Sunday, February 28, 2010

How We Met & Mastered Mr. Reflux

A friend recently asked me some questions about how we identified and dealt (still deal) with Eowyn's acid reflux issues, which spurred me to post about it. So, voila:

Thanks to the weeks spent with the Powell babies, two of which had fairly severe reflux, I suspected Eowyn within her first week of life ex-utero. Signs included:

- raring her head back (very good head control for such a bitty one)
- excessive spit-up (at times projectile) long after being fed
- lots of crying-especially during feeding (babies shouldn't cry then)
- screaming when put on her back, as well as times of inconsolable screaming-- when put on her back (even if asleep) she would usually soon "startle," throwing out her arms with wide-open eyes, and begin crying in pain,
- constant congestion (fairly common in a newborn, but hers didn't go away until about 2 weeks ago, so at nearly 5 mos),
- an obvious preference for an upright position (she always hated being cuddled in the typical "baby" position)
- green poop.

Taking her to the pediatrician when her constant congestion led to labored breathing in the early morning led her to a diagnosis of reflux by week 2. Prevacid was prescribed.

As for what we did,

At first, I gave her the Prevacid because she was in such obvious pain & we thought that might help quickly. The doctor gave us a 3-day supply so that we could see if it was effective before we had to buy it. If it helped, it was minimal. I started thinking about what Prevacid does-- it suppresses stomach acid-- and realized that if her body was already struggling to regulate itself, then this would probably only further confuse it. Since the medicine- treating the symptom- didn't really seem to help anyway, it was a no-brainer to form another strategy. Ours was to try to figure out the cause of the acid over-supply and then try to treat it naturally. I still have the prescription unfilled.

Looking around online, I researched main causes of acid reflux in infants. There are mom-side causes like overactive let-down, oversupply, and a high-acid diet. There are also baby-side causes like poor latch, food sensitivities (top trigger is dairy, then gluten, soy, certain veggies, caffeine, chocolate & alcohol). Since I already was off of gluten, soy, caffeine, alcohol & most sugar, those were eliminated. I decided to try other things before going dairy-free as a last resort if I needed to. I did have LOTS of milk, Eowyn was gaining a lot of weight, and one friend threw the phrase "foremilk-hindmilk imbalance" out there in the discussion. "Block feeding," in which the mother breastfeeds for several consecutive feedings on one breast only, was recommended (the fulness in the other breast tells your body that you don't need to make any more milk, and your supply begins to go down). When her poop turned green, I decided to go with the block feeding and see if that helped. Bringing my supply down was certainly not a bad idea, as I soaked through several changes of clothes each night, and had begun to sleep on a towel because Ryan & I literally would awaken in a puddle!

What is foremilk, you ask? Ok, quick explanation: (breastmilk is soooo cool!) the first milk that comes out when a baby breastfeeds, called "foremilk," is higher in water and in sugar (lactose), so that the baby's thirst is quenched quickly and he is motivated to keep sucking by the sweet taste. The later milk (called hindmilk) has more fat in it, as the fat globules tend to stick to the gland walls until the end of the feeding. If the baby doesn't stay on one breast long enough to get that fat-rich milk at the end, she will get lots of sugar (lactose), which humans only can digest so much of, and will get a full tummy, but won't necessarily be satisfied because the fat is what is filling. The baby's tummy will struggle to digest all the lactose, causing gas, which can push milk back up into the esophagus (aka acid reflux), and the lovely green poop... So I tried feeding her on one side only for as many feedings as I could stand... yeah... the first time I fed only from one breast for eight hours. Yikes! (Normally most moms switch sides mid-feeding, meaning each side empties about 1/2 a feeding's worth of milk every 3 hours!) God has made our bodies so amazingly that my milk supply very soon went down, until I just alternated which side I fed on each feeding. Sorry for all the information if you didn't want it-- I give the specifics because this might help some confused and desperate moms (like I was!)... Hooray for goodbye to green poop!

Our other problem on my end was was over-active letdown. This means my milk was coming out too fast for her, causing her to choke and swallow air, leading to gas bubbles (leading to acid reflux as well as to frustration while feeding). I had to help her stay ahead of the milk by feeding lying down or leaning back. Now that she's older, she's better at both latching and staying ahead of the milk, though her latch is still not great. Feeding her when she's sleepy or only half-awake is best. I also keep a cloth handy, so when I feel the milk let down (more like shoot out in a fire-hydrant of milk), and she comes off, I just catch it in the cloth and put her back on when the torrent slows to a trickle. (Once I caught it in a bottle to measure it and it was 3 ounces. Yikes!)

Other things we did: we started sleeping her on her tummy (with full knowledge & consent of her pediatrician)-- babies with acid reflux usually have very developed head control because of their neck-arching to try and escape the burning in their throats... while this is very sad, it does mean that they are less at risk for smothering themselves by sleeping on their tummies. We raised her bed to about a 20 degree angle and never put her flat on her back. She hated her carseat; it's at a really bad angle for reflux or GERD babies. She also resisted a sling (lying down hurt her), so we used the Ergo a lot and she loved that. I used saline drops every morning & might to keep her nose clear of infection despite the reflux-caused congestion. We deal with the spit-up through bibs and lots of burp cloths. When she rejects feedings for whatever reason, I try nursing her standing up and/or swaying, which usually does the trick. I did find that chocolate & cooked tomatoes, as well as an excess of pasteurized milk products aggravate her. "Tummy Soothers" Disney Natural drops really help, too. They are a suspension of ginger, chamomile and fennel, and have no negative side effects. At her worst we gave those to her 3 times a day and knew it if we missed a dose. (At first I had to give it to her in a bottle of expressed milk, but now she loves the taste and takes it straight from the syringe) I still give the Tummy Soothers to her about twice a week- whenever she has trouble- and spiked my own grape juice with it when I had a stomach flu! =D

Well, if you've read this far, you probably are a mom arming yourself with baby knowledge, or a future mom doing the same. I hope that this all helps!! If you've got other tips, please feel free to post them in the comments!

No comments: