Reflux or oversupply ... And how long before Losec should kick in?

Hello lovely BBers :)

I would love some perspective on a few issues I have with DD2's breastfeeding. She is 6 weeks. Once my nipples healed from initial sensitivity and we established good attachment BF seemed great for the first two weeks with the exception of notable oversupply, and bebe was very settled. I mentioned oversupply in the BF chatter thread a while ago so apologies for repeating stuff. I suspected oversupply and / or forceful flow for the following reasons (While feeding)-

-Gagging
-Sputtering
-Coughing
-Holding breath temporarily while gulping very rapidly
-Pulling off frequently
-Arching back/stiffening legs
-Lots of burping
-Pooing as she drank
-Smelly farts
-Wheezy after feeds or with milky looking mucous in her nostrils like she has snorted the milk/down the wrong way
-Mouthing the nipple but not actually attaching if that makes sense, like she was hovering and dancing her mouth around the nipple.* Not sure what this means actually but always seems to precede behaviour signaling discomfort or wind?

My boobs were always full and it felt like she would never empty even one side and were uncomfortably full again within half an hour of a feed.

After feeds she was a bit unsettled, nothing too dramatic.at this stage she wasn't bringing any milk back up at all. I tried the usual oversupply management tactics of block feeding, feeding off only one side per feed, feeding lying down or reclined, pulling her off until letdown has subsided etc...

This seemed to be working ... However at about 3 weeks things have felt worse... The gagging etc isn't more frequent but now she cries during most feeds as well as after. Sometimes she feeds 'standing' on her legs as they and her back are so stiff. She is always crying after a feed and feeds feel like a battle and i have trouble ascertaining if/when she has had enough as she is mad keen on comfort sucking so won't pull away even if i suspect she has had enough and gets increasingly upset as she feeds and drinks increasingly rapidly like a crazy lady. Sometimes when I feel her tummy as this happens i can feel movement- like air or milk??

This is what is now making me suspect reflux as the crying has increased notably, the other symptoms persist yet my supply feels settled now ALTHOUGH I know my flow is still a but mad because when i pull her off when she gags on let down or starts gulping manically my milk sprays out...

Also DD2 has gone from settled and sleeping well (or well enough for a newbie!) to catnapping and at night waking frequently grunting, gurgling etc.

Went to a gp who told me she didn't believe in reflux, had no advice re the list of symptoms (including a rash- maybe unrelated) but wrote a prescription for losec anyway although she didnt weigh her for the dosage but guessed her weight range based on her discharge weight and a weigh in at 17 days.

DD2 has been on losec, 2mg, 1 ml taken twice a day for 4 and a half days but zero improvement. How long before it kicks in, or is it not reflux (hence zero improvement)?

Hmm...

Woops sorry just saw how long this post is!

It does found like reflux, the coughing, wheezing and husky sounding with lots of crying unless upright were the main symptoms for ds. His poo was green and his breath smelt acidic. Losec takes about a week to work it reduces the amount of acid formed which takes a while. Driving in the car would always help settle him down, it was actually three days at home in a row which sent me to the dr as he was inconsolable and wouldn't feed or sleep.

Poo? how much.

If there's lots of poo, I would say you have all the hallmarks of oversupply and attendant lactose overload. You mention block feeding - how did you do it and for how long?

Initially- up to 2.5 or 3 weeks old yes lots of poo, almost every nappy. But not so much since my milk feels more settled (as I said, not feeling overfull now but still have mega flow - and painful letdown). Now I'd say every second or third nappy? And she doesn't have a huge amount of wet nappies in 24 hours, one extremely heavy sposie overnight and say 4 super wet prefolds or AIOs during the day. Which I know is the lower end of the scale for a newborn.

Re block feeding I think I did it for 5 or so days but I didn't do it in blocks of time but number of feeds per side before the other side felt too full. So say 3 feeds on the same side or something like that.

