Doctor says baby has GER, help!

Cade was born six weeks preterm, but had no complications and is growing well. Two weeks ago at his two month check up, he was diagnosed with GER. The Dr. put him on Zantac for two weeks, it was awful. The symptoms that he had were better, but getting him to take the medicine was a challenge. So, after contacting the Dr. again he is now on Tagamet, which is much better. My question is what other ideas do you have for me to help him out. He is nursing well, about every two 1/2 to three hours. He only nurses on one side at a time for about ten to fifteen minutes. At night we lay down and this really helps keep him from spitting up. Are there any other positions that we can try to keep the milk down. He does not have a weight problem, but is spitting up continually. Thanks in advance.

Kandice and Cade






Dear Kandice,

I am replying to your question you submitted to Breastfeeding.com. I am an IBCLC in WV. GER is a growing diagnosis among breastfed babies. It can pose a real problem. The diagnosis, I mean. Usually the doctor wants to do all kinds of things to stop the spitting up. My understanding of true GER is that it requires some uncomfortable tests in the hospital and usually includes a weight gain problem. Otherwise, spitting up and throwing up in an otherwise healthy breastfed baby is not usually considered a problem.

Now, you may not like what I have just said. Let me add that spitting up can certainly be a worry to moms and dads and can be very inconvenient and that there are ways to improve the situation with breastfed babies but it is not true GER. So I am going to assume your baby does not have a medical condition. If it was a medical condition, I could not give you any advice on it as I am not a doctor! The syndrome you may have is called overactive letdown. In order to determine if you and Cade have this, I have to ask you some questions. (I have helped about 50 women with this syndrome.)

1. Does your milk flow fast and does he gulp when trying to drink at the breast?

2. Has he had any signs of stomach upset too? Colic?

3. Does your milk "spray across the room" ever if he lets go during a let down?

4. How often do you feed Cade? Do you use bottles or pacifiers too?  Have you started feeding solids because he is growing so fast? (Doctors sometimes tell you to do this.)

I will have a lot more to explain after I hear back from you. Laying down to nurse is an excellent way to keep the milk down. Not because of Cade but because it keeps your milk from flowing so fast if you have this condition. There are some other things you can do that have a dramatic effect. Write me back very quickly and I can help you!

In the meantime, keep a cloth diaper handy to catch the spitting up!






 

Dear Matheny,

Cade has not had any hospital tests. The pediatrician said the some of his symptoms were signs of GER. These symptoms were laying his head back as far as possible when put up on my shoulder, raspy cry like his throat hurt, irregular sleep problems, a lot of spitting up, but not projectile vomiting, and wanting to eat all of the time to sooth his throat. I am not 100 % in agreement with the Dr. using the prescription to cure him. This is why I wrote to you.

As for your questions here are the answers.

1. Yes, Cade does have to gulp to keep up with my letdown. He is done eating in about five to ten minutes.

2. No, he has shown no signs of colic. He has gotten fussier since about three weeks after birth. He was a very calm and happy baby before.

3. Yes, my milk will squirt him in the face if I don't put pressure on my nipple when he lets go. I have also noticed that when I use my Avent Isis pump I back it up. The funnel can't keep up with my milk flow.

4. Cade has started to stretch his feedings out. He goes anywhere from 2 to 31/2 hours between day feedings and 5 hours once during the night. I have given bottles of breast milk and he does seem to spit up less and be more content after a feeding. I have tried to use a pacifier when he was very upset and wanting to nurse every five minutes. I had decided that it was not a growth spurt as he was gaining a pound a week and once attached at the breast he would pull away. He is not on solids.

One other symptom that the Dr. used in diagnosing Cade with GER was that during feedings he was very uncomfortable and would pull away and cry.

Thanks for all of your advise, we are looking forward to having some help with this situation and not using drugs to solve a problem that isn't there. Another things is that Cade was two months before the dr. diagnosed him with GER. Can GER just appear, or is it there from the beginning?

Thanks again.

Kandi and Cade






Dear Kandi,

I am glad to hear from you! From your answers I conclude that you are both suffering from the fairly common syndrome known as "Over-Abundant Milk Supply" or also called "Overactive Let Down Reflex". This can be aggravating but not so difficult to improve. Cade's behavior at the breast and the spitting up, wonderful weight gain, and your forceful milk all point to it. The treatment is to endeavor to lessen the forcefulness of your milk. Here are the procedures you can try. (The mini-pill should not be a problem. Just be sure there is no estrogen in it. BF moms are not supposed to get estrogen in their pill until much later in the first year.)

1. To reduce supply and let down force, it has been discovered that moms should nurse on only one side for two feedings (about a 4 hour period). For example, use the right side when he acts like he wants to nurse during the hours of noon to 4 pm. He can nurse on it as often as he wishes. In fact, the more frequent the feeds, the less the let down flows so hard. Then from 4-8 pm, use the other side for all nursing. You can even extend the time to six hours if you do not see an improvement (decrease) in supply after two days. (You may need to stop him three times to burp. That is until the flow decreases. These babies need more burping.)

2. You do not want to pump at all while you are reducing your supply. You may express a little bit from the full side so you feel more comfortable. You may have to pump (or hand express) some milk out before he can latch onto the fuller side so you don't get sore. The idea is to let each side back up a bit to tell the milk glands to make a bit less milk.

3. But you don't want to prolong the time between feeds since that causes the milk to flow too fast. Frequent short feeds are most comfortable for the baby. If the milk is choking him, slip him off and let the first bit flow into a diaper. Then latch him back on. You might have to do this for the next few days, until you see the improvement.

4. The spitting will get better and the fussing at breast will get better. Sometimes it takes a week. When the breasts seem less full, you can go to one side per feeding. You will probably never need to give both sides at a feeding unless he has a very strong growth spurt.

5. Do not worry about how much he is gaining. If he needs to pacify and you know he is not hungry, let him suck on the emptier breast. Everything should get adjusted soon!

Please write me back with questions and updates so I can see how it is working for you. You can continue the medicine or not as you see fit. I will be thinking about you and Cade until I hear back. Give it a couple days to see results!!

Good luck,

Elaine Matheny, BS, IBCLC, LLL Leader

PS. Nursing laying down or reclining back in a recliner also helps until the flow lessens. That way gravity is lessened.





 

Important Disclaimer

This Breastfeeding.com service is designed to help visitors obtain advice and guidance. You are solely responsible for the outcome of any services and/or advice you are given.   Breastfeeding.com is not responsible for any services and/or advice given by the consultants, and shall not be liable or responsible to any person or entity for any loss or damage caused, or alleged to be have been caused, directly or indirectly by the information or ideas contained, suggested, or referenced. Your participation in this service is solely at your own risk