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doc4kids
doc4kids, Pediatrician
Category: Pediatrics
Satisfied Customers: 414
Experience:  General Pediatrics and Pediatric Emergency Medicine
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Hello, We have a very unhappy 4 month old and we are looking

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Hello,
We have a very unhappy 4 month old and we are looking for advice. Here is a synopsis of the last 4 months:

Aisling born December 26th 2012 weighing 7 pounds 5 ounces, 17 days premature.
Unsettled from birth, on average would take 2 hours to settle after breastfeeding, always looking uncomfortable and squirming, with facial expressions implying a bad taste in her mouth. Not a good feeder, ok feeding for first 10 minutes, but would then pull on and off the breast. Shallow latch.
5 weeks old: we tried infant gaviscon with no success and we were prescribed Losec for silent reflux.
6 weeks old: she was checked out by paediatrician in General Hospital, weight was average no signs of infection. Began crying during feeding. She would be very eager to feed from breast, rooting and latching on and feeding for a few seconds, coming off crying, and rooting again.
10 weeks old: diagnosed with posterior tongue-tie by lactation consultant, and snipped. Rooting and latching on continued for a few seconds and screaming and rooting and repeated cycle. No weight gain over a week period so breastfeeding was terminated, and baby was put on Aptamil.
12 weeks old: weaned off Losec as we were not sure it was making a difference and did not want to give it unless definitely required.
13 weeks old: Aisling had her most settled week.
15 weeks old: Aisling started crying heavily (similar to videos online of ‘colic’) in the evenings, screeching inconsolably whether being carried, cuddled etc. Put her back on the Losec. Weighed by GP and is average weight and looks likes a healthy baby.
17 weeks old: has become increasingly agitated, especially during feeds. Often screams during feeding, latches onto bottle for a few seconds, comes off screaming and looking for bottle straight away, and repeats this for 40 min +. Often then for no apparent reason (no significant passing of wind) drink a few ounces of bottle relatively calmly without screaming.
On Aptamil Comfort for last 24 hours with no difference so far. Often arches her back, likes to tilt her head back very far, stiffens up, does not enjoy sitting, much prefers standing. At times though does smile and coo, but even at her best times, she seems uncomfortable. Mostly sleeps for only 30 min after each feed during the day, but does sleep through from midnight to 7.30am each night. She has two strawberry haemangioma, one on her arm and midriff, getting these checked in September.

Any help greatly appreciated. We feel we have been a bit dismissed by doctors up to this stage, but we are concerned for our daughter.
Submitted: 1 year ago.
Category: Pediatrics
Expert:  doc4kids replied 1 year ago.

doc4kids : Hello. How can I help? If you are available for a chat, we can discuss your concern in real time. Otherwise, I can just leave you a reply.
doc4kids : I am sorry she is having so much trouble. I would much prefer answer in chat but as we are in different time zones, I may not be able to catch you online. I will do my best to answer your question and then look for your reply.
doc4kids : Hello. Can't sleep?
Customer :

we are available to chat thanks

doc4kids : give me one moment. I am going to change from my phone to my computer. This'll be easier there. Ill be right back.
doc4kids :

Thank you for waiting.

doc4kids :

It sounds like this has been going on for most of her life, is that correct?

Customer :

Well unsettled all her life, 'colic' screaming only last couple of weeks

doc4kids :

Ok. You have given a very full history in the stem, thank you for that.

doc4kids :

I think you give a very good description of reflux.The lack of response to Losec does not preclude this.

doc4kids :

Losec is not supposed to stop reflux, as you may know. Rather it is to make it more tolerable. The look on her face, is likely the "brash water" sour taste she is responding to.

doc4kids :

Additionally, you describe quite well something we call Sandifer posturing, a sign of reflux. Infants will arch their back and necks, we believe, in an attempt to extend their esophagus.

doc4kids :

It is quite reassuring to have her gaining weight and still interested in feeding. The change of formula is very unlikely to make a difference despite what the different formula makers would have you believe.Formula intolerance is a very uncommon cause of reflux although is is often blamed.

Customer :

OK cheers, XXXXX XXXXX why she often screams during start of feed as if we were giving her poison, very unhappy then in 40 min or so, it's like she decides it doesn't taste that bad and drinks a lot of bottle

doc4kids :

Reflux precautions are likely more helpful, some of which you are likely already doing: upright during feeds, upright after feeds, frequent burping, and smaller, more frequent feeds.

doc4kids :

You can also thicken feeds with the addition of rice cereal. She should still be able to suck it from the bottle. Typically, honey consistency is helpful. A "reflux wedge" may also be useful. This is a foam wedge, with velcro harness on the front, allowing her to sleep on an incline. This works with varying degrees of success.

Customer :

COuld there be a possible dairy intolerance aswell as the reflux?

Customer :

The reflux does seem to be worse at times, our understanding was that it should get better with time?

doc4kids :

Both lactose intolerance and frank milk protein allergy are frequently blamed but unlikely if reflux is the only symptom. Dry skin, blood in the stools would be more concerning for this but, alone, not as likely. Allergy to breast milk is yet more uncommon and should make you feel better that this is not a allergic issue, rather just an unfortunate result of Aisling's esophagus being very short; any burp is a "wet burp" and some children are more vocal about their discomfort.

doc4kids :

I would be careful about changing formulas around too frequently. If you are seeing similar results with breast milk and now two formulas, the chances that she is allergic to all of them is not high. Therefore, frequent changes may be causing her additional GI upset, rather than improving it.

Customer :

OK, thanks for the advice, some interesting points we have not heard before.

doc4kids :

Colic, is also likely at play.

doc4kids :

There are some differences in opinion on the etiologies, I'll try to explain. Traditionally, we are taught that it may be directly reflux, gas or constipation, or a GI cause. There may be an emerging opinion for a neurologic cause, not in any scary pathological sense but perhaps an immaturity. Dr Karp who wrote "The Happiest Baby on the Block" suggests that colicky babies may not neurologically be ready for life outside the womb. As such, when comforting a baby with colic he suggests recreating that environment. He recommends, the five S's: Swaddling, side position, sucking, shhhing and swinging

doc4kids, Pediatrician
Category: Pediatrics
Satisfied Customers: 414
Experience: General Pediatrics and Pediatric Emergency Medicine
doc4kids and other Pediatrics Specialists are ready to help you
Expert:  doc4kids replied 1 year ago.
I got long winded and didn't get a chance to finish. I would though in conclusion like to recommend looking into Dr. Harvey Karp's book, "the Happiest Baby on the Block." My son also had colic and we sought out many opinions on cause and solutions and this book allowed us to calm him quickly. It is summarized in the five S's I listed above but he goes into quite a bit of detail on the topic. We were able to calm him quickly with these techniques. Sorry, I was taking too long to type. Again, let me know if you have follow up questions. Good luck.
Customer: replied 1 year ago.
Many thanks, XXXXX XXXXX that book out!
Expert:  doc4kids replied 1 year ago.
You are welcome.

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