Today we took Carson in to see a feeding specialist at Children's hospital to help us address the condition they diagnosed him with last week. Much less serious than laryngomalacia (which often requires surgical intervention to fix), Carson apparently suffers from gastroesophageal reflux or
GERD (@wikipedia).
If you've heard of "acid reflux" on TV, it's basically the same thing, except in infants. Carson's symptoms are what appear to be painful feedings, particular breastfeeding which is typically done with the infant in horizontal orientation.
On Friday, we picked up a prescription for Zantac, a histamine blocker or
"histamine-2 receptor antagonist" (@wikipedia) which prevents the release of gastric acid (for you chemistry geeks, that's HCl or hydrochloric acid-- pretty caustic stuff).
After a few doses, it seems to be making a difference, particularly with bottle feedings, which are easy to perform with Carson sitting upright (and with gravity's assistance to keep the acid where it needs to stay). Breastfeeding hasn't been any better, though, because that's typically performed with Carson in a horizontal (no gravity assist in keeping acids from reflux) orientation, which means he's still fussy when breastfeeding.
The purpose of today's visit was to get some tips for feeding, changing, and sleeping orientations for Carson to maintain the gravity-assisted prevention aspects of acid reflux. We now have some foam wedges to put on his changing table, to use during breastfeeding, and for his crib/basinette/moses bed replete with velcro straps to keep him inclined when he sleeps.
We hope that these wedges, plus the Zantac he's taking will help soothe his inflamed larynx, reduce the amount of acid (and hence the irritation) when he spits up (most babies do), and ultimately, reduce the fussiness of his breastfeedings which has confounded our ability to reduce not only bottle feeding, but the amount of formula as well. (It's a vicious circle-- fussiness when feeding horizontally at the breast means more bottle feeding is necessary. With less nursing at the breast, breast milk doesn't let down as much, or requires persistent pumping so we can avoid having to supplement with formula to meet his nutrition needs)
Today's session was great. No offense to the Overlake specialists, but the specialist at Children's gave us techniques that will not only help us help Carson, but help preserve our sanity as well... In a sentence, the difference of the approaches is "do two things at once" vs. "more pumpings/feedings!"...
Christine calculated the amount of time that "feedings" take. Here's a list of stuff we need to do at each feeding:
- Wake him up, every 2-3 hours (sometimes we let this go to 4-5 hours).
- Change his diaper, if it's required, and weigh him.
- Christine then breastfeeds for 20 minutes
- 15 minutes in, she dispatches me to warm up the refrigerated breastmilk from a previous pumping and/or formula
- We re-weigh to determine how much he nursed at the breast
- I feed him from one-two bottles for about 15 minutes to satiate him, meanwhile Christine begins pumping to store milk for a future feeding (he hasn't been taking enough at the breast due to his fussiness with GERD)
- Often I pause half way to burp him, otherwise we gets uncomfortable, or you allow the gas to be passed from the other opening-- less gas = happier baby, so add about 5 minutes of burping everytime he comes up for air.
- Then, I need to hold/comfort him for another 15 minutes in an inclined position to prevent reflux from irritating his throat.
- Then it's time to clean the bottles, run the dishwasher, refrigerate unused portions of formula, etc.
- Repeat every 2-3 hours.
Add it all up and it amounts to over 15 hours a day, shared between Christine and I. So more feedings/pumpings is really going in the wrong direction... So we're really happy with our visit to Children's today.
So here's what's next: We're going to use the techniques we learned today (simultaneous feedings of pumped and breast feedings, using gravity assist techniques during sleep and feedings), and continue with the Zantac. If the situation markedly improves, we're in good shape. He should become less fussy, and we'll have broken the vicious circle I mentioned above.
If the situation doesn't improve, we're already scheduled next week for a
"barium swallow test" (@wikipedia) which will help provide insight on the dynamics and severity of the reflux... How much comes back up, what's the physiology at play, etc. From there we'll get a sense of whether the Zantac is doing the trick, or whether we need to "escalate" to what are called
"proton pump inhibitor" (@wikipedia) drugs (aka PPIs like Prilosec, Nexium, etc.).
In any case, it looks like by next Monday, we'll have enough insight to finally see the light at the end of the tunnel, unless the drugs/techniques we're putting in place this week will provide that clarity sooner.
A final thought on selecting the proper duration for paternity (or maternity) leave...
With feedings, diaper changes, travel time, appointments, research, shopping, burpings, etc. you can easily spend 10 hours a day caring for a newborn, with two people on the job.
Plus, it's taken us just 2.5 weeks to uncover, and begin to remediate the primary issues we've had with Carson. We've had a slew of pediatrician visits (a total of 4 so far), a follow up post-partum visit with a nurse, and a slew (4 so far) of lactation/feeding consultants, plus more appointments scheduled for next week.
Now, we fully realize that we have a very happy, healthy boy, who is just struggling with, let's face it, a relatively minor (in the scheme of all possible things) issue. Having said that, the severity doesn't reduce the effort we as parents are making to help relieve his symptoms and solve the underlying issues. Some parents may find an easier path, some might find a more arduous one, but you never know, particularly since you typically need to ask for paternity/maternity time in advance.
If the routine daily demands aren't substantial enough, you need several weeks to just get through the discovery, trial/error, and resolution phases, and having two parents around to handle the demands, for at least 3 weeks, will be key to handle a situation like ours. With every passing week, I'm more convinced that taking just short of five weeks was the proper thing to do.
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Comment/Excerpt: Damn grandpa, why didnt you just tell the kid to "get a job!"? Or explain that your football team was so poor, you had to play without helmets... or uniforms... in the snow... I dont know much about charities but the very state of being needy kind of implies they dont have a lot of resources. Direct deposit seems like a lot of overhead for a few kids. Personally Im a little turned off by the way United Way has turned charity into a major corporate business. I've had employers that forced us to donate so that the department met its charity goals. Save this post and look back at it in 12 years when you and your son are in front of Safeway :)
Name/Blog: Khan
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Title: You had to be there...
Comment/Excerpt: I sincerely don't think this guy was fundraising. I guess my "scam detector" is set on high, and if I were to sit outside a grocery store in 12 years, I'd bring a table, a chair, make a sign, and have some pictures of the team, not just stand there with some candy bars in my hands.