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Reflux and Our Decision To Mixed-Feed

Today our girl is seven weeks old. She’s growing and learning and I swear she’s becoming even more beautiful with every passing day! But life hasn’t been all smiles and long nap-times these last few weeks. Around the four-and-a-half week mark we hit a growth spurt, and Little Miss became unsettled: she slept in short bursts, fed every hour or two, and grizzled constantly. Our placid baby had become impossible! A day or two later she settled, now noticeably bigger than before! Within a few days, however, she became unsettled again. Reading through Facebook posts from other mums, I started to wonder if it might be reflux. At our 6-week check-up, the doctor agreed that this was likely the case. We had noticed the symptoms gradually; on their own, they just seemed like normal baby things, but when we finally put them together, it became pretty clear that something was wrong.

Not happy Jan!

Not happy Jan!

Clues that Amelia has reflux:

  • Vomiting a lot. Little dribbles of reflux became chunky, projectile spew. She vomits after every feed (sometimes DURING a feed, ew!) and in between feeds.
  • “Wet” hiccups. She started to get the hiccups more and more, and we could hear the liquid plopping up and down in the back of her throat with each one.
  • Random fits of screaming, with no apparent cause.
  • Refusing to be put down – she’d seem to fall asleep in our arms, then cry and scream when we put her in her cot.
  • Feeding often, but not getting enough at each feed. She would pull away before reaching the “hind milk” (where the milk changes from thin and watery to creamy, fatty milk), which just left her hungry again.
  • Pulling away from the breast, screaming and arching her back. Feeding her was becoming a nightmare!

I decided to Google “reflux” and found these exact symptoms (Huggies.com has a helpful page on reflux). The doctor prescribed Losec, an antacid that comes in tablet form. These are supposed to be swallowed whole, but may be dissolved for those (such as babies) who can’t swallow them. You’re not meant to crush them, or even break them; they presumably taste nasty; they don’t dissolve so much as break down into little flakes. I tried mixing it with expressed breast milk and bottle-feeding it after she refused to take it from a syringe, and it just got caught in the teat. I went back to the doctor and got a new prescription which I took to a compounding pharmacy, where they made a banana-flavoured liquid version. Much easier!

I spoke to the paediatrician about mixed feeding as I was concerned that she wasn’t getting quite enough food, between her fussing at the breast and vomiting up half of what she got. According to her growth chart she needs to put on a little more weight, so I felt that my concerns were validated. The paediatrician agreed that formula top-ups could be helpful to fatten her up and help her settle. She recommended starting with plain NAN or S-26, but said that if that wasn’t working out we could try a thickened formula that’s specially made for reflux.

We went with NAN, which is what we had been using for top-ups at the hospital and in the days after coming home. She took to it immediately. She had spent the previous hour sleeping lightly and refusing to be put down (Sean had her while I was at an appointment) but after a bottle of formula she sunk into a deep sleep and has been happy since!

Sleeping Beauty - with a full belly, she is content and completely out to it :)

Sleeping Beauty – with a full belly, she is content and completely out to it 🙂

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The Worst Night, then the Best Night

I knew it was going to be a bad night when I saw how tired and grizzly she was...

I knew it was going to be a bad night when I saw how tired and grizzly she was…

By Friday afternoon I knew that it was going to be a bad night. She had been unsettled all day, cluster feeding in little bursts that came every hour or two and grizzling frequently. Sure enough, the night held a similar fate. At one point, after having held her dummy in for what felt like an eternity (but was probably about half an hour), I gave up. I was grizzling as much as she was, desperate for a bit of sleep after a long and tiring day. Sean and I swapped sides, and he told me later that he spent two hours awake with her. At one point a fight erupted between us over a misunderstanding; there was something yelling of obscenities, some slamming of doors, some hurt feelings. It was a bad night.

How I look waking up for a night feed!

How I look waking up for a night feed!

