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Doctor Orders Mom to Stop Breastfeeding to Ease GERD -- Advice Requested

I have a friend who's a first time mom going through some tough times. She had a difficult pregnancy (weeks in the hospital), but is now safely home with her 3-week-old daughter, who has been diagnosed with an intense case of GERD. My friend had been trying to nurse with some success, but has now been told by the doctor that she has to completely stop nursing for two reasons, both associated with easing the GERD: the baby needs to be held upright when she eats, and anything that she ingests has to be mixed with a small amount of rice cereal. My friend is allowed to pump to maintain supply, but has to give her baby the milk mixed with cereal in a bottle.

I never encountered GERD with my son, so I don't know if this medical advice is standard, but it seems off to me. I nursed through some issues (low supply, bad latching, etc.), but persevered, and would have been dismayed if that intimate relationship with my son had been taken away from me. I'm curious if anyone else has had experience with this. My friend is devastated and is looking for support. Have any of the moms out there encountered this condition, and if so, what did you do?

What can I do next?

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As the mom of 3 reflux babies, I can tell you this is absolutely "standard" advice. Reflux babies do need to be fed in an upright position and kept upright at least 30mins after feeding. Thickening with rice cereal is also standard, especially with breastmilk since it is thinner than formula. It will not destroy their digestive systems or cause food allergies, although statistically reflux babies are more prone to food sensitivities. Eventually, the LES muscle (the muscle that controls the opening/closing of the flap between the esophageus and the stomach) will strengthen and function properly and the baby will stop spitting up. This is different for each child. Mine were 9mos, 6mos. And 4mos. Most likely the ped will put the baby on Zantac or something similar to prevent the production of acid so that they don't scar the throat while refluxing, which can introduce more food issues.

It can be a scary thing to go through, and frustrating at times. Just know that it doesn't last forever. If she has concerns, she should consult with a Ped GI. All that said, my daughters are now healthy, happy 6, 7 and 10 year olds with no food issues whatsoever! Hang in there, there is a light at the end of the tunnel!

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Have her contact a lactation consultant. She should be able to get some good advice, and I would have her talk to another doctor.

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Hmmm, seems odd to me too... 1.) because i didn't think children under 4 months (at the earliest!) were suppose to have cereal in their diet (they can't digest yet; it can cause constipation issues or food allergies if introduced too early) and also, this article on an infant reflux website says breastfeeding should be continued: http://infantrefluxdisease.com/infant_acid_reflux/index.p...

I'm not very experienced with GERD but perhaps she can get a 2nd opinion, or ask her doctor to clarify his advice.

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The intimate relationship of breastfeeding is secondary to the baby's health, A.. Your friend is enduring pregnancy hormones, new baby mothering and bonding intensity, and facing the realization that things aren't going well with the baby right now. Please don't argue about her doctor and make her feel worse than she already does. Your issues with nursing have nothing to do with GERD and shouldn't be compared. You didn't have to see the pain in your baby that she is going to be seeing in her baby if she doesn't get a hold of this problem.

Mothers everywhere who either can't nurse or choose not to nurse feel very strongly that they bond with their babies as intimately as if they were nursing. You may disagree (I nursed too), but it's not fair to take away from a bottle fed baby and mother's experience as if it's not close to a nursing experience. It would be so much more humane and helpful to your friend to help her get over that premise.

If you really want to help, find a pediatric gastroenterologist for her to get a second opinion from. Just to reiterate what you wrote, she can still use her own breastmilk - it's not like the doctor said to instead use a specialized expensive formula. The baby is STILL getting that wonderful breast milk. Help her find different kinds of nipples that are most like the breast so that possibly she can switch back to nursing as the baby gets better.

Cereal is not usually used before 4 months - but it is used to help babies who have this awful condition. A lot of moms don't know this if they haven't gone through having a child with GERD.

You say she wants support - please give her support that actually works for what's best for the baby's actual health rather than give her reasons to keep bucking doctors' recommendations.

All my best,
D.

