Typical newborn fussiness? Overfeeding? Reflux?

[Quagmire]

:

So I'm really not sure what's going on here and could really use some advice. Trying to organize my thoughts quickly while baby is napping so forgive my wandering thought process.

We've got some "symptoms":

* Gagging/ choking. Often happens during a feeding where she will pull off, sputter and have a hard time catching her breath, then make some gagging sounds and finally scream bloody murder. This has been going on since the beginning.

* Pulling off breast/ screaming. I have major overactive letdown on the right side and fast flow on the left. I was attributing this behavior to frustration when she wants to comfort nurse and keeps getting milk but now I'm not so sure.

* Wants to be latched constantly. When she is most fussy in the evenings she latches on, sucks a few times, then pulls off and screams and sputters. Sometimes this is accompanied by gagging and choking. I have heard that breastmilk soothes a sore throat so was wondering if she gets a few sips which help her throat but then irritates her overly full stomach. I also wonder if, because she eats so often, she is being overfed.

* Vomiting - 3 times over the past 7 days. Like real projectile vomiting, not spitup.

* General gassiness - major gurgling can be heard in her stomach and she often pulls her legs up to her belly and screams. When I burp her it sounds like the national belching contest has come to town, unbelievable deep loud belch coming from this teeny peanut.



So based on the symptoms above I was beginning to think reflux. However:

* She sleeps well at night lying flat on her back or on her side - at least 4 hours, often 5-6 hours

* She seems comfortable on her back at other times

* She doesn't spit up or exhibit this super fussy behavior every day, though it's been on more than off over the past two days. Yesterday she hardly slept at all so I'm wondering how much of the crank was due to being tired

* She doesn't seem to want a binky - prefers my breast even when she's already upset


So... any thoughts? Am I overfeeding her? (I thought this was impossible at the breast but given that she's latched on so often... possible?) Does it sound like reflux? Or is this just normal newborn stuff?

Basically trying to head off any potential esophogeal damage and/or feeding/ oral aversions before they happen. I've got an appt with the doc tomorrow but really wondering how you can dx reflux?

Any advice is greatly appreciated...

[turtlemama77]

With my first dd (and with ds now), she would nurse so much for comfort that she did spit up pretty often. And it wasn't just little dribbles either. I seem to recall changing my shirt a couple times a day! ds is like that, too, especially in the evenings. He nurses, nurses, nurses, and then spits up. It doesn't seem to bother him, and it didn't really bother my dd either.

I've noticed that when ds is fussy at the breast, it usually happens when he's tired and wants to go to sleep but is having trouble. Have you noticed anything like that? I'm not exactly sure what to do about it because dd ALWAYS fell asleep very easily nursing, but ds sometimes needs to be held/walked/rocked/patted to sleep.

I don't know if that helps...I hope you get answers soon!

[SabbathD]

Okay a few things - we were just diagnosed with GER, and we had a lot of the same symptoms that you are describing. Spitting up, pulling away and screaming is a dead give away according to my Dr., lots of gassiness ect. And yet she had no issue laying on her back, and wasn't always fussy. A constant eater, always wanting to be on the breast. The projectile vomit, which we also have had 3 cases of, I was told, was actually indeed from her just having too much in her stomach. It's not a bad thing, or a flu or anything like that, she just overate and had to get rid of some of it. So I would say it's quite possible that your babe has GER, mine does and we are trying out some medication to help with it.

As far as a pacifer goes, we did choose to use one. After the first couple of 'I ate to much' spit ups because she wanted to suck constantly, we tried a few. The ONLY ONE that she will use, and she hates all the other ones, is a pacifer called the soothie. It's a green clearish one that they use in hospitals. According to our Dr., babies who hate pacifiers will still like this one, and she does. It's been a godsent for her overly fussy 'I just really want to suck on something' periods, and when you have cracked and bleeding nipples, the comfort sucking just isn't always a good thing. I got mine at Target, and they also sell them at babies r' us, and they also make bottles with the same nipples. If you want to use a pacifier, I HIGHLY recommend that you try this one.

[Quagmire]

Thanks Sabbath. What meds are you using??

We have a soothie leftover from DD1 but she won't take it. I got a playtex natural latch which is anything but natural, however she will use it for short periods. She still wants me though I wsh I could shut off the flow for her... was so so determined that this be a binky-free baby :

[Quagmire]

Oh and forgot to ask - how was the diagnosis ultimately made? And what form are the meds? (powder, liquid, etc?)

[MsGrizzle]

We have similar things going on here. Choking, lots of gas and pulling off fussiness. Spit up once in a while but nothing projectile yet. I also turn to a pacifier when my sore nipples can't take it anymore!

I've been using Mylicon after feedings where he chokes a lot to try to head off the gas. I think that is part of the problem.

