Barfy Baby Boy

We had our GI appointment this past Monday. One of our major concerns is that Gabriel's spitting up has recurred with a vengeance. We are routinely cleaning up half of each feed as much as 20 minutes after feeding him. It's so weird, this artificial feeding regimen he's on. The dieticians can calculate how many calories he *should* have based on his age and weight, but that's not necessarily what he needs. Even feeding much less than recommended and him barfing so much this past week or two, he still made fantastic gains in the weight and length department. Gabriel is actually ON the weight/length charts now with his actual age! He's in the 2nd percentile for a 10-month old, but considering he's not supposed to be a 10-month old, that's phenomenal. The actual numbers are 16.5 lbs, and 26.5".

But we still have to get this reflux thing under control. The doctor took a quick abdominal x-ray and saw a very constipated baby. Given that the alimentary canal is essentially a tube through the body, if you fill up the bottom end of the "plumbing", things going in the top end won't make it through and will come back out the way they went in. At least, that's the Reader's Digest non-scientific way of saying it. So, off to the drugstore we went for baby laxative and Gabriel now has a standing prescription for lactulose to keep things regular. He is also on Zantac, the mildest reflux drug. The goal is to have him tolerate his high calorie milk during the day like he does at night. She also wants to do a more in-depth x-ray study of his upper GI tract involving injecting barium into his g-tube and taking timed snapshots of his small intestines as the barium moves through to ensure that there is no twisting or blockage of the intestines. We have this scheduled, but we are not sure about subjecting the baby to the radiation just yet.

However, since Monday, reflux has increased. Cleaning out the baby and reflux drug non-withstanding. At the doctor's request, I put him back on high calorie milk during the day, even though we haven't had great luck with it in the past. Her reasoning is that if he can tolerate it at night, there is no reason why he can't tolerate it during the day.  But, I hope I found a light at the end of the tunnel. Today, when I fed him, I was distracted and fed him very slowly for the first two-thirds of the meal. Then, I got my act together and fed the last 50mL at the rate we've been working at for awhile (7 mL/min). Sure enough, 50mL came right back up the pipe. So, I wondered....are we just feeding him too fast? The last dietician we saw told us that bolus feeding should take no more that 15-20 minutes, so we adjusted our feeding rate accordingly. But the dietician he saw Monday made the suggestion to actually feed him slower or even put him on the pump during the day. So, I tried that. His pump is portable and comes with a little backpack, so I put it all together and set the rate to give him his full meal over the course of 45 minutes. And it worked. No coughing, retching, gasping or any other signs of possible reflux. Of course, he was napping through most of it, but that hasn't been stopping him from vomiting before. The beauty of the pump is that it's hands free for us, and we can sit him in his high chair and work with his spoon feeding while his tummy slowly fills up with food via the pump. I've been so resistant to using the pump during the day, because I kind of hate the whole g-tube/food pump aspect of his life, that it never really occurred to me to do things this way.

The other part of being able to fill up his tummy while on high chair spoon time is that he might start making the connection between food in his mouth and getting full, even though he's not eating enough to make that happen naturally. The dietician at this past visit made a very good point that we hadn't considered: we can make him hungry, but hunger doesn't create feeding skills. So, putting him on a hunger trial would just make him cranky since he doesn't have the necessary skills to successfully swallow enough food to be not hungry. He doesn't "get" hunger, which we knew, but we needed someone to put a different spin on it for us. So, we have some good suggestions to work with, and I hope that the pump will be a good daytime option for us. Because, if we can get him to hold down food and hold down more volume than we're currently feeding, we might be able to get rid of the night-time pump altogether. The only thing holding us back is that he can't hold down sufficient volume in a daily bolus feed.