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Rice cereal at 2 weeks old

Posted by on Nov. 4, 2010 at 3:12 PM
  • 17 Replies

I had to get Elle's EKG done at the hospital today and then head over to the doctor to get the results and do a 2 week check up. Well she's lost 4 ounces and is continuing to lose weight. She is jaundice again but they aren't putting her back on the biliblanket.

Since she throws up literally 30 times a day, the doctor wants me to give her a teaspoon of rice cereal with every feeding which means I have to pump and then bottle feed her. I talked to the lactation consultant at the doc's office and she thinks I have overactive letdown on top of Elle having reflux.

Ugh...this little girl is quite a handful already! She kept daddy up ALL night last night (he didn't sleep at all) and she was fussy all thru her appointments this morning.

by on Nov. 4, 2010 at 3:12 PM
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by on Nov. 4, 2010 at 3:14 PM
:( it will pass. Do what the doctor says and hopefully she gets better. I bet she is crying bc she is hurting. Acid reflux can be so painful. Have they tried medicine? Are you propping her up during sleep?
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by on Nov. 4, 2010 at 3:14 PM

girl on a swingi was told at 2 weeks to put cereal in my daughters bottle i thought she would choke but doc said ok expecting boytoddler girl

by on Nov. 4, 2010 at 3:14 PM
I'm sorry :( have you asked in the breastfeeding moms group?
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by on Nov. 4, 2010 at 3:15 PM

I hope things get better - poor little one :(

by Silver Member on Nov. 4, 2010 at 3:22 PM

Forceful Let-down (Milk Ejection Reflex) & Oversupply

By Kelly Bonyata, BS, IBCLC

     Is forceful let-down the problem?

    Does your baby do any of these things?

    • Gag, choke, strangle, gulp, gasp, cough while nursing as though the milk is coming too fast
    • Pull off the breast often while nursing
    • Clamp down on the nipple at let-down to slow the flow of milk
    • Make a clicking sound when nursing
    • Spit up very often and/or tend to be very gassy
    • Periodically refuse to nurse
    • Dislike comfort nursing in general

    If some of this sounds familiar to you, you probably have a forceful let-down. This is often associated with too much milk (oversupply). Some mothers notice that the problems with fast letdown or oversupply don't start until 3-6 weeks of age. Forceful let-down runs the gamut from a minor inconvenience to a major problem, depending upon how severe it is and how it affects the nursing relationship.

    What can I do about it?

    There are essentially two ways you can go about remedying a forceful let-down: (1) help baby deal with the fast flow and (2) take measures to adjust your milk supply down to baby's needs. Since forceful let-down is generally a byproduct of oversupply, most moms will be working on both of these things. It may take a couple of weeks to see results from interventions for oversupply, so try to be patient and keep working on it.

    Help baby deal with the fast milk flow

    • Position baby so that she is nursing "uphill" in relation to mom's breast, where gravity is working against the flow of milk. The most effective positions are those where baby's head and throat are above the level of your nipple. Some nursing positions to try:
      • Cradle hold, but with mom leaning back (a recliner or lots of pillows helps)
      • Football hold, but with mom leaning back
      • Elevated football hold - like the football hold, but baby is sitting up and facing mom to nurse instead of lying down (good for nursing in public).
      • Side lying position - this allows baby to dribble the extra milk out of her mouth when it's coming too fast
      • Australian position (mom is "down under", aka posture feeding) - in this position, mom is lying on her back and baby is on top (facing down), tummy to tummy with mom. Avoid using this positioning frequently, as it may lead to plugged ducts.

    • Burp baby frequently if she is swallowing a lot of air.
    • Nurse more frequently. This will reduce the amount of milk that accumulates between feedings, so feedings are more manageable for baby.
    • Nurse when baby is sleepy and relaxed. Baby will suck more gently at this time, and the milk flow will be slower.
    • Wait until let-down occurs, then take baby off the breast while at the same time catching the milk in a towel or cloth diaper. Once the flow slows, you can put your baby back to the breast.
    • Pump or hand express until the flow of milk slows down, and then put baby to the breast. Use this only if nothing else is working, as it stimulates additional milk production. If you do this, try to express a little less milk each time until you are no longer expressing before nursing.

    Adjust your supply to better match baby's needs

    • If baby is gaining weight well, then having baby nurse from only one breast per feeding can be helpful.
      • If baby finishes nursing on the first side and wants to continue nursing, just put baby back onto the first side.
      • If the second side becomes uncomfortable, express a little milk until you're more comfortable and then use cool compresses - aim for expressing less milk each time until you are comfortable without expressing milk.
    • Avoid extra breast stimulation, for example, unnecessary pumping, running the shower on your breasts for a long time or wearing breast shells.
    • Between feedings, try applying cool compresses to the breast (on for 30 minutes, off for at least an hour). This can discourage blood flow and milk production.
    • If nursing one side per feeding is not working after a week or so, try keeping baby to one side for a certain period of time before switching sides. This is called block nursing.
      • Start with 2-3 hours and increase in half-hour increments if needed.
      • Do not restrict nursing at all, but any time that baby needs to nurse simply keep putting baby back to the same side during that time period.
      • If the second side becomes uncomfortable, express a little milk until you're more comfortable and then use cool compresses - aim for expressing less milk each time until you are comfortable without expressing milk.
      • In more extreme cases, mom may need to experiment a bit with time periods over 4 hours to find the amount of time per breast that works best.
    • Additional measures that should only be used for extreme cases of oversupply include cabbage leaf compresses and herbs.

    Even if these measures do not completely solve the problem, many moms find that their abundant supply and fast let-down will subside, at least to some extent, by about 12 weeks (give or take a bit). At this point, hormonal changes occur that make milk supply more stable and more in line with the amount of milk that baby needs.

    by Silver Member on Nov. 4, 2010 at 3:23 PM

    Spitting Up & Reflux in the Breastfed Baby

    By Kelly Bonyata, BS, IBCLC

     My baby spits up - is this a problem?

    Spitting up, sometimes called physiological or uncomplicated reflux, is common in babies and is usually (but not always) normal. Most young babies spit up sometimes, since their digestive systems are immature, making it easier for the stomach contents to flow back up into the esophagus (the tube connecting mouth to stomach).

    Babies often spit up when they get too much milk too fast. This may happen when baby feeds very quickly or aggressively, or when mom’s breasts are overfull. The amount of spitup typically appears to be much more than it really is. If baby is very distractible (pulling off the breast to look around) or fussy at the breast, he may swallow air and spit up more often. Some babies spit up more when they are teething, starting to crawl, or starting solid foods.

    A few statistics (for all babies, not just breastfed babies):

    • Spitting up usually occurs right after baby eats, but it may also occur 1-2 hours after a feeding.
    • Half of all 0-3 month old babies spit up at least once per day.
    • Spitting up usually peaks at 2-4 months.
    • Many babies outgrow spitting up by 7-8 months.
    • Most babies have stopped spitting up by 12 months.

    If your baby is a ‘Happy Spitter’ --gaining weight well, spitting up without discomfort and content most of the time -- spitting up is a laundry & social problem rather than a medical issue.


     Some causes of excessive spitting up
    • Food sensitivities can cause excessive spitting. The most likely offender is cow's milk products (in baby's or mom's diet). Other things to ask yourself: is baby getting anything other than breastmilk - formula, solids (including cereal), vitamins (fluoride, iron, etc.), medications, herbal preparations? Is mom taking any medications, herbs, vitamins, iron, etc.?
    • Babies with Gastroesophageal Reflux Disease (GERD) usually spit up a lot (see below).
    • Although seldom seen in breastfed babies, regular projectile vomiting in a newborn can be a sign of pyloric stenosis, a stomach problem requiring surgery. It occurs 4 times more often in boys than in girls, and symptoms usually appear between 3 and 5 weeks of age. Newborns who projectile vomit at least once a day should be checked out by their doctor.


     My older baby just started spitting up more - what's up?

