Dear Jeanette,
"Sounds like you have a bit to go on. Did good to get that much! History
of siblings. (Atopy) Any of family members with asthma, diabetes,
eczema, or other inflammatory diseases? Necrotizing enterocolitis? Has
mom gone on elimination diet for bovine protein? Gluten? Does the baby
hiccup at all? Any supplemental foods for baby?"
"Has this GER been an ongoing problem or just in the last few weeks? Any
dx for the respiratory problem? And is that still a problem? Any
weezing?"
"Do you think the HCP is going to use pumping as a measurement of what
baby is getting at the breast? From what I hear you're saying the milk
is going in but a lot is coming back up. I'm not sure what the 70%
residuals figure is from. A test showing what's the % that's coming out
not absorbed or still undigested?
If there is an allergy reaction to a foreign protein anywhere along the
GI tract there's probably inflammation & poor absorption. Is the reglan
moving the chyme down & out like a speeding train? (wt. loss?)
"I've had a lot of infants come in with reflux and the HCP always
recommend putting cereal in the bottle to 'make it heavier' to stay down,
the participant states. I feel it is only diluting the very food that is
causing the problem in the first place, not making it heavier. (We all
know water is heavier than grain.) The fact that less allergen is present
could be the reason for not as much reflux. HCP always suggest the
breastfeeding moms supplement and add cereal to formula. See a lot of
asthma dx in these kids after 1 yr. If a mom is breastfeeding I
recommend the elimination diet & explain the anti inflammation properties
of breast milk - void of the inflammation causing allergen in her diet."
I always ask about hiccups. 'Mothers of Children With Food Allergies'
support group have told us at a Mass. Lactation Counselor Assoc.(MLCA)
meeting...their children all hiccupped when they were exposed to a food
they were allergic to, even in utero. (No studies that we know of just
good observation.)
Keep us informed.
Regards,
P.Harris-Swenson, MA, IBCLC, Doula in training
WIC Nutritionist & BF Coordinator
Still behind '69 spring cleaning AND Lactnet mail!
Lowell, MA USA
I only get the doozys on Fridays or Saturdays! This mom has had 8
children, the last 5 with GER (or GOR). However, this last baby, born at
6
lbs 5 oz and now at 4.5 months weighs 11 lbs 4 ounces - having lost 4
ounces the last three weeks.
Baby has had every test in the book, The only report she was able to
give
me clearly (very stressed out mom and hysterical baby in the background)
was she had 70% residuals an hour after feeding. Pediatrician now
treating her with Reglan - and coincidentally has lost weight during the
last 3 weeks since the Reglan (metaclopromide) was started. =
Baby has been crying unconsolably from 30 minutes after a feed for 2 -
2.5
hours, then sleeps for an hour or two, then eats and back to the crying
again 30 minutes after eating. =
I got called only because they needed a pump - to see if mom had enough
milk, the pediatrician said... ;-(
So I had to ask lots of questions gently, and try to direct mom about
pumping not reflecting either what she was making or what the baby was
taking... Thanks to all the vomiting.
I've recommended contacting the Lactation Center at UC Davis, as there is
a
Pediatric Gastroenterologist, Dr. Michael Haight, who is the MD there,
but
she does not know if they will be able to go as the insurance company may
not pay and they already have $30,000 in bills for care in NICU (baby had
respiratory distress at birth) and tests since discharge. =
I did suggest breast compressions, letting baby suck at the breast to
maintain a little longer the peristaltic movement of the
gastrointestinal=
tract, but this is not my specialty - luckily I did hear the tape on GER
prior to talking to her, so I was a little more knowledgeable. But I
can=
hear the fear and desperation in her voice. Exhaustion! She even tried
some formula - threw it all up, of course.
Today mom called to tell me she was finding that baby was arching and
sle=
pt
best (if by this you mean 30 minutes at a time between crying spells)
whi=
le
leaning on mom or dad's chest (she didn't want to admit to putting baby
prone due to the risk of SIDS).
Tomorrow she goes to the MD to see how the baby is progressing with her
weight. I would love to hear from you what you would recommend r/t the
u=
se
of Reglan and how to help this mom.
Jeanette Panchula, RN, IBCLC
Vacaville, CA =
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