Refusal to Breastfeed

[Anonymous]

Hello everyone or anyone. I am new to this site so forgive me for rambling and if I don’t know all the lingo. I have an almost 5 month old daughter that I am worried about. She has been on 15 mg (once a day) Prevacid solutabs since about a week before her first month check up. Never really a big issue with spit up but would choke and cough while breastfeeding and gag and cough when not on the breast.

I have breastfed since day 1 and she has done fairly well with it up until now. Her reflux symptoms seemed to improve since one month-Prevacid or age, I don’t know. But, within the past month or so she has nursed less and less on my breast and now is to the point of minimal feedings. I feel like I am force feeding her and it takes everything in my power to keep her on for three to four minutes. She kicks, pushes herself off with her hands, grunts, moans and expels gas (sometimes). SHe will breastfeed great, however, while she is sleeping. She has one good feeding before going to bed (10 pm) and one good feeding in the morning (between 5am and 6am). All of her day feedings are terrible and quite frankly I don’t know how she is getting by on what I force her to eat.

Few things to note: We give her the Prevacid usually at night prior to her second to last feeding (7:30 or 8). We started her on rice cereal two weeks ago and she loves it and does not fight while eating it. She is a happy baby otherwise. You wouldn’t even know it is the same kid-it is like night and day when she is eating and not eating. Sleeping? Husband says she does great. I say she does ok. She fusses a bit at night but never to the point of outright crying. Pacifier or my hands usually soothes her pretty well.

I don’t get why this is happening all of sudden. I thought that this would improve with age??????? I am fearful that she is not getting enough to eat. I would welcome ANY AND ALL SUGGESTIONS. I don’t want to switch to formula and not sure even if that would help as I have read the reflux babies tolerate breastmilkbetter than formula. Up her meds? If I swith to formula or supplement formula with breastmilk, any suggestions on what to try? Is this a relux problem? Am I forcefeeding her? I can’t “trick” her into eating everytime she sleeps and I am becoming anxiety-ridden over her daytime feedings.

please help.

[Anonymous]

Hi Trina! Welcome to the site. Your description of your daughter sounds very much like my daughter except that Hailey was BF the same way almost from a few weeks old, and then it just got gradually worse until she gradually started refusing more and more. We also found that we could trick her to eat while she was asleep, but this got harder and harder until eventually she wouldn’t take anything awake and it was even a struggle to get her to take anything while asleep. I’m not telling you this to scare you, but just to realize that I know what you’re going through. My daughter also choked and gagged a lot while feeding and awake, it turned out to be silent reflux. We put her on medication, but unfortunately for us, we didn’t figure things out early enough and by then her feeding aversion was already full blown.

The first thing I’d check is to make sure that you’re giving the meds right: the solutabs should be given on an empty stomach and followed up with a meal 30 minutes later. The meal is needed to activate the med.

Then I’d try to get her dose increased. Check out http://www.marci-kids.com . It’s a great site about reflux and meds, and they believe in aggressive dosing of PPIs and multiple daily doses b/c of the way babies metabolize the meds. She may have outgrown her dose, or she may be in the difficult part of the hump, meaning that for most babies reflux peaks around 4-5 months of age which is when it’s at it’s worst. Either way, I’d want a higher dose to keep her comfortable. Many babies do well with a dose around 30mg.

You might also want to get a referral to a ped GI, if she doesn’t have one already and if your doc won’t increase her meds. Another thing to try is to give some mylanta cherry supreme (just not within a few hours of the PPI) but before a feeding and see if that helps to settle her at all.

I’d be careful of only feeding when she’s asleep. We had no choice but to do this for my dd b/c she wouldn’t feed at all awake. But it was very challenging and was really not a good way to go. You can also ask for a feeding evaluation by an SLP, though I’d probably go for the higher dose first.

In terms of how much she needs to eat, if you don’t think that she’s taking in enough, I’d talk to your ped and try to take her for frequent wake checks. As long as she’s not losing weight and is gaining along her curve you probably don’t have to worry about her intake, but you might still want to address the problem with higher meds so that things get easier. I’d also look out for wet and poopy diapers and make sure that you’re getting enough of those. My dd never ate anything near what was recommended, but still managed to stay hydrated. Even when BF, she pulled off the breast constantly and only sucked for 1-2 minutes on each side. It was very hard, so I commend you for your efforts.

Laura, our forum mod, is a great resource for BF your refluxer. I’d check out her intro stickied under the introduce yourself forum. It’s long but full of great info. Also, you might want to read up on MSPI (milk/soy protein intolerance) and the elmination diet, and see if that applies to your situation. I know this is gross, but what are your daughter’s bm’s like? Sometimes nasty diapers can be a sign of an intolerance. You’re right BF is best, so you shouldn’t really have to worry about using formula, despite what some docs said. We ended up pumping for Hailey and giving that in a bottle in addition to BF for as long as I could manage.

