Nov 20, 2014

Poor Baby J - not so well check follow up

Two weeks ago, I posted asking for prayers for JMac after his not so well-check. The pediatrician was concerned because he fell off his growth chart (He's small, but being small isn't the issue. The concern is that he is no longer on his curve.) and believed the cause of the slow growth was because he was losing so many calories to reflux. We changed his medications and scheduled a follow up appointment for two weeks later.

Yes I'm reusing the picture. But it's just so gosh darn cute!

Things get worse. The boy stopped sleeping. Like completely stopped napping and struggled at night. The painful back arching got worse. A lot worse. His reactions to soy have gotten worse. The projectile spit up did slow down. But the constant spit up dribble continued.

At his age, 16 hours of sleep would be normal. Hmph.

At the one week mark I had a phone consultation with our pediatrician and she said that we are running out of options and ist's time to try a few "last ditch" things. Her suggestion was to add calories and thicken my breastmilk by adding oatmeal. The benefits or extra calories and of breastmilk. Win! So I pumped. But JMac equates having a bottle in his vicinity to torture. He puts pacifiers in the same category. Anything silicone or plastic near his mouth enrages him. Casey tried to give him a bottle. No luck. I tried. No luck. Our nanny tried. No luck. My MIL tried. No luck. My mom tried. No luck. Point taken Jiminy Cricket. No bottles for you. We tried a sippy cup. No luck. We tried a straw cup. No luck. The pediatricians last ditch effort wasn't a success. (Could someone make a bottle nipple out of A&A muslin? He likes sucking on that!)

Angry baby. Confession: he's not angry about a bottle in this picture. But it's cute. And I needed an angry baby photo here. He's angry I put him down to change his diaper.

I went to the follow up appointment with the pediatrician on Tuesday hopeful she would have a few new ideas for us. We weighed JMac and he gained weight! But not enough. She expected a minimum of 20g per day. She wanted even more than that for him to catch up. He gained 17g a day. He maintained the percentile curve, which is good, but she wasn't impressed with his progress.

Off to the Pediatric GI.

He was also concerned by the growth chart, but said overall JMac looks healthy and looks happy which encourages him. He gave us a few things to try.

  1. He wants me to nurse. He said if JMac would take a bottle things might be different, but since he won't, don't force it. All that screaming burns a lot of calories! This is consistent with the information he gave us when we saw him for the twins. He is a bit of a strong breastfeeding pusher so hearing him say that if J would take a bottle things might be different is actually a bit sobering.
  2. He wants me to cut soy in addition to remaining dairy free (no surprise**) but said I should only cut the soy I can handle. His concern is going completely soy free will make nursing too hard and I'll stop (see point 1). Since the soy seems to be an intolerance not an allergy, continued exposure isn't going to be life threatening or affect his likelihood of outgrowing it. So I need to cut soy sauce, soy milk, soy cheese, etc. but I'm not going to pay attention to baked in soy and I'm not going to stress about soy when we eat out. We'll have to reevaluate soy in a few months when JMac starts eating foods himself, but for now major soy is out and minor soy gets a pass. This seems doable.
  3. JMac gets to try cereal on a spoon since he's a big little boy. We didn't do cereal for the twins so this is just further proof that every kid is different and as moms we do what we have to do!
  4. He increased (by 60%!) little man's medicine dosage. Hopefully this helps with the spit up.
  5. He encouraged me to continue letting JMac sleep in the swing. He said with reflux this severe you accept sleep wherever it happens and don't worry about sleep training or weaning him from the motion. It's what we've been doing but it feels good to have it confirmed.
  6. He said that if JMac is having trouble sleeping we might try Tylenol. Reflux is painful and Tylenol may or may not help. He encouraged some trial and error (although warned of the dangers of using Tylenol too frequently and talked a lot about balance).
  7. He encouraged me to weigh him at home and track his growth. If we notice anything concerning come in. If we can't get a home scale, we will need to go to the pediatricians office for weight checks with a nurse (and call him if we see anything concerning). Getting to the doctor with all three kids is a...challenge. So, I reached out to a sweet friend who had offered to let us borrow their home scale and hope to get that from her to use for a bit.

It feels good to have a plan. Even if the plan is basically "wait and see." While he have some steps of things to try, the big take away was "stay the course" and let's hope he outgrows the reflux and starts keeping enough calories down.

James wasn't impressed.



** I have been suspecting this for a while and have basically already done this. We "tested" the theory and had Chinese takeout on Tuesday night and on Wednesday it was clear that soy sauce wasn't my friend.


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