Ava's digestive tract has been causing her problems since just a few weeks of age. Initially, she was diagnosed with reflux (GERD) and then a milk protein allergy. A little Zantac and removing all milk products from my diet (Ava breastfed her entire first year of life), and she was a new baby. No further back arching or crying after feedings, no more gas, and a much less fussy baby was noticed within a week.
Typically, infants will grow out of significant reflux around 6 months of age, and out of a milk protein intolerance by around a year. However, we noticed each time that Ava started to grow out of her Zantac dosing, she was waking more at night, actively regurgitating, and even developed a chronic cough. Even after she was a year of age she continued to have symptoms - and she continues on Zantac even today.
I will be honest and say that I was not convinced that Ava truly had a milk protein intolerance (which is a gut intolerance to the protein that is found in milk, which is different than a lactose intolerance), mostly due to the fact that I was having to go without cheese, butter, and *gasp* ice cream. Since she was 4 months of age, I have tried numerous times to reintroduce dairy into my diet (when I was breastfeeding) or her diet, and each and every time has been an epic fail. The first time was an accident - I started drinking a daily protein shake and did not realize for over a week that it contained casein. (Whoops.) The last time was a few weeks ago when we tried to start cheeses and yogurt, but this was another fail. Gas, diarrhea....I am sure that you are so glad that you decided to read this post right now. :)
Which brings us to the latest development in Ava's tummy...gluten. Last November (Ava was 14 months old), I noticed that Ava was having loose stools and more gas. We looked closely into her diet, but did not find any hidden sources of dairy. I chalked it up to teething at the time, and moved on. At our December 15 month check-up, we noticed that she was starting to drop off of the growth chart. As an infant, she had always been 50 percentile for her height and weight. At 12 months, she had dropped to around 30th perentile, but this can be very common due to their increased energy expenditure (ie, running around like a mad woman) and I honestly did not give it a second thought....until December. At that appointment she continued to drop off the chart, and was around 25th percentile for height and 20th for weight. I noticed that she was having more diarrhea, gas, and bloating. She also had a small, red rash that had come and gone since around 7 months of age, but had become more persistent in the recent months. The thing that really tipped me over the edge was seeing pictures of a naked, bathtime Ava in October and again in December....the obvious change was startling to me. In October she was chunky all over with an equally chunky tummy; in December her arms, legs, and chest looked thin, but her abdomen was protuberant - she was starting to look like the protein-malnurished children from Africa with Kwashiorkor. She was 15 months old and had been in 9-12 month clothes since May, and with the exception for around her bloated belly, they continued to fit loosely.
As a pediatrician, I am familiar with the symptoms of failure to thrive (poor weight gain), diarrhea, gas, and rash as being related to gluten sensitivities. After discussion with Ava's pediatrician (who is amazing!), we decided to cut out gluten containing foods from her diet, which started completely a few weeks into January. The results have been amazing, to be honest. Her stools are now, for the first time since around 10 months of age, normal. She doesn't have gas pains like she did. Her rash has disappeared. And her growth has been remarkable. In just 6 weeks she grew out of those 9-12 month clothes, into her 12-18 month clothes, and is now growing out of those! At her 18 month check up in March, she had grown so much that she was back to the 50th percentile for height AND weight.
The best parts, and the ones that I was not expecting, were the changes in her behavior and sleep. Ava has always been a wonderful child with a beautiful personality, but during that time she was having frequent tantrums and could be fussy for no reason. I really thought that our toddler years were just starting a bit early, but this stuff has decreased dramatically since gluten has been removed from her food. And those 18 months of sleep deprivation, when everyone insisted that we make her cry it out, and when we tried to let her cry it got worse, and the wakenings became more frequent and crying more severe - well, I am happy to announce that she is now sleeping fully through the night (with the exception of the occasional, quick 4 am shout out). We knew in our hearts that something was wrong when she was awakening, that she did not feel well and that she needed help to calm down and go back to sleep, and I am so thankful that we listened to our gut. Just like I tell the parents of my patients, God gives mommy instincts for a reason.** We are all well rested now, and so thankful for it. We have even had to wake her up to get her to daycare in the mornings! She can finally join the "Good Sleepers Club" that her BFF Amelia has been a member of for so long.
So here we are, gluten and dairy free, and Ava growing well and completely thriving. But a few questions remain: Will she grow out of either of these intolerances? Does she have Celiac disease? Will we ever be able to stop that Zantac? I honestly do not know the answers to these questions, and only more time will tell us more (right now, each time she ingests gluten we know pretty quickly, as the symptoms are very evident). We have discussed further testing for Celiac with our pediatrician, but this can not be done until she is 2 years old and requires gluten in her diet for months - and that is just not do-able for us with all of the symptoms that it causes. Thankfully, Whole Foods and Hy-vee have excellent dairy-free and gluten-free sections, and we have been able to find substitutes for just about everything that we eat. The toughest part for us right now has been finding places to eat out, especially when we want something quick, that does not contain gluten or dairy and that is healthy, too. (If any of you have suggestions, let me know! We find ourselves eating Mexican A LOT, especially Chipotle. And as much as I could eat it every day, I think that Josh feels like he is turning into a burrito.) Overall, we are so very blessed to have a little one who is healthy, happy, and growing!
**For the record, I do not think that crying it out is necessarily a bad thing, as long as the child is old enough. Some kids respond really well to it, and it can help them to have healthier sleep habits by learning to fall asleep on their own, whether it be at bedtime or when they wake up in the middle of the night. But that said, it does not work for everyone, or in every situation. I fully believe that God gives moms (and dads) instincts, to be able to give their children just what they need to feel nutured and to thrive; and, when something like crying it out does not feel right, it needs to be re-evaluated. Just wanted to clarify that I do not think that all of you awesome mommies that have let their little ones cry are wrong for doing so!
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