A follow up to my share on infant acid reflux

You may have read my post on our journey with infant acid reflux - http://gcrealestategirl.blogspot.com.au/2013/02/reflux-hell.html  ... One of my most hellish and painful experiences ... watching my tiny baby scream in agony and be helpless to stop it. I still get tears thinking about those days. 

E is now 12 months old and his doctor has recommended weaning him from the Losec medication that removes acid from his gut in the hopes he is now developed enough to no longer require it. The Losec takes 2-4 weeks to wean from his system so for the last two weeks we weren't expecting any real changes however we have noticed that while E has never been a great sleeper, he had improved over the past few months and has now gone back to his old ways of waking every hour or so the past 3 nights as opposed to sleeping from 7pm-12am then a 2-3 wakeup until 7am. I can't be sure this is the result of his reflux and the Losec weaning but he is waking crying and is extremely restless, settling best propped on my pillow beside me rather than flat on his bed or ours.  

I would prefer not to start him on Losec again but obviously, will do whatever helps him. To this end, I have been doing more research and reading on 'silent' acid reflux and have come across several instances where it has been suggested that breastfeeding mothers taking antibiotics in the early weeks of their baby's birth can be a factor in causing infant reflux.

I had tearing during E's delivery and as a result, was administered antibiotics by IV every 4 - 6 hours for the 48 hours post birth. I was then put on 2 lots of strong antibiotic tablets for the 2 weeks following. I was assured they were compatible with breastfeeding and were to prevent any infections. The sad thing is, they may have contributed to either E developing the reflux or the severity of it.

Here is some of the stuff I found:

Probiotics are the good, live bacteria that live in our body. One of the things they do is coat and protect our entire digestive tract (and also the ears and nose). When the stomach produces too much acid then it is forced up the esophagus and down the intestines and will kill probiotics. (Antibiotics also kill probiotics.)  When the probiotics are depleted then the acid is traveling right up next to the esophagus and intestines with no protection. This is often why reflux burns so badly and why the intestines will sometimes bleed. 

and

Whilst in your womb, your baby’s intestinal tract is sterile – and so its free from bacteria. From birth though, your baby begins the process of acquiring the friendly bacteria in the gut that play such a critical role in health and wellness.

How your child is born, strongly influences what kind of bacteria your child will acquire. Infants that are born vaginally begin accumulating beneficial bacteria including Lactobacillus, Bifidobacterium, Escherichia coli (commonly abbreviated to E. coli) and Enterococcus in the birth canal with the very process of birth. These bacteria form the foundations of a healthy digestive flora and originate from healthy maternal vaginal and fecal flora.

Babies born via cesarean on the other hand, receive a different mix of bacteria at birth. This comes from the maternity hospital itself, notably from nursing staff and equipment and includes Clostridium and Streptococcus.

Following birth, the acquisition of digestive flora continues until your baby is around two to three months of age with most of this beneficial bacteria coming from the mother via touch, suckling and kissing.

The way in which you feed your baby also has a strong influence on his or her digestive flora. A breastfed baby tends to have greater numbers and types of beneficial bacteria than a formula fed infant, notably Bifidobacteria, Lactobacillus and Enterococcus. These bacteria, specifically those belonging to the Bifidobacteria clan (genera) thrive in the presence of breast milk proteins and constitute up to 90% of a breastfed infant’s micro flora. They help prevent harmful bacteria colonizing the infant’s intestine.

Newborns have an immature digestive system that has never processed food. The gastrointestinal system is literally just learning to function. Muscles that support digestion have not developed the proper rhythm for moving food efficiently through the digestive tract. Furthermore, newborns lack the benevolent bacterial flora (probiotics) that develop over time to aid digestion. This explains why a lot of infants outgrow colic within the first six months.

This is obviously not a conclusive reason as to why E has reflux but interestingly, my sister, sis in law and two other friends who had babies this past year also experienced a same degree or worse tear than me and received none or one round of antibiotics by IV and nothing further ... none of their babies have or developed reflux.

