EASY for baby with weight issues :(

[J+M]

I have a 6 month old who has been on a 3.5hr EASY and doing great on it.

This past month her acid reflux has come back and she started eating less. I didn't realize it, but my milk supply was also decreasing.  This cycle continued all month and at her last check up it was discovered she didn't gain any weight for the month. (By the way, she seemed happy and content and has hit all her milestones on track or early.  There was no indication she wasn't satisfied).  She was already on the 5-10% range so now she has dropped below 3%.  I have purchased a scale and weigh her before and after nursings which is how I discovered just how low my milk supply has become.  She's basically only getting 1/2 the amount she is supposed to be eating.  I want to adjust her feeding back to every 2-2.5hrs to give her more nursing sessions in and also to help increase my supply.  So how do I adjust a 6 month old with longer A times to a shorter EASY schedule that works? I tried last night and she, of course, had all her naps out of place and didn't even go to sleep after our bedtime routine (usually drowsy during the bath and goes right out on the clock). 

I just don't know how to make this necessary adjustment.  Any help would be greatly appreciated!

P.S. She's 6 months old and 12 lbs.
We also tried to change her medication but our insurance rejected both the alternatives.  Long story but it leaves us very upset and angry on top of our worries about our daughter....

[sherry lynn]

Do you think maybe you could pump those extra times to increase your supply, rather than feed her and mess up her naps? Especially since she didn't seem unhappy all month?

[J+M]

She has never taken bottles.  We tried a few months ago and she hated it.  I've put in a call to a lactation specialist and also a call to Le Leche League.  I'm just waiting for a call back because I'm not sure how to transition to adding bottles in our routine and I can't afford to have her drink less because of a "learning curve".

[sherry lynn]

When you put her on more see is eating more over all? Or is she eating less each time to make the full amount?

I'll ask some other moms to pop over also to have a look.

[*Liz*]

Hi - difficult situation  but I'm sure we can help.

There are quite a few reflux babies who do best on a similar sort of routine to the one which you are looking for. Basically you stick to the EASY pattern for naps and A time but you add in an extra feed to the cycle so it becomes EAEAS. The second A can be very short - just something to seperate the E from the S. That can even be a nappy change and straight into winddown.

Feeding more often is obviously the best way to improve your supply, and done over a short period of time is great. Done over too long a period and snacking can result.

Can you just pop a bit more info about your EASY at the moment so we can see how to add some more feedings in? What her A time is for example?

The other thing that I am really concerned about though is that without decent reflux control your lo isn't going to be able to take any more milk anyway  . Some refluxers naturally limit their milk to what they can tolerate - it is a way of avoiding pain, discomfort and vomiting - and even a young baby can learn the association. So I think her reflux led to poor feeding, and that in turn has dropped her milk supply.

I had a lot of trouble finding the right medication for my DS at a similar age. He was food refusing and essentially reverse cycled his feeds - so he ate nothing from 4am until 4pm, and then fed every 3 hrs through the night. Trying to feed little and often through the day made no impact at all as he was in too much pain to feed and would only do it when sleepy and relaxed ie at night. I did do a bottle introduction at this stage as I was just too exhausted to continue, and I did have to do a 12 hr cold turkey to do it  . And I must confess that I did do it at a time when his weight gain was very poor - but I just couldn't carry on as I was.

So I then bottle fed from 7 mths old (initially EBM and the formula) and I must add that I was amazed by how little my DS used to take per feed. Obviously with a bottle you can see - and I don't know just how accurate the whole weighing thing is at doing the same - but Jacob didn't take over 4oz per feed until he was about 10 months old. And he never had any extra feeds either - his intake was just always low due to his reflux.

I undertstand the weight concern - we have had periods of loss as well and it is very worrying. Jacob is small as well and hovers between the 0.4th and 2nd centile.

What medication is she having? I'm in the UK where we don't have insurance issues - but J outgrew Zantac at about 5 mths and we went to omeprazole. Still had lots of issues until we went to twice daily omeprazole at 9 mths, and recently switched to lansoprazole.

Do her feeds during the day seem like full feeds and how often are you feeding overnight?

Hopefully once we see your EASY routine we can help a bit more with the practicalities.

((hugs)) 

[~ Vik ~]

Big, big (((hugs)))

I'm busy this afternoon but I will pop on after bedtime for a proper post and give you some ideas to boost supply.

You can feed on a 2 or 2.5 hourly and still do EASY, it will just look more like EAEASEAE... Just focus on breaking up feeding and sleep with some kind of activity, even if it's just a diaper change and wind down. And nursing more frequently for a few days is a good way to build supply back up - you can then stretch the feedings back out as your milk supply is reestablished.