I'm working with an LC and we are doing two things: treating my thrush and changing my diet. According to her, food allergies can often trigger all of those symptoms. So I'm eliminating dairy and some other stuff to see if anything improves.

Is your baby stooling often? Mine is only going every 2-3 days and she said that can also be part of the allergy problem.

Will be interested to hear what happens. We have a weight check tomorrow at the ped and I may bring this up. Here is something I found on Dr. Sears.

http://www.askdrsears.com/html/10/t106000.asp

[TanyaS]

GER and overactive letdown/too much milk often have similar symptoms. Try block feeding for several days. You should see an improvement. Block feeding is where you nurse on one breast for two hours, then switch to the other one for the next two hour window. You can probably read more about it on kellymom.com. If you have too much milk, then your supply will self-regulate within a day or two. You may have to hand express or pump *only long enough to relieve pressure* on the side not being used. If the problem is significant, some mothers can increase the time by an hour until they find a supply that matches baby's comfort. I'd definitely recommend trying this before going to medication right away. It may help some babies, but GER is often over-diagnosed because physicians just don't get very much training in breastfeeding management and the symptoms are similar.

Here's some articles that might be helpful:

http://www.lalecheleague.org/FAQ/oversupply.html
http://www.lalecheleague.org/FAQ/ger.html

http://www.kellymom.com/bf/supply/fast-letdown.html
http://www.kellymom.com/babyconcerns/reflux.html

[gumby74]

I just went and visited a friend of mine who's 5 week old is expereincing the same issues. She was diagnosed with reflux. The interesting thing another friend of mine, as well as this doctor, said was that the reason the baby is nursing non-stop is probably because the milk cools the esophagus as it goes down. Not sure if this was already mentioned, but I just found it interesting.

[sewaneecook]

This has been a very helpful post! I think I may have overactive letdown. I'm definitely going to try some of the ideas in the articles posted to see if it helps DS. Thanks for all the great info.

[TanyaS]

Another thing that I read, but of course can't find the article, is that the infant carseats can aggravate reflux-like symptoms. Something about the way the baby curves in the seat makes their esophogus dip into their stomach, causing upset tummy and reflux symptoms. Since a lot of your babies are having these symptoms, you might evaluate any time spent in the infant carseat. I read about this about the time my dd was born in 2004. She HATED the infant carseat. Cried like we had needles poking out in the seat. She quit when we switched her to the convertible rear facing. She was also not interested in an excessive amount of milk and we nursed on one side per feeding from the day my milk came in. She just was so fussy and spit-uppy (is that a word?) until I changed how I was feeding her.

[MsGrizzle]

Another thing that I read, but of course can't find the article, is that the infant carseats can aggravate reflux-like symptoms

Ack! Noooooooooo....that's one of the few places, other than my arms, that I can get ds to sleep! Ugh!

I'm so confused...ds's symptoms match for both GER and overactive letdown. I've been using only one breast per feeding since the beginning and it hasn't changed it at all. Maybe this is one of the reasons ds only wants to latch on the nipple? I wish this wasn't so complicated!

[TanyaS]

Originally Posted by soapdiva

I'm so confused...ds's symptoms match for both GER and overactive letdown. I've been using only one breast per feeding since the beginning and it hasn't changed it at all.

If one breast per feeding isn't working, then increase the time to see if the two of you need a larger window of time. When you say 'one breast per feeding' do you mean that you are using the same breast for two hours? Or are you using one breast, then if he wants to nurse, say, 1-1.5 hours later do you use the same side or switch to the other one?

If you are using the same breast for two hours, then try using the same breast for three hours. If you switch to the other breast at a shorter interval than 2 hours, try increasing to two, then three, etc. It's not common, but there are mothers who have gone as long as 6 hours on one breast, then 6 hours on the other. That would be for an extreme oversupply issue, though.

Whenever making adjustments to your nursing pattern, be sure to watch output and baby's satisfaction to make sure your supply isn't compromised. If it's oversupply, it's not likely to be a problem. If after a day or two you think your supply has been decreased too much, just go backwards a bit (like 30 minute increments) to find the right balance for you both.

[SabbathD]

Sorry about how long this is.....

Originally Posted by soapdiva

Ack! Noooooooooo....that's one of the few places, other than my arms, that I can get ds to sleep! Ugh!

I'm so confused...ds's symptoms match for both GER and overactive letdown. I've been using only one breast per feeding since the beginning and it hasn't changed it at all. Maybe this is one of the reasons ds only wants to latch on the nipple? I wish this wasn't so complicated!

