5 month old- barely eating during day, most calories at night

[Bee9]

Hello!

I read through the other post that was similar, but really I think we've got two different situations, so I decided to post my question separate.

My LO is a week shy of 5 months and has had 3 tooth buds barely visible since 3 months.  I thought that might have been the cause of our problems, but I'm not so sure.

I started reading The Baby Whisperer after a friend suggested it.  Before reading far enough to see that Tracy Hogg suggests just observing LO for the first 2 days, I had already done that.  Last night was our first structured nighttime routine & it went really well.  Here's my problem:

LO has to eat to fall asleep.  This is why I started reading The Baby Whisperer in the first place.  Background info: he was exclusively breastfed until 9 weeks old when we learned he'd been losing weight because of lactation failure, I have IGT and didn't know it.  Major fail all around & super emotional, that's not what this is about but it's relevant to his feeding style.  Obviously when LO started to get formula it was like "ahha!" to him and he would fall asleep because he was finally well fed.  Now I'm trying to get away from that. 

LO has always had nighttime feeds but last week had several nights where he slept for 6 hours straight.  For the last 4-5 days/nights he has been refusing to eat more than 2-4 oz (a normal feed is 6 oz) at a time during the day and is flat out not interested in any if it hasn't been 3 or so hours since his last 2-4 oz.  But during the night he takes the full 6oz for 4 bottles.  I use the pacifier to get him to wait 10 or so minutes, but that's it, he has to eat.  During the day he's been sucking his upper lip and I thought this was a feeding cue but he'll only take a couple of sucks on the bottle before refusing it again.

He is active (kicking & flailing his arms) and is super fast to return a smile.  He seems to be easily distracted/stimulated, so during feeds I make sure it's quiet and calm (and the dogs are laying down- he loves to watch them).  He was using slow flow nipples, but I just switched today to medium because he's been collapsing the nipple for most of his feed.  He seems to like the faster flow, but this hasn't changed his lack of interest in feeding during the day.

I'm increasing the time between night feeds as much as possible and his activity time between naps in the daytime is 2-3 hours before he starts rubbing his eyes (his nap cue).  I realize change takes time, but I'm wondering if there is anything I'm missing in trying to get his main calories moved to day time?

Thanks!

[*Kara*]

Could you just post his typical eating times and how much he typically takes for each feed for a day - like this:

7am  4 ozs
11am 3 ozs... etc

Just to get a good pic of what is happening

[Bee9]

That's a good idea.  I've only been tracking it the last two days.

Thursday
130 am    6 oz
515          4 oz
7am         2 oz
1030 am   4 oz
1230         2 oz
330 pm     6 oz
6pm           2 oz
7pm           6 oz
1130          6 oz
Friday
4am            6 oz
7am           4 oz
1020          4 oz
1145          4 oz
250            4oz   

If I try to give him the bottle after he's decided he's done with it he makes gagging noises and gets angry.  I made him wait as long as I could last night between bottles.  He trashes around and doesn't really sleep when he's hungry.  Last night he started doing that at 930 (7 is his bed time) and I pushed off the bottle until 1130 thinking maybe he would stop (it's not constant thrashing), but he never did and it got more frequent.  After the 1130 bottle he settled and was sound asleep until 4 am.

[*Kara*]

I think we just need to really push him to a good 4 hrs between feeds to stop the snacking that is happening... It's tough when they only have a partial feed, then are hungry a few hours later, but only take a smaller than ideal feed etc...

Does he drain a 6 oz bottle?  Most LOs at this age are closing in on a 7-8 oz feed every 4 hrs or so...   If he drains a bottle, it should be an ounce more since you want him to stop when he is full, not because the bottle is empty.

First thing I would do is offer a full feed at all times unless if is after 4am.  If after 4am, offer 4 ozs and hope that his will encourage a bigger feed at wake up.    Then push as far as you can to 4 hrs since his last feed, offer a full feed and repeat for the day with pushing to 4 hrs.

