gi issues

INFANT REFLUX X THE MAMA SERIES


INFANT RELUX BY DANIELLE MESSINGER NAHAS


“All babies spit up, it is completely normal, as long as she is gaining weight and has wet diapers every six hours, there is nothing to be concerned about,” said our pediatrician.  Easier said than done. 

Allow me to introduce myself, I am a new mom, and older mom, a nutritionist and one that works in the health and wellness world, as crazy as it may sound to most anyone reading this or speaking to me, “as long as she is gaining weight” isn’t a good enough answer to me when my newborn baby would spit up what appeared to be, her entire meal after every feeding.  I am not one to panic or be overly obsessed with things, however, when it comes to being responsible for a little human, I would say my number one concern is questioning myself and not trusting my “mom gut” as I like to call it.  

Around two weeks of age my daughter Sawyer started spitting up after feeding and I don’t mean just dribble down her chin, I mean projectile vomiting shooting out of her like the exorcist.  When I was walking down the hall with her one morning, she nearly sat straight up in my arms and viciously projectile vomited almost three feet all over the wall and floor.  It scared me so much I prepared to perform mouth to mouth on her thinking she was choking and about to stop breathing.  When I looked at her and saw that she was not turning blue, I collected myself and called the pediatrician to get her an appointment thinking that she might be ill.   

Here we were two days before her two-week appointment at the pediatrician’s office.  She was fine, great, actually, she was gaining weight and had great diaper output so there was no sign of dehydration.  After collecting some basic information regarding her feeding; yes, I am breastfeeding, no I had not been using a bottle, yes, I am pumping and typically 4 ounces from each breast AFTER feedings, the pediatrician figured that I must have a very aggressive let down and an oversupply of milk.  It was determined that I was overfeeding our child and she was getting rid of what she didn’t need.  That answer sufficed I am new at nursing, my milk hadn’t regulated, and I didn’t know how to help that. I was given some recommendations on how to help with my flow and advised that I could start using a bottle for some feedings with slow flow nipples.

Working on those recommendations, I began pumping for a few minutes prior to feedings instead of after, and we started using the Munckin Latch bottle which is an anti-colic bottle with a slow flow nipple -P.S. this was great bonding time for her and her daddy-.  The projectile vomiting didn’t subside, and I noticed that no matter how tightly we swaddled her she would kick and grunt in her sleep, therefore not having a restful sleep.  During the day she became fussy, she would cry when we laid her flat, she would scream when we put her in a supine position in the bouncy chair, she hated rockers or anything that bounced her, she would eat comfortably then right after she would cry and out would come the spit up, nothing seemed to soothe her except holding her and sleeping on my chest.  When she began greeting me in the morning with projectile vomit before I even picked her up – hours after being fed-, and her little coos were sounding hoarse as if her throat were raw, I was done.  This wasn’t my child, I knew immediately something was off she was not a fussy baby and here we were closing in on the month mark and I found myself crying and stressed after every feeding.  During her night feedings I found myself obsessively googling “baby spit up,” “baby vomiting,” only to find that infant reflux kept popping up.  I understand reflux, man I had more heartburn and reflux while pregnant with this child than I would wish on my worst enemy, it was painful for me and I could imagine if this was what she was going through how painful it must be on her little, underdeveloped system. Enter a fantastic website: www.infantreflux.org .  It was here that I learned what the symptoms of reflux are as well as the difference between reflux and colic – we didn’t think she was colic, but it was starting to manifest itself that way-.  She had the top three symptoms on the list and a dozen others.  I love our pediatrician, I interviewed multiple practices prior to having our baby, and she supports our choices of care for Sawyer.  However, I was frustrated with her when she kept telling me “Sawyer is gaining weight, stop stressing.”  I felt that she wasn’t hearing me, and that made me question myself.  I literally melted down to my husband telling him the hardest thing about parenting is not trusting yourself and watching our child in discomfort was heart wrenching to me.  

