Feeding FAQ: 8-12 weeks – Breast Feeding

Due to my 11 week old’s reflux problems he is unable to stay on the routines

My son was a very contented newborn. He fitted easily into the routines; breast-feeding went fine. At 4 weeks he started getting very upset: crying a lot, no dirty nappies for 48 hours, hysterical when lying down, vomiting profusely, dehydrated. We took him to the GP, and he spent 48 hours in hospital being monitored, tested, and was put on a drip; he was diagnosed with severe reflux. He’s had two follow-up appointments. He is now on Gaviscon, Ranitidine (0.45 ml thrice daily) and Domperidone (2.2ml thrice daily).
He is much happier now; being sick doesn’t upset him nearly as much. But he is still very sick, and it’s almost impossible to stick to a routine. On a good day, we nearly get there, but have to spend longer feeding to make up for occasional large vomits than the routine suggests. On a bad day like today, the routine is utterly hopeless. He was very, very sick today, and was feeding non-stop between 6pm and 1am to make up for the milk he’d lost, and then fell straight to sleep at 1.30am when I put him to bed. My milk supply is fine on average days, too abundant on good days (I express then, a lot) and can’t cope on bad days, so we top him up with expressed milk. On a day when he was hardly sick at all, I had expressed 25oz, which gives an idea of how much he’s sick on bad days, I think. On the worst days (an average of once a week) he’s sometimes on a cycle of feeding and vomiting for up to 12 hours, with short naps in between from sheer exhaustion.
How can I introduce any kind of routine? How can I make sure he gets enough sleep without him getting dehydrated and hungry? (And me too, I’m utterly exhausted). I think he gets chronically over-tired; he’s sleeping on average only 9 hours a day including naps, and once he is really tired, he fights sleep as if it’s an enemy. He’s gaining weight at an average 3oz a week now, so he’s not getting too much milk, if anything, not quite enough. His latch and so forth are fine – he takes a full feed in about 30 – 40 minutes, if he’s not sick or exhausted.
I’ve filled in the forms, but because his intake varies so much depending on how ill he is, they aren’t particularly helpful. This was for today.
Feeding and sleeping: 7am, full breast feed 45 minutes, 8am profuse vomiting, 8.15am full breast feed 50mins, 9am 1 hr nap, 10.15am breast feed 25 minutes, 2pm full breast feed 40 minutes, vomiting on and off small amounts for next two hours, whingy with tiredness, dozing off. 4pm nap of 1hr 40 minutes. 6pm feeding on and off for 7 hours, vomiting on and off, dozing on and off. 10pm expressed breast feed 6ozs, 12am expressed feed 5oz,1.30am went to sleep in his cot, a little sick, sheets changed resettled and went back to sleep.

The amounts that your son is still vomiting despite the medication still seem to be excessive. Ask for another appointment to see the gastric specialist at the earliest opportunity. His low weight gain and the possibility of him becoming dehydrated again need to be attended to.
Feeding a reflux baby little and often can help them take better feeds. Look at the routines laid out for younger babies and even if you have to wake him from a sleep try to keep to those timings where feeds are about 3-31/2 hrs apart.
This will mean starting your day at 7am even if you have been up in the night a lot. Although it is tempting to let your son feed for 45-50 minutes at a time, on the times when he does, he seems to follow these longer feeds with profuse vomiting. Try giving him a break after twenty minutes on the breast. Sit with him quietly or let him sit in a chair in an upright position, making sure that there is no pressure on his tummy or that he is not bent at the tummy. This should help him begin to digest the milk before being offered the breast again and finish the feed.
Begin to settle him for his nap with a wind-down period beginning about 1.5 hrs after he woke so he does not become overtired and fight sleep. You may need to sit with him in his darkened room and hold him against you but with no eye contact until he is sleepy before putting him down.
Feed him again about 10am and again split the feed into two halves. This may mean you are finishing slightly later than the timings on a routine but it may help prevent these excessive vomiting sessions. Offer him a small top-up expressed feed before settling him for his lunchtime nap around 11.45am. This should help him have a good sleep during the middle of the day. Make yourself have a rest at this time and eat a proper healthy lunch.
If you can encourage your son to stay awake after his 2pm feed for some play time, it may help him settle better in the evenings. Split the feed at 5/6pm as described in the routines up to 6 weeks. This should help him take a good feed at this time. Wait at least 30 minutes before bathing him after the first half of the feed. Getting this bath and bedtime routine in place will help you get the rest of the day to gradually fall into place. A warm bath can help your son relax before settling to sleep for the evening.
If he will settle by 7pm after the second half of the feed you can have a good rest yourself, enjoy supper and offer an expressed feed at 10pm. Try to keep him awake a little at this feed so he will settle better at night.
If the prolonged sessions of vomiting still continue despite seeing your specialist again you may find the routine being put out. Keep trying each day with a 7/7.30am start and bath and bed by 7pm.