So how much poo? And what's it like? Any history of food allergies or intolerances?
How often is she feeding?
You mention initial sensitivity. Were there any issues with attachment? Was she assessed for tongue/lip ties? Sometimes inefficient latch can result in these sorts of symptoms, also, and be misidentified as reflux.
It's quite common for babies to sleep well in the first 2-3 weeks, and then "wake up" and become unsettled. It might be that there are a few things going on, some normal, some not.
Have you consulted with an LC? It would probably be a lot more helpful than speaking to your average GP.
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No tongue or lip tie, attachment is good.

Poos are normal mustard colour, not frothy. A bit smelly though her gas seems to smell worse. The amount is neither here nor there, a few side blow outs but how much is a 'lot'?

She feeds about every 2 hours during the day with maybe one longer stint of 3 or 3.5 hours. At night a stint of 4.5 hours then 3 hourly until morning. So I'm waking about three times at night and feeding more often during the day. Give or take as I demand feed.

I don't have any allergies or intolerances, hubby is a 'dormant' asthmatic as in he used to suffer quite badly but in the last 7-8 years he has hardly needed ventolin st all. DD1 is allergic to egg (white and yolk) and peanut.

Thanks for the links. So frustrating as I feel I've done everything right- positioning, burping, trying to address flow, even medication in the event of reflux but still can't work it out.

If your doctor has NFI about what's going on, then you'll need to speak to someone else. Even if it is reflux, then you need to know that a) you're on the right treatment plan and b) if you're medicating, that you're using the right doseage! It won't work if you don't.

Often, these mysteries are easily resolved as soon as you speak to someone who actually knows what they're on about. Call an LC. They can rule out a number of possible feeding issues and point you in the right direction if there's an underlying medical problem.

Oh, last question, did your DD2 get the rotavirus vax and did it get worse after that?

No not yet she hasn't had her first lot of vaccs yet.

Hi girls,

I thought I'd post an update in case our story is ever useful to others. It is an active, continuing update as we have no answers yet. Basically I thought the crying and 'yelling at my boob' during feeds was at it's worst- I'd given the Losec seven days to kick in before contacting a LC. On the 5th and 6th days she was crying through every feed bar night feeds. On the 7th day and for almost two weeks after there was a notable difference - she only cried through a couple of feeds a day- almost always the last to second last feeds before bed at night. I thought we had cracked it- the problem was reflux, helped enormously by losec. But after those 1.5-2 weeks things slowly returned to bad again. Oddly she doesn't seem bothered when she spits up. Still taking losec.

Anyway bit the bullet and booked a LC, she spent a few hours with us just yesterday. And it is a mystery to the LC too! We think I did have oversupply issues earlier but now my supply is a little low- despite still having an obviously forceful letdown and fast flow. The gagging/sputtering/snorting milk up the nose continues but is improved. Just once a feed, as opposed to several times, and not as severe.

Now It is as though at first DD2 is bothered by the forceful flow, but later is bothered by milk not enough coming fast enough. :wall:

Because while her weight at 7 weeks is not bad at 4422 it *could* be higher considering significant weight gains up to 3 or so weeks old- exactly when the fussy feeding started. Her weight wouldn't bother me except for the extreme fussing. We think the fussiness means she is refusing to finish feeds even when still just a bit hungry so of course my milk has adjusted. She also tends to be a tad unsettled between feeds.

How weird is this though- I fed DD2 off one side so the LC could observe then weigh her to determine approx mls taken etc. We both noted a couple of strong let downs. She didn't feed for too long before getting fussy and refusing more but when was feeding had a great suck swallow pattern, was swallowing deeply, there was milk in the corners of her mouth etc. It looked like lots of milk and a thorough albeit brief feed! LC said maybe despite the brevity of the feed DD2 had had a 'monster' feed going on what we had observed and I thought so too as DD1 had always fed like that - fast and furious - and gained well. But according to the weigh in DD2 had only taken about 14mls!!! But then with some coercion she had a more 'normal' amount from the other side.