A friend told me her son went through the same thing and they ended up putting him on Zantac, I wasn’t sure this was the route I wanted to take but she referred me to a Pediatric Gastroenterologist who I immediately scheduled an appointment with.  I began educating myself on everything reflux, in my learnings, I found it is common among babies, their Lower Esophageal Sphincter (LES) is immature and can take up to a year to develop, however, it can also be exacerbated by food intolerances from milk or soy proteins, or a formula that is fortified and babe isn’t handling it well.  Since I was breastfeeding I did an elimination diet, removing all dairy for two weeks, I also introduced an infant probiotic, a powder formula that I put on my fingertip and rubbed on the inside of her cheek.  Alas, we used Mylicon which worked in our favor and for a little while she stopped kicking and grunting while sleeping, which I figured was the cause of her discomfort in the morning. Lying flat didn’t give the acid any place to go but up, she was kicking from discomfort and it became a domino effect creating gas and burning her little throat which was making her hoarse.  What we often forget is all these systems are connected, when one is not functioning at its highest level, it creates an imbalance in the rest of the systems.  My firm belief is when treating, you need to get to the foundation of the problem and hopefully it will create equilibrium in the other systems.  

At our GI appointment the most important thing for me was to find out if she had any intolerances from my breastmilk, or any ulcers or sores from the acid production.  He tested her stool to make sure there was no hidden blood in it as well as any discharge -which would indicate intolerances-.  Both these tests came back normal.  He did some additional testing (nothing invasive) and determined that yes it was reflux and he wrote a prescription for Zantac.  Here is the kicker, with babies if you go the route of using Zantac, you cannot use it on an as needed basis, you need to do it consistently and that could mean medication for many months.  Once their LES begins to mature you then ween them off the Zantac.  Completely acceptable, however, my husband and I decided that Zantac would be a last resort.  The GI supported our choice gave us the prescription to have and then recommended a few other things to try; probiotics, I could add a half a teaspoon of oatmeal to my breastmilk and give her that morning and night in a bottle to help coat her belly, have her sit upright for 20 minutes after each feeding, and put her on an incline when she slept.  All great recommendations and we did everything but the oatmeal.  I also started taking her to a pediatric chiropractor that worked on her diaphragm to help it release and palpitate it to encourage strengthening.  I noticed that the day after the appointment she would have a bad day but it was all “old milk” that the chiropractor explained was sitting behind the sphincter keeping it from functioning properly.  The rest of the week after those appointments she would spit up very little, so it helped settle things and slowly her symptoms started to lessen.  She became less fussy, she stopped kicking and grunting, her sleep was more restful, the morning side of spit up and the hoarse throat went away and now, here we are 5 months old, we haven’t fully kicked the habit but now it is more along the lines of the “normal baby spit up routine.”

After that GI appointment, I was able to breathe easy and trust that I was doing all I could to support this little human and that there was nothing seriously wrong with her.  We are very blessed to have a healthy, developing baby, but first-time mama’s, we all know there will be something that scares the pants off us and in our hormonal, exhausted phase, little problems are very daunting.   If there is anything I know from working in my field, you have to be your own health advocate, if there is anything you take away from this article it is to trust yourself, listen to your intuition, find a practitioner who is going to support you, do your research and press, press, press if you feel that something is not right or you are not happy with an answer.  As I said to my husband, I don’t want to ever override my mom gut, because the moment I do, it will be a bigger issue.  As a new mom I need to learn to trust myself and so that is what I am working on hour by hour, while enjoying every moment I can with our baby girl!

A MOTHERS INTUITION


Ford's story 


I've been putting off writing this blog post all day. I'm not really sure why but I suspect it's because I've tried not to think about how the last three months really didn't turn out like I thought they would. I remember when Charlie was a newborn I wanted time to stand still. He would sleep on my chest for hours during those first three months. He was the happiest and most predictable baby. I always felt comfortable bringing him anywhere, even the library in the quiet section :) If he was fussy he was hungry and that was it. He could even sit in a dirty diaper for hours with not a peep.

Then Ford came along. From day one he seemed so uncomfortable and I had an overall feeling something was just not right. I couldn't put my finger on it. During our one week check up I told the doctor that he was fussy, seemed uncomfortable after feedings and had bad gas. He was 100 percent breastfed so I knew this wasn't supposed to be the case. The doctor didn't think anything of it and told me if he was even colicky that wouldn't present itself until week two or three. I then said there also seems to be something  off about his face. It seems stiff.... The doctor looked at me like I had three heads. As I was leaving the office, he asked me, "Are you OK?"  I just couldn't shake the feeling that something was just not right with my baby. When I left, I took ten minutes in the car and just sat thinking .... am I going crazy?

Instead of deciding, YES,  I am crazy, I headed right over to the ENT specialist thinking what if he had suffered a trauma to his face during delivery. Ford's arrival was a very intense, but quick delivery. The ENT examined him and determined that everything was fine. So, I took a breath and chalked it up to fourth trimester fussiness. However, I still couldn't shake my gut feeling that something wasn't right and found myself searching on the internet late into the night, still unable to find anything that made sense.