Then yesterday, Saturday, came and she was a little more settled during the day. Having overcome a bout of thrush (and deciding that yes, it’s definitely gone), I was finally able to start expressing again. As it had been a while, I was only able to get 60ml (I say “only” because before the thrush I was getting up to 120ml after a feed). I set it aside though, thinking that perhaps Sean could do a night feed with that.

We survived Friday night, and come Saturday things were looking up.

We survived Friday night, and come Saturday things were looking up.

As it turns out, I needed my EBM (expressed breast milk) sooner than expected: the last feed before bed left her a little unsatisfied, and I was already too tired to keep trying to breastfeed her when both boobs were pretty empty – it would take forever to slowly fill her up as my boobs refilled themselves! So I whipped out my bottle of EBM, and she guzzled it down, probably about 50ml on top of the boob feed. After that she slept for about 6 hours. Can I get a HALLELUJAH over here?! We literally went from our worst night, straight to our best night.

Yes, that's a towel she's wrapped in... blame daddy, who thought she didn't need a blanket while we were out at my sister's house!

Sleeping peacefully. Yes, that’s a towel she’s wrapped in… blame daddy, who thought she didn’t need a blanket while we were out at my sister’s house!

Today I’ll be starting up my pumping routine again, to help build up supply and hopefully get a good store of EBM for top-ups and those occasions when I need Sean to feed her, for whatever reason. Breastfeeding is great, but it is very challenging; not being able to pump for a while really taught me the value of expressing and having that EBM on hand!

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Eating Fish During Pregnancy and Breastfeeding

Fish is a healthy source of protein, and oily fish are a valuable source of Omega 3 fatty acids. However, pregnant women need to be cautious about the kinds of fish they eat. Some fish have high levels of mercury, which can impact the developing fetus. In Australia, we have range of fish options, and finding information for each variety can be difficult. As a breastfeeding mother who got over-excited and bought nearly a kilo of Blue Grenadier (also known as Hoki) to eat over a couple of days, I suddenly wondered if this could be potentially harmful to my newborn bub.

Googling the mercury levels of Hoki, I came across this fantastic resource from the New Zealand government. It points out that the level of mercury in breastmilk is very low, and it does not pose a high risk to eat fish while breastfeeding, as it can in pregnancy. There is a useful chart included which lists a wide variety of fish under three restriction categories: no restriction necessary, 3-4 servings per week acceptable, and 1 serving every 1-2 weeks acceptable. Luckily for me, my Blue Grenadier/Hoki is in the “no restriction necessary” category. I’m having fish tonight!

I'm having fish tonight!

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Breastfeeding With A Nipple Shield

My baby was hungry; she was rooting, and seemed to latch well when I put her to the breast – but she just wouldn’t suck! In the hospital, the midwives helped me to hand express, then set me up with an electric pump. Off to a slow start, I was told she would have to have her feeds topped up with formula. Our future as a breastfeeding pair was suddenly uncertain: would we be able to establish ourselves? Would she ever feed from the breast?

Then the lactation consultant came, managing to squeeze me into her overflowing schedule of appointments. I am very grateful that she did, as her advice was helped to start us off, finally. She came with a little silicone teat called a nipple shield or nipple guard. Clear and completely flexible, it sits over the nipple and the baby takes this into her mouth, with the nipple inside. It has holes in the end for the milk to flow through.

Avent nipple shield

Avent nipple shield

From the first moment, it was a raging success. She attached with a vengeance and got to guzzling milk like there was no tomorrow. Since then we’ve had no issues using the shield – well, not with feeding, anyhow. I’ve just had to learn to put a cloth underneath to catch the excess that collects in the shield for when she inevitably knocks it off! I’ve also found that she occasionally gets a bit too much and chokes a little, so that’s something else to watch out for, though it doesn’t happen very often.