Her latch is great, no tongue or lip tie, our positioning is good. No thrush. I'm already doing everything LC had planned to suggest regarding keeping her feeding longer - optimal positioning, feeding while walking, sneakily calming with a dummy then swapping it out with my nipple, having little breaks, swapping back and forth between sides, compressing when she seems bothered by no/slow flow. she burps without effort but does seem to be in obvious pain part way through and intermittently after a feed. LC thinks maybe a gut issue (horrendously smelly farts, though poo looks normal) and /or immature swallowing/nasal bits as she gets a bit wheezy/snores and gets a snotty nose for a period after feeds. And hiccups!

We are trialling two weeks of me taking a high level probiotic and if that fails two weeks of no dairy (hard as I love the stuff!) will keep everyone posted. Continuing losec for time being.

Babies at that age need medication dosages adjusted very regularly so your baby may need the dose adjusted, even if not much weight gain some bubs require a higher dosage.

I am highly suspect of CMPI (cows milk protein intolerance) based on what you have written. A huge proportion of reflux babies have CMPI and then about half of them are also soy intolerant. I am a member and volunteer for RISA ( reflux infants support association) and they have lots of great info on the website and if you join as a member you have access to our private Facebook page, a library with lots of books about reflux and allergies, intolerances and gut issues, forums and more. My only regret is that I didn't job. Earlier in my children's reflux journey as I was told that babies grow out of it ( which most do by 12 months but my daughter is 4 and only recently off meds and my son is 2 and only just come off meds and probably needs to go back on them.

My son who is four had horrible reflux. He was on losec from 12 months when we figured it out and got better - not perfect but better. We now know he has other issues which would have been causing some of his problems too. My other son is nearly two and he has been on Zantac since about 3 months old. He has it morning and night and and goes pretty well - but we know when he misses it! Does she have her medicine spaced out? Maybe check in with dr again about the dosage and time it's given? Has she had her ears checked? Perhaps it's causing referred pain for her to swallow? Hope you figure it out soon.

Hi Ladylove, thanks for the update. Sorry things still aren't sorted. Did you get on to a doctor about the doseage at all?
Which LC did you see? If you haven't already, maybe have a chat with Joy Anderson, the intolerance/allergy guru.

I saw Cathy Garbin. In a way although we have no 'solutions ' yet I felt reassured that I have been doing all the right things , going through the right motions etc and that with my second babe I do have a pretty sound knowledge of BF and troubleshooting.

Maybe I should try the dairy elimination first- before the probiotics.

Joy Anderson, yes she has a fantastic reputation but wish she did home visits. I just can't do a Freo trip on my own with two little ones, it would be diabolical. And not sure about Skype. I like face to face.

ETA- no have not seen a doc again. must get dosage checked now she has a recent weight recorded.

I'd suggest giving it a go. She really is great to talk to on this subject, probably one of the most knowledgeable people around on breastfeeding and food stuff, reflux, etc.
Cathy's great, too, so glad you're feeling good about it. You already know your stuff, for sure.

Ok rang the compounding chemist since they have the original script for losec and I can increase the dosage. So instead of 1ml twice a day they suggested 2ml. If that doesn't work a tad higher. In the meantime waiting on my Fast Tract probiotics order. Had a *reasonably* settled day yesterday- a 3 hour nap and i could calm her during a feed enough so she would finish feeding herself without histrionics. Today so far not so good. Unsettled even during naps and goes from smiling and cooing to crying and scrunching her face in an instant.

Thank you all SO much for your guidance so far. If this was my first child I reckon I'd be out of my mind by now. Luckily feeling pretty calm and focussed... For the most part!

Have you tried mylanta at all? It can be good way to see if it is acid reflux that is causing the discomfort. It was recommended by mchn as method of diagnosis before trying the losec etc.