4 month old started refusing dream feed and waking up at 5-6 am...

[Apsof2010]

Hi everyone

This is my first post on this forum though I've read a lot of useful information on here. But I couldn't find the same issue posted before so I thought I'd ask...

My 4 month old daughter is formula fed and used to take 4 bottles a day plus a dream feed and then sleep till 7 am ish. She slept like this from 2 months old and we considered ourselves very lucky (still do:))) anyway recently she first started to take less food down, it was hard to get her to drink more than 2 oz at a time! We put it down to teething although no teeth are through yet. Then she started refusing her dream feed - she would let me change her nappy np, but absolutely refused to drink anything... So for a while now she has been drinking a less during the day plus no dream feed so now she wakes up at 6 ish but not crying, just happy playing in her cot (still impossible for us to sleep)

So this morning I tried to feed her at 6 am as I thought maybe she's hungry because she effectively dropped one feed. She took 1 oz and then fell asleep again until 7:30 and then only took 3 oz 

I am really not sure what to do. The 5 am feed is the hardest for me and was the most difficult to get rid of and I really don't want to go backwards, but i also worry about her food intake.

She sleeps fine during the day in fact she really likes her sleep ... She takes 3 naps in one day of a total anywhere between 3 to 5 hours (she's happier when it's 5) goes to bed at 7 ish but quite often is tired and has to be in bed at 6:30

Of course early waking is affecting her day time sleep and everything basically.... Feel like our routine no longer working

Maybe somebody had the same problem?how did you resolve it?

Do I need to start solids maybe?

Thank you



 

[Lolly]

Hi there and welcome!

Have you tried using a faster flow teat? How much is she taking over all in 24 hours? If her milk intake is dropping I would be hesitant to add solids in because it will take up milk space in her tummy.

Can you post her EASY in terms of

Eat - what times, how much
Activity - how long for
Sleep - what times, how long for.

It could be teething causing the problems or some babies get very distractable at this age. Have you tried feeding her in a darkened room with no distractions?

Sorry for all the questions but a bit more info will help us!

Laura

[Apsof2010]

Thank you for your reply, Laura

I have tried faster flow teats and she chokes on them. When she does drink she finishes her bottle really quickly - 10 -15 minutes on the medium flow. And it doesn't make a difference whether it's quiet or not, I really don't think distraction is an issue here.

Her daily milk intake varies from 16 to 26 oz (on a good day).

We had similar feeding issues when she was a little bit younger and even took her to the doctor but because she was actually gaining weight they didn't bother. First doctor said colic, second constipation, then maybe reflux, but she didn't improve on gaviscon either. She improved by herself until now.

Her EASY before she decided to drop her dream feed:

Wake up 6:30 ish
E 7:00
A usually 2 hrs from last awake
S 8:30-9:30 (or 11:00)
E 10:30 (or 11 if she slept longer)
A
S 11:30-13:00 ( or 12:30-13:30 if morning nap was long)
E 14:00
A
S 16:00-17:00
E 17:30
A bath routine
S usually by 7, sometimes even 6:30

E 10:30 dream feed which she suddenly decided to drop.... It used to work really well, but now she absolutely won't take it

Overall her nap times are not really controlled, I just let her sleep as much as she wants but not past feed time. So she will usually have one long nap and 2 shorter ones.

She will not take a bottle after her bath, so we are now stuck with  just 4 feeds in 24 hrs. I'm puzzled....

Oh I also thought about teething, so now we give her 'teetha' granules and some teething gel before feeding... Works only sometimes... The main problem for me is the missing dream feed that I think messed up her sleeping through the night....
 
Thanks

Anna

[Lolly]

How is her behaviour on the bottle when she feeds and after a feed? Have you tried a variflow teat? She seems to be sleeping well generally - are her naps solid or do you have to resettle at all?

Laura

[Apsof2010]

She sleeps with a dummy but I don't resettle during the day, I just assume she's had enough when she wakes up since she wakes up really happy and sometimes I don't even know she's awake she'll just play in her cot.

We use mam bottles and i don't know if they do variflow ...
She usually takes 2oz no problem and then arches her back and cries sometimes, turns head away.... Sometimes she'll burp and drink some more, but usually it's whatever I can get in her in one go, she rarely takes bottle again after a brake.
She calms down quickly after a feed

[Lolly]

Hmmm - that's pretty typical reflux behaviour and certainly how both my refluxers behaved before we got things under control.

I would go back and see your Dr and ask about reflux again. If she is on normal formula it may be worth trying a reflux formula - both mine did much better on Enfamil AR than they did on gaviscon. Reflux can flare up around 4months so with her reduced intake, behaviour while feeding and refusing feeds it's certainly worth considering.

