I’m a worrier. I worry – a lot – it’s what I do. I’m pretty good at it. I know that I’m a worrier and I work really hard to keep it in check (but I’m not so good at that part). So, keep this in mind as I recount E’s first four months of life.
E was born about 3 weeks before he was due and about 5 weeks after we moved from Florida to Pennsylvania. Luckily we had a wonderful team of family members who helped us unpack, build furniture, and stock the nursery. We were pretty much ready for his early arrival, except for the fact that the carseat wasn’t installed and our last childbirth class was scheduled for the day after my water broke. But we had a crib and diapers and lots of adorable little clothes, so we would be able to manage. Like any new parent, we were super-excited and had no idea what to expect.
I’m sure you saw this coming, but even in my haze of overwhelming love and awe at the human that we created, I found something to worry about. I was concerned that nursing wasn’t going well and that he was losing too muchweight. To be fair to myself, this worry was the result of the fact that nursing wasn’t going well and he was losing too much weight. These are facts. It had been my goal to nurse E for as long as it was possible and realistic for us. I tried not to have unrealistic expectations related to breastfeeding. Other women in my family had difficulties nursing and with supply and I was worried that I might too. But I was determined to try. The first time I nursed, in the delivery room, E latched on immediately! I was so relieved, which only led to more intense frustration hours later when the nursing stopped going well. I worked so hard at it, I saw several lactation consultants and talked to some very patient postpartum nurses while we were in the hospital. We were doing ok with the nursing by the time we were supposed to be discharged but E had lost a significant amount of weight (just over the acceptable 10% weight loss). The hospital pediatrician wouldn’t discharge us until we confirmed that we could get an appointment with our pediatrician the next day. At that appointment the pediatrician strongly suggested that I start supplementing with formula. She also referred me to another lactation consultant who was great and supportive and had us doing all kinds of crazy things to support breastfeeding while supplementing with formula. By his weight check at 4 weeks he was back to his birth weight. We breathed a sigh of relief and stopped supplementing. I could stop worrying about that (for now).
Which was good, because I had already found something else to worry about. As a newborn, E had a tendency to spit up. He spit up a lot. Like all the time. And not just a little dribble of spit-up, but an amount of spit up that often required an outfit change, for him and everyone in his general vicinity. I never left the house without two or three changes of clothes for him and at least one change for me. I still feel a little guilty because he spent about 6 months in one-peice pajamas. He rarely wore those adorable little outfits that I was showered with prior to his arrival. It just didn’t seem worth the trouble of getting him into a complicated outfit that would be drenched with spit-up within the half-hour. My parents and in-laws learned to wear old clothes when they came to visit and cuddle with their new grandson. It was a given that they would leave covered in vomit. I didn’t get out much but when I did I usually had the pleasure of mopping spit-up off of the floors and furniture of our hosts. I can keep going but I don’t think you’ll ever comprehend the amount of spit-up that came out of this adorable tiny creature.
I was a new mom but I knew that babies have a tendency to spit up. Whenever I brought up the amount and frequency of the spit up, I was assured that spitting up was completely normal and we had nothing to worry about. Still, it didn’t seem right and I started to worry. When we reported it to the pediatricians they asked if he spit up after a meal. Yes. He spit up after a meal, and before a meal, and during a meal (which is great when your are breastfeeding). He spit up all the time! Granted, he was a newborn who was a bit of a lazy eater. He nursed every two hours and usually fed for about an hour, so it was almost always after a meal. I was told (and read) that the amount of spit up always seems to be larger than it really is. I was told that he was a “happy spitter,” a baby who spits up just because his esophageal muscles were still weak and that it wasn’t bothering him. I was told not to worry.
I worried. I worried when we put him in the cradle. Is back really best for babies who spit up so much? Couldn’t they aspirate? I read study after study until I was convinced that it wasn’t a concern. I still worried. I didn’t believe that E was a “happy spitter.” I’ve taken a lot of psychology classes and read a lot of books on happiness and depression, and I was pretty sure that spitting up didn’t make my baby happy. He cried a lot. He arched his back. It woke him up and prevented him from sleeping. In fact, I started to recognize the pre-spit-up grimace that provided me with a couple of seconds of warning and a fleeting opportunity to reach for a burp cloth before the eruption. If it didn’t bother him, why did he grimace? I worried that something else was wrong.
