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.

No I haven't Hotl. How much would I give?

i will see if i have the notes still. i think it was 1ml before a feed (dd was 4 months ish)

Increased losec to 2ml twice a day and a slight improvement (it has been two and a half days). Weight gain not great- 9 days ago was nudie weighed at 4.42kg today was weighed with pants and cotton top (dry nappy, not sure how many grams clothes add) at 4.87k. But very long for her age (9 and a half weeks now) at 58cm. Starting probiotics tomorrow (me that is). Dairy elimination in a couple of weeks if no improvement. Just battling through it! Thanks for listening- just helps to note everything down. :)

So 450g in 9 days, less clothes? That sounds fine, no?
Has there been any change in nappy output?
Hang in there

No change to nappies. Wet ones still the lower end 4-5 a day, MCNs. A big dirty one every few days. I weighed her clothes and a dry nappy with the kitchen scales (obsessive I know!) and it was close to 200 grams.

Not obsessive, clever! 250g in 9 days sounds like good weight gain. You feeling ok with that amount?

Yes... I think LC must have miscalculated or misheard the numbers I told her over the phone as she was saying it was a low 120g gain... I couldn't work out how she arrived at that number. DD2 does look healthy. Alert, engaged, pink skin, good muscle tone.

Even 120g over 9 days would be fine.

Do you remember how your DDs gains were? Do they have similar body shapes?

200g is fine. 120g is a bit low, but not alarmingly so.
What's the poo like? That is quite infrequent for a little baby. Was it different before you started the medication?

The poo looks normal for a 9 and a bit weeker. Pretty big, nice consistency. I thought after 6 weeks it was normal for poo to appear less frequently?

Hotl as it happens I was comparing the girls' weight last night. DD1 was just over 4.5 kg at 11 weeks I think. DD2 is already only a tiny bit shorter than DD1 was at 13 weeks. Both are long 'uns. DD1 was always under the 50th percentile for weight. Interestingly I have my own baby book from 34 odd years ago and my weight gains were along similar lines. If we didn't have feeding issues I would not be fazed at all by DD2's weight because she looks perfectly healthy if not small and is reaching her early milestones on target.

my girls have both been slow ish growers, average 90 - 100g a week, and DS was only a little more. The nurse stressed some with #1, but by #3 we know that this is the pattern of my kids (born big, then steady but low-ish gains). And when i was chatting to my mum, she said i did the same thing!

my #3 also had feeding difficulties , but not the gut (reflux) issues, and i too looked to weight gains for reassurance. Thankfully she wasn't my first or i would have been more worried about her weight gains not being enough.

I am looking for evidence she is taking enough I guess because with the crying and pulling off etc I cannot tell when she has had enough.

makes sense to me!

Thanks Hotl and OTF.

So anyone know much about Miessence Fast-Tract? LC told me to take a good probiotic so I've got this, am taking 50ml a day. I wonder if I can give a couple of drops direct to DD2 as well?

My post disappeared! I totally lost a month and thought your baby was younger. All good.
Um. I have no idea about pro-biotics, what did the LC say? Personally, I wouldn't give a little baby anything other than breastmilk without good medical reason. But that doesn't really answer your question :)
The idea is that the health of your gut flora will directly impact on the quality of flora in your baby's gut, via breastmilk, which is the way the system is designed. Giving it directly to baby might mess with this. Or it might be better. I dunno.

Hmm will stick with me taking it methinks.

Ok another update, for anyone interested. A little more than a week into dairy elimination and no difference :wall:

However When our LC was here she checked for tongue tie and said it was all good but I couldn't remember if she checked for lip tie, anyway was talking with a few other BBers and saw some photos of upper lip tie plus researched the symptoms and I am pretty sure she has lip tie.

Could lip tie cause all of those reflux type symptoms plus the crying during feeds? Is surgery our only option given we already employ most of the the positions and techniques suggested for helping lip tie babes to feed, to little avail?

The clue to look further into it was reading about the upper lip not flanged out properly and DD2 does sometimes not flange her upper lip but her attachment when she is attached - I.e. when she's not pulling off-on-off-on and mouthing around my nipple like something is in the way (more clues) - is otherwise perfect.

Yes, it sure can. A lot of babies who are diagnosed or suspected reflux actually have a feeding problem, which may be caused by anatomical problems like a tongue or lip tie. Sometimes the symptoms are subtle, there may not be any obvious problem with the latch, or any pain or damage, but baby might feed quickly and frequently, come on and off a lot, seem to struggle to feed, get windy, be irritable and so forth.

And yes, surgery is probably best option, if confirmed. There is a go-to guy out Fremantle way (I think?) I can find out his name. It's best to get it done sooner, rather than later, obviously
First, though, you'll need to get the LC or someone to confirm that there is a lip tie.

She has her CHN check up next week, I will also touch base with our LC again.

Ps just call me the boob detective. What a journey we are on!

It's been a tough few days. Noticed my let down was very slow at times over the last week, Very unusual for me. DD2 was waking more frequently and earlier at night, still fussy as anything. Was talking to our LC who put us in touch with a GP specialising in lactation. At the appointment I went to feed DD2 and let down would not happen at all! I was mortified, DD2 was hysterical. GP immediately said supply issues, probably due to DD2 being so random, fussy and on again off again with her feeds. It made sense in hindsight but I was rocked - me, with the oversupply, who had never ever had supply issues! I was actually ashamed but that I suspect was the stress talking. So on motilium and doing the pumping thing. Trying to get DD2 onto the boob as much as possible except we have also been getting breast refusal. Not a nice position to be in at all.

In the meantime spoke to LC again re my suspicions of lip tie - she has been fantastic - and she rang the North Freo clinic to explain the situation and implore them to fit me in (usually booked far out in advance as I think he is the only one that lasers TT and ULT in Perth). They could only get us in a week from this coming Monday but then rang today to say they had a cancellation if we wanted to come in. We Arrived, they already had and had read the LC's notes as she had briefed them in advance, the dentist and staff questioned me some more then did it then and there. ULT and mild TT. DD2 has been in some pain tonight though. Had two big feeds after the procedure but refused to feed off me or ebm tonight and screamed the house down. I am hoping that this improves things even just a little and that the breast refusal/pain association issue has not been imbedded too deeply. I know it can take some time for positive effects to take place so fingers, and everything, crossed.

Hugs LL, you & DD2 have been on such a journey with feeding! I hope the tablets & the laser work will both help things to improve & you will continue to have a successful feeding experience. I feel your frustration, my DD2 is a week off 5mths & we still have difficulties with feeding with no apparent cause or reason. You're doing a wonderful job xx