When I mentioned to my son's current pediatrician that he is having reflux and spitting up a lot, she told me that it was possible that he was eating too much. She told me to feed 5 min per breast to cut the amount down. Would this not cause a decrease in my supply? I have always been told to watch the baby. Not the clock. What do I do??
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Breastfeeding and Reflux
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1) Reflux is common to all babies, it is just a matter of what degree. It has to do with the immaturity of the lower esophageal sphincter muscle (the muscle the sits on top of the stomach and keeps food down in it).
2) Reflux only should be treated if it is causing great distress to the infant AND preventing him or her from gaining weight appropriately. Do NOT put him on Zantac (ranitidine) if he is doing well.
3) Yes, overfeeding is a common cause of reflux but is much more common in bottle fed babies where there is less regulation--you can keep making more and more formula!
4) I dislike the recommendation to feed for such a short time on the breast. Please google "hind milk" and you will see that breast milk comes out in different forms, and if your son only gets the foremilk (first milk) he is at risk for missing out on the great nutrition in the last portions of the milk. What you CAN do is feed on the breast, pull off, burp, and put back on (i.e., burp more frequently). But, you should make sure you empty one breast completely before going to the second breast (I always say, "one breast for dinner, and if he is hungry for dessert, he can take the second breast."
Christopher J. Russo MD FAAP
Director of Pediatrics
Centra Medical Group
Lynchburg, Virginia
2) Reflux only should be treated if it is causing great distress to the infant AND preventing him or her from gaining weight appropriately. Do NOT put him on Zantac (ranitidine) if he is doing well.
3) Yes, overfeeding is a common cause of reflux but is much more common in bottle fed babies where there is less regulation--you can keep making more and more formula!
4) I dislike the recommendation to feed for such a short time on the breast. Please google "hind milk" and you will see that breast milk comes out in different forms, and if your son only gets the foremilk (first milk) he is at risk for missing out on the great nutrition in the last portions of the milk. What you CAN do is feed on the breast, pull off, burp, and put back on (i.e., burp more frequently). But, you should make sure you empty one breast completely before going to the second breast (I always say, "one breast for dinner, and if he is hungry for dessert, he can take the second breast."
Christopher J. Russo MD FAAP
Director of Pediatrics
Centra Medical Group
Lynchburg, Virginia
If your worried about your supply I would recommend pumping in between
Breast milk supply depends in the frequency and length of time of the feedings. I can refer you to a excellent lactation consultant her name is Tammi & her tele is 702.517.4285, call her she can help you
I also agree with Dr. Russo. Reflux is very common with babies. In order to minimize it, you can burp the baby more frequently, position the baby slightly upright, and avoid over feeding. As long as the baby is gaining weight and is not bothered by the spit ups, they are considered "Happy Spitters".
Reflux is common among all infants. It peaks by 3 months of age and reflux precautions include elevating head above abdomen and altering rate of feeding when possible. If you're nursing then nurse completely from one breast before considering switching sides. That way the hind milk is adequately consumed. Watching the baby, not the clock is true. If your baby is gaining weight properly and not having discomfort then no further intervention is necessary. If there is discomfort and reflux precautions are inadequate, then consideration of ranitidine (Zantac) may be considered.
If your baby is nursing well, growing, i.e. gaining weight, getting longer, and seems content during and after nursing, this spitting up a lot can be perfectly normal. Breast milk reflux is not the same thing as Acid Reflux Disease where one might expect some evidence of heart burn and/or some evidence of impaired growth or recurrent respiratory symptoms, like cough or wheeze.
Heartburn burns. It is painful. Baby's with acid reflux disease with heartburn cry during nursing and shortly thereafter. They may arch their backs, stiffen and squirm, and constantly pull off the breast. They may not settle in to comfortable soothing feeding.
Baby's get most of their breast volume in the first 5-10 minutes. Suckling after that time is important for satisfaction and nurturing. Some babies naturally only nurse 5-10 minutes and are perfectly content and satisfied; others need 20-40 minutes to be equally content. Happy babies that constantly spit, reflux or bubble have functional gastro-esophageal reflux and nothing needs to be done other than monitor their comfort and growth. 90% will cease this refluxing by 12-18 months of age with no treatment at all.
