Should I Offer Both Breasts to Baby With Refglux

Reflux or no Reflux?

A female parent of a 4 months old, (7.2 kg) fifteen lbs 13 oz, infant writes:

"My infant male child is on reflux meds since around 7 weeks of age.  This was washed because he spits upwards a lot and chokes while lying down.  He takes only one breast at a feeding. He won't breastfeed unless I feed him side lying. He has always been very gassy and I think his latch is not skillful.  His lips do not actually flange. He oft will cry and fuss at the chest if we're not side lying. He sometimes chokes on my letdown when not side lying. The fussing started effectually a month ago, and he has been gassy from the first week or 2. I take sore nipples though not all the time. I am exclusively breastfeeding.  His weight gain has been skillful and the pediatrician is happy.

"I am on the mini pill for birth control from half-dozen weeks later on birth.  The baby is taking ranitidine (Zantac) for reflux, but things are not getting better."

So, what is going on here?  Why is the infant fussy?  Why is the infant "choking" at the breast? And why is it thought that the baby has "reflux"?

Allow us consider iii possible explanations of this situation:

1. This is overactive letdown reflex and the mother is producing too much milk.
2. The infant has reflux and all his symptoms are acquired past reflux.
3. The mother's milk supply has decreased in the by few months.

Which do you think is correct?

A medieval painting showing a super "overactive letdown reflex".

Hither is an analysis of the three possibilities:

ane. Baby not able to handle the flow of milk ("overactive letdown reflex", baby "choking" at the chest, "also much milk")

If the babe cannot handle the flow, it'southward not usually because the flow is too rapid, it's usually because the baby'due south latch could exist amend. Mothers are ofttimes told the latch is perfect, but we at our breastfeeding clinic teach the latching on differently from most others and we show mothers how to achieve an disproportionate latch.

And why is the baby not latched on well?  Considering of:

• The way the baby is positioned and latched on is extremely important to how well a infant gets milk from the breast. The latch determines whether a baby can handle the menses and non choke.

• The apply of artificial nipples such as bottles, pacifiers and nipple shields.
• The baby has a tongue necktie. Some tongue ties are obvious, but many tongue ties are more than subtle and require an evaluation that goes farther than but looking, but includes feeling under the baby'southward tongue as well and knowing what to feel for.  Unfortunately, few health professionals, including lactation consultants, know how to evaluate whether or non the babe has a tongue tie.
• Those who claim that these situations happen considering of "overactive permit-downward reflex" and "overproduction" ignore the fact that this babe was breastfeeding for the showtime vii weeks of his life and was able to handle the period. The "let-down reflex" wasn't a trouble for the first 7 weeks then why would it be a problem afterward when the baby is bigger? Observation of the baby at the breast shows that they may drink happily the first few minutes at the chest when they are getting enough of milk and kickoff to "asphyxiate" and "pull away" when they are only nibbling rather than drinking. The fact is that oft "choking" from "too much milk" or "the infant not being able to handle the flow, choking at the breast" is actually a problem of the baby pulling and crying at the chest because he wants more than flow .Late onset decreased milk supply is common. And when the milk flow slows, the baby tends to sideslip down on the nipple and the latch is fifty-fifty worse, so that decreased milk supply itself tin can pb to more subtract.  And this may also result in sore nipples.

Therefore possibility ane is not the correct answer.

2. The infant has reflux.

I actually doubt that exclusively breastfed babies have reflux except rarely. They may spit up but late onset spitting up as described above is a symptom of something else as explained below.  Many say that tongue tie can cause spitting up.  I have not seen any proof of this, only many of the babies with tongue tie do indeed seem to spit up a fair flake.

The diagnosis of "reflux" has become so common that one gets the impression that half the babies in affluent countries are on anti-reflux medication or anti-reflux formula.  And though on occasion, babies seem to ameliorate on anti-reflux medication, they are the exceptions and most do not amend, every bit in the female parent's story in a higher place. The fact that the infant has been on medication for several months at present and the symptoms have worsened instead of improving, in nigh other clinical situations would have fabricated the female parent and physician at least dubiety the diagnosis. And the reason the symptoms exercise not improve is that the baby does not take "reflux" if nosotros mean "gastroesophageal reflux disease" (GERD) which is besides rare in exclusively breastfed babies. This baby besides does non have another popular diagnosis – "silent reflux", whatever that is supposed to exist.  Something like a "silent headache", because there is no hurting?

This diagnosis has come near as an caption of "fussy babies" because it is convenient. A pill for every sick. Just prescribe medication and there is no demand to deal with a fussy babe and his fussy and solution-seeking mother. Most pediatricians know little about breastfeeding and rarely practise they ever lookout man a baby at the breast.  Even if they did, few would know how to tell if the baby is getting milk from the breast.  So, a fussy baby who is gaining weight well, is perceived to have reflux.

Even so, over again, observation of these babies at the breast shows that they are not getting milk very well from the breast and ofttimes drinking merely some of the time, and pulling when the catamenia of milk is slow.  This doesn't necessarily mean that he infant is not getting enough milk. In fact, this trouble is the problem of the mother who started out with an abundant milk supply, so decreased milk supply could all the same mean a lot of milk but less in relation to what the baby was used to.  Only babies respond to milk flow and if information technology slows, then they can sideslip down on the nipple and cause pain and damage of the nipple, pull at the breast further increasing pain and impairment, cry at the chest, even refuse the breast birthday.  The issue is not the amount of milk the infant is getting, just rather, the way the baby perceives the flow of milk relative to what it used to be.

Conspicuously, reflux, possibility 2, is not the answer.

iii. The milk supply of the mother has decreased in the past few months.

Spitting up ("reflux"), choking, the infant'due south latch non beingness good, fussiness, sore nipples, feeding just one breast at a feeding and the demand to feed only when side lying are all office of the picture of late onset decreased milk supply.

Late onset decreased milk supply is common in mothers who contact our clinic and may occur fairly before long later nativity, even within a couple of weeks.  Why would milk supply decrease?  This mother undoubtedly has three reasons for a decrease in milk supply:

• The female parent has sore nipples. Sore nipples are due almost ever to a baby having a less than adequate latch.  When the babe'due south latch is less than acceptable, the female parent may accept sore nipples, or the baby may not go milk well from the breast or both problems at the same time are possible.
• The female parent is feeding the baby on only i breast at a feeding which decreases milk supply.  This is non a adept thought.  The mother should "finish" one breast and so offer the other.  If the baby is full, the baby will not take the second side.  Simply if the baby is on the outset side until he is fast asleep, he may not wake up and accept the second side.
• The mother has gone on the nascence control pill. I don't know where the idea arose that the progesterone just pill does not cause a subtract in the milk supply. Our experience and that of many mothers shows that information technology does.  How doctors practise non seem to know this tin only be explained considering they never make the connexion and when things are not going well with the breastfeeding will simply advise formula supplementation and then everything is fine, except that information technology's not.

Then the real reply for this question is iii., the mother's milk supply and period to the baby has decreased.

Having difficulties with breastfeeding?  Make an appointment at our clinic.

Copyright: Jack Newman, MD, FRCPC, Andrea Polokova, 2017, 2018, 2020

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Source: https://ibconline.ca/reflux/