After 4 weeks of countless hours of fussiness, crying and one very uncomfortable baby, I decided enough was enough. Instead of feeling like wanting time to stand still, I was sitting in the living room one day praying time would speed up. I couldn't take it anymore. Seeing Ford in pain and also being around a fussy baby all day was just torture. No cuddles, hardly any smiles or interaction. I felt guilty but when people were around, I would immediately hand him off. 

I then decided no matter what, I had to figure this out. When I googled colic, it seemed like "colic" is just not really ever figuring out what is wrong with your baby but having to wait a few months for it to clear up.

I brought him to a GI specialist. You can read that post HERE. She had me cut out dairy and at first I thought it was really working...but it ended up not making much of a difference. I had trouble picking a photo for the GI & Colic post. I wasn't sure what photo to post on instagram. Should I post the picture that summed up my reality? My baby screaming in pain? Was that picture too intense ... too real? I thought in that moment I needed to admit to myself that this is my reality. The night that blog post above went live, something beautiful happened. Mothers from all walks of life commented with their similar stories of living with a fussy baby. Some moms had questions and other shared their personal stories.

And then, a few hours later, I checked my instagram and found this..."He looks like he has a lip tie from this picture. Seeing a specialist would probably be helpful. My son had a lip tie and it caused so many issues, from gas to not getting full. His dad also has one and it created a gap between his teeth." 

Oh my goodness!   WHAT I thought, is a lip tie? I had never even heard of a lip tie.

More comments flooded in....

Did you check him for a lip tie? ..then another "Have you had him checked for a lip tie by any chance? Looks like he may have one from this pic. I know that can cause fussiness as well." Then another, "Has he been checked for a lip tie? My daughter had one and was miserable acting (tons of screaming) until we had it reversed by laser. It can cause reflux, gas etc." 

Ford was asleep and for the first time I anxiously waited for him to wake up. I googled lip ties for hours. I thought there's no way he could have one. He was looked over at the hospital and he's been seen by two specialists and our primary care doctor multiple times. Someone would have obviously checked for it.  

The moment he woke up I opened his mouth and OMG!!! THERE'S A LIP TIE!!!

It all made sense. EVERYTHING came crashing together along with a wave of anger and guilt. I knew I would never get that time back with him. And all of these doctors...how could they possibly over look such an obvious thing??  

After being up all night, I needed answers. I showed up at my primary care doctor unannounced. It was immediately confirmed. I couldn't see our regular doctor,  but another doctor at the practice examined Ford. "Yeah, it looks like he has a lip tie." That was it??  She didn't seem very concerned. Should I see a specialist? The doctor basically shrugged her shoulders and said since he's gaining weight I shouldn't worry.  What?? Weight? That's all you care about? What about the fact my baby is in constant pain? 

I asked to see a specialist and was sent back to the ENT. That appointment didn't go so well either. "Yes, he has a lip tie and a little tongue tie. He's gaining weight so I wouldn't worry. Are you sure it's not reflux?"  NO!!!  I said I've been to a GI specialist and it's NOT reflux!! I  couldn't believe what I was hearing! "Are you sure?", he pressed.  "You should try reflux meds. And these lactation consultants are sending me way too many lip and tongue tied patients. They so over react." I felt like I was taking crazy pills. So many moms said their babies lip and tongue ties caused gas pain, fussiness and colic like symptoms. 

My next stop was to an oral surgeon. I couldn't believe I was having the exact same conversation. Since the baby was gaining weight, he advised it might be a good idea to wait a few years. Weight again seemed to be the only concern. He also gave me very incorrect information. He said if he did not stitch the muscle together after the lip tie, it would definitely reattach. He said he would have to put him under in the hospital to perform the procedure.  I left that appointment so upset! I immediately called my primary care doctor with whom I couldn't get an apt earlier that week. He said he has seen many babies in his practice who have had great experiences and never needed to be stitched or go under anesthesia. I was given such horrible misinformation. 

My husband's co-worker then gave me the name of a specialist, Dr. Siegel, in Huntington that successfully helped his baby. Dr. Siegel is the first and only Oral and Maxillofacial Surgeon in the United States that was awarded a fellowship in the American Academy of Pediatrics. I made an appointment for 2 weeks. My husband walked in that night and found me staring at Ford and basically sobbing. I just wanted to feel a connection and it was so hard for me and him. We decided to call back and basically beg for an appt. They got me one the next day. I walked in and he told me Ford had a stage 4 lip tie (worst level) and a tongue tie. All of the air I was hearing him swallow during breastfeeding was due to the fact that he couldn't properly latch. I had such an aggressive let down that he was gaining weight despite all his challenges. His lip & tongue tie paired with an aggressive let down resulted in one fussy baby. 