It makes me sad to think E might have developed reflux as a result of my medications and it makes me angry that the doctors prescribed them to me without consideration to this fact. However I also accept that this may not be a fully proven factor in reflux and I haven't researched any studies etc on this apart from one I found at http://www.bellybelly.com.au/forums/f36/study-links-maternal-antibiotic-use-colic-reflux-98850/ ...

FEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY
Volume 56 Issue 1, Pages 80 - 87
RESEARCH ARTICLE
Influence of antibiotic exposure in the early postnatal period on the development of intestinal microbiota
ABSTRACT
The influence of antibiotic exposure in the early postnatal period on the development of intestinal microbiota was monitored in 26 infants including five antibiotic-treated (AT) subjects orally administered a broad-spectrum antibiotic for the first 4 days of life and three caesarean-delivered (CD) subjects whose mothers were intravenously injected by the similar type of antibiotics in the same period. The faecal bacterial composition was analysed daily for the first 5 days and monthly for the first 2 months. Terminal restriction fragment length polymor-phisms in the AT subjects showed less diversity with the attenuation of the colonization of some bacterial groups, especially in Bifidobacterium and unusual colonization of Enterococcus in the first week than the control antibiotic-free infants (AF, n=18). Quantitative real-time PCR showed overgrowth of enterococci (day 3, P=0.01; day 5, P=0.003; month 1, P=0.01) and arrested growth of Bifidobacterium (day 3, P=0.03) in the AT group. Furthermore, after 1 month, the Enterobacteriaceae population was markedly higher in the AT group than in the AF group (month 1, P=0.02; month 2, P=0.02). CD infants sustained similar, although relatively weaker, alteration in the developing microbiota. These results indicate that antibiotic exposure at the beginning of life greatly influences the development of neonatal intestinal microbiota.
________________________________________
Received 11 July 2008; revised 17 January 2009; accepted 15 February 2009.
First published online 6 April 2009.

With consideration to this information though, I am going to start E on some children's Inner Health plus (a probiotic) in the hope of promoting good bacteria in his gut thus improving and aiding in his digestion.

Do you have or know a bub with reflux? Have you heard of this or had any success with treatments other than medication for severe cases?

I recommend going to http://www.reflux.org.au/ for some information if you think your baby might have reflux.

Reflux hell

From day one at home, Ethan was never what you would refer to as a settled baby and sleep was a struggle always. While he would happily sleep in anyone's arms or on Scott and my chest, lay him down on his back (as per SIDS guidelines) and his eyes would instantly fly open accompanied by screaming and tears following until he was pick back up and put to the breast.

A voracious yet ridiculously fast feeder, it seemed Ethan was always needing to nurse and was very vocal about his need to. My mum queried whether he was getting enough milk and crying from hunger but No matter what I did from wet face clothes to stripping him to playing with his feet to tickling his chin, when he was done he could not be coaxed to feed more... Even if the feed had lasted just a few minutes on only one side. But lay him down no matter how out to it he was and he would wake up every single time.

Concerned I visited a lactation consultant who weighed Ethan and then observed us feeding. She reassured me that our feeding was perfect and his weight indicated he was thriving. I was reassured to know it wasn't me but still frustrated, confused and utterly sleep deprived.

To say the early nights were hard was a massive understatement. I sat up in the cold (it was the middle of winter) in our lounge room trying desperately to get Ethan to feed enough to have a few hours sleep. More often than not, the nights played out with me getting a few hours while Scott held him then me up from midnight to 5am feeding and holding a baby that would not settle.

We thought his inability to sleep could be related to the cold temperatures of our home and installed a heater to our room. Nothing changed. A few people suggested he was just colicky and to spend longer burping him, watching what I ate and that he would grow out if it. I spent hours trying to pat and burp etc but the screaming continued and the only way to settle him was to put him to the breast. Everyone around me agreed he was a windy baby and at 6 weeks I was told to use infants friend - a remedy to help babies release wind.

By 5/6 weeks, we were experiencing screaming episodes that would go on at anytime of the day or night continuously unless he was being held or fed. We were existing on just a few hours sleep a day and night and it was taking its toll. I was constantly worried I was failing my baby somehow and Scott felt helpless that he couldn't do more to give me rest or settle Ethan. I shed lots of tears in the shower and spent as much time out and about as possible because everything seemed easier away from home.

