Will this ever get better? 4mo with multiple hysterical NW's

[chesterella]

Hello
So here's whats happening and I cannot get a grasp on how to fix it at all. DS is 4 months and has had terrible wind and reflux since the start but just as he turned 4 months about 2 weeks ago his reflux went out of hand. He actually had to go to the ER because he could not breathe from it. After that day he has been crazy uncomfortable, but before that we were starting to get some good night stretches out of him. There were a couple of times he slept from 10pm to 6:30am! Now, nothing. He takes great naps, with a little help to get over the 45 minute mark for his afternoon nap. I have tried and cannot fix his 45minute morning nap. His day looks like this:
 Wake 8:30-9
E 9 (cereal and bottle)
A 9-10:30
S 10:30-11:15
E 12
A 11:15-12:45/1
S 1-3:30
E 3:30
A 3:30-5
S catnap 5-5:45
E 6:30
A 5:45-7:30 (now this is when it starts to go haywire, I cannot get him down for the night. He will scream and reflux and swallow air and cry until his next feeding which we cluster feed him at 8:30 and then a "dreamfeed" at 11:30. He is then up and down all night long crying sometimes and then happily awake at 4:30-5:30 for his last feeding until 8:30-9. He sleeps on top of me on the couch from 4:30-5:30 until he wakes at 8:30-9. I do this so that I may get some sleep during those hours. If I try to put him in his crib he does not sleep soundly and needs to be put back to sleep over and over and over again.
What do I do? Should I try to switch him to 4 hour EASY? I find that he is starving every 3 hours because the doctor had me cut his bottle down to 4oz from 5.5oz because of his reflux. I started giving him the 4oz 2 weeks ago, is it maybe time to up his bottle so he can go for longer stretches? He also has started cereal last week which the doctor told me should help his reflux and help him sleep better........?
Please any advice on how to stop these NW's !

[Bex09]

Oh ((HUGS)) that must have been so scary when the reflux flared so badly. It does sound like the reflux has a big part to play in this and 4 mo is a time when reflux can peak. What meds is your DS on and are they helping to control the reflux now? Did the NW or the 45 min morning nap get worse/start when you introduced the cereal? We tried cereal with my DD at 5 mo (on paed's recommendation) to help with her reflux, but she just could not handle it and was so uncomfortable that it actually made things worse and we stopped.

If it weren't for the reflux I would have said yes start the transition to a 4 hr EASY, especially because your DS's A times are at 2 hrs now. So I would imagine that he is waking from naps hungry at the 3hr mark so that is why they are short. Tricky when you have been told to feed small amounts frequently though.

If you can get back to me with your answers about meds etc and then I will see if I can get some more experienced reflux eyes on this for you. Hang in there.

[chesterella]

Hi and thank you for responding.
He is on 1.2ml twice a day of Ranitidine. I also give him Mylanta sometimes if he is still upset and already had the Ranitidine. I'm not quite sure as to say if the cereal has made him worse or not. He wasn't on the cereal a week before the reflux got terrible. I am seeing another gastro on Thursday so I guess I will see what they say. He does nap really well during the day though, just can't get through the night at all. Why would he be comfortable with his daytime routine and not get through the night if he has had cereal at both times, morning and night?

[Bex09]

Good that you are seeing another specialist this week, will be interesting to see what they say.

I agree that your afternoon nap is great, but I notice that after the morning cereal that nap is then only 45 mins (from 10.30-11.15) so I wonder if it is causing him some issues. My DD had silent reflux and hers was always worse at night because she was laid down for such a lot longer and was more upright in the day time.

Is your DS's cot raised? Does he nap in his cot or in a bouncy chair, etc? Being raised up can really help. Also do you keep him upright for a while and burp him after his evening and DFs? I wonder if this would help him to settle a bit more. Especially as you said that he is refluxing and swallowing air with all of the crying at this time.

I also wonder if the 4 mo growth spurt has a part to play in this. It is a really big one and many LOs will demand more food at this time too. It also usually comes hand in hand with needing to move towards a 4 hr EASY, but again you will need to ask your doc if this is appropriate for your DS. So do you think that your DS is genuinely hungry when he is crying at night? If he isn't taking in a great deal at each DT feed then maybe he is needing more at night. What do you think?

[ZacsMumme]

Hun the nature of reflux is unfortunately not consistent for us Z was awful all day, but crashed all night and STTN for 10.5 hrs straight from exhaustion at 8 weeks or so. He would wake starving poor thing.

4 months was when the reflux peaked for us and unfortunately we needed to move too
PPI. It ay be your Dr needs to consider that option if the ranitidine is no longer effective. The GS, developmental leaps and general mobility increase at this age really doesn't help!

Personally I would stop the cereal, if you are offering it as solids maybe try pear or pumpkin instead ese are very very gentle on LOs tummies and usually better tolerated than cereal which an constipate.

Totally agree with Bex re raised cot and bouncy chair etc. doe your LO take a paci?

Hugs

[chesterella]

Bex09
Hello again
Well, his morning nap has always been 45min. For some reason a couple days ago he got to an hour but I'm thinking it is so short because after his 5am wake and bottle, he goes back to sleep generally til 8/9am. Maybe he is not so tired because he has just had a long stretch from ~5:30am to ~8:30am? Doesn't 45 min naps mean he is UT?
His cot is not raised but he does sometimes sleep with a pillow propping him upright. Should I raise it anyway?
He only sleeps in his crib unless of course my mother-in-law is here and then she INSISTS he sleep on top of her :/
I definitely keep him upright after feedings and during burps. Even during feedings he is sitting up so high he looks like a baby goat taking a bottle
I would really love to try the 4hr EASY and give him a half an ounce more, which would bring him to 4.5oz every 4 hours. I do not think he is generally hungry when he wakes at night, I honestly know it is discomfort and wind. He has very definite cues.
I think I will try to move him to the 4hr EASY, what do you think?

