Hmmmm, if she seems to be objecting to the breast even when the flow is ample and you see she's getting milk I wonder if you have an overactive let down that is too fast and forceful and bf is uncomfortable for her OR...the other possibility is reflux which can make babie very fussy and not want to eat b/c the swallowing can hurt in severe cases.
Here's more on reflux:
This is from my notes from a lactation conference where I attended a session on reflux. Let me share some of my notes from this session presented by Susan Boekel RD,CSP,LD,IBCLC:
*crying after feedings can be a symptom of reflux and it doesn't necessarily need to be associated with vomiting, reflux can be "silent" meaning it only refluxes into the esophagus causing pain and not all the way up to the mouth.
*Most babies outgrow reflux by 9-12 mos
* babies may try to "posture" to relieve reflux pain, they arch their back which lengthens the esophagus and reduces discomfort ( think of what adults do, when I have heartburn I sit up straighter)
* lots of babies either under or over eat b/c of reflux....overeating b/c suckling causes stomach contents to go down into the stomach and also can soothe the irritation in the esophagus, undereating b/c they associate feeding with the after feeding pain or it can be painful to swallow
* Babies have a different response to pain than adults...when they feel pain it leads to a increased sensation of pain, which leads to more pain, which increases the sensation and so on. This means in the beginnng what felt like a small amount of pain may feel like a large amount of pain later on. Adults generally do just the reverse, as they get used to a pain it seems like less.
*Excessive caffiene in mom's diet can contribute to reflux
* if you suspect any other foods in mom's diet it takes at least a 2 week elimination trial to determine if that is causing problems. Dairy foods in mom's diet are the most common offender.
* the pH probe is the "gold standard" for testing for reflux. Barium swallows (upper GIs) are not effective to diagnose for reflux in babies, it can only identify strictures (narrowing of the stomach valves)
* there does seem to be a family tendency toward reflux so if you had it or another child in your family had it that may suggest this baby is at a greater risk of reflux disease.
* co sleeping with the baby on his left side seems to help during sleep
* elevate the head of the changing table for diaper changes and/or you can change diapers by rolling the baby side to side, rather than lifting the legs.
* carrying the baby in a sling can help b/c of the position and vestibular movements
* car seats can be very uncomfortable b/c the stomach is "bent" and constricted and may induce more refluxing (the speaker compared this to having on a tight belt or clothing when you have heartburn)
* why bf works best for reflux: small frequent feedings, breast milk leaves the stomach faster and if there is less in the stomach it can't be refluxed as easily
* the speaker did not agree with thickening breast milk or formula with cereal b/c it causes the stomach contents to stay in the stomach longer and more likely to cause refluxing. Also can lead to constipation and straining that increases the risk of reflux.....research in the area of adding thickening agents is conflicting.
* It may take 2-3 days for meds like Zantac to take effect
* the best combination of med for the baby is H2 antagonists (like Zantac...reduces stomach acid production) and prokinetics (like Reglan..makes the stomach empty faster)
* dosing of the meds is related to the baby's weight. Frequently as the baby feels better after treatment with the meds they gain rapidly and the doctors sometimes need to be reminded that the med dose needs to be increased as the baby grows, parents should not assume the med is no longer working as they often do, they should ask the doctor if the medication dose needs to be increased as the baby grows.
* after the baby starts treatment it may take awhile to improve b/c it takes time for the esophagus to heal
I hope some of this information will be helpful for you and I hope your baby is better soon.
Warmly,
Kathy