Well to be fair - the GER would be a problem for her, and the overactive let down would be a problem for you. My baby coughs and sputters, when let down happens, but then (most of the time) is happy to be back on the breast feeding as soon as she has caught her breath. I would attribute THAT to the let down. But, the fact that several times during the feeding she will suddenly break away and start crying, that I will attribute to the GER, if that indeed is the problem. We have also used Mylicon, which is great if she is really gassy after the fact, and I find myself only really having to use that very seldom, provided I watch my diet.

There are four culprit categories of food that seem to be the same for almost every nursing mother. I am stealing this passage from The Nursing Mother's Companion. I highly recommend that book as well as The Womanly Art of Breastfeeding. They have become my bibles as of late, and are GREAT books.

So, they recommend eliminating completely the following four 'food groups', for 3 days, and then reintroducing them to your diet one at a time to try and find what may be causing your babies issues.

-Chocolate and Spices - major offender in chocolate is theobromide, even in small amounts it's a potential offender in small digestive tracks. Spices that may cause issues are cinnamon, garlic, and curry.

-Citrus - Oranges, lemons, limes, tangerines, grapefruit ect ect. Other strongly acidic fruit also such as kiwi, strawberries, pineapple can produce the same effect.

-Gas Producing Vegetables - Cauliflower, cabbage, brussel sprouts, broccoli, bell peppers, cucumbers and onions. Especially onions, even in tiny amounts, and even onion powder.

-Cow's Milk - All dairy. Cheese, sour cream, cream cheese, milk, cream, ice cream, ect ect. Some babies are so sensitive that simply eating less dairy won't do it. You must eliminate it completely from your diet.

Other things that can do it are laxatives, aspirin and certain decongestants (those containing phenylpropanolamine). Vitamin C, brewers yeast and flouride have all been shown to cause colic in some babies. Caffiene can cause fussiness as well.

There is a group for pediatric and adolescent GER called PAGER, and here is there website.

https://www.reflux.org/reflux/webdoc...m?OpenDocument

They describe GER as -

Gastroesophageal Reflux (GER) or Reflux is the medical term used to describe a condition in which stomach contents - food and gastric acid - frequently flow back up out of the stomach into the esophagus. The food that comes up may or may not flow all the way out of the mouth. It may be forceful vomiting which rapidly and completely empties the stomach, or it can be more like a "wet burp" that doesn't reach the mouth

And they list common symptoms as -

There are many different symptoms of GER. Your child may only have a few of these symptoms. The most common symptoms include:

• • <LI type=disc>pain, irritability, constant or sudden crying, "colic" <LI type=disc>frequent spitting-up or vomiting <LI type=disc>vomiting or spitting-up more than one hour after eating <LI type=disc>not outgrowing the spitting-up stage <LI type=disc>refusing food or accepting only a few bites besides being hungry <LI type=disc>poor sleep habits, frequent waking <LI type=disc>"wet burp" or "wet hiccup" sounds
  • bad breath

The less common symptoms of pediatric GER include:

• • <LI type=disc>constant eating and drinking (to soothe a sore throat) <LI type=disc>intolerance of certain foods <LI type=disc>poor weight gain; weight loss <LI type=disc>swallowing problems, gagging, choking <LI type=disc>hoarse voice <LI type=disc>frequent red, sore throat <LI type=disc>respiratory problems; pneumonia, bronchitis, wheezing, asthma, nighttime cough, apnea, aspiration, noisy or labored breathing <LI type=disc>ear infections <LI type=disc>constantly running nose; sinus infections <LI type=disc>tooth enamel erosion <LI type=disc>excessive salvation, drooling
  • peculiar neck arching, Sandifer's Syndrome

I am still sort of weary that she actually has GER, not because the symptoms aren't there, but because I am just....I don't know cynical about the quick diagnosis and a little concerned that they are just tossing a label at what may be infant fussiness, and nothing more. They prescribed Axid which is an acid suppresser. I guess we will give it a try and if we see some positive changes then awesome! And if we don't, then I am ruling it out.

[Mama2ABCD]

if a baby is getting too much foremilk, it can cause gassiness, fussiness, etc plus pooh's that are slightly green. it helps to pump off some of that foremilk so the baby can get more hindmilk unless you got an eager older nursling they can suck off some of the foremilk before the baby takes over.

the breastfeeding forum should have some archived threads on formilk vs hindmilk.

[Hazel]

I wish I had all this info when my 9 year old was a baby! We had the WORST time breast feeding and I could not get any help from anyone.
We are expecting another late Sept/early Oct and I will keep all this in mind this time around. I hope this experience is more like that of my first babes though, he was so easy to nurse.

[Quagmire]

Originally Posted by kstsmith

If one breast per feeding isn't working, then increase the time to see if the two of you need a larger window of time. When you say 'one breast per feeding' do you mean that you are using the same breast for two hours? Or are you using one breast, then if he wants to nurse, say, 1-1.5 hours later do you use the same side or switch to the other one?