Be back tonight with more, but don't worry, we can help you get back on track
Vikki

(posted at the same time as Liz)

[A pair of Charlies]

Sherry was good to her word: more eyes here 

Not really anything to add on the EASY. Nod in agreement with pps; use EASY for naps and A time predictability and add in the extra Es as neccessaryPulled a few bits over from BFg for you:

This is worth looking at for possible reasons as to why supply may have dipped (latch etc): 
 * http://babywhispererforums.com/index.php?topic=65905.0
 * http://babywhispererforums.com/index.php?topic=64926.0
 * http://babywhispererforums.com/index.php?topic=88759.0

And copied this over for you... Things that you can do to increase your supply. Try for at least 3 days and do as many of these as you can:

*First and foremost - your lo!  Nothing will stimulate your supply like your baby so key here is to nurse, nurse, and nurse some more

*Skin to skin contact - as much as you can - strip yourself off - strip lo off and climb into bed.  Play, cuddle, nurse etc.  Spend the whole day in bed if you can.  Failing that, make sure the house is nice and warm and strip your lo off and yourself and just play like that all day.  Bathing together etc...  This will increase teh level of oxytocin (one of the primary milk producing hormones) and therefore help a LOT

*switch nursing: when lo has finished with the first side, offer the second.  When done with the second, offer the first.  When finished with the first for a second time, offer the second again.  This will normally stimulate a further let down with each switch and tells your body to make more milk.

*Pumping directly after the feed preferably for at least 15 mins per side although anything is better than nothing.  You can also "switch pump" which is basically going back and forth between the breasts when the milk stops coming...

Things you can consume to help:

*Fenugreek, Blessed Thistle, Mothers Milk Tea & Brewers Yeast are all things you can buy at your local health food store that can be really great for helping to boost supply.  With the fenugreek, it's arguably the most effective but unless you are smelling like savoury maple syrup (and I mean everything - your urine, your sweat, you!), you're not taking enough haha!

*Oatmeal/porridge.  This can be great for some - I personally notice a difference with this   When I've been low in the past, I've had it for breakfast and for lunch - you can also eat tons of flapjack or oatmeal cookies ~~~ porridge is great for me: porridge, milk, cinnamon, pinch of ground cloves, drop of vanilla essense and fresh berries - really helps my supply everyday. Also, oatmilk available from healthfood stores and some UK supermarkets - even do chocolate flavour

*make sure you're getting plenty of water - this really can be a major factor for many! In those early months (up to 6 months or so), I'd drink a large glass of water or milk during / or with each BF. All other drinks during the day I saw as drinks / hydration for me.

*make sure you're eating properly - well balanced diet, with enough calories, enough dairy fats and health fats (such as are found in seeds and nuts etc). Up until 9 months or so, I ate an awful lot. I viewed main meals as nutrition for me, and then additional meals and snacks as feeding the boy...so I'd have breakfast and then toast an hour or so later... lots of healthy, carby nutritious snacks all day. It helped me make sure I was taking on enough to feed us both.

Hope this helps. Let me know what you think and how you get on?

Charlotte 

[J+M]

Thanks ladies.  All of your support is very much appreciated!  I really appreciate your input from different perspectives.  I agree this is a multi-layered problem.  This helps a lot. 

I'm going to try to answer your questions and I hope it helps...
I think, adding the Es into my A time is still distracting her and keeping her from eating.  I'll post my usual EASY and what we've been doing today for you to see what I mean.

Also, I read your suggestions and bought fenugreek, oatmeal, and made a batch of cookies with oatmeal and yeast.  I have a question about pumping 15 min after nursing, (hard for me to do often since I am home alone most of the time), but if I nurse then pump...nothing is really going to come out, right?  It's just to tell my body to make more, right?  I just want to know so that if I do it and nothing is coming out I know I'm still on the right track and I won't stop just because milk is no longer coming out.

Regarding the reflux, she is on Zantac but it seems that at 5 months she has outgrown it as well.  She is not sleeping in her stroller at night because she will be in pain in her crib.  I used to raise the mattress but she is so mobile at night that she can turn and be head down instead of head up, so we took the rise out.  We tried to change medications but our insurance rejected them (Nexium and Previcad).  I'm going to try to go to a specialist next week to get other alternate options.  I'll bring in the names of the 2 listed to see if that's something we can try.  I know it's a big part of this problem and it concerns me that we're hitting a road block with our insurance company.