Laura

[Apsof2010]

Thanks Laura

I have been considering it. She doesn't spit up though... Did your babies spit up? It feels like the doctors are reluctant to really do anything because she is on her % tile and not vomiting....

[Apsof2010]

Woke up with more questions

Do you have to have a prescription for enfamil ar? I'm in the UK and haven't seen it anywhere... Is it likely to cause constipation? Our baby tends to get constipated easily (her worst constipation was on aptamil comfort!) we manage it by giving her 1-2 oz of well diluted apple juice a day

Well, my lo keeps surprising me... Yesterday was a bit off cause we were out most of the day. So the day went something like this:
Wake early but waited to feed til 7
E 7:00 only 4 oz
A
S8:30-10:00
E 10:30 4 oz again
A we went out
S 12-12:30
E 13:30 4 oz struggle
A
S 14:30-15:00 in the car
Then we got home and I didn't know what to do with her, she seemed both tired and hungry
E 17:00 6 oz!!
No A
S 17:30 I hesitated wether or not to wake her up or just leave her to sleep for the night.
A 18:30 On advice from my husband I woke her up at 18:30, gave her a bath, then offered a bottle,
E 19:00 she took 4 oz. And she never drinks after a bath( maybe because very tired?)
S 19:30

And didn't hear from her until 7:10 am! I even woke up before her
So what do you think made a difference?

Thank you

Anna

[Lolly]

Enfamil AR is usually only found in pharmacies and they will probably have to order it in for you and it only comes in  400g tins. I know I priced it over 1 year ago and it was just under £4 a tin which made it slightly cheaper than the Aptamil comfort gram for gram! That said it is available on prescription so your Dr should do that. It has rice starch in it so it can cause constipation in some babies but mine have both been ok on it.

Not all refluxers spit up/ vomit. My DD is mostly a silent refluxer with an odd mouthful here and there but you can hear her bringing stuff up into her throat and swallowing back down. She also had a cough from birth which only went away when she was on the formula and meds. She started life on the 75th centile and moved to the 91st where she has very firmly stuck - but the difference in how she fed was very marked after treatment. She has always been a good sleeper and napper, but has also slept on an incline from birth which really helps.

Have a look here for some info http://babywhispererforums.com/index.php?topic=654.0 , take a list with you to the Dr and emphasise how difficult feeding is for her. If you are getting nowhere ask for a peadiatric referral.

As for yesterday - not sure! Maybe the short naps wore her out! See hoe today goes!

Laura

[Apsof2010]

Thanks for your advice Laura. You really made me think more seriously about the possibility of reflux. I just ordered some enfamil AR from boots, will try and see. It worries me that it can cause constipation because it's a real issue for my dd. But I guess we just have to try and see. Can I give her enfamil only at "difficult" feeds and her regular hipp in the mornings when she is usually ok? Just to try to avoid constipation....

My dd sleeps on her stomach from birth. We got some grief from HV about it but it's the only way she will sleep. I wonder if it can also be related to reflux...
 

[Lolly]

You could, but I wonder if that would cause more problems with chopping and changing. Personally I would give the enfamil a good go and see what happens - you can give her some cooled boiled water between feeds or lactulose works well - it's a stool softener which the Dr can give you.

You will probably need a faster teat, although the enfamil works by thickening in the stomach it is a bit thicker than normal formulas! It does need to be made in a different way too. You need to add the powder to cold or room temp water not warm. We sterilise bottles, put in the water from the kettle then keep them in the fridge. We add the powder at feed times and you have to keep the bottle upright and roll it between your hands to let the powder settle in to the water before you shake and then warm it.

And yes, lots of mums find their refluxers sleep better on their tummies!

Laura

[Apsof2010]

Sorry for asking so many questions... Thank you so much for your advice!

How long were your LOs on enfamil AR before you noticed the difference?

I'm still confused about her missing dream feed? Should I try to fit 5 feeds between 7am and 7pm? Or feed if she wakes up at 5-6am?
 

[Lolly]

It took a few days with DD when we started her at 10 weeks and for DS he started on it at 6 months and again a few days and we saw a difference. For both of them they fed more comfortably and took better feeds and in DS's case stopped vomiting bottles back up .

If she is only taking small feeds it probably would be a good idea to take her back to 3.5 or even 3 hourly feeds for the time being. Some refluxers tend to do better on smaller more frequent feeds so if it is reflux and you can get her sorted you can move the feeds further apart again.