ZacsMumme
Thank you for responding.
Yes, his reflux certainly hasn't been consistent. We had it under control until he hit the 4mo mark and went to the hospital. I have talked to the pediatrician about the Ranitidine not working for him and he suggested I see another gastro, which is what I am doing Thursday. He has only been on cereal for a little over a week now, is it ok to try pumpkin or pear so soon?
He does take a paci but he spits it out when he falls asleep. I do use it to control his crying when he is uncomfortable.

[ZacsMumme]

I have talked to the pediatrician about the Ranitidine not working for him and he suggested I see another gastro, which is what I am doing Thursday.

I hope you get some good support on thursday Let us know how you go.

is it ok to try pumpkin or pear so soon?

I think if you are going to offer any solids these are both more gentle on the tummy, esp for refluxers, than rice cereal. They also don't cause constipation and are easily digestible.

Have you considered probiotics?

[chesterella]

I have been giving him probiotics for a couple months now. It seemed to help at first

[Bex09]

Hi hun, I totally agree with Sara's advice. As I said we had to stop the rice cereal as it just made reflux, wind, constipation, everything worse. It can be very hard on refluxers, our paed said it would either make reflux ten times better or ten times worse!

We also had to move to a PPI (which my DD is still on) when she was 6 mo. We tried ranitadine, but it just wasn't effective enough for her. Once we were on the PPI, sleep and reflux got so much better. Up until that point sleep had been horrific, day and night! Hope you get some good advice from the specialist, I would definitely mention how bad sleep is and that you know it is from discomfort, etc. I would also ask about feeding more milk and moving to 4 hrs to see what he/she says about this. It is up to you though, you know your LO best.

I think if you can raise the cot then that is worth a try. We used cot blocks under the legs, but you can put books under the legs, obviously making sure it is stable enough.

45 minute naps can be a sign of UT, they can also be developmental or discomfort though. Just to confuse us. Does DS seem UT at all? If so you could try adding just 10 mins more A time on in the morning and see how he copes.

[ZacsMumme]

We tried ranitadine, but it just wasn't effective enough for her. Once we were on the PPI, sleep and reflux got so much better. Up until that point sleep had been horrific, day and night!

Uck same! The entre time Z was on Ran it never really controlled the reflux, just helped a 'bit' It wasnt till Z was on a PPI the sky just cleared and I had a feeding, smiling sleeping baby!

Yes cot raising helped us too, good thinking Bex I forgot about that.

[chesterella]

Thanks so much for your input ladies! I am definately going to ask about the PPI on Thursday. I took him to his pediatrician yesterday because his reflux was SO BAD that I thought it may have given him pneumonia. He was coughing and wheezing like crazy. His ped said he was fine and the reflux wasn't reeking much havoc on his body. He also doesn't want to eat his cereal, do you think that is from his reflux too?!
He doesn't seem UT, in fact his cues are pretty clear. He gets all cranky and starts to turn his head away from the room or into my chest when he is tired. But his discomfort screams are intense. He's an angry cryer when he is in pain and it breaks by heart. I'm going to pick up a cot wedge today and see if that helps. I had him elevated last night but I didn't notice any difference. I am not even sure how to elevate him as much has doc says. He says try between 45/90 degree angle!

[ZacsMumme]

Has the ped heard his cough/wheezing?
Do you think he could asi have a virus?
Hugs he could be having a flare up. Teeth and GS often cause these

[Bex09]

You can buy a special cot wedge that has a kind of harness thing to keep LO in place so that they don't slip down. TBH we never elevated the cot to this degree though, it worked fine just being raised a good few inches for us.

Good luck with the appointment, let us know how you get on. If you really feel like the reflux is causing your DS so much discomfort then really push this with the doc. We had to fight so hard to get a referal to a specialist and then he put her on the PPI straight away saying all her issues were classic silent reflux. Docs before had always fobbed us off. You know your LO best and see what goes on all the time. Hope all goes well hun anyway.

[chesterella]

Oh you gals were so right on!
ZacsMumme - he did come down with a virus/bronchiolitis. His weezing got pretty bad and the doc put him on a bronchial dialator and steroid for inflammation. Not sure what came first, chicken or the egg kind thing going on. I had been back and forth to ped but he just kept saying it was his reflux and not a breathing issue until FINALLY on my last nerve I went in on a particularly bad afternoon when DS chest was pumping and ped finally agreed with me that he is having trouble breathing. Phew!
Bex09 - I did just as you said and really did push with the Gastro that his reflux is causing a great deal of discomfort and he put him on the PPI. I mapped out exactly what was going on and what we have all been through with this and I honestly think he was impressed with the lengths I have gone through to ease the reflux. If anyone deserved some help with this terrible reflux, it's us! DS just had his Prevacid for the first time tonight so we will see how it goes...
I really want to thank you all for listening and supporting us through this. Its been so bad and I almost feel like it will never get better but with your help I get a little boost!

Do I just keep up with what I am doing right now? No BWing? I try to follow a good EASY schedule but he is so miserable it is very difficult. I wish there was an EASY routine with reflux babies!

[ZacsMumme]

Oh poor wee man
I hope he recovers quickly.
I'm glad he is on a PPI, hopefully in a week or two you will see some great improvement

Yes while he is poorly, just go with the flow, lots of cuddles and you can still do a bit of shh/patting in your arms, or if he is settling in the cot fine but just needs reassurance.

Lol EaSy with reflux babies is known as HARD

Hugs, so glad you have some answers and progress