BabyWhispererForums.com
EAT => Bottle Feeding => Topic started by: L76 on July 27, 2010, 07:21:26 am
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DS (9wks) hasn't been feeding that well over the last few days, really fussy and only taking 1-3oz in a feed. Adding to my worries about his lack of weight gain.
Anyway, over the weekend when DH was looking after him, he was feeding him after about 10mins of waking. Fine.
He was then feeding him again when taking him up to bed! Not so fine.
He said he would then drain the rest of the bottle (6oz bottle) and go to bed with no fuss, no crying etc. He would put him down awake. When I feed him, I feed at the start of the A time, and put down awake. He cries ALL the time and has to be coaxed into sleep. He is also very fussy and cries during his A time.
DH did this again this morning. He fed him at 6.30am (he woke at 6.20am after a 2.30am nw where he took 4oz) and he took 1oz. He then fed him again at 7am ish when took him to bed where he took a further 4oz.
So, what do you think? DH says for me to try it today. He thinks that A) he feeds better in a dark environment and B) if doing this means he goes to bed happy, who cares and C) he obviously isn't hungry enough at the 3hr mark.
I am nervous about this as it is not what we *should* be doing and don't want to create bad habits of feeding / snacking and him expecting feeds before naps.
Argh, what do I do now?
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Hmmm...
How long is his A time? Maybe making it half way through the A time, so there is still lots of A time after the feed and the feed is not associated with sleeping?
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Agree with PP, but also, is DS touchy? They do like to bed fed in dark quite, so I frequently feed DD in her room before we leave after she wakes.
Also, could it be time to try 3.5hr EASY? How does he handle his A time? I think both my kids started around this point with 3.5hr EASY
just some thoughts
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Well I gave his theory a go over the last two days, and on one occasion it worked, but the rest he refused the bottle still so I am none the wiser.
He has had a few, what I would call, good feeds of 4 or 5 or even 6oz but some he only takes 1-2 oz. And really still isn't that interested in the feed. Does a lot of pushing his legs into me so that he's almost trying to stand up.
Will be interesting to see if he is gaining weight as he's dropped from the 75th to 50th centile so the doctors want to see him again - probably as he's on nutramigen.
His A time is anything from 1hr (1st A time) to 1hr 30. But mainly gets fussy around 1hr 10-20mins. Difficult to sort his day out when A time isn't quite there, but E time is probably 3.5hrs if not more. Depending on when he wakes up for the day, if it is 7am I struggle to do 3 big naps (2hrs) and then a cat nap. But if it is 8am, I just do 3 big naps.
Oh well, expect another few weeks and his A time will increase again and we may be able to do the 3 big naps. All a bit alien to me as DD did 2 big naps and a cat nap from about 7 or 8 weeks. He just seems to not be able to do as long A time as she did - but she was an angel baby that never cried, even if tired. Whereas he fusses like mad. Am yet to do his quiz, havent got round to it yet, but expect he will be touchy (and a bit grumpy in there too!).
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Leanne I was going to say that this sounds SO similar to my DS's behaviour before his milk allergy was diagnosed - but then saw you said he is on Nutramigen already. How long has he been on it? Could be that the milk proteins are still working their way out of his system and he's still a bit uncomfortable, or could be that Nutramigen is not broken down enough for him and he needs Neocate?
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Hi Mashi
He's been on nutramigen about 3 weeks I suppose. I don't know much about MPI to be honest. It is interesting that you say his behaviour is similar.
What's the difference between nutramigen and neocate?
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Hi Mashi
He's been on nutramigen about 3 weeks I suppose. I don't know much about MPI to be honest. It is interesting that you say his behaviour is similar.
What's the difference between nutramigen and neocate?
In nutramigen the milk proteins are broken down significantly (called extensively hydrolysed), which makes them easily digestible to those who can not break down the proteins in their bowel (ie/ have a milk intolerance) or who are allergic to them (ie/ in the immune system). A hydrolysed formula like this is suitable for most MPI babies and toddlers so it's the first choice. However, there are some who are even more sensitive and need these proteins to be broken down 100% into their amino acid form (so often called elemental formula as aimno acids are the most basic elements of a protein) - and this formula is Neocate. (Well, Neocate is the main brand that has been around for ages but there are others, one of the newer ones on the market is Nutramigen AA, the AA standing for amino acid). It just means if he is still having issues with the proteins while on the Nutramigen, there is another formula worth trying...might be something to talk to with the doctor.
