Thursday, October 27, 2011

Eat, Play, {Pray}, Love

Declan is working on his first full day on Prevacid.  His balking at the breast has lessened lately with the use of the shield, so I'm hoping the medicine will help his gagging and spit up, although it's not really supposed to lessen the spit up (shame... my washing machine could use a small vacation).  This morning I found a list of symptoms associated with infant acid reflux on  I was wide-eyed.  Declan has all but two of these symptoms.  Had I found this before, may I have been convinced that it was acid reflux, the very first diagnosis we received?

  • Spitting up – common among most babies, spitting up does not always warrant a reflux diagnosis or require medication.  Your baby’s doctor will consider spitting up along with other symptoms when making a reflux diagnosis and determining if meds are needed for pain management.
  • Gagging and choking - during feeds or after
  • Vomiting – large amounts of spit-up or projectile in nature
  • Frequent or wet hiccups – while many babies get hiccups, it’s especially common in refluxers to have frequent and long-lasting hiccups; “wet” hiccups can be an indication of silent reflux
  • Abdominal pain – indicated by arching back, either during or after feeds or both
  • Bad breath – can occur any time of day but is often most apparent after waking from sleep
  • Poor sleep – inability to sleep soundly, frequent waking, and/or crying in sleep
  • Over or under eating – while most refluxers will under eat to avoid pain associated with feedings, many will comfort eat to soothe themselves
  • Unexplainable, inconsolable crying and/or fussy temperament – especially during or after feeding, while burping or hiccupping, and/or while arching their backs
  • Feeding aversions or refusals – usually related to bottle or breast due to the associating pain with feeding, although is not solely limited to formula or breast feedings
  • Swallowing or gulping – after a feeding or burping
  • Chronic cough – after a feeding or burps
  • Chronic congestion – rattling in the nasal passage or chest that does not appear to be related to illness and that doesn’t seem to clear up over time
  • Hoarse voice – especially when not related to illness
  • Gurgling sounds – during or after feeding
  • Back arching – especially during and after feeding
  • Apnea – trouble catching a breath or stops breathing
  • Wheezing – especially when not accompanied by illness
  • Clawing at breast or bottle or pulling off the nipple
  • Sandifer’s Syndrome – twitching, grimacing, arching, stiffening, and seizure-like symptoms
  • Poor weight gain or Failure To Thrive (FTT)

I would say many of the symptoms have not yet been taken care of with the Prevacid, but one very important one has.  SLEEP!  I don't know if it was a coincidence or the medicine helping to keep the heartburn from waking him, but he took a long morning nap.  Unfortunately, the apartment below us is being gutted this week so the noise ended up waking him after about an hour and a half.  I am looking forward to days ahead as my sweet boy suffers less and less.  I've only had heartburn a handful of times, but it was NOT fun!  And that Sandifer's Syndrome - I didn't know it had a name - that was killer to me.  It really felt like he was having a seizure as I was rocking him to sleep one night.

Some things that are strange:  everyone tells you to keep an acid reflux baby upright as much as possible.  During feedings, for at least 20 minutes after feedings, elevate the head of the crib, changing table, etc. so that he isn't flat on his back too much.  I have noticed that this helps his spitting up issues ZERO.  He can be sitting completely still and calm after a feeding.  I'll talk to him or let him play with my hand or we'll watch TV - whatever to keep him calm and still for as long as possible after his feeding.  Most times, that regurgitation comes right up no matter what.  No doubt he would spill his guts if we bounced him and spun him around like we only dare to do right before a feeding, but still, it doesn't help as much as you'd think.  So, if you've got a reflux baby and you've experienced this, know that you're not alone!

Another strange thing is that he seems to spit up less when I feed him a lot.  Like when I have given him a bottle.  I have read about other moms of 4 month olds feeding their babies about 4-5 ounces.  My kid doesn't stop til 6 or 7 ounces, and even then it's just sometimes that's because the bottle's empty.  The overfeeding may make his heartburn worse (haven't concluded this yet) like what happens when I myself eat too much, but for some odd reason, my husband and I agree: he doesn't spit up on a very full belly.

