Monday, May 19, 2014

Spitting-Up and Downward Trajectories

Baby Van has been a spitter-upper since the very first night of his life. I remember the shock I felt when he woke us up spewing at 3:30AM during our first (and only) night in the hospital. I had never had a baby that just randomly spat it all up for no reason, and I hadn't expected it. It began then and hasn't slowed down at all over the course of the last five months.

All along, I have never been too concerned about this situation because Van is what we call a "happy spitter." He doesn't seem at all distressed about spitting up and there is obviously no pain. He smiles right before he spits up, then unleashes it, and then grins hugely again. Weight gain wasn't too much of a concern in the beginning either; he was born large at 9 pounds 5 ounces, so we expected him to lose a little bit of that anyway in terms of percentage. BJ and I just don't make big boys. George, for instance, is in the seventh percentile for weight, but this is also not a problem because he has always had a consistent trajectory.

Apparently, however, we are learning that Van's trajectory is sloping to the point of intervention. His percentages across appointments have gone from the 90's, to the 82nd, to the 70th, to the 61st, and down to the 45th percentile at four months old. It was enough of a decline that Dr. Harmon felt it warranted a weight check at five months old, when he wouldn't normally have an appointment. She also had me begin feeding him every two hours instead of every three, stating that he might be sleeping too long at night and needs one extra feeding in there. Van did not tolerate being fed every two hours, and the spitting up increased by quite a bit. After only one week of that I abandoned it. About ten days ago Van began waking up in the middle of the night for a feeding, and I certainly have been obliging, knowing that he needs the calories. I have been hoping it meant a growth spurt and that his overall percentage would be up at his check-in today. Instead, he had dropped down to the 37th percentile. His height, however, remains in the 92nd percentile.

I welcome advice and help. I should mention that I am exclusively breastfeeding. Let me tell you what our new plan is and all of the things we have tried. As of today, Dr. Harmon told me to set my alarm for 3AM every night and get that extra feeding in. I will certainly do this, but I no longer have confidence that this action in and of itself will make a difference. After all, I have already essentially been doing this over the last ten days and he has still dropped in percentage. During the day I will continue to feed every two-and-a-half to three hours. She also told us to introduce rice cereal two times a day, beginning today. In two weeks we will drop back to rice cereal once daily and introduce vegetables twice per day. Her thought process here is that a heavier solid food may keep his stomach held down better, resulting in less spitting-up overall.

I had very much hoped that Dr. Harmon would not suggest medications (for reflux?) or formula supplementation, and she suggested neither of those today.

I have tried tweaking my diet, eliminating dairy for a period of time, and seen absolutely no difference.

Spitting-up continues to be excessive. He typically goes through at least six outfits a day and I go through two or three different shirts. Burp cloth turnover is frequent; we use receiving blankets as burp cloths and probably go through at least 15 a day if not more.

Some days are worse than others. He may be able to stay in the same outfit half the day sometimes; sometimes we go through four outfits in an hour. It all depends, though I can't tell on what.

I have tried using the baby scale at The Changing Table, the cloth diaper store co-owned by my friend Kristina. I weighed him initially (without clothes or diaper at all weigh-ins), then fed him and weighed him again (he took in six ounces), then spent 30 minutes in the store meandering as he spat up, and then finally weighed him again. He spat up a normal amount that time and it was two ounces, equaling a total intake of four ounces during that feeding.

We have had several friends tell us that their child spat-up inexplicably, and that this usually ended on its own at about six months with no interventions necessary. For moms that experienced this, did your child also experience the downward trajectory of growth that Van has? I would sure love it if this would stop a month from now! As I said before, I am opposed to formula supplementation and am also opposed to medications, unless either of these was explained to me by our physician as being necessary.

Thoughts? Advice? I welcome the help! I feel discouraged and aimless. Thank you, friends!

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