She wasn't eating at night and going 10-12 hours of straight sleep.  But now whenever she wakes crying from the reflux, I nurse her just to get an extra feed in.  As far as the day, no, it doesn't seem like full feeds.  She'll empty one side, then only nurse a little on the other and leave milk in that one.  I tried cutting the first time back and switching back and forth during the nursing session but she just stopped after the 2nd breast anyway and our nursing time was even shorter.  I noticed over this last month that is when she was really starting to do this.  She would unlatch with milk running down her chin after 30 min of nursing.  I know she was getting milk, but she would just be "done" even though I could feel I still had more milk to offer. This happened over and over so no wonder my supply just dwindled down.

I went to a breastfeeding support group after she was born and they suggested weighing before and after a nursing to tell how much she's drinking.  I don't know how accurate it is but it seems like it would be in theory.  We're getting anywhere from 1.5 to 3 oz but averaging in the middle, mostly 2 or 2.5 oz per feed.  That's after a 30 min nursing session, too!  

TYPICAL EASY
7am  E
        A 2h 5 m (15 min walk and 5 min story windown included here)
        S 45m up to 1h 10 m (if she wakes early I would keep her up until I hit 3h 30m)
        Y My time unless she wakes early then we have more A time
10:30 E
        A 2h 5 m (15 min walk and 5 min story windown included here)
        S 45m up to 1h 10 m (if she wakes early I would keep her up until I hit 3h 30m)
        Y My time unless she wakes early then we have more A time
2:00 E
        A 2h 5 m (15 min walk and 5 min story windown included here)
        S 30 up to 45m (or she doesn't nap and I would keep her up until I hit 3h)
        Y My time unless she wakes early then we have more A time
5:00 E
       A 2 h (start bath at 6:45, jammies, 1 book, medicine, and ready to eat at 7p)
7:00 E
7:30 S
Wouldn't nurse at night because she was sleeping through the night until the next morning.
************************************************************************************

(Last night I nursed every time she woke.  11:30pm, 2:30am where she was then awake until 4:15am, she woke on schedule at 7am still)
TODAY'S EASY
7:10am  E
            A 2h 10 m (10 min walk windown included here)
            E
            S None, wouldn't go to sleep.  Woke fully after I fed her and weighed her.
            A 1 h 45 m
11:10a  S 1 h 10 m
12:20p  E
           A 2h 40m
3:00     E
           S None, wouldn't go to sleep. Woke fully after I fed her and weighed her. I went on a 20 m walk but she was still wide awake).           
          A 2h planned (in progress now)
5:00    E planned
          A 2 h (start bath at 6:45, jammies, 1 book, medicine, and ready to eat at 7p planned)
7:00    E
7:30    S planned (last night she was up another hour.  Finally dosed at 8:30.  Day was similar to this. I was trying to feed every 2 to              2.5hr)


I need to get ready for her 5:00p feeding so I will have to check this later this evening or tomorrow.  Thank you for your help.  I am taking everything you suggest very seriously.

[~ Vik ~]

Hi

I have a question about pumping 15 min after nursing, (hard for me to do often since I am home alone most of the time), but if I nurse then pump...nothing is really going to come out, right?  It's just to tell my body to make more, right?  I just want to know so that if I do it and nothing is coming out I know I'm still on the right track and I won't stop just because milk is no longer coming out.

You are absolutely right - you might get little to nothing out when you pump directly after nursing, but it's the pumping itself that stimulating your body to make more milk.  Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.
(From http://www.kellymom.com/bf/supply/low-supply.html TONS of great breastfeeding info on this site!)

It is definitely a challenge to pump when you are home alone with your lo, so just do the best that you can.  A short pumping session is still helpful, and can still help increase your milk supply!  I pumped and bottle fed almost exclusively for the first three months due to various issues, so I understand how difficult it is.  Do you have an exersaucer, bouncy chair, jolly jumper, or other device that could keep her contained and occupied while you pump?  Instead of pumping both breasts after every feed, could you find the time to pump just one and switch back and forth?  You might have to do some juggling, but any pumping that you can do will be beneficial

We tried to change medications but our insurance rejected them

Big (((hugs))) for this, that is so frustrating   I hope that seeing the specialist will get you somewhere.


If you're finding that she wakes fully after feeding and weighing her, could you do the feed a bit earlier?  I wonder if you end up missing her window and she gets a touch OT and that's why she won't settle...  Or for those pre nap feedings, could you skip the weighing if it's that process that's waking her fully?  (don't know if you're tracking the weighings, or if it's doctor's orders, or something like that)

Let us know how things are going tonight
Vikki

[*Liz*]

I'll be back on this evening about the whole routine thing as I am on my way to work now   but just about the reflux drugs - I'm wondering if they would say yes to omeprazole (Losec MUPS in the UK) - it was the first PPI and is cheaper than nexium or prevacid. Nexium is so new it actually has no evidence in children yet anyway.

