has anyone experienced this?? I need help and guidance

[D2323]

My  6 month old has been battling me to eat. She has reflux and has been taking meds for 3 months. They have been adjusted for weight etc. Around 3 months she began refusing to nurse. I don't know if it was the reflux, my letdown or a combo of the two. She would take a bottle at that point and while she would sometimes struggle and choke, was getting plenty of milk down. Within the last month it has progressively gotten worse. We battle with every bottle. She will only drink around 2 ounces at a time so we are constantly trying to offer her the bottle and fighting to get enough milk in. I feel like all I do is try to feed her. With that constant attention and at times making her eat even when she is trying to refuse I can get the bare minimum in her to keep her hydrated and from losing weight. The doctor says if I don't start getting more in, it will begin to negatively impact her and she won't grow. She already went from the 50th % to the 35th in weight. I pump breast milk for her and we have looked into all the allergies and intolerance already. We have started to introduce formula because my supply is dropping. There is no difference with the formula. We have tried every kind of bottle with no luck.  If she is asleep she will eat just fine and suck down a bottle quickly, which makes me think it is not something mechanically wrong with her throat, swallow, etc.  I end up trying to feed her all night long, just to get in the ounces. I for the life of me can't figure out why she battles so much to eat when she is awake. I keep thinking it will get better but it doesn't and I'm so worried that she is not going to gain weight. Has anyone experienced this or have any advice?

[Lolly]

Can you give us a bit more info please!

What weight is she and what meds is she on for the reflux and at what dose?

What bottles and teat flow are you using? Have you ever tried thickening?

Can you give us a typical day/ night with times and amounts of milk? Is she on solids - if so when and how much?

It could bet he reflux isn't as controlled as you think, it could be that feeding her at night is having an impact on the day or you have a snacking issue going on. With a bit more info we can try and help!

Laura

[D2323]

She is 14 lbs 6 ounces (or she was last weigh in)
She is on Prevacid 15 mgs. Takes half in am and half in pm
-we are using medium flow (3 months +) we moved up from the 1 mth + hoping that would helped and have also tried the next step up nipple too but she was choking a lot
-She eats a tablespoon or 2 of oatmeal at dinnertime
-Typical feeding is sporadic because she will only eat a little at a time and it is constantly changing how much she will eat. Sometimes I can get 5 ounces in but the next day same time it may only be 2. It's really hard to list because it changes so much but here is a general day:
DF at 10 (3-4 ounces)
wake 6:30 (3ish ounces or more if she will) will try to get 2-3 more in before nap
sleep 9:30 when wakes from that 3ish ounces will then try to get 2-3 more in before nap
sleep 2:30: when wakes from that 3ish ounces will then try to get 2-3 more in before nap
oatmeal around 4:30 then another 5 ounces before bed.
We generally try to get 15 ounces in before 4 p.m. then another 5 before bed (which usually have to be given while she is falling asleep)
then a DF at 10.  It can be very sporadic, I may get the first whole bottle down in 45 minutes then it may take 2 hours starting and stopping to get the next down.

[Lolly]

I think you have a snacking problem really - she is having little amounts too often and she isn't having a chance to get properly hungry and take a decent feed. When you say you looked into intolerance etc are you doing an elimination diet? If so what are you eliminating and does that include all the hidden stuff in foods? If you have formula in a bottle you need to discard it an hour after a baby has started drinking from it as it gets contaminated from bacteria in their mouths - breastmilk is ok for longer.

I *think* the prevacid dose is ok but although splitting it is often a good move as babies metabolise the PPI quicker than adults it may be that the half dose isn't at a theraputic level for her.

A bottle feed should be done with in 20 mins really - a baby should be able to take what they need in that time. I would start afresh in the morning and give her the first bottle, let her feed for about 20 mins, 30 max and then stop the feed. I would then not feed her again for 4 hours (or a bit sooner if she only takes a couple of oz and then is showing clear hungry signs but stretched for as long as possible) which is how long she should be able to go between feeds at this age. You may well get a day when she takes less than you would like and you need to keep an eye on nappies and hydration levels but what you should find is that as the day progresses and she is going longer between bottles she should be getting properly hungry and taking better feeds.

What do you think?

Laura

[D2323]

I can try that again tomorrow but what I have found in the past is that even when I let her go 4 hours in between she will still only eat a couple ounces at the feeding and that's how we got into the problem with her not gaining weight. Even when she hasn't eaten all night, since dreamfeed, she will fight the bottle in the morning. Do you think I should give it another shot and just let her go tomorrow without eating as much? I just know that is what will happen because it has before. Sometimes I feel like she really is hungry, just won't eat. Because she will refuse the bottle but will down it quckly five minutes later while asleep. Could it be anything else besides a snacking problem?

[*Kara*]

Could be the reflux hun...

[Amanda5555]

Hi hon ((((((HUGS)))))) Been here and still here. My son has always been a fussy fussy feeder taking long times to get through BF/ bottles etc. He has MSPI/Reflux and has always had this weird swallowing difficulty. Now has been diagnosed with dysphagia and aspiration. We are still not sure why and looking into it but feeds are at least a little better.  Uncontrolled reflux can cause swallowing problems due to inflammation and swelling of the throat from the acid so that could be your problem. But also could be something else.

My LO was diagnosed with dysphagia with aspiration after a modified barium swallowing test. Although i new all along and kept saying there was a swallowing issue. We never had weight loss. Our weight gain slowed briefly but evened out. It concerns me alot that your LO is not gaining and/or losing weight. That seems pretty significant to me.

A couple of things you can look into (which if your MD is concerned about weight gain he should have ordered testing for)Ask for a pediatrician referal. Have LO checked for any kind of obvious tongue ties or structural issues with the tongue lips etc. Often these go missed. Have your MD refer you to an ENT to have a look down the throat and check for inflammation and/or structural issues. Ask him to do a modified barium swallow test which can identify what kind of swallowing issue there is.  You could always ask your MD to allow you to attempt the prevacid 15mg once daily. My LO's feeding was even worse until his reflux was better controlled. Its still not ideal but better. Our swallowing difficulty got worse at three months and has continued to be very troublesome. We tried prevacid half twice a day but it was not effective until he had the whole dose once per day. Its best taken on an empty stomache. We also have to thicken his liquids so he can work with them better.

Have you tried playtex variable flow teats (not sure where you are in the world)? I tried every bottle and teat on the market as well and these were the only ones that actually only came out when LO sucked. Everything else was too fast or too slow (newborn) Worth a try. Is your LO coughing and choking still frequently during feeds? If its with every feed then something sounds amiss there for sure. Video tape your LO feeding and show the doctor. Often times they underestimate what parents are telling them or feed your LO in front of the md. This sounds like more than a simple issue IMO.

HTH 

[*Kara*]

I am wondering if this is a reflux flare with teething...

[Lolly]

It's more than likely the reflux then - I would go back to the dr and see what they say. Feeding shouldn't be this much of a struggle - both my two were refluxers and the feeding was only better when the reflux was controlled.

Laura