10 moms found this helpful

I'm going to go another direction with this..and its not to tell you that she will have lost some connection with her child. While Breast is best as they say, sometimes its not. I find it wrong that people tell others that they should never give up on breastfeeding. I had too..I didn't want to stop but I had to ..when there is no milk, you cannot feed via the breast and it was simply gone..in the middle of the night and never came back until my next child..and it lasted just six weeks for her. I never made enough milk to support my children and I didn't feel guilty about it. The fact my children are in this world at all is a miracle..I wasn't supposed to be able to have them.
If the child is suffering due to this than you should tell your friend to do what is best for her child not what is best for her. No, she doesn't want to give up breastfeeding...but a doctor very rarely says one should quit breastfeeding without a good reason. Getting information off the internet on this issue will give you many many answers. Now, I am not saying trust one doctor blindly ...get a second opinion..but I realize money, insurance and other issues may prevent that. If there is no other option and she CAN pump, at least the child will get breastmilk..which we all know nutritionally is usually best. As far as bonding, there are many ways to bond with a child and breastfeeding is not the only way. (Ask a few dads about that..they know!) . While I totally support her reasons behind wanting to keep breastfeeding, maybe she can do both. Pump enough to fill her up and comfort nurse (using a more upright position...I found the football hold with a pillow underneath my arm worked best for me for all my kids. If I did it any differently they were too easily distracted. The child needs to be able to eat without throwing up or as she gets older she may develop issues with food in general because her first food caused her pain. I find nothing wrong with quitting breastfeeding if the needs of the child show that breastfeeding is NOT the best thing. If she is better off with a bottle then so be it..the mother can hold the child when feeding, she can use breast milk if she pumps and there is nothing wrong with nursing in between..at nap times, at bedtimes..when she wakes up at night as long as she can find a hold that doesn't cause the GERD flare up. If she can't..that's okay too..hold her while she has her bottle, she can even mix formula and breastmilk if pumping doesn't create enough. Nothing is worse than watching your own child suffer. If breastfeeding makes her suffer, why put her through it? My advice is..if she can afford a second opinion, get one..but be honest with the doctor and make sure the advice of stopping breastfeeding is reported. If the first doctor is right and the second one is wrong..you could be setting this baby up for more discomfort than she needs to endure.

6 moms found this helpful

When my grandson was in NICU, weighing only just over 3 pounds, he had bad reflux. My daughter was unable to breastfeed OR pump because she has to take immunosuppressants and they cross breastmilk. The ped in the NICU put him on formula with rice cereal with the explanation that rice cereal gives a little weight to the milk causing it to settle further into the stomach and not be spit up so easily. It seemed to work for him, although at 16 months he still sometimes "burps up" stuff.

Not breastfeeding doesn't make you a bad mom. My daughter got many nasty looks and even rude comments for bringing out a bottle at feeding time. I felt SO bad for her. But really - sometimes it just isn't working. A good mom does what is necessary for her baby.

3 moms found this helpful

Don't let this turn into a battle over breastfeeding vs bottle feeding!!! The doctor is not telling her to quit breastmilk..he is telling her, for her baby's health and comfort to start using a different delivery method! I don't understand the addition of the rice cereal into the breast milk and i would certainly as for clarification on that but I do understand the needing to nurse in an upright position.
That being said, I can think of ways that you could nurse the baby while in an upright position...if they can get the GERD under control that might be an option for her. But she doesn't want to just ignore this GERD issue as "just heartburn"...it can do all sorts of permanent damage to the esophagus and cause some life long problems...so she needs to take this seriously.
Help your friend concentrate on the POSITIVES...after a difficult pregnancy and a lot of time in the hospital she has a wonderful new little life to delight in and this is just the first of many things that she will have to make decisions about, and putting her child's best interests above her own desires is just one of the things that Moms and Dad's do!!

3 moms found this helpful

I would tell your friend to contact a Lactation Consultant ASAP! There is no reason that she could not nurse the baby in an upright position. Also, do they know for a fact that it is GERD, and not just an oversupply or forceful letdown? That can also cause the baby to spit up a lot. Reflux is not *as* common in breastfed babies, as with formula fed babies.
Mom should try adjusting her diet, the baby may have some food sensitivites. If she has a lot of caffiene, she should try eliminating that.

I am glad your friend does not want to immediately listen to the doctor, they are not always right!! Good Luck to her!! Keep us posted! You should check out Kellymom.com, type in GERD, and it should pop up some good info ;)

2 moms found this helpful

Have her contact a lactation consultant. She should be able to get some good advice, and I would have her talk to another doctor.