Good luck to you. I know how hard it is with difficult feedings.

[Anonymous]

Hello and welcome,

What you are describing is exactly what I went through with both of my reflux babies. They would arch, cry, kick and gag, choke and pull on and off the breast while nursing. I was at a complete loss with my first reflux baby and I assumed it was a nursing issue so I stopped pumping and started bottle feeding. Big mistake! After a few days she was doing the same thing with the bottle, and she would not go back to the breast. Every feeding was a nightmare and the only way I could get her to eat was to swaddle her tightly and then walk the floors with a bottle in her mouth. She was treated with Zantac but it was not helping her.

So, then I had my son and he started with the same frenzied feeding behaviors. I knew what the problem was this time (thanks to this site and another – http://www.marci-kids.com ) and I got him on a good dose of Prevacid and things turned around.

My guess is that she has outgrown her Prevacid dose. The researchers at marci-kids have found that babies need higher doses of these meds than adults because they metablolize and eliminate the drug 3-4 times faster than adults. Also they need at least two, and better yet – 3 doses a day. So, I’d work on getting her Prevacid dose increased and try to get her on three doses a day. Also make sure you are giving it on an empty stomach and following it up with a full meal 30 minutes later. This is important, but many docs and pharmacists don’t tell you.

And just so you know….it’s common for reflux babies who are in pain to feed better while asleep or half asleep. This is a warning sign that they are in pain.

Be sure to check out Laura’s intro link (stickied in the Introduce Yourself Forum). It has lots of valuable information which may help you.

Good luck and glad you found us.

[hellbennt]

hi there! welcome! I’m laura

well, I would work on getting her meds increased and in the meantime maybe try some zantac if you have it in the house still or even try some pepsid complete- others will have to help you with the dosing though- I can help with zantac dosing and the prevacid dosing comes from http://www.marci-kids.com …

also I would get some mylanta cherry supreme- it’s adult- and try & give a squirt of 1ml right before trying to feed her…this coats the esophogus and also tastes good and feels soothing

have you tried lots of skin to skin time to get her interested in eating? maybe try feeding her in the bathtub- nice & relaxing for both of you– these suggestions are short-term kind of things…maybe try them when she’s up from a nap? I would also look into your local la leche league and also an IBCLC (int’l board certfied lactation consultant) to also help in the meantime…

it’s great she’s doing well with the rice, but she really is under 6 months and doesn’t even *need* to start cereal (solids) so young, HOWEVER you’re trying to get calories into her, I know so this is a hard one, hmm…that’s why I think meds & lactation support will help…

let us know more how we can help you & oh yeah, since you say you don’t want to switch to formula, then don’t- just try & get the help you can with breastfeeding & reflux medication(s)

[Anonymous]

Welcome Trina,

I think you have come to the right place. You will get lots of support and ideas here from experienced moms.

By any chance do you have OALD (over active let-down)? It’s where you produce too much milk, and the milk comes out forcefully (sprays out) and chokes/gags the baby. This can cause reflux symptoms and colic.

I had this and took measures to get it under control. A lactation consultant could give you tips for doing this if you believe you have this. I could tell you what I did too as an example, but you have to be careful, because the techniques you use to reduce this problem also reduce your supply, so you want to be sure you actually have this before attempting to correct it.

Also, some babies do get better with age. My baby did get better and better as he got older with respect to fighting nursing. All 3 of our boys did this. So, some do improve with age. However, there are others who continue to get worse, and as Lori mentioned can eventually end up with an eating aversion, so you don’t want to let it go.

Hang in there! I know you will find this group to be very supportive and helpful. I hope you find the answers soon

[Anonymous]

to

lori,laura and christine who replied to me-

thank you so much for aquick response. I will call her dr. now.

couple of ?s: you mentioned mylanta cherry, pepcid and Zantac. use 1 of these in additiion to the Prevacid? Is Zantac otc? are these allsafe to use w. prevacid? How do these function diff. f. the P
revacid???

you mentioned the timing of the Prevacid as being important- we give it to her right before a feeding. should i try and give it toher maybe between two feedings now instead of right before? By the way, I read on different postings about compounding the Prevacd-what does that mean??

Sorry for all the ?s- Thank u-

[Anonymous]

Emily-

I did have OALD. This seemed to get better -that is why I thought she was getting better as her choking and gagging on the breast had improved. But now, she is just outright refusing to eat or minimally eating. And yes, my milk supply has diminished already.

Thank you for your words of support.