[Bee9]

Thank you for the suggestions!  He's been draining the 6oz bottles when he does drink them & before his snacking started.  I'll bump up to 8 oz, that's a good point about stopping because he's not hungry any more versus stopping because the bottle is empty.

Thanks again!

[*Kara*]

Let me know how it goes after a few days to allow him to adjust

[Bee9]

Okay...some good progress some questionables.  Added into the times below, he didn't poop at all on Friday or Saturday (normally he has 2 pops a day).  His tummy obviously was hurting on Saturday night and Sunday morning.  He had two pretty hard poops Sunday morning and then had 3 more much softer poops during the rest of the day.  I read in Dr Spock's book that constipation can lead to baby eating less (makes sense if their stomach hurts).

Saturday:
230am    4 oz
5             4 oz
730         awake
8             4 oz (offered 8 oz)
950         nap (1 hour 40 minutes)
1140       4 oz (offered
135 pm   nap (40 min)
320         4 oz (offered
430         nap (50 min)
630         8 oz
745         asleep
1030       4 oz

Sunday
230 am   4 oz
430         4 oz
730         awake, 3 oz (offered
930         nap (45 min)
11           4 oz (offered
145 pm    nap (1 hour 15 minutes)
310         6 oz
350         2 oz, nap (35 minutes)
720         8 oz
825         vomited (Large amount projected several inches so definitely vomit & not spit up.  Only contained formula, no yellow or green color.  No fever, he seemed overstimulated but not unhappy except for the few minutes following the vomiting.)
850         asleep (no dream feed offered because of vomiting to give his stomach a chance to really settle)

Monday
130am    4 oz
320         4 oz
630         awake & offered bottle, didn't want
730         3 oz
830         nap (1 hour 40 minutes)
1030       4 oz (offered

So as you can see we've been only giving him 4 ounces when he wakes up hungry at night and it satisfies him.  Is the dream feed supposed to be the same full amount they eat during the day?  We've been only giving him 4 ounces for it.  I think his stomach being upset (the constipation & then the vomiting) are likely impacting his eating.  Nothing else has changed except the time & amounts of food.  His teeth aren't coming in any more than they already were and he isn't irritable like when we could first see the tooth buds.  We did have company Friday-this morning (Monday), but LO's routine stayed the same.  He loves the guys (his uncles & Grandpa) and had lots of great activity during his awake times.

Looking at the times, I think at least one of his wakings in the night is not because of hunger but habit.  Tonight I'm going to cut it down to 2 oz for his second waking (the one normally around 3-4 am) and see how that changes his morning feed.  It seems like stretching feeds closer to the 4 hour mark and giving less in the night is helping.  Any other thoughts after seeing our last few days?  The vomiting concerned me, but with no fever or any of the other warning signs, we weren't sure what caused it but he seems fine now (and even shortly after it happened and he was able to fall asleep).

[Bee9]

I had another thought on the constipation & vomiting.  LO is eating Similac organic formula which is dairy based.  I have a lot of food allergies/intolerances (dairy is one of them).  Knowing that he is predisposed to them, we were planning on exclusively breastfeeding and starting solids a little later than 6 months and super slowly.  Having IGT obviously changed all of that since I don't produce enough milk to feed him.  We started with a non-dairy formula but it was based on corn and not organic (and therefore most likely contained GMO corn), which we weren't comfortable with.  My point to all this is: do you think the dairy formula might be the cause of his stomach issues over the last few days?  We have about a month's worth of formula in the pantry.  I'm guessing this is a 'don't worry about it unless it happens again' sort of thing.  I'm going to look for info on food allergies in infants and though I would mention it as obviously if the formula is hurting his stomach he isn't going to want to eat it.

[*Kara*]

Will be back tonight, but the dairy allergy could certainly cause the issues hun....

[*Kara*]

Which country are you in and which formula were you feeding before the Similac?