Just sounds like what you are going through is SO much what DH and I went through - it's cause we are not holding him right, the room is too bright, should have waited half an hour, increase the nipple, decrease the nipple, room quieter, put the TV on to distract him, and on and on - until we found out that it was MPI. And so if your LO is already MPI then it might be something further to think about. ???
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Is there a test that can be done to find out for sure if they have MPI?
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Not reeeeeeeeeeeeeeallly. I mean, yes, there are tests that exist to see if a baby is allergic (immune system reaction, so usually a blood test) and to see if they are intolerant (bowel can not break down proteins) I am pretty sure it would have to be a bowel biopsy as that is the only definitive testing that I know of for an intoelrance.
So they exist, but can pretty much guarantee that in the UK, it won't be done. Even the blood test - it's just seen as traumatic, invasive and expensive to do to an infant when a clinical diagnosis will be just as good (ie/ LO has issues, remove milk and issues are gone, pretty conclusive, iyswim?). They might do a blood test, but they'd have to have a good reason for NEEDING that blood test.
In the US there are lots of people who have had their LOs blood tested for allergy but is rare in the UK. Also, if it is an intolerance and not an allergy then a blood test is pointless as it will come back negative. So another reason why they dont bother, kwim?
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Nope - no tests for MPI - just improving when the dairy is removed :-\. (actually that isn't true - but it would never be done as it is actually a biospy from the small intestine which is VERY invasive).
Are you still doing any BFs as well?
It can take a few weeks for a LO to get used to HAF as they taste horrid. I tried to get J to take one for about 4 weeks and never suceeded. He was older at 7 mths by then though and realised it tasted foul.
He *might* not be hungry at the 3hr mark - some LOs do prefer a 4hrly feeding routine when on formula - even from a young age.
Mashi - how long did your DS take to get used to the nutramigen? I remember you had a period of adjustment to it as well?
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Yes, we had an adjustment period to it but DS started it at 5.5 months old, so it took him longer to get used to it. The younger they are the easier it is to adjust to it, and if Leanne's LO started at at 5 weeks old, it should not take TOO long to get used to the taste?
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Hey
He doesn't seem to mind the taste...if he can take an entire bottle (6oz) then surely he is ok with it!?!
His last four feeds have been 6oz (nw), 4oz (7am), 4oz (10.30am) and then 5oz (1.30pm). So ok really. It is just the struggle and fighting he does when giving it to him. He seems *in pain* maybe? Would this be the case...perhaps as it hits the stomach?
DHs brother had pyloric stenosis so I do wonder if he is going to be a bit of a handful feeding wise....?
I also have a hiatus hernia.
Anyway, thanks for the info re: neocate and testing etc. Since going on it, the differences I have notices are:
His stools have been sooooooo solid and he seems in pain to go IYKWIM
He takes less time to settle (but that may have been improved with age too?) although still a nightmare to settle in the evening
He still arches his back and practically turns over in the cot when laid flat and kicks like mad - pumping his legs
Still suffers from wind - top wind that it - doesn't often break wind from the bottom!
And the feeding is a stuggle as explained
BTW Mashi - did you notice a drop off in weight progress or was you DS too old to really notice anything? Since going on nutramigen, his weight has fallen off from the 75th to 50th.
We have got an appointment to go back to get him reweighed as they wanted to monitor him so will see what they say.
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Oh meant to also say, no, no longer bfing - stopped at the weekend.
Milk supply pretty much gave up on me :(
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It might be that the milk proteins from your breast milk is still working itself out of his system.
The arching, kicking etc sounds like it might be reflux ontop of the MPI. The struggling with feeding might be that he is refluxing whilst drinking and then he is trying to swallow whilst milk is coming up, a very uncomfortable thing to do. also when babies drink/feed - and grown ups eat ;) - we have a reflex called the gastrocolic reflex. Basically your body is trying to get the bowels moving and that is why many babies poop whilst drinking. If he is constipated, it can be that he is so uncomfortable while feeding because the poop is not moving along well. But my first instinct would be reflux. Does he ever bring up milk? I think you once mentioned he is congested alot. Is that still the case?
With pyloric stenosis you would expect significant amount of vomiting - projectile vomiting to be exact - ontop of the weight loss.
Henry was also quite constipated on the nutramigen. I added in lactulose once or twice a day, sometimes a half a teaspoon of brown sugar also did the trick. Once he was older, I added in an extra oz of water - so example I would add 5 scoops of formula to 6 oz of water, but I would NOT advise that atm with your LO, as he needs the calories if he is losing weight, and dropping off his percentiles.