    Some older babies will start spitting up more after a period of time with little or no spitting up. It's not unusual to hear of this happening around 6 months, though you also see it at other ages. If the spitting up is very frequent (particularly if baby does not seem well), consider the possibility of a GI illness.

    If baby does not seem ill, then here are some possible causes:

    • It's unlikely that your baby has suddenly developed a sensitivity to something in your milk, unless there's something really new in your diet or you're eaten LOTS of a particular food very recently. Any foods that baby eats are more likely than mom's foods to cause the spitting up. Has baby started solids recently or tried a new food? Are you or baby taking any new medications? Have you or baby started taking vitamins or changed your vitamins?
    • Has baby been fussier than normal, and/or crying more lately? If so, he is probably swallowing more air than usual, which can cause the spitting up.
    • Spitting up can be caused by teething. When teething, babies tend to drool more and often swallow a lot of that extra saliva - this can cause extra spitting up.
    • A cold or allergies can result in baby swallowing mucus and spitting up more.
    • Baby may be hitting a growth spurt and swallowing more air when he nurses, especially if he's been "guzzling" lately.
    • If you tend to have oversupply or a fast let-down, some moms see renewed symptoms (which can include spitting up) after a growth spurt.

    Essentially, though, if your baby is healthy and doing well despite the spitting up -- gaining well, having enough wet/dirty diapers -- then this is a laundry problem rather than a medical issue.


     Gastroesophageal Reflux Disease (GERD)

    A small percentage of babies experience discomfort and other complications due to reflux - this is called Gastroesophageal Reflux Disease. These babies have been termed by some as ‘Scrawny Screamers’ (as compared to the Happy Spitters). There seems to be a family tendency toward reflux. GERD is particularly common in preemies (due to their immaturity) and in babies with other health problems. GERD usually improves by 12-24 months.

    Following are symptoms of GERD -- there are varying degrees and need your doctor's involvement to diagnose:

    • Frequent spitting up or vomiting; discomfort when spitting up. Some babies with GERD do not spit up – silent reflux occurs when the stomach contents only go as far as the esophagus and are then re-swallowed, causing pain but no spitting up.
    • Gagging, choking, frequent burping or hiccoughing, bad breath.
    • Baby may be fussy and sleep less due to discomfort.

    Warning signs of severe reflux:

    • Inconsolable or severe fussiness or crying associated with feedings.
    • Poor weight gain, weight loss, or failure to thrive. Difficulty eating. Breast/food refusal.
    • Difficulty swallowing, sore throat, hoarseness, chronic nasal/sinus congestion, chronic sinus/ear infections.
    • Spitting up blood or green/yellow fluid.
    • Sandifer’s syndrome: Baby may ‘posture’ and arch the neck & back to relieve reflux pain--this lengthens the esophagus and reduces discomfort.
    • Breathing problems: bronchitis, wheezing, chronic cough, pneumonia, asthma, aspiration, apnea, cyanosis.

    GERD may cause babies to either undereat (if they associate feeding with the after-feeding pain, or if it hurts to swallow) or overeat (because sucking keeps the stomach contents down in the stomach and because mother’s milk is a natural antacid).

    Current information on reflux indicates that testing or treatment for reflux in babies younger than 12 months should be considered only if spitting up is accompanied by poor weight gain or weight loss, severe choking, lung disease or other complications. Per Donna Secker, MS, RD in the article Gastroesophageal Reflux Disease PDF, "The infant with significant reflux who seems to be growing well and has no other significant health problems benefits most from little or no therapy."

    When GERD is suspected, many doctors first try a trial of various reflux medications (without running tests), to see if the medications improve baby's symptoms. If testing is done, a 24-hour pH probe study (PDF) is the current “gold standard” for reflux testing in babies; this is a procedure where a tube is placed down baby's throat to measure the acid level at the bottom of the esophagus. A barium swallow (upper GI) is not so invasive (baby swallows a barium mixture, then an x-ray is taken) but is not really effective for diagnosing reflux in babies, since most babies will reflux when given barium. An upper GI will not identify whether baby's stomach contents are higher in acid or if there has been any esophagus damage due to reflux, but it will show if there are any blockages or narrowing of the stomach valves that may be causing or aggravating the reflux. Additional tests may be recommended in certain circumstances (see the links below for additional information). In rare cases, when baby has very severe reflux that is not relieved by medication, surgery may be recommended.