If you are using the same breast for two hours, then try using the same breast for three hours. If you switch to the other breast at a shorter interval than 2 hours, try increasing to two, then three, etc. It's not common, but there are mothers who have gone as long as 6 hours on one breast, then 6 hours on the other. That would be for an extreme oversupply issue, though.

Whenever making adjustments to your nursing pattern, be sure to watch output and baby's satisfaction to make sure your supply isn't compromised. If it's oversupply, it's not likely to be a problem. If after a day or two you think your supply has been decreased too much, just go backwards a bit (like 30 minute increments) to find the right balance for you both.

I have been block feeding since last week It worked fairly well with my last daughter and I had been thinking perhaps the gassiness had something to do with a foremilk/ hindmilk imbalance, plus the engorgement was a problem and I used block feeding to manage that problem as well. I did see an initial improvement in spit up frequency but haven't seen a change since then.

I should also mention that the letdown problem is a big one for me. I have several letdowns per feeding. When my breast is very full it seems to happen every few minutes. Gusher here. It's one or more streams of milk and they last up to 30 seconds. Very frustrating for DD either way - if I wait it out and let off the milk into a towel she screams, if I feed her she screams I can't win.

Output is very good anyway. Lots of wet diapers, poop almost every time.

I am going to try the elimination diet. We'll get some soymilk so I can continue to have cereal (keeps me from being constipated) and go cold turkey on the other stuff. I don't eat a lot of citrus but I have had strawberries and OJ pretty much every day, and I drink a cup of coffee every morning. *sigh* I do love my coffee...

Thanks everyone. I appreciate the advice. Like you Sabbath, I am wary of the reflux diagnosis. That's why I was wondering how it's made. The Sears link provided by Cori above was useful there - I'm not thrilled about having a string down DD's throat overnight. But I do want to manage the problem correctly - the severe reflux stories that lead to oral aversions and feeding tubes really scare me and right now DD seems to be in pain when she's experiencing symptoms

[MsGrizzle]

If one breast per feeding isn't working, then increase the time to see if the two of you need a larger window of time. When you say 'one breast per feeding' do you mean that you are using the same breast for two hours? Or are you using one breast, then if he wants to nurse, say, 1-1.5 hours later do you use the same side or switch to the other one?

If you are using the same breast for two hours, then try using the same breast for three hours.

Ah okay - I think most of the time I stick to one breast for that feeding but then switch for the other one without watching how long its been. If its only been 30 minutes or so, I do usually keep to the same one, but it sounds like I need to try increasing that. Thanks!

[TanyaS]

Originally Posted by SabbathD

-Cow's Milk - All dairy. Cheese, sour cream, cream cheese, milk, cream, ice cream, ect ect. Some babies are so sensitive that simply eating less dairy won't do it. You must eliminate it completely from your diet.

Dairy is usually the #1 culprit and it's a great idea to start there. Dairy accumulates in your body and it usually takes 2-3 weeks being dairy-free to see any changes. Dairy is often hidden in other foods, so check for ingredients like whey or casein. I think www.drjaygordon.com has a list of the hidden names for dairy.

Also, overactive letdown is often paired with oversupply which can make babies fussy at different times during the feeding. The other thing to consider is that there is not just the one letdown at the beginning of a feeding. It happens many times throughout a feeding, but is typically not as forceful as the first one.

Someone (SabbathD?) mentioned that it could be plain-old fussiness. Honestly, she's right. Babies are fussy, babies spit up and babies have gas. Even babies who truly have GER will still spit up and still be fussy. Babies who are block nursing can still do the same. Babies are born with an immature digestive system and a perferated gut that does not fully close until 4-6 months. Often 3-4 months is the time when colic, gassy, GER symptoms disappear, making the problem with the baby pretty much normal behavior. I'm not saying food sensitivites and problems like GER don't exist, because they definitely do! I'm just pointing out other possibilites to explore because I know I would be reluctant to give my newborn a prescription med, too.

to you mamas trying to figure it all out. It'd be nice if they could tell you to turn down the faucet or that they have heartburn. Certainly would make it easier than all this detective work.

ETA: You all are keeping my mind off the fact that my baby is not here yet! Thanks!

[MsGrizzle]

We'll get some soymilk so I can continue to have cereal (keeps me from being constipated) and go cold turkey on the other stuff.

Keep in mind that soy is also a common allergen in case you still see issues. My LC recommended almond milk. No idea what it tastes like...

[Quagmire]

Originally Posted by soapdiva

Keep in mind that soy is also a common allergen in case you still see issues. My LC recommended almond milk. No idea what it tastes like...

Ok thanks for the tip! I think I've seen it at Trader Joe's...