I am optimistic and relieved!  This beautiful, cool, drizzly day plus cup of coffe + chai frappe have me feeling good.  And Declan's taking another lengthy nap.  So glad he is sleeping better!  Must mean he's feeling good, too.

Sunday, October 23, 2011

The Great Eating Mystery

Okay, lots of you know that Declan has been having eating problems.  Yes, you probably thought we had it figured out, too.  Well it came back... again.  We are going to see a lactation consultant in the morning, and I will also be seeking out a chiropractor tomorrow. Anyway, my purpose in writing this is primarily to share our journey in hopes that it can help someone else - because I KNOW we will get through this - and secondarily, to seek help!

His main symptoms  center around feedings.  At most feedings (during the day, sometimes at night) he will latch on when I try to breastfeed him.  On a "good" feeding he will eat for 5 minutes, but usually just a few seconds to 1 minute.  He will repeatedly latch on and pull off several times, seems to get less and less patient each time.  Sometimes he will be fussy or even furious, and then other times he will just look around and coo and even smile at me.  Between feedings he is his happy, normal self.  His daytime naps have not been affected too much, but his nighttime sleep has been broken up.  He will usually wake 1-2 times in the night, and I have taken to feeding him then because they have become the only time he actually will take a full feeding.

This behavior began when he was 3 months and 4 days old.  After 10 days of dealing with it, I took him to a doctor (not his normal one) who diagnosed him with acid reflux and prescribed Zantac.  The medicine took up to a week to work.  On the 7th day of taking the medicine, he had a perfect eating day and I thought it was solved with the Zantac.  The next day, everything went back to bad, and he had additionally developed the habit of waking 5-6 times a night.  I got him an appointment with his regular doctor who told me to take him off of the Zantac, which I did.

When Declan was 4 months and 5 days old, I randomly tried the breast shield that we sometimes used (we had started using it a lot less since he was pretty weaned off of it - I just kept it around in case).  He ate perfectly, and continued to do so for the rest of his feedings that evening with the help of the shield.  The next day went well too, with only a couple of minor problems.  Now the problem is back in full force.

So here's the long list of my theories and the supporting facts for them.  However, I can't seem to settle on one because of the contradicting facts that also exist.  I realize that I probably just don't know enough about some of them and perhaps what I consider to be "contradictory" is in fact a support.  Do you know?  Should I be considering another theory?  Can I rule out a theory?  Please enlighten me!

Theory:  Nipple Confusion
  Supporting facts:
  • eats fine from a bottle
  • we used a pacifier early (I can't remember how early, but before 6 weeks for sure), and some bottles too because we had to supplement with formula at the beginning
  • will sometimes do better with the breast shield
  • the weekend before the problem began, we took a road trip and he received 3 feedings in a row from a bottle, and the next day another bottle.
Contradictory facts:
  •  will often nurse fine for 1-5 minutes and then pull off - it sure doesn't seem like he's forgotten how to eat!
  • he went weeks without a bottle (although we did still use a pacifier) and it did not solve anything.

    Theory:  Has he become more efficient and doesn't need the long feedings anymore? 
      Supporting facts:
    • his wet and dirty diaper count have not changed during this whole ordeal
    • he spits up a lot... more than he used to
    • he will often seem content and look around after nursing less than 5 minutes
    • he is normal and happy between feedings
    • he appears to be gaining weight within the acceptable range
    Contradictory facts:
    • he acts hungry shortly after I've tried and tried to feed him and he has convinced me that he's not interested
    • I can hear his stomach growling
    • he sucks on his fists and cries angrily - which I think means he's hungry?
    • is it really possible or normal for him to go from five to six 25 minute feedings a day to six to seven 1-5 minute ones overnight?

      Theory:  Food allergy
        Supporting facts:
      • several experienced ladies have suggested this to me, though I don't know much about it
      • I do eat a lot of dairy, eggs, nuts - those things that often cause allergies
      • many of his dirty diapers are green and gooey, which could indicate a dairy allergy
      Contradictory facts:
      • his behavior seems feeding-centric - he does not seem irritable between feedings
      • he will take a bottle of my pumped milk with no resistance

      Theory:  Bad milk taste?
        Supporting facts:
      • hormonal changes like resuming "Tom" or *sigh* another pregnancy can change the taste of breast milk.  It's still a mystery to me if either of these are to blame, and I am too scared to take a test so I comfort myself with the contradictory facts
      • upon just observation of his behavior when feeding, he sure seems to just really dislike the taste
      Contradictory facts:
      • a change in the taste of milk usually only causes a nursing strike for a day or two, whereas this has lasted over a month now
      • after a month of this nursing strike, "Tom" is not around... and I am on BC thank you!

