Crying over spilt milk - a mother and doctors journey

Hurray my first blog post! Brought to you courtesy of my wonderful friend and colleague, Dr Verity. She has written about her journey with her son's reflux. It has been eye opening for me as a doctor and will prove informative for anyone who is struggling with feeding, I hope you enjoy reading it and find it as useful as I did.
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Although this blog gives you evidenced based and tried and tested advice, if you are ever concerned about your child, please seek advice from a trained medical professional.

Crying over spilt milk

When my baby was 3 weeks old I went for coffee with a friend who was a fellow doctor. Struggling to breast feed for the second or third time out the house I got my muslins ready, one tucked into my bra to catch all the vomits whilst he fed and one ready to burp him for the inevitable deluge of milk post feed. She watched me struggle as my boy bobbed on and off the boob screaming, arching his back and then watched him vomit up the majority of his painful feed. She exclaimed “poor little thing’s got reflux”. Before this conversation I was just thinking “shit this breastfeeding stuff is hard”.
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Reflux is when a baby brings up milk, or is sick, during or shortly after feeding. Its very common (50% of babies have it) and most children outgrow it by a year. There’s a wide range of severities from a small amount of extra washing every day to babies needing hospitalisation for failing to gain weight from severe symptoms. Reflux is caused by many things and sometimes it’s a symptom of an underlying problem including allergies or intolerances. 

From that day to now (my boy is now 5 months) the weeks have consisted of trying anything and everything to ease his symptoms, analysing said interventions and trying to quantify whether they’re making any difference at all.

For us, reflux dominated his early days in this world. He fed so often because he vomited a lot of his feeds and was always hungry. We had to rock him to sleep or let him sleep on us because we had to hold him upright for 30 minutes post feeds so there was no way we could start sleep training. We had to do nappy changes with a screaming hungry baby because if we waited until after he fed as soon as he lay down he’d vomit again. The inordinate amount of washing every day led to my inability to give a shit about what he wore other than baby grows because I knew I’d be changing it in 2 hours.
Early on we didn’t go out to “nice” places that weren’t specifically baby friendly because we knew there was no such thing as a discrete breastfeed with him screaming and vomming whilst he fed. Always holding a muslin in front of his mouth and never being able to be at ease playing with him because you know if you jiggle him too much he’ll probably be sick really takes its toll. But the worst part of it was I was still feeding him at least every 2 hours up to 4 months in. When you’re holding your baby upright for 30 minutes after these feeds, I’ll let you do the maths to work out how long max you can sleep for. When you’re chronically sleep deprived like lots of mums you suddenly understand the saying crying over spilt (vomited) milk! 

However, we’re really lucky because my boy’s reflux was not severe at all compared to how bad it could be. Other than feeds or lying flat he’s a very happy baby and he very rarely would be inconsolable from his reflux. He always continued to gain weight, was thriving developmentally and some of the “treatments” really helped to settle him. Ranitidine, although it didn’t stop his vomiting, did stop him from being unsettled. My GP was supportive (when we managed to get to see them) and did organise a prompt paediatric referral. Unfortunately, these positives mean that my boy is, like many babies, not categorised as ‘severely ill’ and in our current underfunded and overstretched NHS is therefore not a priority. He was given a gastroenterology appointment 6 months after the GP made the referral and we were left alone in the meantime.

The main thing I think I learnt from being a mother of a reflux baby as well as a doctor was that there’s unfortunately no quick fix. I meet other mums with older children and they see the muslin draped over his pram and give a knowing look and they all say it gets better and they will grow out of it. They are right. It is not forever and I can see that now but it doesn’t make it any easier in the meantime. I think however, being realistic and not chasing a cure can help you stay sane rather than being upset that nothing is stopping your poor baby from vomiting. Also you may be someone for whom one of the interventions along the way works and things get much better for you, fingers crossed!

Struggling with reflux? Here are some things to try...

• Simple positioning: get a wedge https://wedgehog.co.uk/ for the pram and moses basket for lots of babies this helps .
  

• Feed upright. This really helps babies with reflux whilst they are feeding and makes winding them easier too.
  

• Hold baby upright for 30 minutes (yes, genuinely 30 mins) after each feed finishes. This is what made the biggest difference to my boy’s symptoms. In the daytime the bouncer (and then high chair) and using the sling/carrier was a great passive way to do this!
  
• Swaddling - we found this really helped our baby to sleep in the early days.
  
• Think about a routine - 'eat, activity, sleep' meant that in the day we weren’t trying to put him to sleep just after a feed and he had time for his milk to go down.
  
• Get LOTS of bibs and muslins and take them out with you along with a spare change of clothes for baby AND you.
  
• Feed little and often rather than long spaced out feeds (I found this nearly impossible with my little one as he was always ravenous and any attempts to slow down or stop him feeding resulted in full on meltdowns).
  
• Thickener (carobel) added to expressed milk or formula.
  
• Use a bottle asap! Whether with formula or expressed milk, this way you can add thickener with gavison and also so breastfeeding mums can have a break as you’ll need it (try not to worry about nipple teat confusion its quite rare and most babies manage well).
  
• Use a dummy! This really helped as when the reflux is bad, babies want to feed to wash the acid away but feeding makes more acid come up. The dummy breaks this endless cycle! 
• See your GP who may suggest some/several of the following: Gaviscon (remember it has a success rate of only 30% and can constipate), Ranitidine - an anti acid medication, Consider dairy free diet/formula (10% of babies with reflux have cows milk protein allergy).

My top tips

• Trust your instincts and don’t feel bad about asking for help from the health service as well as your family and friends.
  
• Be realistic about what any intervention might achieve. There is no “cure” and maybe a combination of all the above will help you get a few extra Zzz’s and help your baby be a bit more settled or maybe all their symptoms will go away after positioning 
  
• It unfortunately does take weeks to assess whether interventions are working and teasing apart causation and correlation is difficult. You need lots of patience and although it’s tempting to do everything at once being systematic and trying things one by one will save you time in the long run and keep baby on as few medications as possible.
  
• Although its painful when a doctor says 'they’re gaining weight and doing fine' take solace in those facts. There are many other parents with babies who fail to thrive from severe reflux. 
  
• If your baby’s vomiting is excessive and they are unwell in other ways then it might not be reflux. See someone urgently. 
  
• Talk to other mums and dads of reflux babies. I always found it really reassuring to see people on the other side of it and knowing that one day it would end!