The doctor then proceeded to swaddle Ford, put little glasses on him and in less than 2 minutes lasered off both ties. Two minutes and it was all over. That was it.

I was supposed to immediately feed him, so I did. I know some babies have trouble latching after the procedure, but not Ford.  He fed beautifully and as I put him down to learn how to do the mouth exercises that I would have to do for two weeks to make sure the ties did not come back, he smiled!! I could never put him down ever without him screaming bloody murder. I would have to rock him with the noise maker going full blast just to get a minute. Not this time! He smiled at me with a really long cute smile and all that time that we didn't bond just melted away. So many thoughts ran through my head but the one I remember the most was, "There you are...I knew you were in there somewhere". 

It will be two weeks this Thursday, July 19th,  and for the last two weeks every 5 hours around the clock I have had to stretch out his upper lip and tongue to make sure the ties don't grow back. Even with stretching out his wounds, he's a much happier baby. The first week he was definitely still fussy, but a different kind of fussy. I could tell it was from the procedure. I never thought I would be able to say this, but this past week Ford has been the easiest baby, just like Charlie.  We recently started building a beautiful relationship and it is the best feeling in the world. It's like we are making up for lost time. 

I keep thinking what if I never posted that picture, what if I never shared my story, what if those mothers felt it might be too forward to post their intuition, what if I listened during those first few drs appointments, what it I didn't trust my motherly intuition?? 

Two seconds. Two seconds is the amount of time it would take to check if a baby has a tongue or  lip tie. It would take 2 seconds to change the first few months or years of a child's life, of those early bonding days where new mothers are in need of that connection with their babies to get them through the day. Two seconds. Lip and tongue ties go overlooked way too often. I'm not sure if doctors don't take them seriously or don't believe they really cause anything but all it would take is 2 seconds. 

After talking to multiple mothers with the same exact story, I know its not just me. Dr. Siegel was a wealth of information. He explained that not only can lip and tongue ties cause so much discomfort for the child during feedings and after feedings, but it can also cause speech issues, dental issues, sleep apnea and even can significantly change the way a child's face develops. We are talking about lifelong issues. 

Many times they go undiagnosed until kids are getting braces. One mother told me her daughter had been going to a speech therapist for years and the therapist had overlooked her lip tie. The dentist caught it. They had it lasered, and she stopped speech therapy. One mom had a child that was not talking at two and a half year old. After multiple specialist and no answers they eventually discovered he had a lip tie. After the lip tie revision his vocabulary exploded.  Another mother told me her daughter was misdiagnosed with reflux. They had her lip tie reversed and she came off of reflux meds shortly after. Story after story.....

I just hope this reaches as many moms as possible. If you have had a similar story please go back to instagram and share. If you have questions go back to instagram and comment. I feel so grateful for this platform. I want to scream our story from the mountain tops and spread the word. I feel like I need to pass the gift of bonding on to other moms  that those  three mothers gave to me. Never ever question the strength of a mother's intuition. 

 

A few other things: 

-You can see a chiropractor that specializes in working on babies right before & right after the revision. Many mothers told me that body work really helps after this procedure. 

-There are occupational therapist that also help babies and children after a tongue or lip tie revision. One of the therapies is called Craniosacral Therapy. This website HERE is a great resource to find an OT near you that specializes in ankyloglossia (tongue tie) & lip tie therapy. There are also a bunch of very useful resources for the parents, you can find them HERE. 

-Visiting a lactation consultant is always a good idea.

-You can find the benefits of body work after a revision, HERE. 

-We used infant Tylenol to help manage Ford's pain. 

-I also put organic coconut oil on my fingers while doing the lip & tongue exercizes every five hours. 

-One mom swore by this homeopathic solution she gave her baby. See below. 

Homeopathic recipe 

2 tablets of arnica, 2 tablets of chamomile in one ounce of purified water. ( check with your doctor first) Just mix it up in a dropper and give the baby a drop or two when he/she needs it. 

-There are also facebook support groups. Many mothers found these so helpful. 

-This website has a bunch of good post procedure information along with video tutorials of the lip and tongue stretches to prevent reattachment. HERE and HERE