2 moms found this helpful

As the mom of 3 reflux babies, I can tell you this is absolutely "standard" advice. Reflux babies do need to be fed in an upright position and kept upright at least 30mins after feeding. Thickening with rice cereal is also standard, especially with breastmilk since it is thinner than formula. It will not destroy their digestive systems or cause food allergies, although statistically reflux babies are more prone to food sensitivities. Eventually, the LES muscle (the muscle that controls the opening/closing of the flap between the esophageus and the stomach) will strengthen and function properly and the baby will stop spitting up. This is different for each child. Mine were 9mos, 6mos. And 4mos. Most likely the ped will put the baby on Zantac or something similar to prevent the production of acid so that they don't scar the throat while refluxing, which can introduce more food issues.

It can be a scary thing to go through, and frustrating at times. Just know that it doesn't last forever. If she has concerns, she should consult with a Ped GI. All that said, my daughters are now healthy, happy 6, 7 and 10 year olds with no food issues whatsoever! Hang in there, there is a light at the end of the tunnel!

2 moms found this helpful

My daughter had GERD and my niece currently has GERD. I exclusively breastfed my daughter for 8 months before introducing any solid food because the gastroenterologist told me that babies with GERD have an increased instance of food allergies and sensitivities. I wanted to do everything I could to avoid that. There are positions that you can breastfeed that keeps the baby in an upright position. My daughter actually did best when I fed her while I was reclined back a little and she so upright that she was almost laying on her tummy. I was very careful about what I ate and avoided foods that tend to upset a baby's stomach like dairy, caffeine, and spicy foods. I made sure to keep my daughter in an upright position as much as possible around the clock. I carried her in a wrap and she slept in her carseat or on my chest. Also, my daughter took medication to help with the acid.

My sister introduced cereal mixed with breastmilk at 4 months old to her daughter. She says it seems to make a little bit of a difference. She feels that the medication helps the most.

I would recommend that since your friend feels strongly about breastfeeding that she should contact a LLL leader or a lactation consultant. There are many different things that she could try in order to help her baby. If she is getting information from her doctor that doesn't feel right to her as a mom than she should get another opinion and more information. Moms have strong instints, and she should trust herself.

1 mom found this helpful

Hmmm, seems odd to me too... 1.) because i didn't think children under 4 months (at the earliest!) were suppose to have cereal in their diet (they can't digest yet; it can cause constipation issues or food allergies if introduced too early) and also, this article on an infant reflux website says breastfeeding should be continued: http://infantrefluxdisease.com/infant_acid_reflux/index.p...

I'm not very experienced with GERD but perhaps she can get a 2nd opinion, or ask her doctor to clarify his advice.

1 mom found this helpful

First of all she needs to leave that Dr. Her 3 week old's body is too young to ingest cereal!!!!! Where the heck did this Dr get his/her credentials from? The stomach first lacks the enzyme to break down and digest anything other than his/her mother's milk and/or formula that is best suited for the baby. So the cereal is the absolute worst idea and you would never put it into a bottle even when the child is old enough. Sorry, that is completely ridiculous. I would stay breast feeding as it is best for the baby and is geared towards his/her needs. Some formulas may exacerbate the problem at hand. All she has to do is sit the baby more upward when nursing. Then, take frequent breaks to get a solid burp. After the baby is done and has burped, place the baby in a bouncy seat that is more elevated for about 20-30 min for complete digestion before laying flat. the baby should grow out of this gradually and almost completely by 6-8 months of age. Have her hang in there and for sure get a new Dr!!!!!!!!

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Has your friend seen a specialist regarding this condition? I am assuming the baby had some tests in the hospital that came up with the GERD diagnosis? My daughter had this as well (she was 3 months premature). It is very important to address this issue with GERD and while you may want a specialists opinion, the upright feeding and rice cereal is standard treatment for this issue (as is sleeping on an incline or in a carseat). The rice cereal makes the milk thicker so it does not come up as easily.

My daughter is now 4 and we *still* have issues with reflux and eating. Getting this addressed sooner rather than later is important for the baby's current health and for future eating habits. Although the mother is sad she won't have the experience she wanted, it is important to concentrate on the positives and do what is best for the child.