     Breastfeeding Tips
    • Aim for frequent breastfeeding, whenever baby cues to feed. These smaller, more frequent feedings can be easier to digest.
    • Try positioning baby in a semi-upright or sitting position when breastfeeding, or recline back so that baby is above and tummy-to-tummy with mom. See this information on upright nursing positions.
    • For fussy, reluctant feeders, try lots of skin to skin contact, breastfeeding in motion (rocking, walking), in the bath or when baby is sleepy.
    • Ensure good latch to minimize air swallowing.
    • Allow baby to completely finish one breast (by waiting until baby pulls off or goes to sleep) before you offer the other. Don't interrupt active suckling just to switch sides. Switching sides too soon or too often can cause excessive spitting up (see Too Much Milk?). For babies who want to breastfeed very frequently, try switching sides every few hours instead of at every feed.
    • Encourage non-nutritive/comfort sucking at the breast, since non-nutritive sucking reduces irritation and speeds gastric emptying.
    • Avoid rough or fast movement or unnecessary jostling or handling of your baby right after feeding. Baby may be more comfortable when help upright much of the time. It is often helpful to burp often.
    • As always, watch your baby and follow his cues to determine what works best to ease the reflux symptoms.


     What can I do to minimize spitting up/reflux?
    • Breastfeed! Reflux is less common in breastfed babies. In addition, breastfed babies with reflux have been shown to have shorter and fewer reflux episodes and less severe reflux at night than formula-fed babies [Heacock 1992]. Breastfeeding is also best for babies with reflux because breastmilk leaves the stomach much faster [Ewer 1994] (so there’s less time for it to back up into the esophagus) and is probably less irritating when it does come back up.
    • The more relaxed your infant is, the less the reflux.
    • Eliminate all environmental tobacco smoke exposure, as this is a significant contributing factor to reflux.
    • Reduce or eliminate caffeine. Excessive caffeine in mom's diet can contribute to reflux.
    • Allergy should be suspected in all infant reflux cases. According to a review article in Pediatrics [Salvatore 2002], up to half of all GERD cases in babies under a year are associated with cow’s milk protein allergy. The authors note that symptoms can be similar and recommend that pediatricians screen all babies with GERD for cow’s milk allergy. Allergic babies generally have other symptoms in addition to spitting up.
    • Positioning:
      • Reflux is worst when baby lies flat on his back.
      • Many parents have found that carrying baby in a sling or other baby carrier can be helpful.
      • Avoid compressing baby’s abdomen - this can increase reflux and discomfort. Dress baby in loose clothing with loose diaper waistbands; avoid “slumped over” or bent positions; for example, roll baby on his side rather than lifting legs toward tummy for diaper changes.
      • Recent research has compared various positions to determine which is best for babies with reflux. Elevating baby's head did not make a significant difference in these studies [Carroll 2002, Secker 2002, Craig 2004], although many moms have found that baby is more comfortable when in an upright position. The positions shown to significantly reduce reflux include lying on the left side and prone (baby on his tummy). Placing the infant in a prone position should only be done when the child is awake and can be continuously monitored. Prone positioning during sleep is almost never recommended due to the increased SIDS risk. [Secker 2002]
      • Although recent research does not support recommendations to keep baby in a semi-upright position (30° elevation), this remains a common recommendation. Positioning at a 60° elevation in an infant seat or swing has been found to increase reflux compared with the prone (tummy down) position [Carroll 2002, Secker 2002].
      • As always, experiment to find what works best for your baby.
    • If your child is taking reflux medications, keep in mind that dosages generally need to be monitored and adjusted frequently as baby grows.


    What about thickened feeds?

