4 month old not interested in feeding

[Freckles1981]

Hi there

I'm really worried about my LO who is 16 (nearly 17) weeks as his feed intake is reducing. He was always taking 6oz every 3.5/4 hours but now he is refusing to feed, or taking smaller volumes between 2/5oz. Often the 5oz feed won't be taken until around 15.00 and his other feeds are more like 2oz.

I have tried feeding him more regularly, especially when he takes a small feed, but he's completely uninterested and just refuses, pulls away from the bottle and cries.

I have tried changing bottles, teat size, feeding him in a quiet and/or dark room but nothing makes a difference. We've also tried teething gels & granules in case his gums are hurting.

Our routine has now had to completely change from EASY to AESYA since he wakes up at 7/7.30am and refuses a feed. He has a small 2oz dream feed (he just won't take anymore than this), another night feed sometimes at 1am (which is also small), though most of the time it's around 3am (which is a larger 5oz). If he feeds at 1am, he will then have another feed between 4/5am which is also small.

Even if he's had a 3am NF, he won't feed again till closer to 9am and then fusses and takes a couple of oz.

I have also posted on the NW board with regards to our routine which has been reviewed and seems to look okay. If we don't DF, he wakes between 12/1am and again at 4/5am and we are still in the same situation with his day feeds.

Reflux and tongue tie has been ruled out. His weight is very slowly increasing but he's starting to drop from 25th to 09th centile so I'm getting really worried about him and where we are going so wrong. We had really struggled to establish bottle feeding as he was in SCBU and tube fed, and has been in hospital a few times since and also tube fed. He's been out of of hospital now for 2 months.

He doesn't sleep well and now he doesn't feed well and I'm in tears nearly every day as I feel like we are failing to get anything right :-(

I don't know what else to try to get him to feed regulary, or should we just follow his lead now and wait for him to demand feeds even if that is every 5 hours for example? Any help/advice would be greatly appreciated

[Lolly]

Can you keep a track of bottles for the next 24 hours and write down every time you feed him and how much he takes at each bottle - just so we can look at feed intervals and total amount.

What is he like when he feeds - does he feed comfortably or is he fussing during the feed? You say reflux has been ruled out, what symptoms did he have that made reflux a possibility and does he still have any symptoms? What is his poo like, normal or any mucous etc?
Which formula do you have him on too and which bottles?

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

Laura

[Freckles1981]

Hi, thanks for the reply. Here is our typical feeding pattern and volumes:

07.30 - 3oz
11.30 - 3oz (no hunger signs but don't want to leave him longer than 4 hours)
15.30 - 5/6oz
18.30 / 19.00 - 5/6oz
DF 22.30 - 3.5/5oz
NF 02.30 / 03.00 - 4/5oz

I'm trying to perservere with feeding at 7.30am, but I thinks it's apparent that LO is taking most of his feed volume during the evening and at night feeds and then isn't interested come day. Even if I feed him later in the morning, he still takes a small feed. We've tried to not feed at the circa 3am night feed but he cries and won't take a dummy settle. He has over the last two nights taken a larger DF but this hasn't changed the time he wakes for a NF.

LO will generally feed comfortably until around 3oz and then pushes the bottle out of his mouth. We try to continue feeding but he pulls away, we try winding him and trying the feed again, but he still pulls away.

He was always taking 5/6oz, sometimes even a 7oz in the afternoon, until a couple of weeks ago. His feeds are now slowly decreasing to what I feel is now a worryingly low amount.

He is on Aptamil first milk, and we use Mam bottles. I've tried different bottles & teats, and we tried hungry milk which made him constipated. He does still struggle with constipation and sometimes doesn't poo for days and then it's hard pellets and a greenish colour. For the moment, the constipation seems to be under control again but we go through phases of a week being good, then a week where he really struggles.

With regards to reflux, he used to get frequent hiccups, crying/agitated during feeds, coughing and waking continually through the night. He still wakes continually through the night even with the dreamfeed, but the other symptoms have stopped.

Our Doctor reluctantly gave us gaviscon to try for a week but at that time, it didn't make a difference and made his constipation worse so LO was even more grouchy day & night.

We were thinking of changing his formula but our Health Visitor doesn't think this is a good idea. Our Doctor prescribed lactulose for the constipation, but this gives him such bad wind that he would scream in pain, so we now do baby massage and give LO an extra bath during the day when we need to get things moving.

Do you have any suggestions? Should we consider moving his feeds closer during the day, or spacing them out more? I'm really at a loss :-(

[Lolly]

Well, that's a bit of a puzzle!

Given that the is waking frequently at night I would guess that reflux could well be an issue. Hungry milk is really hard on the tummy as it's made to be harder to digest. Have you tried one of the comfort/ easy digest milks? We used the Aptamil one with my DD for a while (she was/is a refuxer), it is a thicker milk so often works well for milder refluxers, especially at night. It also has a stool softener in it so it would help the constipation which was the reason we put my DD on it initially. They are also low in lactose which is why they are easy to digest. You will need to use a fast teat with it if you try it though, I would (did!) try it with both my kids it was the cow& gate for DS.

He's getting around 24oz in 24 hours which isn't a worryingly low amount, my DD took 25oz on a really good day until she started solids and she stuck like glue to the 91st centile. That's what you need to keep an eye on, make sure he is having enough wet nappies and that he is following his growth curve.

I wouldn't reduce the feed intervals as he may not take the bigger bottles then and that would reduce his intake. You could try leaving him for a while at wake up to see if a bit of A time first helps. Not wanting to feed in the morning, taking more later in the day and refusing to feed after a fairly low amount are classic reflux symptoms so it may be worth seeing the Dr again and asking for a trial of ranitidine. Gaviscon for babies isn't a medication, it's a stomach stabiliser which helps to stop them refluxing but doesn't reduce acid or neutralise it. It isn't absorbed by the body which is why it constipates them as it passes through - it's pretty useless for most babies really.

What do you think?

Laura