Then there was the poop, or lack thereof. E would go several days without pooping, almost a week. And he just seemed so unhappy. He was squirmy, like he couldn’t get comfortable and acted like he was in pain. We assumed he had awful gas pains and was terribly constipated. We called the doctor frequently. I’m sure our name was on some sort of list by the phone. But we were worried. We didn’t know any other baby who pooped so infrequently. The doctors weren’t worried, but I was.
E’s 2 month well visit was traumatic. He was significantly underweight. At that visit he was in the 0.37 percentile for height and 1.25 percentile for weight. For the first time since we left the hospital, I felt justified in my worry. I could tell the doctor was also worried. I was devastated but I had a whole list of things I wanted to discuss with the doctor. I was really worried about the lack of poop and the discomfort that he seemed to be in as a result. I was worried about spitting-up. I was worried about his baby acne, which had spread from his face to his neck and chest and seemed to be getting worse. The doctor prescribed Zantac, believing the spit-up may be acid reflux. He prescribed a topical steroid, explaining that what we thought was baby acne was actually moderate eczema. He ordered an upper GI to confirm that the spit up wasn’t an indication of a blockage preventing him from digesting his food. Most significantly, he suggested that we go back to supplementing and go back to the lactation consultant.
The upper GI was normal. His spit up was determined to be normal. Once again, he was labeled a “happy spitter.” The lactation consultant determined that he was latching well but that my supply was low. She recommended that we continue to nurse but also continue to supplement. I’m still surprised that the lactation consultant was so encouraging of supplementation, but that isn’t the most important thing she said to me. She told me that it seemed like E had a milk allergy. She noted his spitting-up and his eczema and strongly encouraged me to explore the possibility of an allergy.
At that point I tried to limit my dairy intake, but I didn’t cut it out. I didn’t really believe that milk was the problem. But I brought it up at our next weight check (E was getting weighed every 2 weeks). I also brought up the fact E was still spitting-up a lot. This time we saw a different pediatrician in the practice. She switched E to omeprazole, saying that Zantac doesn’t work for everyone. She thought the lactation consultant may be on to something and suggested switching him to a soy formula. By the way, he was gaining weight at this point. phew.
By now I was getting really worried. My little man was still spitting up a lot. I felt like no one really understood what “a lot” meant. That was when I remembered – I’m a scientist. I needed to quantify “a lot.” We started keeping track. I put a post-it on the coffee table and made a tick mark every time there was spit-up. One day we had 27 tick marks! We shared our data at E’s next pediatrician visit. Finally, we got our point across! The doctor admitted that this was an usual amount of spit-up. We also reported that we had to stop the soy formula after a couple days because the spit up didn’t improve and E became really constipated. (We now understood that what we were seeing before was not constipation. The poor kid wasn’t pooping because he didn’t have enough in his belly, between my low breast milk supply and all the spitting up.) The doctor heard us! She had us switch E to Nutramingen, a partially-hydrolyzed formula and referred us to an allergist. In the meantime, I decided that it was time to start weaning E from nursing and focus on only formula. He wasn’t getting that much milk from me anyway and I wanted to know for sure what proteins he was ingesting.
At the end of December 2012 we had the allergist appointment. It was the most thorough medical appointment I’d ever attended, including the ones that I led (which I always thought were incredibly thorough). The doctor took a detailed history, which suggested to her that he was allergic to dairy and possibly soy, but conducted a scratch test of the top 8 allergens to be sure. I remember waiting for the results and talking to my husband about what a dairy allergy meant. His cousin has a dairy allergy that had required hospitalization but we still didn’t understand the severity of E’s allergy in the moment. We thought surely a dairy allergy wasn’t the same as something like a peanut allergy. When the nurse came in to read the scratch test she initially thought they all were negative. However, when she got out her ruler she realized that the dairy scratch was slightly positive. The doctor came in to discuss the allergy, along with an emergency aciton plan and we were trained on how to use an epipen. That’s when it hit us that our son had a life-threatening allergy to milk (of all things!). The doctor prescribed an elemental formula, which doesn’t have proteins in it at all, just amino acids. She told me I could continue to nurse but that I should cut dairy from my diet. She seemed pleased when I told her that I had already decided to stop. I felt validated in my decision to wean and, as scary as it was, we were glad to have an answer and a plan.
That’s the difficult thing about worry – sometimes there is a real reason for it. These four months taught me to trust in myself and my gut. To not work so hard to conceal and ignore my worry. To believe that I knew what was best for my son, and to always remember my strengths and my ability to collect data.