    Baby cereal, added to thicken breastmilk or formula, has been used as a treatment for GER for many years, but its use is controversial.

    Does it work? Thickened feeds can reduce spitting up, but studies have not shown a decrease in reflux index scores (i.e., the “silent reflux” is still present). Per Donna Secker, MS, RD in Gastroesophageal Reflux Disease PDF, "The effect of thickened feedings may be more cosmetic (decreased regurgitation and increased postprandial sleeping) than beneficial." Thickened feeds have been associated with increased coughing after feedings, and may also decrease gastric emptying time and increase reflux episodes and aspiration. Note that rice cereal will not effectively thicken breastmilk due to the amylase (an enzyme that digests carbohydrates) naturally present in the breastmilk.

    Is it healthy for baby? If you do thicken feeds, monitor baby’s intake since baby may take in less milk overall and thus decrease overall nutrient intake. There are a number of reasons to avoid introducing cereal and other solids early. There is evidence that the introduction of rice or gluten-containing cereals before 3 months of age increases baby's risk for type I diabetes. In addition, babies with GERD are more likely to need all their defenses against allergies, respiratory infections and ear infections – but studies show that early introduction of solids increases baby’s risk for all of these conditions.

    The breastfeeding relationship: Early introduction of solids is associated with early weaning. Babies with reflux are already at greater risk for fussy nursing behavior, nursing strikes or premature weaning if baby associates reflux discomfort with breastfeeding.

    Safety issues: Never add cereal to a bottle without medical supervision if your baby has a weak suck or uncoordinated sucking skills.

    by Bronze Member on Nov. 4, 2010 at 3:31 PM

    I have a question for you.  When you say she throws up 30 times a day is it every feeding and is projectile?  If it is I would lean towards pyloric stenosis.  It is uncommon in little girls, but it can happen.  Both my son and daughter had it and they both were juandice on top of it all.  An ultrasound of the stomach area can detect if the pyloric spinchter (SP) is thickening.  With my 2 it usually started right after the 2 week checkup.

    Camille Proud Working Mamma to Joseph (4) and Mary (11 months)
    by on Nov. 4, 2010 at 7:39 PM

    Just a head's up, there are enzymes in your milk that are going to break down the rice cereal almost instantly.  It is not going to help the issue.  The only products I know of that will effectively thicken breastmilk are Simply Thick and Hydra Aid.  Good luck though.

    by on Nov. 5, 2010 at 1:04 PM

    Yep, every feeding and projectile. She throws up several times in between feedings too.

    Quoting mom2maryjoseph:

    I have a question for you.  When you say she throws up 30 times a day is it every feeding and is projectile?  If it is I would lean towards pyloric stenosis.  It is uncommon in little girls, but it can happen.  Both my son and daughter had it and they both were juandice on top of it all.  An ultrasound of the stomach area can detect if the pyloric spinchter (SP) is thickening.  With my 2 it usually started right after the 2 week checkup.

    by Silver Member on Nov. 5, 2010 at 3:18 PM

    I posted a couple of articles, but didn't have time to say anything about them at the time - - -

    Forceful letdown can and does cause frequent throwing up - I had that issue with my 2nd, and got all sorts of bad info from our Dr.  The LC I talked to was a lifesaver, however - she encouraged me to block feed (feed on the same side for 2-3 feedings ina  row, then switch for the next 2-3 feedings).  I also nursed "uphill" whenever possible - reclining back so that the milk had to work against gravity to get out.  The combination of the 2 helped, but it did take some time. 

    If reflux is the problem, or part of the problem, then cereal really isn't the way to go - your Dr is giving you outdated information.  For starters, breastmilk will break down the cereal before any gets in baby's tummy.  Second, using a thickener of any kind will mask the visible signs of reflux (throwing up), but it doesn't actaully stop the acid -- because it takes longer for the food to digest when things have been added to it, baby's tummy will actually produce MORE acid, and baby will still have problems that you can't see and they can't tell you about.  As much as I hate using medicine (on me or my children), sometimes that really is the best way to go.

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