Spitup or reflux? So confused.

[papal]

I am so confused by all the conflicting opinions and articles on whether my baby is just spitting up or has reflux. Please help!

Story so far.
My baby girl is almost 7 weeks old. She was kind of choking at the breast and was gassy and burpy and spitting up a lot..so after reading up on kellymom.com i realized that i had an overactive letdown.. i spray all over and it is hard for the baby to keep up hence the choking and gassiness.
I had the Lactation Consultant come over a couple of days ago to address my concerns about the overactive letdown. She observed me breastfeeding and noted that the baby was having a hard time keeping up but was doing a good job and sucking and swallowing really fast....poor thing. Anyway, the LC suggested I put cabbage leaves on my breasts for 48 hours to reduce the milk so that the baby could cope..i think the letdown has improved a little.. i still spray but not as much or for as long... she also said to offer only one breast which is what I used to do anyway (now i worry that baby is not getting enough milk!).
Anyway, the LC noticed that the baby was making weird noises and had congestion and suggested we visit the ped. So we go to the ped yesterday and they tell us to go to the ENT doctor.. by now I am getting really worried! The ENT doctor puts a tube down her nose and tells us she has laryngomalacia.. that is causing her duck-like noises. Now this does not concern me because it resolves by itself.. however he also prescribes Zantac for reflux.. this concerns me..yes she spits up but that i thought was because of my overactive letdown.. not reflux!! I am wary about giving her the med.. and just now my ped calls me back and I review what the ENT doctor said and my concern about the Zantac and she says 'don't give her the Zantac'. Ok, so now i am really confused.
How can I be sure that she does not have reflux. Sometimes she spits up a couple of hours after a feeding. Is that normal? What does spitup look like? What she spits up looks like digested milk.. like curds... does reflux look the same?
Has anyone had experience with this issue?
Any opinions or advice would be great.

Thanks in advance,
Rashmi
(mommy to Leela born 10/17/03)

[peanut4us]

Well first, did you tell the ped that you were concerned/didn't really want to give your DD Zantac unless it was absolutely necessary? If your ped thought you had strong feelings about it, and wasn't absolutely sure your baby had reflux, the ped might have said not to take it because of that.

My baby has been on meds for reflux since she was about 4 weeks old. She was on Zantac first. It's nasty tasting stuff, but it made Sara a whole new baby. before the med it was like she had colic 24/7. After the drug, she only cried when a normal, healthy, uncolicky baby would cry.

I also had overactive letdown and fed on one side only. Reflux is hard to really diagnose. It usually involves a scope to be 100% sure. We were lucky, IMO, to have a ped that was willing to try a drug for a few days first and see if it helped before subjecting her to a scope. If your baby doens't seem to be in pain while eating or lying down, and if the spit up is a normal, digested amount, awhile after eating, then your baby probably doesn't have reflux (obviously not a medical opinion, just my experience). Also, FYI Zantac does not stop the spitting up, it just curbs the pain.

[papal]

When the ped called I told her that the ENT doc had prescribed Zantac and after reading up on the internet about over-active letdown and spitup, I was not too sure that she had reflux and did not want to medicate her unecessarily. That is when the ped said to not take the Zantac then. Do you think she was just being cautious because of my concern? If she had said she was sure it was reflux then I had no objection to giving Zantac, but she was not sure.
Anyway, I am going to see if things improve in the next few days since my milk has slowed down a tad.

Leela is a pretty happy baby..she only cries if she is hungry or needs a diaper change or is sleepy.. also if she needs to burp. But her sleep is fitful sometimes.. she tosses and turns. I think that is just gas though..because she settles down after a burp or a spit-up. I cannot tell if she is in pain, how do you tell? It is so confusing and I want to be making the right decision for Leela.. especially if she is in pain... i wish they could tell me for certain she has reflux.

When she does spit-up, she grimaces like there is a bad taste in her mouth..and smacks her lips. I was watching her today.. she spitup once in her sleep and settled down into sleep again.

Rashmi

[kwc]

Hi Rashmi,

Sounds like Leela has been through a lot!
I also have overactive letdown (diagnosed by my LC) with a gulping gassy baby which has improved a lot as she has gotten older (better at keeping up!), burping after 1-2 minutes, and my supply has adjusted after only going on one breast at most feeds... I had an idea something was wrong when I pumped for the first time at 2 weeks and got 7 ounces in 6 minutes.
My LC also suggested pulling her off with the letdown to spray into a cloth diaper but I had trouble timing it and the baby would freak.

Reflux is a funny thing... all babies have it to some extent as the muscle (esophageal sphincter) that prevents milk/ food from coming back up is weak in all infants but improves as they get to 6 mos- 1year usually. How weak it is determines how bad their reflux is (whether it is pathological or clinically significant). Joey is right, the best test for it is a endoscopy or ph probe but you really don't want to do that unless really necessary... often docs start medication based on symptoms rather than submitting infants to these invasive tests. For babies that have severe reflux, they are usually in horrible pain much of the day, may get aspiration pneumonia, may have trouble gaining weight, etc. It definitely doesn't sound if Leela has any of these. Her grimacing after spit up sounds normal too (prob does taste bad!).

