Hi there

Our one month old daughter was born at 41 weeks and we have been having sleeping, wind, spilling and reflux type issues since her first night. She cries and screams in pain most of the time when not sleeping or feeding. Early on we suspected she just had wind issues because she pulls her knees up and thrashes her legs and arms and head about generally after feeding. However, over the past three weeks she has been spilling with increasing regularity. She has put on very good weight so far and generally seems healthy, but she gets very distressed and spills the feed back up and is not sleeping well. Here are her symptoms:

--I have very fast milk and she feeds well. I try to burp her in between feeds and after but she gets very distressed the moment she is off the breast. We rarely get a burp out of her. She is having many wet nappies but has passed only two stools in the past two weeks

--She spills up at least 10 times after every feed, sometimes lasting for as long as two hours afterwards. This upsets her and keeps her unsettled. It also wakes her up when she is sleeping.

--She is very distressed and in what seems like intense pain (pulling up her knees etc)

--Her tummy is very bloated and hard

--She is not sleeping well at all. She won't settle in her bassinet on her own. She needs to be settled on a person with static on the radio and movement and this takes hours. In this time she spills, cries and screams. If we manage to get her to bed early she often throws up on herself waking herself up and starting the whole process again

--She is often not sleeping from 4 in the afternoon to 2 in the morning. If she does go down at 10pm (if we are lucky) then she will sleep for 2-3 hours and will take another two hours to settle in the middle of the night (if she manages to go back to sleep). We have had many nights where she has not gone to sleep until 4am, meaning 1 hour sleep for us.

We have been to the Dr and we have tried infant gaviscon although she was just bringing it back up. We are willing to try it again but were concerned about it giving her constipation. She started Ranitidine yesterday so hopefully this will reduce the pain, however often it is the spilling that is keeping her from sleeping.

What can we do? We hope the Ranitidine will stop the pain (and help her sleep) but as for the spilling we are beside ourselves. She won't sleep because she is in pain or keeps spilling. Should we try a thickened formula before breastfeeding? We can't believe she won't sleep, she must be so tired and distressed.

Firstly, huge hugs. It's a tough road ...

Have you been to the website: http://www.cryingoverspiltmilk.co.nz? It's the official NZ reflux website and has good info about medication, tips and advice, and all sorts.

Things that helped me: keeping bubs upright for half an hour after a feed, and keeping them as upright as possible. Basically the valve at the top of their tummy isn't working (which is why she's spilling) very well and allowing stomach acid (which she's producing too much of) to come back up and causes burns. So there are two issues - gaviscon helps thicken the feed making it harder to spill (you can get a prescription for lactulose to help with constipation - many of us have used it and it's the best thing for it at her age). Then you need meds to control the amount of stomach acid being produced. Currently you're on ranitidine, but many of us have needed to progress to losec. Rantidine turns the stomach acid pumps in the stomach down while losec turns them off. Also rantidine is very weight dependant, so you'll need to continuously increase the dose in those first few months while they're putting lots of weight on.

I spent many nights sleeping in the lazy boy with my girls as it was the only way to keep them upright ... also propped the cot up on an angle ...

about 30-40% of reflux babies have issues with dairy, so it might be worth trying a dairy free diet for a couple of weeks (this is how long it takes to get it all out of your and bubs system) as this can make the reflux flare up ....

ok, i know there's other stuff but I better go deal with my two .... BBL

Oh hugs hugs hugs! I really feel for you. What you are describing sounds almost identical to my DS. It's so hard on them but also really hard on you and your DH, the lack of sleep is a killer not to mention worrying 24/7 about your little one.

I found the dummy a real help, especially with trying to get burps out between feeds. I would finish one side and quickly pop the dummy in (before the screaming started) then would continue to try to burp and usually would get one out.

Also, completely agree with all the advice from Dolphin elevate the bed etc. My DS finally got his reflux under control with taking Losec. But most meds take a week or two to see the results so be patient over the next week or so and if there is still no change go back to your doc.

Also, with DS there was nothing that stopped his spilling, it was just the way he was. He was still spilling right up to his first birthday. Now he only spills if he is teething or sick. Stack up on the bibs!!!

All the best, I hope your wee one can get some rest soon....oh, do you have a hammock? They are meant to be good for reflux babies. Are you in Auckland? I have a hammock which you would be welcome to try for a few weeks to see if it helps. Otherwise you can just end up spending heaps of money on things that don't even help. The offer is there for you if you like

Firstly if she is gaining weight well on BM, then stick with that - she will still spill on formula and the same 'tools' you have with formula can also be used with BM. e.g. you can give gaviscon prior to a breast feed, and you can alternatively use karicare food thickener - which is the same product which is in the thickened reflux formulas anyway. So if you can stick with the Breast milk then go for it.

For those hands free times when she won't sleep - I use a wrap e.g. a hug-a-bub (so I can draw the curtains on my one) and I walk even through the squawking...

I also use infacol (0.4ml) prior to each breast feed and follow the NZ baby whisperer burping technique - demonstrated in the latest treasures mag (but I can describe later if you need me too)

Regarding the night settling - I don't pick up to settle her - I settle her in the cot - I figure all that up and down business is not so good for a bub who has a weak stomach and further churns things up. Also side sleeping using a wedge.

Would recommend making sure she is the right dosage for her weight on the ranitidine as it is so very weight dependent.

Where about are you in NZ?

Other suggestions are - see a specialist paed or at least everytime you go to your GP take the dosage schedules off the COSM website. Losec granules are better than suspension if you switch to losec. Going Dairy free can help. Will she take a dummy? Can you use that to settle her in her bed?

BBL

Thanks so much for all your advice. We will definately try those suggestions. We are not in Auckland but thanks for the offer of the hammock. Today we had actually talked about hiring a hammock so will try that out.

Just now she was very calm and settled in her bassinet after feeding and burping but just spilt back up waking her up and upsetting her. But fingers crossed the ranitidine will make it less unpleasant for her even as she keeps spilling.

I will keep up the ranitidine 0.5mls twice daily, try the gaviscon for alternate feeds (can't be taken together right?) and try cutting out the dairy. Our midwife booked us in with a specialist so hopefully that too will answer some questions.

Thanks again, will keep you updated along the way...

Also, has anyone used probiotics or slippery elm with success??

Have used both probiotics and slippery elm - but as a complement to the other medication - not as a be all or end all

Have you checked her dosage against the COSM website?

2 hrs apart for the gaviscon and ranitidine - but can be closer to together if the benefits of using both outweigh reducing the effectiveness of the ranitidine e.g. ranitidine on waking, gav prior to a sleep = gap of 1-1.5hrs

The dairy free thread at the top of this page has some safe foods if you go dairy free. Also have a think about if there are other food sensitivities in your family.

Plunket family centre can assist with sleeping routinues

Food allergies other than gluten don't tend to be inherited. The tendency to be allergic (hayfever, asthma, or foods) is what is inherited. The top offendors are milk in our infants with reflux. Next are gluten, soy, egg, peanut - from memory. There are some foods that if the breastfeeding mum eats them, can make reflux worse. It is on Crying Over Spilt Milk on the food and reflux page.

Ranitidine may take up to three weeks to reach its full effect and it is weight dependant. Ranitidine decreases the acidity in the stomach by a different mode than Omeprazole. Omeprazole turns off MOST of the pumps that produce acid but as far as I know Ranitidine has no effect on the pumps. It works against histamine but in a different way to most antihistamines. It also reduces another enzyme the stomach makes.

You may find our breastfeeding forum at Crying Over Spilt Milk useful for any breastfeeding questions. Best wishes