[Anonymous]

About the meds- The solutabs are called delayed release. They really work the best when given on an empty stomach and then followed up with a meal 30 minutes later. The empty stomach ensures that the meds won’t become inactive and break down in the stomach, and the timing of the meal is intended to activate the meds when it’s at it’s peak in the bloodstream. I’ve read that if you don’t give the med this way, the effectiveness can be reduced by up to 70 percent. That being said, you do the best that you can, b/c we all know how hard it can be to time meds around feedings.

Compounds are called immediate release. The advantage is that you don’t have to time them around meals ie you can give it any time. BUT, they are very difficult to get made correctly, and as much as we tried, they were a nightmare for us (though they’ve worked for some). I personally wouldn’t go this route- to get one made you need to go to a compounding pharmacy and they make the med from scratch, but like I said, they’re notoriously unstable. (Yes, I’m bias.) There are other options like Zegerid and CaraCream (talked about in Laura’s intro) that are stable forms of immediate release, and you can look into those. I don’t know if you can get caracream there anymore. It’s a way of making a stable compound, you do it at home, using your prevacid.

Good luck.

[hellbennt]

mylanta cherry supreme is otc- it’s for adults- get the cherry supreme kind, as it doesn’t contain aluminum- you cannot overdose your baby with this- if you give too much it results in loose stools, that’s ‘all’

so I would try giving this before feeding her- it can be given with zantac

zantac can be given w/ the prevacid, only you have to space the 2 meds apart – give then 4 hrs seperate from one another

pepsid complete is otc-for adults- I don’t know how to administer this, but many people here do- it is the ‘same kind’ of drug as zantac so you would try either zantac or pepsid – again pepsid should be given 4hrs seperate from prevacid

here’s a bit about pepsid complete: https://www.infantreflux.org/forum/forum_posts.asp?TID=7815&a mp;KW=pep

https://www.infantreflux.org/forum/forum_posts.asp?TID=7954&a mp;KW=pep

Dr Phillips said it was okay to give Adriana 1/2 tablet of Pepcid Complete dissolved in a teaspoon of water. She is 6 months and 16 lbs.

hellbennt2007-6-21 19:42:50

[Anonymous]

Mylanta Cherry Supreme is an antacid that can give some temporary relief while you are waiting for the full effect of the Prevacid (usually two weeks). You can give it anytime (before or after feedings) but space it at least two hours apart from the Prevacid. It can cause gas and loose stools if too much is given, so watch for that.

Zantac and Pepcid are H2 Blockers (an acid reducer) and is available by prescription only. It’s pretty useless on it’s own (for most babies) but sometimes helps in conjunction with a PPI for breakthrough acid.

Pepcid Complete is an OTC antacid and I think acid reducer combined. You’d have to space this 4 hours apart from the Prevacid. Most of us who are using it for our infants/toddlers are giving it before bed, at least four hours after the last PPI (Prevacid) dose. Dr. Phillips (from marci-kids) has adviced a few moms here that an infant can have 1/2 of a tablet once per day, but you can email him for his direct advice. I think the other infants on the board who are taking it are closer to a year old, so I’d ask him what dose he’d reccommend for your daughter. You can email him at phillipsjo@health.missouri.edu

I’d work on getting her Prevacid dose increased. For most babies the right dose of Prevacid will do the trick. Good luck!

[Anonymous]

Hey Trina, Just wanted to say hello from another breastfeeding mama. I know how difficult it is, and what you have described sounds like both of my little refluxers. It got bad with both of them right around 4-5 months, so you are probably in the peak of it with your little one. I ended up feeding Benjamin by putting him in his bouncy seat and hanging over him! A crazy sight to see, but he just wouldn’t eat otherwise.

I ended up getting his meds increased at this time and it made a huge difference! He ate so much better and is a big chunk to prove it! I also have OALD and that has made it even more difficult, so, like Emily mentioned, I would be happy to discuss how we worked with this as well.

Best of luck to you!

[Anonymous]

Hi Trina,

I’m so glad you wrote for help on this. My little girl is the same

age as yours and we’re going through the exact same thing

right now. I’m bf too, mainly because she’s even worse with a

bottle. AArghhhh. It took me 1.5 hours to get her first feed into

her this morning. I have no advice for you, but I know what

you’re going through. We’re working on getting our meds

upped too, but getting a lot of resistance from docs.

I just hope all this effort somehow gives us some brownie

points with them when they’re in their snarky teen years.

Yana

[Anonymous]

I’m sorry, Trina. It’s so hard to figure out what is going on with our little ones…if only they could talk to us!

Since you have your OALD under control, it does sound like maybe upping the meds is a good idea.

I was lucky that getting my OALD under control solved most of Caden’s issues. He still has fussy days, but nothing that would warrant medication at this point.

Good luck

[Author]

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