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I'd say get a second opinion from another doctor. A local La Leche group should know some pediatricians who are very supportive of nursing. My son was given cereal mixed in formula early on (maybe 6 or 8 weeks) for reflux but he was also on medication. I tried to breastfeed both of mine and couldn't make it work because of medical issues of each baby. But the reflux was not the reason I couldn't nurse! It is very hard to pump enough milk to keep your supply up--I spent months pumping exclusively with each child.

1 mom found this helpful

You can nurse sitting up, prop pillows behind you and have the baby sit facing you straddling your belly, then the baby latches on while in a completely upright position.

I disagree with cereal in the bottle... even though my child had projectile vomiting I still nursed.

Tell her to take the baby to a chiropractor first, bet that takes care of it - that's what cured my daughter

Honestly, I think she should not listen to her doctor...or at least get a 2nd or 3rd opinion. There are homeopathic remedies that would help (helped my twins with reflux and I breastfed them until they were almost 2). I believe I tried silica 6x. I found the information at abchomeopathy.com
There are breastfeeding positions that would allow the baby to nurse in a more upright position....she may consider trying those and I wouldn't want to feed my 3 week old rice cereal, as it will totally mess up their digestive system.

My son had reflux and I nursed him for 10 months (when he self-weaned, or it would have been longer). If your friend wants to nurse, then I would tell her to get another opinion and not to give up. She might have to change her diet so that she can figure out if anything she is eating is upsetting the baby's stomach more than usual. Tell her to call a lactation consultant or La Leche League to get advice on how to go about it (usually an elimination diet to see what might be the issue). It may not be anything in her diet (my son just plain had reflux), but it could help. Also, did they give the baby any medication for the reflux? My son was on Prevacid starting at around 6 weeks old and it worked great for the pain. He still spit up a lot, but didn't scream and arch his back for 30 minutes following every feeding anymore. I think doctors these days are too willing to give up on breastfeeding because they honestly don't know much about it and can't give any advice on the subject. My advice would be for her to make some calls to other pediatricians and interview them, specifically about their knowledge/stance on breastfeeding and find another opinion. I, too, would hate to see her lose out on that experience if it isn't absolutely necessary. Best of luck to her!

Get your friend in contact with somebody from the La Leche League or at the very least a very good lactation consultant for another opinion!
Any doctor who says quit breastfeeding makes me cringe!
Good luck!

If the baby is only three weeks old I am trying to understand why RICE cereal. Anyway, have her call the pediatrics department, or the ward she was on and ask for a nurse to advise her. It is quite possible Doc is overstressed and didn't think about the age. On the other hand maybe there is something to this. My second son wouldn't nurse at all, but no one advised Rice cereal until after about six months. Wow, things are different...

Is it possible that the doctor is suggesting that she try bottle feeding with cereal to see if this helps? Often we, including doctors, have to try various things to find one that works.

My grandson had GERD and it wasn't easy to diagnose. After he was diagnosed I suspected that his older sister also had GERD . Her symptoms were reduced by switching her to a non-dairy based formula. She tested allergic to the protein in milk.

Both babies slept better and actually preferred sleeping in their car seat. This kept them in a more upright position which does reduce GERD. We swaddled them, because that is also what worked for them, and then buckled them into the car seat and set the seat in their crib.

Your friend should be able to find a position while nursing that keeps her baby more or less upright. I'd suggest that she experiment with different positions. I also suggest that she consult with a lactation consultant and/or the LaLeche League.

I would try different things before searching for a second pediatrician unless this pediatrician is not pro breast feeding. The fact that he made that suggestion, alone, does not mean he's not supportive of breast feeding. I could just mean that he wants her to try something different to see if it helps.

my dd had sever GERD and my pedi never told me to stop BF. I would postition myself to have her upright alittle and after feeding i gently would ease her into the over shoulder postition and would have her stay that way for about a half hour yes she did spit up but not too bad. have her nurse for a little burp take a break then continue. try not to over feed. we did both formula and BF plus she had to take the baby zantac to help withthe acid erosion that can occur. but dont give up the BF Pump if she has to so she can bottle feed. gl it will pass mine was done at 4 months when we started solids. oh yeah we did do the cereal in bottle both b and f.

