INFANT RELUX, DANIELLE MESSINGER NAHAS
“All babies spit up, it is completely normal, as long as she is gaining weight and has wet diapers every six hours, there is nothing to be concerned about,” said our pediatrician. Easier said than done.
Allow me to introduce myself, I am a new mom, and older mom, a nutritionist and one that works in the health and wellness world, as crazy as it may sound to most anyone reading this or speaking to me, “as long as she is gaining weight” isn’t a good enough answer to me when my newborn baby would spit up what appeared to be, her entire meal after every feeding. I am not one to panic or be overly obsessed with things, however, when it comes to being responsible for a little human, I would say my number one concern is questioning myself and not trusting my “mom gut” as I like to call it.
Around two weeks of age my daughter Sawyer started spitting up after feeding and I don’t mean just dribble down her chin, I mean projectile vomiting shooting out of her like the exorcist. When I was walking down the hall with her one morning, she nearly sat straight up in my arms and viciously projectile vomited almost three feet all over the wall and floor. It scared me so much I prepared to perform mouth to mouth on her thinking she was choking and about to stop breathing. When I looked at her and saw that she was not turning blue, I collected myself and called the pediatrician to get her an appointment thinking that she might be ill.
Here we were two days before her two-week appointment at the pediatrician’s office. She was fine, great, actually, she was gaining weight and had great diaper output so there was no sign of dehydration. After collecting some basic information regarding her feeding; yes, I am breastfeeding, no I had not been using a bottle, yes, I am pumping and typically 4 ounces from each breast AFTER feedings, the pediatrician figured that I must have a very aggressive let down and an oversupply of milk. It was determined that I was overfeeding our child and she was getting rid of what she didn’t need. That answer sufficed I am new at nursing, my milk hadn’t regulated, and I didn’t know how to help that. I was given some recommendations on how to help with my flow and advised that I could start using a bottle for some feedings with slow flow nipples.
Working on those recommendations, I began pumping for a few minutes prior to feedings instead of after, and we started using the Munckin Latch bottle which is an anti-colic bottle with a slow flow nipple -P.S. this was great bonding time for her and her daddy-. The projectile vomiting didn’t subside, and I noticed that no matter how tightly we swaddled her she would kick and grunt in her sleep, therefore not having a restful sleep. During the day she became fussy, she would cry when we laid her flat, she would scream when we put her in a supine position in the bouncy chair, she hated rockers or anything that bounced her, she would eat comfortably then right after she would cry and out would come the spit up, nothing seemed to soothe her except holding her and sleeping on my chest. When she began greeting me in the morning with projectile vomit before I even picked her up – hours after being fed-, and her little coos were sounding hoarse as if her throat were raw, I was done. This wasn’t my child, I knew immediately something was off she was not a fussy baby and here we were closing in on the month mark and I found myself crying and stressed after every feeding. During her night feedings I found myself obsessively googling “baby spit up,” “baby vomiting,” only to find that infant reflux kept popping up. I understand reflux, man I had more heartburn and reflux while pregnant with this child than I would wish on my worst enemy, it was painful for me and I could imagine if this was what she was going through how painful it must be on her little, underdeveloped system. Enter a fantastic website: www.infantreflux.org . It was here that I learned what the symptoms of reflux are as well as the difference between reflux and colic – we didn’t think she was colic, but it was starting to manifest itself that way-. She had the top three symptoms on the list and a dozen others. I love our pediatrician, I interviewed multiple practices prior to having our baby, and she supports our choices of care for Sawyer. However, I was frustrated with her when she kept telling me “Sawyer is gaining weight, stop stressing.” I felt that she wasn’t hearing me, and that made me question myself. I literally melted down to my husband telling him the hardest thing about parenting is not trusting yourself and watching our child in discomfort was heart wrenching to me.
A friend told me her son went through the same thing and they ended up putting him on Zantac, I wasn’t sure this was the route I wanted to take but she referred me to a Pediatric Gastroenterologist who I immediately scheduled an appointment with. I began educating myself on everything reflux, in my learnings, I found it is common among babies, their Lower Esophageal Sphincter (LES) is immature and can take up to a year to develop, however, it can also be exacerbated by food intolerances from milk or soy proteins, or a formula that is fortified and babe isn’t handling it well. Since I was breastfeeding I did an elimination diet, removing all dairy for two weeks, I also introduced an infant probiotic, a powder formula that I put on my fingertip and rubbed on the inside of her cheek. Alas, we used Mylicon which worked in our favor and for a little while she stopped kicking and grunting while sleeping, which I figured was the cause of her discomfort in the morning. Lying flat didn’t give the acid any place to go but up, she was kicking from discomfort and it became a domino effect creating gas and burning her little throat which was making her hoarse. What we often forget is all these systems are connected, when one is not functioning at its highest level, it creates an imbalance in the rest of the systems. My firm belief is when treating, you need to get to the foundation of the problem and hopefully it will create equilibrium in the other systems.
At our GI appointment the most important thing for me was to find out if she had any intolerances from my breastmilk, or any ulcers or sores from the acid production. He tested her stool to make sure there was no hidden blood in it as well as any discharge -which would indicate intolerances-. Both these tests came back normal. He did some additional testing (nothing invasive) and determined that yes it was reflux and he wrote a prescription for Zantac. Here is the kicker, with babies if you go the route of using Zantac, you cannot use it on an as needed basis, you need to do it consistently and that could mean medication for many months. Once their LES begins to mature you then ween them off the Zantac. Completely acceptable, however, my husband and I decided that Zantac would be a last resort. The GI supported our choice gave us the prescription to have and then recommended a few other things to try; probiotics, I could add a half a teaspoon of oatmeal to my breastmilk and give her that morning and night in a bottle to help coat her belly, have her sit upright for 20 minutes after each feeding, and put her on an incline when she slept. All great recommendations and we did everything but the oatmeal. I also started taking her to a pediatric chiropractor that worked on her diaphragm to help it release and palpitate it to encourage strengthening. I noticed that the day after the appointment she would have a bad day but it was all “old milk” that the chiropractor explained was sitting behind the sphincter keeping it from functioning properly. The rest of the week after those appointments she would spit up very little, so it helped settle things and slowly her symptoms started to lessen. She became less fussy, she stopped kicking and grunting, her sleep was more restful, the morning side of spit up and the hoarse throat went away and now, here we are 5 months old, we haven’t fully kicked the habit but now it is more along the lines of the “normal baby spit up routine.”
After that GI appointment, I was able to breathe easy and trust that I was doing all I could to support this little human and that there was nothing seriously wrong with her. We are very blessed to have a healthy, developing baby, but first-time mama’s, we all know there will be something that scares the pants off us and in our hormonal, exhausted phase, little problems are very daunting. If there is anything I know from working in my field, you have to be your own health advocate, if there is anything you take away from this article it is to trust yourself, listen to your intuition, find a practitioner who is going to support you, do your research and press, press, press if you feel that something is not right or you are not happy with an answer. As I said to my husband, I don’t want to ever override my mom gut, because the moment I do, it will be a bigger issue. As a new mom I need to learn to trust myself and so that is what I am working on hour by hour, while enjoying every moment I can with our baby girl!