At his 6/8 week needles, I spoke to our GP (a specialist in child health) about the episodes for want of a better word and he told me it sounded like Ethan was colicky. He gave me some literature on the subject and told me to use bathes and infant massage in addition to infants friend as a soother and the unsettledness would pass eventually.

Over the weeks I tried everything from burping to propping up the bassinet to natural remedies, massage and everything in between but nothing changed. I started to have my suspicions but quashed them rather than acknowledge - it seemed easier and a lot less scary. I asked a few people including the GP if I should see a paed but all told me it was a growing stage and would pass.

It was the middle of winter,cold and rainy and i was just exhausted. Out shopping one afternoon I called into Toys R Us and was browsing the baby items. It was then I spied the Fisher Price rock n play. Like an upright hammock type rocker, it suggested it could be used for sleep and better yet, it was half price. I was desperate to try anything by that point and figured it couldn't do any harm seeing as the bassinet wasn't creating much of a sleep environment.

That first stretch in it, Ethan slept five hours straight for the first time ever! Scott and I were in shock... And also a little better rested. His sleeps improved but were still very patchy and the round the clock feeding hadn't stopped. He was also having the most horrific screaming episodes that were getting worse and lasted hours. He couldn't be soothed or comforted at all. He would arch his little body and scream till he had energy left but to sob with tears streaming and we couldn't do a thing but hold him, rock him, cuddle him and tell him over and over how much we loved him. Many a day I spent hours sitting on my bed with tears streaming holding him while he screamed, helpless to do anything.

I began to suspect Ethan had silent / acid reflux. My best friends daughter exhibited the same symptoms from birth and was diagnosed at about 3/3.5 months with it. having spent a lot of time at her house helping her through the hell of it, I was well able to recognise the signs and had suspected it from early on but was brushed off with all the other suggestions and most of all, that I was a first time mum and it was unlikely.

I took Ethan to another child health GP and suggested reflux. He told me it was an infant thing to cry, that he was colicky and I may be overreacting slightly as a first time mother.

I headed back to work 4 days a week when Ethan was 4 months old and left him in the care of his grandmothers. It was a kind of break from the exhausting and draining days at home where I was getting no sleep at night and none during the day due to a steady stream of visitors. Unfortunately there was still no resolution or treatment and things got steadily worse. On a bad day, Ethan would scream the entire day, exhausting himself to sleep before waking again to repeat. On a good day, he would only scream for half of the day.

When Ethan wasn't in pain, he was the happiest most responsive baby and it was beyond heartbreaking to see the pain he was clearly in.

I would often get a call from my mother letting me know he was having a bad day and my mother in law was in tears too. I would spend my day at work worrying, crying privately and dreading going home to go through it all again then feeling guilty for thinking that way as I truly couldn't wait to get home to see Ethan.

My mum spent hours researching what could possibly be the matter and one week it was lactose intolerance, another week it was something else. I broke down after a few weeks and begged her to tell me what to do: stop bf, cut out all dairy and wheat... Should I take him to a paediatrician? She agreed it was probably a good idea by this point to have Ethan checked over thoroughly. Relieved I had something constructive to do, I set about getting an appointment with one my mother recommended. I called to make the appointment praying for one sooner than later. I spoke to the lovely receptionist there, starting to give her a history and next thing I was sobbing my heart out. She let me go then calmed me and slotted me in for the end of the same week.

I made all sorts of notes and headed along to our appointment. A older paed, Dr Price was a nonsense to the point doctor who didn't appreciate interruptions but was amazingly kind and gentle with Ethan. He took a history, asked a lot of questions, checked Ethan over thoroughly and then said 'well, it would appear Ethan has pathological reflux.' Holding back tears, I nodded and he asked me to please watch the following power point and hold all questions till it was over.

