Weaning/Reflux/Breastfed

[*Heidi*]

Hello,
I am after some advice...having a bad day. Will tell you some background first then a list of questions after!
My little man was born in may has been exclusively breastfed for 6 months. After a rocky start of not gaining his birth weight for 5 weeks, he has put weight on according to the 9th centile. He was diagnosed with reflux at 5 weeks old, so has been on gaviscon and ranitidine ever since. This greatly improved his sickness and arching back etc...Hence the eventual weight gains! I have been weaning down his gaviscon every 4 weeks since about 4 months old, and now down to 4 times a day of single sachets. (Taken in 15mls of water via a Tommee Tippee CTN bottle). His sickness has remained as it was from being on gaviscon full dose. Which is a small possett 3 times a day. Nothing to write home about.
S sleeps through the night 7-7 and has done since 3 months old. Woken up on the odd occasion for a feed when he has been poorly. His daily routine kind of goes:
7am BF
8.30 Nap
10am BF
11.30 Nap
1pm BF
2.30 Nap
4pm BF
6pm Bath
7pm BF then Bed
As of 2 weeks ago I started to wean... 1st week 1 taster a day after 1pm BF... which he loved so next week have done solids at 8 and 2. He has fruit puree mixed with a little porridge or readybrek in morn and an ice cube of veg puree and an ice cube of fruit puree at lunch. I had him weighed last week and he had put on only 1oz in 5 weeks! Still within the 9th centile... just at the bottom end. So HV not concerned... just to crack on with the weaning. Hence why I added in another meal. He loves his solid and gets upset when it has finished.
Development wise... He is sitting up unaided for about 3-5 mins, rolls front to back and can almost go back to front.
Now for the Problems....
This last week especially today he has been very sick throughout the whole day.... straight after a BF all the way up until the next feed is due. He is still having lots of wet and an increased amount of dirty nappies. This week it has been a nightmare trying to get him to take his gaviscon. Sometimes he will just point blank refuse it. Or even sometimes he sicks it up as soon as he has had it. So Hubby left for work this morning and suggested that I just skip the gaviscon all day! Now I know why he didn’t tell me that at the weekend when he wasn’t here. It has been nonstop sick all morning. Struggled to get him to nap for longer than 30 mins earlier. When he usually has a good hour and a half. He is so grizzly between feeds and naps. The Jumperoo is not even doing it for him today! The only thing he smiles at is the clock on the mantelpiece!!! Hmm!!!

So questions....
1.   Does weaning make reflux worse?
2.   Should I go back onto full dose of gaviscon?
3.   Breast fed mummies... How many feeds do your little ones have a day at 6 months old?
4.   When should I go onto 3 meals a day?
5.   Should I give solids before or after a BF?
6.   Do you think any of this could be teething?? (No Teeth yet)
Please help... My house smells of sick!
*Heidi*

[~inbalance~]

Hi there Heidi!!  (((hugs))) for the bad day!  You've definitely got a lot going on.  Let me see if I can help some, at least with your solid food questions.

Starting solids is usually thought to improve reflux, because the solid food helps keep the contents in the stomach instead of coming back up.  But reflux is a funny monster, so who knows what causes flareups a lot of the time!  Often certain foods can make the reflux worse.  If your LO has certain food intolerances, like dairy for example, eating that food can make the reflux worse.  Here is a link about solids and reflux:  http://babywhispererforums.com/index.php?topic=68459.0

I'm not sure about the gaviscon.  What does your LO's doctor recommend?  You could also ask some of your more reflux related questions over on the reflux boards, found here:  http://babywhispererforums.com/index.php?board=13.0

In terms of BFding, usually by this age LO's are BFding every 4hrs during the day, some will have no BFds at night, others may still have one or two.  So 4-6 BFds a day would be right around normal.  These links might give you some ideas of how to work BFds after starting solids: 
http://babywhispererforums.com/index.php?topic=68458.0
http://babywhispererforums.com/index.php?topic=57483.0

When you move to 3 meals a day is really up to you and your LO.  If he is doing well and enjoying it, and solids are not affecting his milk intake, then you can start to move towards 3 meals a day.  Some moms go a little slower, especially if their babies have sensitive tummies.  You are the best judge of whether or not your baby is ready for more.

Milk is still the primary source of nutrition for your LO and will be up until a year.  So you should offer the breast first, followed by solids 30mins to an hour afterwards.  You want to make sure your LO maintains his milk intake.

Absolutely teething can aggrevate reflux or cause increased spitting up.  I'm not sure if this is proven, but many a mother have commented that their LO's reflux got worse during times of teething.  But at the same time, teething often becomes the scapegoat for all sorts of things, including low grade fever, rashes, loose stools, as well as spit up.  It's always important to explore all the other options first before assuming it's 'just' teeth.

One final thought, I noticed by looking at your routine that your LO is still BFding every 3hrs and is only up for 1.5hrs before going down for a nap.  Are you familiar with Baby Whisperer or are you doing EASY with your LO?  Usually starting at around 4mos LOs are able to go 4hrs between BFds.  Often if you are feeding less they become snackers and don't feed properly.  Also, by this time most LOs can handle 2hrs or more awake time.  I think you could have a look at your routine and tweak it to make it more age appropriate.  Here is a link with some sample routines, you can check out what other 6 month olds are up to:  http://babywhispererforums.com/index.php?topic=164253.0  And if you need some more help with your routine you can check out the EASY boards:  http://babywhispererforums.com/index.php?board=41.0

Hope I've been able to help a bit! 

[~Sarah~]

I too agree with all of Martina's advice.  I might just add that ranidadine is VERY weight dependent in a lot of LO's, maybe you need a dose change?
Sorry, I don't know about the gaviscon.  They don't seem to prescribe it in the states, at least not where I live.

Good Luck!

[*Heidi*]

Hello,
Thank you for the feedback.  Yesterday I upped his dose of gaviscon and did 3 small meals a day about an hour after BF.  He was not sick the entire day and was a lot happier.

With regard to his EASY routine... which yes he got himself into at 6 weeks(I googled why is baby not falling asleep at breast and this forum came up!!) I have been struggling to lengthen out his Activity to 2 hours.  This morning I got it to 1 and three quarter hours then put him up to bed as he was so tired and 30 mins later he is already grizzling up there.
Also if i get him onto a 4 hour EASY then he will only have 4 BF's a day and I am worried that that his dropping his milk intake too much!

Aahhh it is such a puzzle!  What do you think about just 4 BF's a day.  Although not sure this keeping him up longer has helped he is really getting cross now!

Heidi

[~inbalance~]

They really are little puzzles!  With the 4hrly feeds, LOs are big enough at this age that they don't need to eat every 3hrs.  If they do, often they become snackers, and never take a full, proper feed, which means they are not getting the fuller hindmilk which is what will sustain them longer.  If they feed every 4hrs, they make up for it by feeding longer and getting the richer milk.  Hope that makes sense.

Of course EASY at this point is all about finding what works for you and your LO.  It might take a little while to find that groove, especially since their needs are always changing as they grow.  If you'd like some help with your routine, I would suggest posting on the EASY forum.  You can get some advice there about how to stretch out his A times.  He will be tired for awhile at first because he is used to shorter As, but should catch up.

HTH