        Theory:  Low milk supply
          Supporting facts:
        • the problem is usually nonexistent in the middle of the night when I'm "full"
        • he seems to get more frustrated when he has eaten a minute or two, could because he is having to work for it more
        Contradictory facts:
        • on a 2 or 3 occasions, he has refused to nurse even when I am "full"

        Sunday, October 16, 2011

        4 Months Old: Happy Baby, Tired Momma

        Sitting funny (c:
        Declan is 4 months old today!  I'm looking forward to breaking out some of the 4-month gear we have in the closet, like the Johnny Jump-Up and a sling for older babies.  I have started using the Bumbo with him even though I think it's more of a 4-month thing, but I tuck a little rolled blanket around him to keep him from leaning too far over (c:

        He is enjoying tummy time more, although he still has trouble remembering how to roll over.  Our hands are some of his favorite things to hold and stare at.  He'll grab a finger and pull it towards him, then push it out over and over.  He's very vocal and also loves to be talked to.  He'll often stare at me with pure delight listening when I talk to him, which is all the time.  Grandma GoGo started teaching him to make an "aaaa" noise while we pat his mouth -- "awa-wa-wa-wa-wa..."

        His personality is definitely starting to show.  When I'm carrying him around over my shoulder, he will "comment" on what he sees with sudden little outbursts of, "uh!"  or even, "ooooo!"

        He holds his toys pretty well - enjoys the octopus from the Baby Einstein ocean play mat the most.  It has a rattle and a ring in the shape of a fish that is easy for him to hold onto and put in his mouth.  It goes with us everywhere.

        We're still waiting on the baby laugh.  Supposedly, my dad got him to laugh on October 2nd.  Only he and my mom were there to hear it.  We haven't been able to get him to do it again, despite our desperate efforts.

        Mid-September, Delcan suddenly started to refuse feedings and cried a lot.  It was easy to see he was hungry, but something was wrong.  I took him to the doctor who diagnosed him with acid reflux and prescribed Zantac, which took a week to work.  In the meantime, I tried to breastfeed him, but most feedings ended up giving him a bottle of pumped milk because they were easier for him to take (I guess the acid reflux made his esophagus irritated).  4 days later, he and I went to visit my parents in New Braunfels for a week.  The medicine started working while we were there, but by then he had developed nipple confusion from all of the bottle feedings, and although he was not crying in pain from reflux, his cry had changed to frustration because he wanted the easy bottle.  A week later we are still struggling with it, but the past two days he has shown dramatic improvement and we are almost back to normal.  We'll be staying away from bottles for a while, needless to say.

        Sleep has become difficult for him lately, too.  While we were visiting my parents, Declan, who normally sleeps 10 hours a night at home, started waking every 3 hours, then 2 hours, and on the last two nights we were there, he woke about every hour.  I hoped that when we came home, his sleep would settle back into its normal rhythm.  3 nights home, and he has been waking 3-4 times a night.  A great improvement, yes, but I can tell something is still up.  When I investigated Zantac on the Internet, I found that a side affect is insomnia.  His sleep has gotten a little better every night since he has been off of it (3 days).

        I feel like I go through a different theory every day, sometimes several times a day, regarding his sudden change in eating habits.  Most recently I have been reading about nursing strikes.  There are a lot of different reasons why babies do it at this age.  However, I think I've come to realize that since we have ruled out the potentially serious problems like illness, teething pains, ear infection, and acid reflux, the reason is not really important.  The treatment is to keep trying frequently, be patient, and keep an eye on his output to make sure he's not getting dehydrated.  So that's where I'm at (today).  Sometimes it really helps to remind myself that this is temporary.

        Time for his bath!  That's always a good time.  Let's hope 5 months brings about me laughing at how little of a deal all of this hard stuff was!