4 month old has started vomiting after both breast and bottle meals

[pippaknight]

My 4 month old James has started vomiting after both breast and bottle feeds.  I bfeed but formula feed for the last feed of the day in an attempt to fill him up so that he sleeps longer.  This doesn't work - the longest he has EVER slept is 4 hours and that was early evening (7pm until just 11pm) which was no good for my sleep!  Anyway, apart from the fact that he won't sleep at night and won't nap.  He now vomits after each feed although he seems OK and quite smiley after puking (he seems to vomit up the entire feed - not just a dribble) but then shouts for food again shortly afterwards.  He is chomping constantly on his fists and drooling which is a new development.  The vomiting is worrying me.  He is literally soaked each time and he, his father and I are changing our clothes more regularly than a supermodel.
His birth weight was 3.2kgs and we are now up to 6.5kgs so the midwives are telling me not to worry - but I AM worried.  I have asked the other mothers at my group and all of their babies eat and sleep and are larger and bouncier than James who is quite pale and slim, not chubby and pink-cheeked.
Any ideas what i'm doing wrong?
Thanks
Pippa (English but living in Sweden)

[Bryony's mum]

Sorry you're having a hard time with feeding James and getting him to sleep.     It might be worth getting it checked out by a doctor.  It's probably something quite innocent, but if you're worried, go with your gut feeling.  My friend's daughter started vomiting up feeds and it turned out she had a hernia and parts of the intestine were getting stuck in the gap, causing the vomiting.  That's probably worst case scenario, though, and I'm sure other people will have more ideas about what could cause the vomiting.

The chomping on his fists and and drooling constantly sounds completely normal though.  All of mine have started to do that around 3 to 4 months.   

[Samuel's mum]

I like the super model comment. I also had a big spitter so I know where you are coming from (it didn't both him either).

Although spitting up is very very common (and it's not the same issue as reflux which causes pain and discomfort) it is quite unusual for it to suddenly start at 4 months.

Has he suddenly become more active after a feed? Rolling more? Having more tummy time?

Has your diet changed suddenly (e.g. taking a new supplement) although that wouldn't explain why the spitting up would happen after bottled feeds too?

Could he be overeating? (e.g. you've recently switched to double-sided feeding where single-sided was happening before)

Has your supply recently had a bit of a boost (growth spurt, extra pumping) and he may be responding to an oversupply issue or an overactive letdown?

There are lots of different kinds of babies. Not sleeping for longer than 4 hours isn't actually that unusual at this age - check out the sleep boards for more advice. His waking may well not be hunger related. Not all babies are chubby and pink and his weight gain is clearly fine. As Alisa says chomping on fists and drooling is absolutely normal.

I would also agree with visiting your doctor just to be on the safe side because the spitting up has come on suddenly. However there could be an innocent explanation.

I presume you are trying to keep him still and settled after a feed and reasonably upright. You can make the post-feed time 'singing and story time' rather than tummy and play gym time.

[pippaknight]

Thanks Bryony, I will take him to the baby clinic today and insist that we see a doctor. It's quite hard to communicate - we are both speaking English but my midwife isn't answering the questions that i'm asking!  

Anyhow, I am so stupid but i left out the real point of me posting a message- Namely that when i pump i find that my milk seems to be very weak and watery compared to how it was a few weeks ago.  No hind milk to speak of and when he's sick immediatly after feeding it just gushes out - watery fluid.  I started drinking a fennel tea to try to boost milk production cos he was feeding so quickly and wanting more jfood ust an hour or two later so i figured that he wasn't getting enough from me (hence adding a formula feed in the evening).  Do you think that the fennel tea could be causing me to be producing gallons of fore milk?  I stopped taking it yesterday and James is still being ill.

He slept in bed with me last night and fed off and on whenever he wanted to and he seemed to keep most of it down until he woke properly this morning and then the rollercoaster started up again.

Thanks again.

Pippa

[pippaknight]

Bryony's mum and Samuel's mum - sorry i'm such a dunce with the technology!

I think i answered part of Samuel's mum's question regarding the supplement - fennel tea.  It seems to be a very popular thing to take in Sweden.  Bfeeding is the big thing over here and formula feeding is the last resort (only 2 types of formula on sale).  I WANT to keep on bfeeding, i enjoy the closeness with James but I feel a little insecure - if he spits up or if he doesn't gain enough weight each week then i obsess that i'm not producing enough or that it isn't good enough quality!

I'll let you know what happens at the clinic today.  I shall def try moving reading time to after meals rather than more active play to see if that makes a difference and avoid tummy time for a day or two to see if that helps.

Thanks again.

Pippa

[Samuel's mum]

Fennel tea could be causing some kind of reaction. Although fennel is not a particularly powerful galactalogue (not compared to fenugreek) if it was to be boosting your supply it might cause a foremilk imbalance. If it was causing a reaction it could take a few days for it to leave your system.

Breastmilk is normally very watery. When expressing if you leave it to settle you'd expect to see less than a cm of opaque cream on top. Composition of breastmilk is constantly changing. Trust that if your diet is normal and he is feeding well it is very unlikely milk would suddenly reduce in quality (nature is rarely that daft). His weight gain should reassure you.

[lovedtodeath]

"Has your diet changed suddenly (e.g. taking a new supplement) although that wouldn't explain why the spitting up would happen after bottled feeds too?"

Not true... I eat onions ONE time and Jake spits up formula and breastmilk for three days!!