The ENTs often see reflux in conjunction with laryngomalacia (which also improves with time, yay!) and may be aggressive in treating if there are signs of reflux. Although Zantac is considered a very safe medication, different docs (and parents) have different thresholds for treatment. Based on the fact that Leela sounds like a very happy and otherwise healthy baby (who I assume has been growing well) I think your hesitation to treat is VERY reasonable and that your ped is supporting you in it... I am sure if he/ she was worried, your ped would express concern to you.

In short, Leela probably has some reflux as all babies do, and maybe hers is a bit more than some others. However, I think waiting and watching while you see if her getting used to your milk supply/ letdown helps is a great idea.

BTW, my DD (now 4 mos) still spits up a ton but probably from gulping air... it's much worse in the day when she is active and when she "talks" while nursing... she almost never spits up at night despite lying flat on her back... I guess it is because at night her nursing is "all business" and she goes back to sleep.

I am smiling at your and DDs names because growing up one of my best friends had little sisters named Lela and Rashmi... and they are not Indian! Just had a lot of Indian close friends so most of their 5 kids had Indian names.

Hope this helps!

Karen

[TaChapm2]

I went through a similar experience with my son. He didn't spit up a lot but he was so fussy and thrashed around in his sleep a lot. He really fought taking the bottle. It was like we were pouring gasoline down him. His ped. gave him Zantac for the reflux but it didn't seem to help so I took him off of it after a week. I also tasted so bad! Later that month she insisted that it was reflux and sent us to have an upper GI done. In this test they make him drink barium and take several X Rays while he is drinking and after. You can tell for sure if they have reflux by doing this test and sure enough he did. It is not as invasive as a scope. DS was 2 months old when we did it and he didn't seem to mind. He has now been on Prilasec (compounded RX) for 11 mos. This made all the diffirence in the world. I hate that I put him through that pain for 2 mos. but I just wasn't convinced. Ask about having an Upper GI done. It is your right as a parent to request these tests for a answers. Most babies outgrow reflux but we are still dealing with it. Not so bad once you know for sure what it is.
Good Luck!
Tara
Mommy to Jackson (11-10-02)

[peanut4us]

I think your ped is great to follow your lead. You know your baby best. And it doens't sound as if she really has severe reflux. If it's not stopping her from eating and sleeping then I would probably just wait it out. If her symptoms worsen, you can always start the meds when she's older. Good luck and keep us posted

[COElizabeth]

Our ped said the same thing as Karen - that all babies have reflux to some extent. The only times you need to worry are if one or both of the following occur:

1. The baby spits up so much that he doesn't gain weight well.

2. The baby is in pain.

James never spit up a whole lot, but he would cry immediately after nursing (when most babies are content), even if he had been perfectly happy before eating. He also sometimes arched his back and hated to be carried or held lying down. These were all clues that he was in pain from the acid.

My peds have all said that Zantac is a very safe medicine for babies, but I agree that you certainly shouldn't try it if you don't have any real reason to believe your child has either of the two problems. If things worsen, you can always try it later.

I hope all goes well!

Elizabeth, Mom to James, 9-20-02

[chlobo]

Can you tell me a little bit more about the strange sounds your baby makes? My baby makes so really weird noises and sometimes sounds like she's gasping for air or sounds like a horn. I'm not sure how to describe it to the pediatrician and I don't want her to suffer. Not sure what to do.

[papal]

I don't know how else to describe it other than 'duck-like' noises. Like huh-huh-huh-huh... She does not make them all the time.. but when she does the sound happens on the inspiration (inhalation). She is not in any pain when she makes these noises and the doctor said it is a condition called laryngomalacia. It is not uncommon in infants.
Here is a great article on it.
http://www.emedicine.com/PED/topic1280.htm

If you are concerned you should definitely see the ped, if nothing else to reassure yourself. If your baby is not crying she is not in pain .. i know Leela cries at the slightest discomfort.. when she has a wet diaper.. when we put saline spray in her nose to suction out the boogers.. so i am sure if your baby was in pain she would be crying.

Rashmi

[papal]

Thanks for all your responses. It was reassuring to hear that Zantac it is not that uncommon for doctors to prescribe to infants.

Anyway, I finally decided to give Leela the Zantac for a week and see what changes there are in her, if any. I was noticing that before she spits up she does thrash about a bit.. similar to what she does when she has to burp. She is often sleeping when she spits up and last time she let out a cry (in her sleep) before spitting up.. must be causing her some pain.
Also, now that the excess milk thing is under control, and the let-down is not so fierce, she is doing a much more controlled as opposed to frenzied feeding. I think the overactive let-down made her more effiicient because she is done feeding in about 12-15 minutes on one side only. She is gaining weight (about 1.5 ounces a day, we went to the ped again today for her congestion) so I am no longer worried she is not getting enough to eat.

In short, the problem seems to be resolving itself and she is getting cuter by the day. :)

Rashmi