Kathy and Diane,
I do think oversupply is often a part of the picture, but certainly not always. And, I think we have another chicken and egg issue there--what is the cause of oversupply? My guess, unless mom has driven up her own supply through pumping--is inflammation. 

And if indeed baby would benefit from relief while whatever cause there is is treated, then slippery elm is a far safer alternative to meds. in fact, It is healthy, nourishing and heals the gut and esophagus. I do not understand how meds provide relief--they do not heal the damage in any way. 

As to Nancy's comment re: food allergies. The proof is in clinical practice. Remove the allergens and see what happens. The thing is that in a NICU you are far more unlikely to accomplish this, since HMF, meds containing allergens and AIM are so often used. Do a search on the internet of mother forums--they are very educational. Time and again moms talk about being frustrated by being given meds for GER when all they had to do was remove dairy or gluten from their diets and symptoms disappeared. Yes, human milk has more anti-inflammatory cytokines, but when you have a damaged gut, you have a different playing field. 

While it may be true that there are cycles in diagnoses, I think that may well be bc the concept of diagnosis is really irrelevant for the most part. Is a bit of tissue beneath the tongue a tongue-tie if it never causes a person a problem? Does a mom with a large milk supply have oversupply if her baby has no problems handling it and it never causes her plugs or mastitis? I prefer to just describe what I see and think about how to normalize the function. Drugs in infancy are risky. Why subject babies to them needlessly?


Jennifer Tow, IBCLC, France
Intuitive Parenting Network, LLC
 




------------------------------

Date:    Sat, 4 Jun 2011 16:41:24 -0400
From:    Kathleen boggs <[log in to unmask]>
Subject: reflux and oversupply

Sent from my iPad

On Jun 4, 2011, Diane Wiessinger wrote:

> I recall thinking years ago that babies got better on alimentum/nutramigen
> because they no longer had to deal with an oversupply that was causing
> lactose overload and irritating their gut.  The mother pumps for a week, her
> supply drops, and when baby goes back to breast he's fine and everyone
> credits the alimentum.  Just a thought.

And a brilliant one at that. Only occasionally do I see a baby suffering from 
reflux whose mother does not have oversupply. When a mother describes a gassy, 
spitty baby gulping, choking and arching at the breast the first thing I do is 
explore her supply.  Some of these mothers have persistent, difficult to treat 
oversupply as evidenced by a baby that can slug down 5 oz. in 5 minutes. No 
wonder the lower esophageal sphincter cannot take it. When supply is brought 
under control reflux symptoms improve or disappear.  It's not an easy fix but if 
oversupply is the underlying cause then meds and elimination diets won't work.  
If baby's esophagus is very irritated from persistent reflux then meds can 
provide comfort for baby until the esophagus heals.

Kathy Boggs, RN, IBCLC



 
I agree with your statement that many babies are MISDIAGNOSED with  GER.  I 
still see no evidence that it is food allergies causing the  problem.  I am 
not physiologist enough to know if the research supports  your cytokine 
theory.  Human milk has many more anti-inflammatory cytokines  than 
pro-inflammatory cytokines and the microbiome interacts with both.
 
I do know that diagnoses, like many things, swing on a pendulum - like  
ankyloglossia, laid-back nursing (the old Australian position), finger-feeding, 
 candida mastitis, etc., etc.
 
Nancy
Nancy E. Wight MD, IBCLC, FABM,  FAAP
Neonatologist

 



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