Keep your well checkup appointments so you and your pediatrician can monitor this situation, the baby's comfort and satisfaction and the baby's growth.
There are some simple interventions that might diminish the spitting, but no guaranty. One might try different burping positions; you might try not jiggling the baby around excessively during and after nursing (treat the baby like T&T and move him/her slowly after nursing to the infant seat inclined at a 30 degree angle. The baby should sleep on the back not the tummy to minimize the chances of SIDS.
The issue of the baby "eating too much" is probably not a real concern for a nursing baby. A bottle fed baby has a hard time saying no to gravity and the fluid flow, but a breast fed baby is well in control of the flow of breast milk, once the let down reflex and milk production is established.
The issue of your milk supply is a simple one_more or less. If you feel your milk supply is diminishing, the baby needs to nurse longer and frequently and your breast will make more milk. If your baby is content with 5-10 minutes of nursing, and you feel less full after nursing compared to when you put the baby on the breast, all is probably well. My prediction is that a happy content baby who is nursing well and spitting often WITHOUT EVIDENCE OF PAIN OR WEIGHT LOSS, will probably spit whether you nurse 5 minutes or 40 minutes. Painless spitting can be perfectly normal. You may want to expect it and make appropriate use of a towel when nursing.
Now all this being said, we have been talking about spitting, what the British call bubbling. Recurrent forceful vomiting, shooting some distance from the baby in the first 8-10 weeks of life is a different animal and should be discussed carefully with the baby's doctor.
Please enjoy your nursing experience. If the baby's spitting is as comfortable as I've outlined above, it will be much better by 12-18 months of age.
Regards,
Dr. T
Heartburn burns. It is painful. Baby's with acid reflux disease with heartburn cry during nursing and shortly thereafter. They may arch their backs, stiffen and squirm, and constantly pull off the breast. They may not settle in to comfortable soothing feeding.
Baby's get most of their breast volume in the first 5-10 minutes. Suckling after that time is important for satisfaction and nurturing. Some babies naturally only nurse 5-10 minutes and are perfectly content and satisfied; others need 20-40 minutes to be equally content. Happy babies that constantly spit, reflux or bubble have functional gastro-esophageal reflux and nothing needs to be done other than monitor their comfort and growth. 90% will cease this refluxing by 12-18 months of age with no treatment at all.
Keep your well checkup appointments so you and your pediatrician can monitor this situation, the baby's comfort and satisfaction and the baby's growth.
There are some simple interventions that might diminish the spitting, but no guaranty. One might try different burping positions; you might try not jiggling the baby around excessively during and after nursing (treat the baby like T&T and move him/her slowly after nursing to the infant seat inclined at a 30 degree angle. The baby should sleep on the back not the tummy to minimize the chances of SIDS.
The issue of the baby "eating too much" is probably not a real concern for a nursing baby. A bottle fed baby has a hard time saying no to gravity and the fluid flow, but a breast fed baby is well in control of the flow of breast milk, once the let down reflex and milk production is established.
The issue of your milk supply is a simple one_more or less. If you feel your milk supply is diminishing, the baby needs to nurse longer and frequently and your breast will make more milk. If your baby is content with 5-10 minutes of nursing, and you feel less full after nursing compared to when you put the baby on the breast, all is probably well. My prediction is that a happy content baby who is nursing well and spitting often WITHOUT EVIDENCE OF PAIN OR WEIGHT LOSS, will probably spit whether you nurse 5 minutes or 40 minutes. Painless spitting can be perfectly normal. You may want to expect it and make appropriate use of a towel when nursing.
Now all this being said, we have been talking about spitting, what the British call bubbling. Recurrent forceful vomiting, shooting some distance from the baby in the first 8-10 weeks of life is a different animal and should be discussed carefully with the baby's doctor.
Please enjoy your nursing experience. If the baby's spitting is as comfortable as I've outlined above, it will be much better by 12-18 months of age.
Regards,
Dr. T
It is impossible to advise on the best action plan without additional information. Baby's weight gain, any discomfort that appears to be related to eating and spitting up. One thing to consider: in 5 minutes of nursing the average breast is only about 50% empty. Cutting nursing time to 5 minutes my deprive your baby necessary nutrition