The power point was simple and concise, describing the condition, how it happens, symptoms etc and had some video clips of children having episodes - it was Ethan to a tee. Dr price recommended continuing Ethan on breast milk but also starting him on solids that day with a view to getting him up to 3 meals a day as soon as possible. He also prescribed the use of adult gaviscon before a bf and adult mylanta following a bf in small doses. We made a follow up appointment for four weeks time.

I burst into tears in the car park and my mother just hugged me. I told her how relieved I was to know what was wrong but also how upset and frustrated I was that no one had listened to me earlier, writing me off as an overreacting first time mother.

We started Ethan on rice cereal that same night and he loved it, instinctively opening his mouth for the spoon. Expecting only a teaspoon or two to be swallowed, Ethan surprised us by eating the two tablespoon serve entirely without fuss. He took the gaviscon and mylanta solutions well and we hoped for the best.

Over the coming weeks, Ethan ate everything we fed him with gusto and we saw an improvement but not completely. His pained episodes were further apart but still regular so we went back to Dr Price with the summary. Dr Price didn't seem surprised that the course of action hadn't been entirely successful and told us he had suspected Ethan's reflux may be too severe for such a mild treatment but that he always tried the mild treatment before medication.

Ethan was prescribed an anti reflux medication just before Christmas to reduce the acid levels in his stomach. The fun part, the medication only came as tablet form and Ethan only needed half a tablet so we had a lot of fun cutting, crushing, dissolving and then droppering to get it into Ethan until a girlfriend suggested seeing a compounding chemist. There is quite a big one that just opened near my work and thankfully they were able to prepare a suspension that makes it so much easier.

Ethan is now on 3 meals plus snacks and is still bf or given ebm at 7.5 months. His reflux is still quite severe with us avoiding dairy, tomatoes etc from his diet even now. We try a small amount every so often but in the past week alone, a teaspoon of yoghurt caused a reflux pain and the following day he was mistakenly given a meal containing tomato purée that had us up all night. We also notice the reflux becomes noticeably worse or flares up when Ethan is teething and when the weather turns hot and humid.

Acid Reflux really is hell... Especially for the poor baby suffering it. It's not much better for the parents though because you are utterly helpless to do anything but perpetuate the cycle until its diagnosed. Ethan has always been a great albeit constant feeder, put on a steady amount of weight and apart from the pained episodes, is a happy outgoing baby so it's very hard to pinpoint and diagnose what could be wrong. The constant feeding is where the vicious cycle exists however - a baby with this form of reflux will feed, experience the burn then want to feed again to stop or soothe the burn and on it goes.

My best advice, if you suspect your baby has pathological reflux, see a paed! Don't let anyone tell you you are overreacting... Listen to your instincts. And buy a fisher price rock n play for bedtime. Ethan slept in his till just under 6 months as the upright positioning was and is key to managing reflux.

Tokyo part 2

The Government building - there is a free viewing deck up top. S loves heights and was desperate to visit this one and see Tokyo before dark. I think the platform was 50 or 56 stories high and I was adamant that I was staying in the lobby while S went up but in the end decide to hell with it.

So many skyscrapers for one little island.

Nightfall coming in - this is looking out to the Roppongi Hills and Tokyo Tower.

Such a dense city - every inch is built on.

Another very rare clear day allowed us another rare view of Mount Fuji from Tokyo.

Evidence of March 2011 earthquake in the Harajuku district.

Downtown/main street Harajuku.

Shibuya - graet for shopping and people watching but S of course didn't spare me enough time before our J League game to look around properly.

The busiest (and most famous) crossing in the world - Shibuya.

S extra large JD & Dry served at Hub (an english chain of pubs throughout Japan) - it became a favourite of ours for a few drinks at happy hour.

A true Japanese dinner with sake - no one in the restaurant spoke any english and there were no english menus so lots of sign language and gibberish led to a dinner of fish, vegetable, dim sim and tempura.

We were pretty proud of our efforts to navigate a locals restaurant and still manage to eat.

Downtown Shinjuku.. its ridiculously easy to get lost as we kept finding out.

More Shinjuku by night - we stayed in Shinjuku (the Sunroute Plaza) and explored the area most nights for restaurants, bars and karaoke.