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What Causes Reduced Appetite For Breast Milk Despite Ranitidine Intake By An Infant?
Question: Hello doctor, this is me again from UK about my three months and one week old baby daughter. I had asked you few questions over the last few weeks about eczema, then feeding problems etc. I had also sent you a blood report. I am expressing breast milk and give it by bottle. At the moment my baby is feeding half breast milk and half formula.
Last time her PTH(parathyroid hormone) was normal and also calcium came down to normal range. So the consultant said all look normal. We said our baby still has some feeding issue. She rejects bottle most of the time. Halfway of most feeding she turns her face away from bottle. Not asking for feed herself. We need to offer her and also wake her up in the night for feeding.
The doctor said we can try for silent reflux as most symptoms are related. She gave us renitidine liquid form to give three times a day. We stated it about three weeks ago.
First week we thought she had some improvement. But last two weeks she seems as she was before. Last three four day she is refusing more and more. Only one or two time she take full bottle of 110ml during the day. Rest of the time it is struggle to feed her. She will take 30ml, sometimes 50ml etc.
I am very tired of this. All the time I am on her feed issue.
After whole day's hard work she takes about 650ml in total (I think if I do not try hard whole day, she will not take 650ml). She is 3 months + 1 week now. Her birth weight was 2.96kg and last week at three months it was 4.55kg. She does 1-3 times poo and about 10-15 times pee. She sleeps ok and plays well. Does not cry all the time. She comes in happy child category but weight gain is not as per standard chart according to the doctor, but not concerning as well.
- Does it sound like she is suffering from silent reflux or something else? She does not vomit.
- If it is reflux, what else can be tried?
- Is her feeding can improve later on?
-Can she be suffering from something else?
Please reply.
Last time her PTH(parathyroid hormone) was normal and also calcium came down to normal range. So the consultant said all look normal. We said our baby still has some feeding issue. She rejects bottle most of the time. Halfway of most feeding she turns her face away from bottle. Not asking for feed herself. We need to offer her and also wake her up in the night for feeding.
The doctor said we can try for silent reflux as most symptoms are related. She gave us renitidine liquid form to give three times a day. We stated it about three weeks ago.
First week we thought she had some improvement. But last two weeks she seems as she was before. Last three four day she is refusing more and more. Only one or two time she take full bottle of 110ml during the day. Rest of the time it is struggle to feed her. She will take 30ml, sometimes 50ml etc.
I am very tired of this. All the time I am on her feed issue.
After whole day's hard work she takes about 650ml in total (I think if I do not try hard whole day, she will not take 650ml). She is 3 months + 1 week now. Her birth weight was 2.96kg and last week at three months it was 4.55kg. She does 1-3 times poo and about 10-15 times pee. She sleeps ok and plays well. Does not cry all the time. She comes in happy child category but weight gain is not as per standard chart according to the doctor, but not concerning as well.
- Does it sound like she is suffering from silent reflux or something else? She does not vomit.
- If it is reflux, what else can be tried?
- Is her feeding can improve later on?
-Can she be suffering from something else?
Please reply.
Brief Answer:
Doesn't appear to be reflux, may need evaluation
Detailed Answer:
Hi,
To me it doesn't appears to be due to reflux. But as you have mentioned the weight gain is not satisfactory. I would not have got worried regarding the amount of milk (650 ml is OK for this weight and age) if weight gain was appropriate.
There is no improvement in weight even after starting the anti reflux measure. Most of the time it is due to mood changes in the baby and improper feeding techniques. But as you have already taken lactation consultation and the feeding pattern is prolonged it is really difficult to comment about the cause.
As there is no significant symptom apart from poor weight gain and I am sure that your treating doctor must has examined properly to rule out any other problem like underlying heart, kidney, abdominal disease; even then I would like to get baseline investigations done for any major abnormality which can be missed.In majority of cases this comes normal and the cause can not be explained properly. Weight gain, appetite and all the things get normal as the baby grows. But being a doctor every remote possibility should be ruled out.
Although it is too early for investigations but I would suggest you to discuss it with your doctor just to alleviate your anxiety.
I would like to get renal function test, urine routine examination, Echocardiography(for heart examination if suggested), blood pH(to see acidosis) done to rule out remote possibility of underlying disease if any.
I can understand that being a mother it is very difficult when baby feeds are not OK but sometimes it is due to over concern even when there is no significant issues.
If all these are normal I would suggest you to consult your lactation specialist again for feeding techniques, any need of change in formula feed or some other help.
