I had a call from a mom yesterday with a 4 week old baby who cries almost
constanty and spits up a lot. The first week of BF went fine.  Then
fussiness, spitting, gassiness and finally a diagnosis of reflux with
Tagamet prescribed.  Nothing has helped.  I could hear the baby crying over
the phone.  She sleeps an hour or less after feeds, then wakes up crying.
Dad made mom put baby her car seat and leave her in another room to "cry it
out" yesterday, because he felt that nothing they were doing helped, and
saw how stressed and upset mom was by the crying.  When mom could not stand
it any longer, she went to baby, picked her up, and baby fell asleep
immediately in mom's arms.
        MD put baby on Lactofree formula last week.  There were about 7 hrs of
relief of symptoms (mom would have weaned at that point in desperation),
then symptoms came back and baby went back to the breast. Baby is gaining
well. Mom tried simethecone drops without relief of symptoms.  It sounded
as if mom may have hyperactive letdown; I recommended she try having baby
straddle mom's knee to nurse, and try pumping off first milk and freezing
it for later use, burp baby frequently, and eliminate all dairy from her
diet for the next few days. MD has mom switch nursing (5 min on a side,
back and forth between sides). I think this might cause baby to get even
more foremilk, so recommended she stay on one side after pumping off
initial letdown as long as baby will stay there, then switch.
        I told the mom I would ask the experts on Lactnet for any help you all can
give. She will call me back on Friday to find out if you have any more
advice, and to let me know how things are going.
        Thanks for your input!    Anne Stiller, RNC, BSN, IBCLC