Laura

[Apsof2010]

Laura, thank you so much for your help

So for the last 2 days I managed to squeeze 5 feeds in 12 hours and both nights she slept soundly till 7:15am. I guess it's the way to go to solve a missing dream feed problem!

This morning she took 8 oz which is unheard of! I had to burp her once during the feed. Yesterday was also a little better, morning feeds 6 oz each, it's the afternoon ones I usually have to struggle with... Do you think it might be wind rather than reflux? I put her in her play gym 10 mins after her morning feed and she seems to be fine... Although she hates being on her back any other times, especially in the car (we have a lie flat carseat since she won't stay a minute in the regular one)

Who knows.....you see, she 's not too bad for me to convince doctors to investigate further, but she is uncomfortable most feeds, even if she takes a full feed, she will sometimes cry for some time afterwards, which suggests there's something bothering her...

[Apsof2010]

I think I spoke too soon.... Last feed was back to 'normal' 3 oz down and then fussing and crying, calmed down after a burp for a little, then refused to take any more milk and carried on crying until we went out...

Oh well, got some AR formula to try at the next feed

[Apsof2010]

First feed of AR formula was a disaster... Although she took almost 5 oz she screamed worse than ever:( but I'm going to keep trying for a couple of days, maybe she just didn't like the new taste...

It's always something with babies, isn't it?

[Apsof2010]

Laura, I hope you don't mind me asking a few more questions...

I prepare AR according to instructions, but I still see little crystals on the sides of the bottle as though it's not dissolved properly. Is it normal?

And it also gets very bubbly from shaking, do you wait for bubbles to settle before you feed?

And how do you warm it up? My DD likes her milk warm. I usually just warm it up in a bowl of water but not sure with this new formula

Thank you!

[Lolly]

Reflux can give you good days and bad so don't rule it out on a few good feeds/ days! Yeah for two good nights! Try and keep her upright for a while after feeds, that will help the milk settle. They don't usually do any investigations with babies, it's diagnosed on history and symptoms and usuallu a meds trial - if it helps it's reflux if not think again. If you can get the Dr to agree a trial of ranitadine at a decent dose (at least 2mg per kg x 2 per day - 4mg per kg is top dose) for a few weeks you should know if it is helping or not. Ranitadine (zantac) is safe for babies and has very few side effects so if it isn't reflux you won't be doing any harm in trying the meds.

The enfamil does go a bit bubbly when it is shaken, you can let it settle or try another bottle like Dr Brown's if it's a problem (if you are happy to try another bottle type that is, I know it's expensive). We use Avent bottles and their vari flow teat which is quite a fast teat but suits DD and the teats help the air to escape. I find that some bottles look really grainy on the inside after a feed and then we get some bottles that are totally clean after. I used to notice the grainyness (is that a word ) with the comfort formulas too so I don't think it's anything to worry about. It could be the temp it's warmed to, or shaking it a bit longer - who knows!

It's totally fine to warm it in a jug/bowl of water like you used to do - we are very bad and use the microwave but DD will drink it at room temp so we don't warm them that much anyway any more.

It could be the taste she was objecting too, I think it smells a bit better than some formulas! It will take her a few feeds to adjust and it doesn't start working until it hits the acid in her tummy so she will need to have a few feeds for it to start helping her - if that makes sense! Did you use a faster teat - maybe it wasn't flowing fast enough for her if you didn't.

Let us know how tonight and the next feeds go! Sorry I didn't get back sooner - today was a work day, which my daughter obviously knew as she decided sleeping was for wimps last night .

Laura

[Mama2boys]

brb

[Apsof2010]

Laura, I can't thank you enough!

It seems like I am the only one in our family who thinks our DD has an issue... My husband thinks she is fine and she just doesn't want to drink anymore where's I see that she is in a great deal of discomfort mid feed and after. She's not inconsolable that's why my hubby thinks it can't be acid because it would burn for longer periods...

Feeds on enfamil are not going great so far, tried the fast flow of our mam bottles - it was too fast for her, then tried variflow boots own brand, the flow seems fine, but the shape of the teat is so different to mam's that she gets confused and doesn't latch on properly...not sure what to do, but determined to give this formula a go and also see how it affects her BM tomorrow. Gave her some water today from her new sippy cup
 

[Apsof2010]

Just wanted to give an update on us....
AR formula made DD constipated, so we didn't really give it to her for long enough to see a difference...
We took her to a private paediatrician, described all the symptoms, and he said milk intolerance was more likely than reflux. So he prescribed neocate to try for a couple of weeks, and if she doesn't improve, then consider reflux more seriously. So we are now struggling to get this terribly smelling neocate into her