I hope this will help you. If you need any further assistance, kindly let me know.
Regards,
Dr. Pradeep Kumar
Pediatrician, Cardiology
Doesn't appear to be reflux, may need evaluation
Detailed Answer:
Hi,
To me it doesn't appears to be due to reflux. But as you have mentioned the weight gain is not satisfactory. I would not have got worried regarding the amount of milk (650 ml is OK for this weight and age) if weight gain was appropriate.
There is no improvement in weight even after starting the anti reflux measure. Most of the time it is due to mood changes in the baby and improper feeding techniques. But as you have already taken lactation consultation and the feeding pattern is prolonged it is really difficult to comment about the cause.
As there is no significant symptom apart from poor weight gain and I am sure that your treating doctor must has examined properly to rule out any other problem like underlying heart, kidney, abdominal disease; even then I would like to get baseline investigations done for any major abnormality which can be missed.In majority of cases this comes normal and the cause can not be explained properly. Weight gain, appetite and all the things get normal as the baby grows. But being a doctor every remote possibility should be ruled out.
Although it is too early for investigations but I would suggest you to discuss it with your doctor just to alleviate your anxiety.
I would like to get renal function test, urine routine examination, Echocardiography(for heart examination if suggested), blood pH(to see acidosis) done to rule out remote possibility of underlying disease if any.
I can understand that being a mother it is very difficult when baby feeds are not OK but sometimes it is due to over concern even when there is no significant issues.
If all these are normal I would suggest you to consult your lactation specialist again for feeding techniques, any need of change in formula feed or some other help.
I hope this will help you. If you need any further assistance, kindly let me know.
Regards,
Dr. Pradeep Kumar
Pediatrician, Cardiology
Above answer was peer-reviewed by :
Dr. Prasad
Thank you doctor for your reply.
During the last blood tests Renal function was normal. Urine was ok. Three different visits time heart (via stethoscope) sounded ok, abdominal external physical examination was ok.
Doctor here is not too concerned and every time tells me to take it easy. If I take it too easy I am sure my baby will not take the amount of feed she is taking now. And her weight will even gain more slowly.
I did research the internet quite a lot and many symptoms are related to silent reflux such as refusing feed, arching back during feed, crying during feed, poor weight gain etc.
I tried different bottles, different positions etc but no improvement. I am even confused what else can I try? Another confusing thing is that occasionally she takes 110ml without fuss during the day and is happy. Sleeps well.
I will see the doctor again in 10 days time when renitidine finishes and lets see what they say.
Thanks.
During the last blood tests Renal function was normal. Urine was ok. Three different visits time heart (via stethoscope) sounded ok, abdominal external physical examination was ok.
Doctor here is not too concerned and every time tells me to take it easy. If I take it too easy I am sure my baby will not take the amount of feed she is taking now. And her weight will even gain more slowly.
I did research the internet quite a lot and many symptoms are related to silent reflux such as refusing feed, arching back during feed, crying during feed, poor weight gain etc.
I tried different bottles, different positions etc but no improvement. I am even confused what else can I try? Another confusing thing is that occasionally she takes 110ml without fuss during the day and is happy. Sleeps well.
I will see the doctor again in 10 days time when renitidine finishes and lets see what they say.
Thanks.
Brief Answer:
Keep trying for frequent feeds
Detailed Answer:
Hi,
In my clinical practice, I've seen many mothers really struggling to feed the babies. Sometimes it's really very difficult to explain the things but if otherwise, the baby is active and in the absence of other significant issues I have noticed that everything gets normal over a period of time.
Personally, I suggest you to continue putting all your efforts to feed the baby. Sometimes changing the formula milk might be helpful.
Please update me on the clinical status and let me know if I can help you.
Wishing good health for your baby.
Regards,
Dr. Pradeep Kumar
Pediatrician, Cardiology
Keep trying for frequent feeds
Detailed Answer:
Hi,
In my clinical practice, I've seen many mothers really struggling to feed the babies. Sometimes it's really very difficult to explain the things but if otherwise, the baby is active and in the absence of other significant issues I have noticed that everything gets normal over a period of time.
Personally, I suggest you to continue putting all your efforts to feed the baby. Sometimes changing the formula milk might be helpful.
Please update me on the clinical status and let me know if I can help you.
Wishing good health for your baby.
Regards,
Dr. Pradeep Kumar
Pediatrician, Cardiology
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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