The weight loss can definitely be due to him being MPI - on our BC you have read about Vicki and Emma right, with her also now having to go onto an ED. And as Mashi said, DS might need more than the nutramigen, he might need neocate. In the UK you do get pregestimil, which is another HAF/hydrolyzed formula. My DD could not tolerate the nutramigen, but does better on Alimentum - which is also a hydrolyzed formula here in Canada and slightly more broken down than nutramigen. In theory very similar to nutramigen, but she just is doing better on it. Still does arch a bit and still grunts abit whilst drinking, but MUCH less so than the day we tried nutramigen.
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I think Pregestimil is more than just a regular hypoallergenic formula -- is it not for babies that have additional problems breaking down sugars and/or in absorbing fats? I do know that it's not a direct substitute for Nutramigen (though Pepti Junior is, I am pretty sure).
If you have only stopped BFing then it could be as Di says him getting the last of the milk proteins out - seems strange but we had more of an adjustment or struggle with him about a month after he was fully onto the Nutramigen (ie/ no longer mixing it with other formula for the taste purposes) and paed said he felt it was just the last of his bowel struggles to eliminate the end of the proteins. Seemed odd to me but <shrug>.
We did also have some adjustments with poops on Nutramigen - just took a while for him to get used to it, really.
I would take lots of notes of behaviours, photographs of poops, small videoes if you can on your digital camera of all of his odd feeding behaviour, screaming episodes, pooping (ie/ if you can catch him on video really straining to poop, etc) and take them all with you to the doc - EVERYTHING helps!
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You are right Mashi, it has the MCT Oil (Medium Chain Triglicerides) which is for fat malabsorption, as the fats are absorbed with greater ease and it helps babies with low weight gain. It is used though as a direct comparison/substitute in the UK by some paediatricians, if they feel nutramigen is not doing the trick. Some will trial that prior to going to neocate. :-\
Interesting how on their own website, they go to and from nutramigen and pregestimil.
http://www.enfamil.co.uk/products/pregestimil.php
So essentially pregestimil seems to be nutramigen with the MCT added. I do know though some babies seem to tolerate it better than nutramigen. Weird.
Here is the Canadian version.
http://enfamil.ca/en/products/babies/pregestimil.html?gclid=CJmhjIGFkaMCFdVb2god-ni7sQ
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Blimey you ladies are sooooo knowledgeable! What would we do without you!
Mashi - I already took a photo of DS's poo yesterday! It was so solid!
And last time I went to the doctors I took a video of what he does when we lay him down for a nap!
Think I will definitely take another one of what he does when feeding.
He has been doing many more wet burps lately too. Sounds like bits of milk coming up when he burps - this is always after the initial easy to get up burp IYKWIM.
Didn't realise the milk proteins could hang around for so long. I think my last bf was last Friday night or perhaps Thursday night - so nearly a week. The feeding standing / arching thing began about a week ago. We've always had trouble with him when feeding in a sense that if you take him off to burp him mid feed, he won't take it again. So whilst for wind purposes it would be good to burp him mid feed, b/c of his weight issue, I've not been doing this.
Sounds awful, but at least if his weight is still an issue, they may look to do something more.
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Sounds awful, but at least if his weight is still an issue, they may look to do something more.
I hear ya! Before DS was diagnosed with MSPI and we were having sooooooooo many problems (I think I just used to cry from eyes open to eyes closed every day, ironically that's because that's all DS did too :-\ ) DH and I used to talk about how "great" it would be if DS would just lose loads of weight and then my GP would listen to us. How horrible is that? So I know where you are coming from. :-*
On the Neocate website it gives calculations on how many scoops to use per ounces of water depending on how many calories your LO needs - basically when a baby has lost so much weight from MPI they need to get it back up so they do more than a 1:1 ration, usually a paed would work it out for you how many calories your LO would need and then you work out how much extra to add to a bottle...not saying that you should do this or anything, just saying that if/when they decide he has lost weight there are things they do to try to pack in the calories and bring it back up iykwim.
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Does the feed fighting correlate with stopping the ranitidine and domperidone?
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Hmmm, you know Liz, I am not sure now. Things are getting blurred on what we have and havent been doing IYKWIM?
We stopped the meds at the same time we changed to nutramigen so we could see what made a difference. But thinking about it, the fighting is probably only the last week at most. I know he was doing it at the weekend - so yes, about a week.
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So if it is reflux ontop of MPI, then that might be why he is fighting more and arching and restless with feeding and laying in bed. Something to consider at least.