I do suspect that the constipation is causing much of the feeding issues hun (I have been there and ended up in the hospital with LO twice at 8 months).  The drop in eating is a red flag, but terrible constipation would be far worse in terms of eating.  I would bet the vomiting was simply because he took more than he is accustomed to and the extra came back out.

If he was only taking 6 oz feeds before, i would go back to offering that much for now so you aren't tossing as much formula (it's clear that 8 ozs is too much for him at this point).  6-7 ozs would be quite typical for his age.

I do think we need to get those feeds 4 hrs apart to ensure he is hungry enough to eat.

But first, let's figure out if the formula is maybe the issue.

[Bee9]

I didn't realize the 8 and the ) would make a smiley face; how annoying!  Anyway.

I'm in the US.  Before Similac organic (which is dairy) we were feeding Similac alimentum.  I won't use soy as it's a major allergy and he's a boy (issues with the hormone mimicking possibilities).  The alimentum's proteins are more broken down to reduce chance of allergic reaction, but as I said (at least I think I mentioned this), it's main ingredient is corn and as it's not organic I know that means it's GMO & full of pesticides.  I'd use an organic rice based formula, but as far as I've found, it doesn't exist.  I did read in Dr Spock's book that I can give him a teaspoon or 2 of stewed prunes to ease constipation.  We bought some but his stools are back to normal now.  I'm thankful for formula because without it we'd be in a dire situation.  But I'm angry at the formula options (or lack of good options) and it just continues to throw it in my face that I can't produce enough milk to feed him.  Our pediatrician thinks dairy formula is just fine and that we should start solids at 6 months (and therefore reducing his formula intake), never mind the allergy concern. 

I think one of our biggest issues is the teething.  In the last few days he's gumming his fingers like crazy and even chomps the air.  I've given him cooled (refrigerated) teethers, a room temp teether, a soft teether, but he isn't really interested in them. He isn't upset so I hesitate to give him any tylenol or camilia.  I think he just needs to chew on something but he doesn't seem to want to take more than a few chomps on anything.

[*Kara*]

Actually Alimentium is corn-free.  Nutramigen is corn based though.  As for pesticides, I am sure that the FDA wouldn't allow such a thing in baby formula at all - so no need to panic about that now.  I know how hard it is to realize that BFing isn't going to happen and that you need to use formula (me too).  I don't have IGT, but we encountered our fair share of roadblocks that ended our BFing relationship).

If you aren't certain that he has a milk allergy, I agree with your ped hun.  From personal experience, I would try Gerber Good Start formula first - it doesn't contain casein protein (whey only) and given that casein is generally the culprit with a milk allergy, it might be fine for your LO.  My DD is 26 months and still can't tolerate cow's milk in any amount without a horrid reaction (cramping/screaming etc) but she is and always was okay with GoodStart (yet other milk formulas like Enfamil would cause the same screaming/cramping for her).  She has also always been fine with other dairy like cheese, yogurt etc.  Starting solids at 6 months should not reduce formula intake - the goal is that the solids are in addition to the formula, not a replacement at all.  You want LO to keep at the level they were at when solids were started, so you offer things that really don't have much in terms of calories etc to cause LO to reduce formula intake.  Please don't worry about that now, we will cross that bridge when we get to it.  Solids at 6 months are the general rec to prevent LO from being reluctant to take on new textures (which is common if solids are delayed).

As for teething, some LOs don't really like cold things... my DD only like room temp silicone teethers...  And also, once teething is starting to disrupt sleep, Tylenol and Camilia won't do much of anything   You will learn soon that Advil is far better!  Lasts longer, works faster and brings down the painful swelling.

So overall - I would try GoodStart now and give it a good week.

[Bee9]

I certainly appreciate your help.  I wanted to provide a link to Alimentum's ingredients list in case any one else is reading this thread, as the first ingredient is corn maltodextrin.  http://abbottnutrition.com/Products/similac-expert-care-alimentum

** Edited by mod to clarify - powdered Alimentium does contain corn as stated above.  This formula is also available as a ready to feed product and is corn free in this form.  The above link confirms this. **