Author Topic: 5-week-old baby with gas/reflux cries a lot and doesn't sleep much  (Read 1397 times)

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Offline SlipperyFish

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Hi everyone,

I just registered to the forum and this is my first post. As I feel quite desperate, I'll skip the introduction and will kindly ask directly for advice. I've read the Baby Whisperer book before the baby's birth and loved it - everything seemed indeed easy; then reality happened.

Our baby girl is almost 5 weeks now. On the first day after being released from the hospital (3rd day of life) she had a severe choke (spillage) through mouth and nose 2 hours after her feed while she was sleeping. We took her to the ER and she was hospitalised because of jaundice and problems with eating. She was released home on her 8th day. She was diagnosed with reflux and prescribed a thickener for pumped breast milk as well as 3 different drops (ColiPrev, InfaCalm, Vigantol - we live in Portugal, I'm not sure if the brands are the same elsewhere).

She feeds quite well and has been gaining weight on target. In the beginning mum's breasts seemingly weren't providing enough milk so we were advised to supplement with formula after the feeds. At the moment mum gives half an hour of breast plus 30 or 60 ml of formula (one breast gives less milk so we supplement with more formula). The formula we use is anti-reflux. At night we give 10 minute breast and 90 ml formula. 6 days ago we were advised to give at least one full breast feeding at night but the girl hasn't taken it very well for a few days it so we moved back to the old routine.

The baby girl now eats around every 3.5 hours (counting from the end of the feed, e.g. she starts eating at 10 am, ends around 10:45-11 am, therefore the next feed is around 2-2:30 pm. She eats well and seems to burp well enough too but after feedings has a lot of trouble falling asleep. She has jerky movements with her arms, flapping around and scratching her face or my neck; lifts legs up; body becomes extremely rigid. Basically what the Baby Whisperer describes as gas and reflux. She has regular-ish constipation which leads to extreme crying tantrums. We stimulate her rectum with a thermometer tip which leads to explosive bowel movement (quadriple, even quintiple), then healthy looking bowels a few times a day until the next constipation.

In the beginning she would cry a lot after feeding, then eventually would fall asleep, so we wouldn't wake her up. She would end up with absolutely random feeding patterns. We moved on to making sure she feeds at least every 3.5 hours and waking her up if she doesn't demand.

She seems to enjoy her pacifier a lot - it must aleviate her a great deal. When we put her down, she sucks the pacifier, loses it after a few minutes and starts panicking and crying a minute later which leads to us reinserting the pacifier. This continues for 30-60 min probably (haven't been timing it). The nights are actually better than days - she normally has her last meal around 8:30 to 9:30 pm, falls asleep by 10:30-11pm. Wakes up crying around 2:15 am to eat, then around 7am again for the 2nd feed of the night. Falls asleep OK at night, certainly better than during the day.

The crying tantrums feel inconsolable, although some things do help. Going up and down the stairs seems to calm her; patting on the tushy as well. We have a sling and she seems to enjoy it while I'm standing, walking, etc. If I sit down, she gets uncofortable and cries.

She absolutely adores car rides in the car seat and sleeps all through it; same with stroller walks(the car seat acts as the stroller seat at this age too). But if she's simply seated in the car seat while we prepare to leave, she starts crying.

The bed mattress is tilted around 30 degrees but she absolutely resents the bed during the day. She starts crying pretty much the moment she's put in bed or put flat to be swaddled. Once I start swaddling, she jerks her arms violently and cries. When put in bed she makes all kinds of gurgling noises.

The mother is vegetarian, eats quite healthy, lots of legumes, homemade soups, salads, home-cooked food - vegetable stews with tofu, seitain, etc. Doesn't drink cow milk but does eat cheese and other dairy products.

One possible issue I thought might be that she feeds too rarely with quantities that are too much for her? Perhaps we should stop supplementing during the day? Although she does take the formula supplements very willingly. At night she sometimes refuses food when we offer too much so she does know when to stop.

I've tried to name as many symptoms as I could come up with. We'll appreciate any comments, ideas, suggestions - anything.

Best regards to everyone who reads it,

Daddy

Offline jessmum46

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Re: 5-week-old baby with gas/reflux cries a lot and doesn't sleep much
« Reply #1 on: March 06, 2016, 13:23:07 pm »
Hi there and welcome, great to see a Daddy posting :D

There's a lot in your post so I'll try to respond to bits individually - apologies if I miss anything and please feel free to ask again.

ColiPrev, InfaCalm, Vigantol
So I've had a look at these - as far as I can see the first contains lactase (breaks down the lactose in milk), second contains simeticone (meant to be good for gassiness), and third appears to be a vitamin.  All fairly gentle things, none of which would help reflux however if that is the issue.

The baby girl now eats around every 3.5 hours (counting from the end of the feed, e.g. she starts eating at 10 am, ends around 10:45-11 am, therefore the next feed is around 2-2:30 pm.
Feeds are usually counted start of one feed to start of the next - so a feed at 10am, next feed at 1.30pm would be a 3.5hrly feed.  Currently your LO is feeding 4-4.5hrly ;)  It strikes me that 45-60 mins is a very long time for a feed.  I never bottle fed but at 5 weeks that long is likely totally exhausting her and suggests she is not feeding effectively.  It may be a bottle problem (wrong teat/flow) or it could be a baby problem (tongue tie for example).  What bottles/teats/flows are you using and has anyone examined your LO for a tongue tie?

jerky movements with her arms, flapping around and scratching her face or my neck; lifts legs up; body becomes extremely rigid.
These can also be signs of over tiredness.  At 5 weeks a maximum awake time would be about an hour, perhaps even less so if she is taking that long to feed, over tiredness could be causing some of your problems.

