Bennett's Visit to the Gastroenterologist

Yesterday, I took Bennett to see a GI doctor up in Baltimore regarding his feeding and reflux issues. It was a very reassuring appointment!

First, with regard to the reflux, the doctor believes that Bennett is getting better, not worse. Think of it as a mountain with a sharp peak at around 4-5 mos of age and then a steep decline. He believes that the hunger strikes Bennett went on the past month were evidence of the "peak" and the fact that he has been much better recently signifies that he is on the downward fall. He said that 65% of all babies have some reflux, but only 2% of them have it at 12 mos of age. So, we should expect to see things getting better from here on out!

I asked about the possibility of acid damage caused by the severity of his reflux previously, such as an ulcer or esophogitis. He said that he could scope Bennett to see if there is damage if it would make me feel better, but he really doesn't believe that he will find anything. Babies will damage like that are incredibly fussy and inconsolable. That is NOT Bennett :) He's such a happy baby absent feeding. So, we're going to put that issue on the bottom shelf and revisit it if things get bad again. But for now, the assumption is that the reflux is quickly on its way to resolving itself.

What he does believe is causing the persistent feeding issues (albeit MUCH better than before) is a combination of Bennett's "opinionated" personality and a minor oral aversion that he acquired during the peak of the reflux. While we can't do much to change his personality (nor would we want to!), we can give him time to see if the oral aversion dissipates. If not, then January we will take him to a feeding clinic that specializes in this sort of thing. In the meantime, we should avoid creating any negativity around feeding. He said let him eat for about 20-30 mins, but don't push it beyond that.

Now, with regard to the growth issues, he said although Bennett is incredibly tiny (the size of a 3 month old), his height to weight ratio is excellent. That means that he is very healthy, as the first thing you see decline in a baby that is nutritively lacking is a decline in their height to weight ratio. He is on the lower end of "normal" for caloric intake, so if his weight gain continues to be an issue we may consider adding back in some fortifier to make the milk around 24 calories per ounce. The normal range is 80-120 calories per kilo, and Bennett gets exactly 80 calories per kilo if he eats his usual 24 ounces per day.

So, why is he growing so slowly? We still don't know. But the doctor believes that the most likely cause is simply prematurity. The "norms" for what is expected for preemies in terms of growth are skewed by the fact that the vast majority of preemies are much larger at birth (78% of all preemies are born over 34 weeks - yay!!). But they typically think of preemies who are born under 1500 g (like Bennett) entirely different. These babies tend to have many more medical issues and tend to grow much more slowly. But the good news is, most of them, absent persistent medical issues, DO catch up by 2 years of age. Hardly any <1500 g babies catch up by 1 year of age. So the problem here is more our expectations than anything "wrong" with Bennett. I asked him about the drastic drop in his status on the growth chart, and he said that was caused by a drop in the calorie per kilo intake that occurred as Bennett grew older, but didn't increase milk intake. He said that if Bennett had been on regular breast milk from birth with no foritification, we probably would have seen this very slow growth patter from the start. But this is clearly something that is really out of our control. If he "falls" more on the growth chart, we will take him to an endocrinologist to test for metabolic disorders, but he doesn't think that will be the case.

I am actually very comforted by all of this. I'm finally getting explanations that make SENSE, and feel confident this doc knows what he is talking about. It makes me VERY happy to hear that Bennett isn't suffering in any way. It seems that the slow growth is more of "my" issue than his, and I have to try to let that go.