have to go through a process of re-learning how to suck correctly. She gave me a few exercises to do with him to help him learn how to use his new tongue. He was tired when I tried them with him, but I'll keep working with him.

I found out that I do not need to wake him up at night to do the stretches, and instead just to do them throughout the day. Being able to watch the dental assistant do them and have her explain where to push and how much pressure to use was immensely more helpful than just the written instructions, and I was able to successfully do his first stretch a few minutes ago, right before I laid him down for a nap.

I'll be glad when the white scab forms, because right now, his poor lip and tongue look like they have a gigantic ulcer. I wish I'd seen a picture of the immediate post-op appearance beforehand so it wasn't so shocking to me.
post #11 of 16
Thread Starter 
Well after those two nursing sessions this morning (including one at home with an IBCLC), he's been spitting up all afternoon and refusing to nurse at all. He just bites me when I offer, not even trying to latch. I gave him some sleep, thinking he was too tired and would rather sleep than nurse, but he's still refusing even now that he's awake. I've been giving him Tylenol every 4 hours as well as Arnica and Rescue Remedy.

But right now, he's refusing to the point that I'm pumping and have to syringe feed him to get something into him.
post #12 of 16
I have no advice to give, just wanted to offer support and sympathy. Sounds like a rough go for your little guy, and I'm sure it's hurting you as a mama. Hate to have our little ones hurting and refusing to nurse. greensad.gif hope this passes soon and he starts to eat and gain as he should!
post #13 of 16
Thread Starter 
The Tylenol ended up kicking in while I was pumping, so I saved that milk and nursed him instead, and a few other times throughout the evening. He's sleeping now, down for the night.
post #14 of 16
Thread Starter 
Two weeks ago, he was 11 lb 5.9 oz on an empty stomach. Today, he was 11 lb 6.7 oz on an empty stomach. I nursed him on both sides, then he had a wet and dirty diaper (which was removed because all his weighings were naked ones) and we weighed him again and he was 11 lb 10 oz. I don't know what to think.
post #15 of 16
Thread Starter 
I took him for another weight check yesterday, and he gained four ounces since the previous week, which is great news, since in the six weeks before that, he had only gained two ounces total.
post #16 of 16
That's great! It sounds like he's getting the hang of it and that the tongue tie was the issue, not reflux.
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