We have a sling and she seems to enjoy it while I'm standing, walking, etc.
Given how young she is I would make use of this.  Although it is not strict 'by the book' many of us here have found that our LOs just need closeness and containment to settle well in the early weeks.  There is plenty of time to develop independent sleep a little later down the line, so don't be afraid to use the sling or cuddles if she's getting tired and hard to settle.  She will only be this tiny for a short time!

The bed mattress is tilted around 30 degrees but she absolutely resents the bed during the day. She starts crying pretty much the moment she's put in bed or put flat to be swaddled. Once I start swaddling, she jerks her arms violently and cries. When put in bed she makes all kinds of gurgling noises.
Normal for such a tiny baby :)  It takes time to get used to sleeping on a bed when you've been carried for 9 months :D  You can take it slow, try one nap a day for now in bed but don't worry too much if no success just yet.  I found 10-12 weeks quite a turning point for both my LOs.

One possible issue I thought might be that she feeds too rarely with quantities that are too much for her? Perhaps we should stop supplementing during the day?
If you do stop supplements I would do so gradually as the fact you have been giving them will in itself have impacted on Mum's milk supply.  The body produces milk in response to demand, so the extra mls she has had from the bottle instead of Mum are signals Mum's body will have missed out on, so if you stop the supplements all at once there won't be enough milk ready to feed LO.  If you are keen to get back to pure breastfeeding I would seek some advice from a breastfeeding counsellor (e.g. La Leche League) to support you all :)

Hope that's useful to start with.  She may well have reflux but equally a lot of behaviours you have described are pretty normal or common in such young babies.  If you strongly feel she is in discomfort I would discuss with your doctor the possibility of starting some 'proper' reflux medications that actually tackle the painful acid.  However equally I don't think it would be unreasonable to just hang in there a bit longer (I'm assuming of course she is otherwise thriving and growing?) and see if she settles a bit as she matures :)

Good luck!

Offline deb

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Re: 5-week-old baby with gas/reflux cries a lot and doesn't sleep much
« Reply #2 on: March 06, 2016, 13:50:50 pm »
You've already gotten some great advice there. I did have a couple of other thoughts, though, as a mother to a super-refluxer (fountains of milk everywhere!) many years ago. The first thing that came to my mind was mother's diet: dairy and soy (and other legumes) can cause symptoms of digestive discomfort similar to reflux. To further complicate matters, many formulas are based on....dairy and soy.

One of the best ways to see if it might be dairy would be to eliminate it completely from mom's diet for a couple of weeks and see if you notice a reduction in symptoms. It takes 2 weeks for dairy proteins to completely clear the body, but many parents notice a reduction in symptoms in a few days. Soy protein is apparently somewhat similar to dairy proteins, so a baby who reacts to one may react to the other as well, so in your case you may end up doing a double elimination so you can see for sure what the issue is. (See: Milk-Soy Protein Intolerance:  Milk/Soy Protein Intolerance (MSPI) Part 2 and Does my LO have food intolerances? ) And legumes in general can cause gassiness even in adults, so it's not unreasonable to think there may be a connection there.

Another question is about the thickener for the breast milk - what is it made of? I'm wondering if maybe baby's tummy is having a hard time with that.

Offline SlipperyFish

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Re: 5-week-old baby with gas/reflux cries a lot and doesn't sleep much
« Reply #3 on: March 07, 2016, 23:37:54 pm »
Hi jessmum46 and deb,

Thank you both for responses, some very sensible advice here.

I'm quite happy to say that we've had two very decent days in a row. We've been allowing the baby to sleep in the car seat instead of the bed during the day and she's taking it much better. Today we also started increasing the feeding frequency, apparently we'd been counting the wrong way all along (counting time from the end of the feed rather than from the beginning).

We're using Medela bottle which has a slower release. We always thought that the slower the release, the less air the girl will swallow, is it not? Also quite sure she doesn't have a problem with the tongue, although she hasn't been specifically tested for that as far as I know.

We'll consider for mum to quit dairy and soy for a while if things don't normalise, although it would be quite difficult. Being a vegetarian, she drinks soy milk and eats tofu which is derived from soy; quitting those would present challenges to intake enough protein and stay healthy for her, which is as much a priority as the baby's health.

I believe, the main thickener ingredient in the powder is carob. In reality we don't use that much of it anymore, in the beginning mum was pumping plenty of milk (when the baby was in the hospital we couldn't spend the nights with her, so she would pump a few times a night); but the formula we use is also anti-reflux. Since it's the same brand, I'd guess the thickener in it would be the same.

Thank you very much for taking your time and helping us. We'll let you know how things go!



Offline jessmum46

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Re: 5-week-old baby with gas/reflux cries a lot and doesn't sleep much
« Reply #4 on: March 08, 2016, 07:25:56 am »
Good luck! :)