If you read my post on our breastfeeding journey, you'll recall it ultimately came to an end due to Harper's eating problems and low weight gain. We officially diagnosed Harper with silent reflux as the root cause. I'm sharing our story here.
What is silent reflux?
Silent reflux can occur in infants due to an underdeveloped sphincter muscle, a shorter esophagus, their liquid diet, and the fact that they spend a lot of time on their backs. The pain comes from the stomach acid backing up into the throat, larynx, or the back of the nasal airway. It can cause inflammation in areas that are not protected against gastric acid exposure. The tricky thing with silent reflux is there is usually no vomiting, which is the normal tell tale sign of infant reflux. Symptoms can vary, but Harper's symptoms that ultimately led us to her diagnosis with silent reflux were the following:
- Failure to thrive & low weight gain- Harper dropped from the 50% percentile for weight to 20% then to below 10% when she was 6 weeks old.
- Short feedings with abrupt stops- Harper started taking much shorter feedings around 6 weeks old, decreasing from 20-30 minutes to less than 10 and sometimes as little as 2 minutes. She would stop nursing suddenly and wiggle away with no interest in continuing.
- Arching back when waking up- When she would wake from a nap, she would often cry and arch her back.
- Frequent choking & wheezing- Harper also had a stridor, so this symptom may have been due to the stridor and reflux. Harper would choke during almost every feeding until we started using a super slow flow nipple.
- Sounds of congestion in her chest after eating or lying down- This symptom is what ultimately led me to talk to her doctor seriously about the silent reflux diagnosis. When I would wake her from a nap, her chest sounded so congested and noisy even though she wasn't sick and had no other symptoms of a cold or ear infection. When I took her into the doctor suddenly one day when the congestion was really bad (trust your mom gut!) the doctor found nothing wrong with her in terms of a cold or flu. This was when we diagnosed her and started medicine.
Treatment
We tried 3 different medicines before finding one that worked. We also went to feeding therapy at Children's Healthcare. In the middle of all this, we also dealt with a feeding aversion and had to work through that before we could move forward. I will dedicate a post specifically to that as well!
Note: This is not medical advice and you should always consult with your pediatrician on a treatment plan for your child.
- Mylanta- We started with Mylanta before each feeding since this was not a prescription and had the least long-term effects. This worked for about a week with Harper eating closer to 5-6 ounces per feeding compared to her normal 1-3 ounces. After this short stint, Harper started to get fussy again with her eating, so we moved to a prescription medicine.
- Pepcid- We tried Pepcid for a very short time, it did not help at all so we moved on to the next.
- Nexium- We ultimately landed on Nexium packets that we dissolved into a liquid and fed to Harper by a syringe every day before breakfast and dinner. It was the most effective when we gave it to her 1 hour before the meal. It was difficult to do this since babies eat every 2-3 hours and are only awake for 1-2 hours at a time! In the morning, we would wake her up and immediately give her the medicine and try to hold off on her bottle for 45 minutes. In the evening, it was a bit easier since we would give her the Nexium right after her last nap, around 6 pm and then her bottle at 7 pm. We continued on the Nexium packets until Harper was 9 months old. We slowly weaned her off by offering just one per day and then one every other day.
- Feeding Therapy- We started going to feeding therapy appointments at Children's Healthcare at Atlanta and this was a game changer! They were so helpful and supportive that I finally felt like there could be light at the end of this tunnel. The therapist watched Harper drink her bottle then she suggested we try Dr. Brown's bottles with the preemie nipple to eliminate any air that might be disrupting the feed. She said the smallest amount of air could be adding discomfort for Harper. We left this appointment feeling hopeful!
- Feeding Position- Harper ate really well when we propped her in the boppy pillow on the floor in a slightly reclined position. We utilized this position for almost all feedings and still do for her nighttime bottle at 1 year old!
- Tummy time- Lots of tummy time helped! It helps develop the muscles and relieves the baby from being on their back and cause a reflux flare.
- Introducing solids- We introduced purees around 5 months old. We did a very small amount, but the solid food helps keep the liquid and acid down away from the throat and esophagus. We stuck with purees for a while before trying the baby-led weaning approach due to her choking issues.
- Dream Feeding- We introduced a dream feed for Harper when she was 3 months old. Since she was not eating great during the day, she needed the extra calories and silent reflux babies drink better drowsy or asleep. This additional feed allowed us to get a solid 6-8 ounce bottle in during the dream feed. Even though Harper slept through the feed and did not struggle to fall back asleep, I do think a dream feed disrupts that most important phase of a baby's sleep from 7pm - midnight. You also want to be mindful not to load all baby's calories at night because then they will not be hungry during the day and will ultimately land on a schedule where they feed all night! We dropped the dream feed around 4.5 months, when Harper was eating well, gaining weight, and started sleeping through the night.
Products that got us through!
- Dr. Brown's Bottles- I tried SO hard to avoid Dr. Brow's bottles, there are just so many parts to clean! But let's face it, they are the BEST. Just use them, end of story. We used the preemie nipples for a long time, then transitioned to size 1 and stopped at size 2.
- Boppy Pillow- We used the boppy pillow to prop Harper in the perfect feeding position. She was more comfortable using this than in our arms.
- Frida Baby Syringe- This is what we used to give Harper all her medicines. It is a must-have, even for Tylenol and Motrin.
- Pacifiers- I think using a pacifier helped keep the reflux down and personally I don't think the sucking motion can hurt!
- Formula- I gave up pumping and nursing when we were dealing with Harper's issues. it was too much for me to handle and I needed to focus on Fed is Best! We used Gerber Good Start formula- it was the least smelly formula and Harper took to it the best.
Harper is silent reflux free as of 9 months old! It was quite the journey and tested us as new parents, but we stayed strong and supportive of each other. Be patient, since babies cannot tell us what is wrong or how they are feeling, it takes some trial and error to resolve.
XOXO,
Nichole @ Little Peach Sleep