I’ve seen the lactation consultant since then, and she gave me hope that we’ll be able to wean off the guard eventually. I have flat nipples, which means that Amelia misses the stimulation on her palate that tells her to suck; however, she should get the hang of it as she grows bigger. In the meantime, I’ve found that about once a day (usually the 11 am feed) my boobs will suddenly start cooperating, with nice pointy nipples, and she’s able to feed nicely without the guard for at least one side.

Even if we never get to the point of breastfeeding without the nipple shield, at least we will have been able to breastfeed, in spite of the challenge of flat boobies.

Happy breastfeeding bub

Happy breastfeeding bub

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What they don’t tell you about breastfeeding

Breastfeeding can get messy!

This was something I didn’t expect. After all, it seems like a pretty simple, no-fuss feeding solution. Right? Wrong! For me, there are three factors which make it messy:

  1. When the milk comes in, there is no controlling the flow! There are times when it is dripping out at such a rate that it’s all over my chest and baby’s face before I can even get her close enough to latch. Not to mention that at least once a day it manages to leak out around my breast pads and leave stains on my shirt.
  2. Bub does not always do such a good job of keeping the milk contained within her mouth – often it will just trickle down her cheek where it subsequently rolls down onto her clothes and mine.
  3. I am using a nipple shield to help with latching, and this little duvalacka (a silicone teat placed over the nipple) fills with milk, from whence baby drinks it. Amelia tends to knock it off my breast while it’s filled with milk, and then things get really messy!

My solution: terry toweling nappies have been invaluable. I go through 2-4 a day, using one to protect my clothes (usually by tucking it into my bra, under the boob being fed from, to catch spills) and one to wipe baby’s face. If I am feeding skin-to-skin and don’t want to wear a bra, I’ll use one towel to soak up the leak from the breast not currently in use.

Breastfeeding is hungry, thirsty work

I have never been one for drinking large quantities of water. In fact, I’ve always tended to be a bit dehydrated. Now I can’t get enough of the stuff! I’ll easily down two litres a day minimum, perhaps closer to three. I always have a water bottle on hand, and take glugs (no time for sips here) constantly throughout the day.

The hunger thing is a little more sneaky. My meals have stayed the same size, and I don’t tend to feel too much hungrier, but if I don’t snack regularly between meals then I will inevitably experience a very noticeable drop in blood sugar. When this happens I feel shaky, I quickly lose my ability to concentrate or make coherent sentences, I struggle to make simple decisions (like what to eat) or prepare food (it all becomes too hard – like when I cried because I couldn’t get the lid off the cake) and, as just mentioned, can become hysterical if not fed in a timely fashion.

My solution: snacks everywhere! Muesli bars, dried fruit, Belvita breakfast biscuits, crackers, fresh fruit, home-baked cookies, toast, yoghurt – these are some of the snacks I have around the house at the moment. I like to keep some snacks in my bedside drawer for night-time feeds, so that I’m not too hungry when I wake up.

Baby can latch herself

This last one is something I had sort of figured out already, but had clarified by the Australian Breastfeeding Association last night. Baby-lead attachment is a thing, though you’d never guess from the advice given by midwives! Because I have rather flat nipples, Amelia and I have struggled to establish ourselves as a breastfeeding pair. The lack of stimulation on her palate means she doesn’t get the cue to start sucking.

However, I have started letting her try at the breast without the shield, and attach herself. At first this was accidental – I was just a bit clumsy and inexperienced. But after a while I noticed that a) she was able to feed properly, and b) it wasn’t hurting! This second point seemed impossible, as for all intents and purposes it appeared she wasn’t latched “properly.” That is, she didn’t look to have enough boob in her mouth. I worried a little about this, until I read the ABA article on attachment. Now I’m content to let her do her thing, and only occasionally do I have to take her off and let her reposition. So far we’re successful about once in every 3-4 feeds, but I’m now very hopeful for the future that we’ll be able to wean off the nipple shield.

Is there anything else I should know about breastfeeding? Leave a comment below if you have any pearls of wisdom to share!