I saw your question and wanted to give you a link to PAGER - a non-profit organization dedicated to helping families with a child suffering from GERD and helping doctors. I learned about them through ToyBlock Music - a Chicago company owned/created by a mom whose baby also suffered from severe GERD. (She donates part of the proceeds from their kids music albums to PAGER since they've helped her family)....

http://www.reflux.org/
They have a "Talk to an Expert" Button - where you can talk to experts and get good advice for free. Here's that link from their site
http://www.reflux.org/reflux/webdoc01.nsf/vwWebPage/talkt...

There is so much at this site---info, support, help, forums, just tons of resources. Thought I'd share this with you hoping it would help!

I'm an adoptive mom, I haven't dealt with GERD but my child has some other issues, and I know how frustrating it can be when you can't get answers you feel you can trust and don't know where to turn.
Hope this helps you!

A.

A Dr is recommending rice cereal? I would seek another professional opinion.

I'd contact LLL.

The baby is 3 weeks old? That is way to early for rice cereal. The American Academy of Pediatrics recommends nothing but breast milk before 6 months of age. Babies can breast feed in a sitting up position. She should contact a local LLL for support or find a good lactation consultant in her area. It is likely that the babies GERD could be improved with some good breast feeding support. I think this MD has given this mom some very bad advice.

She needs to talk to a lactation consultant. Sorry, but doctors don't really understand breastfeeding. Get a 2nd opinion and get help from someone who deals with breastfeeding all the time. I don't really understand how breastmilk, which is made for infants, is bad and actual food, which is NOT for infants, can help. A lactation consultant can probably find a way to feed the baby in a more upright position.

Good luck with your friend!

definitely ask your friend to go to a lactation consultant. If the baby is having GERD issues, introducing solids so early could compromise the baby's future health. And she should not stop breastfeeding!

Someone previously also suggested a chiropractor for GERD. Please have your friend try this option as well. I thought my son had GERD - so I took him to the chiropractor - and he did not spit up as much afterwards.

Like someone also said earlier, your friend should look at her diet as well. Good luck to your friend.

that is HORRIBLE! the best thing for baby , the easiest digestable material would be breastmilk! tell her to go to a pediatric gastroenterologist

I don't have personal experience with GERD. In her situation, I would not stop nursing. Many people mentioned nursing upright but no one offered a link, so here:

http://www.kellymom.com/bf/supply/fast-letdown.html#posit...

I don't know about diagnosing reflux and if it can be mixed up with overactive letdown (OAL) so she can take a look while on the page. The positions would help in either case.

I'm sure she's looking for good info on it, so here's kellymom's webpage about spitting up/reflux:

http://www.kellymom.com/babyconcerns/reflux.html#refluxsy...

And finally, since you said she's looking for support, here's the kellymom forums: http://forum.kellymom.net/

She can go into the newborn to 6 months forum and get lots of advice and support from mom in her same situation. I'm sending lots of support your friend's way. Being a new mom is tough! And adding in extra issues like reflux makes it even tougher.

ETA: Another thing she can do since babies with reflux need to be upright a lot is to get a sling or baby carrier. The ones I have personal experience with where the baby will be sitting upright are the Mei Tei and the Ergo. I prefer the Ergo myself.

Hi A.,

I haven't encountered this personally, but I have several friends whose babies have been diagnosed with acid-reflux. They've had some success with Zantac and Mylanta drops. I know that keeping the baby upright after nursing/feeding for 20 min. is important, but that shouldn't preclude nursing. And most doctors are not recommending any solid foods until at least 4-6 mos. I definitely think your friend should contact a different doctor/lactation consultant!

Best,
R.

I think she should definitely get a 2nd opinion. Any doc who advises a woman to stop breastfeeding is suspect in my opinion. She should call la leche league, or go see the doctors at homefirst in Naperville. They also provide baby and child wellness in addition to maternity services. Especially if the baby has health issues, nursing is by far the best choice. She could modify the position to get baby in a more upright posture when nursing. It can be done, I nursed two kids through toddlerhood, and it is one of my proudest achievements.

I have never had such a bad time with nursing, but I agree -- this seems off. This baby can't even hold her head up; how is she upright at every feeding? I cannot imagine that she can't swallow anything, and the present delivery system is no question the best. If I were your friend, I would get to La Leche immediately and get some better guidance.

Good luck!!! This too will pass!!!
Mama S.

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