We used losec until J was 13 mths and it did work VERY well once we were on a twice daily dose. Not as easy to give as prevacid - but certainly was effective - and a life saver after zantac failed.

Sounds very similar situation to what we went through.

((hugs)) and back later.

[J+M]

I'm going to try and talk to a specialist and see if I can request those drugs.  Thank you for the recommendation.

We had another rough night.  She's just up and uncomfortable and also farting a lot, which I think may be part of the reflux problem.  I did nurse her when she was up and she went back to sleep all but the last time where she stayed awake for over 2 hours. 

She was up 9pm-E, 10:30pm, 11:20pm-E, 1:30am-E, 3:15am-E (up until 5:30am)  then went to sleep and woke up on schedule at 7am    So you can see I really did not get much sleep. (sigh)

I will check back and see what schedule recommendations you have.  I will continue to follow the EAEAS but I'm just thinking my timing is still a little off.

[*Liz*]

Well you certainly have the right idea - it really is hard to fit all those feeds in.

I would suggest perhaps not weighing after every single feed - perhaps select 2-3/day to use as a sample - and vary which ones on a day to day basis so you can keep an eye on each feed as it were.

I remember having issues with J when BF's were too close to nap times - I think the sleepy BFs can refresh them a bit and if they wake up they decide they are not tired anymore.

Your EASY was looking really good before though  .

I'm thinking stick with this for a few days to try and boost your supply, but then try and just do a few extra rather than an extra every cycle? That might be easier on both of you?

This really is so similar to what we went through - but I think you are catching it in time and once you get new meds things will be much easier. I did actually reestablish my daytime supply by pumping during naps - but it didn't help the night feeds until J's reflux was improved.

I agree the tummy ache and wind could be reflux. When they are in pain their feeding is awkward and they take in more air as a result.

[J+M]

I have an appointment with a specialist tomorrow morning and a lactation consultant tomorrow afternoon.  Hopefully those things will help.  I also rented a hospital grade double pump and am pumping after nursing, just as much as baby allows me to.

We had another very rough night.  I got an hour of sleep in here and there.  I hope we're able to get new meds and they work because I feel like I'm up 24 hours and I just can't do this forever. 

I think you are right and the sleepy BF is keeping her up.  I almost gave up but after 90 more minutes she finally rubbed her eyes and I was able to get her down for a short nap. Only 37 minutes but it's better than nothing.

Got another nap in the car while I was picking up the breast pump and her prescription (the old one she's grown out of but better then having her on nothing) but no cat nap in the afternoon though she must be tired since she's hardly sleeping at night.

Will try to post when I can on how everything is going in another day or two, after my appointments and seeing how my supply is adjusting.

Thank you so much!

[*Liz*]

The hospital grade pump is a GREAT idea. When I pumped to sort my supply it worked really quite quickly, and I was just using a mini electric pump.

Do let us know how you get on - will be thinking of you both 

I'm sure you will gets some decent meds soon and then normality will start to return.

[J+M]

It's been awhile and a lot has happened.  I wanted to let you know where we are now, and what challenges we're still facing.

First, we went to a G.I. specialist and Lactation Consultant and were told 2 different theories. 

The G.I. specialist  thought this was NOT reflux because of the weight gain issue appearing at 6 months does not happen with reflux.  He ordered an upper GI x-ray, which we did, because he thought something physical was going on that was preventing her from finishing eating from 5 months on.  The x-ray came back normal.  So he gave me samples of Nexium to put her on (since my insurance won't approve it) and asked that I come back in 6 weeks to see how she's doing and maybe from there we'll have more clues to what is happening and if the medication should be increased or decreased.

The Lactation Consultant said the problem was my supply.  She said the problem started with me following BABY WHISPERER and having a baby that slept through the night from 2 months on.  She said a baby should not sleep through the night for the first year.  That caused my supply during the day to go down.  That along with my baby being distracted easily and a "happy to starve" baby who would rather look at other things then fill her belly (why she wasn't emptying me) caused my supply to drop big time.  Then when she started rolling over and working on crawling (around 5 months) that's when her caloric need went up but she wasn't eating more so she stopped gaining weight.

I was just at a loss, not really knowing what to think but thinking that if I work on my supply and it helps, then we'll know that was the issue.  Also, BABY WHISPERER has helped me so much in getting her to nap well in the day with ease and sleep well at night.  Both of which ARE NOT happening anymore.    i'd really like to know your take on this and if you've heard this critique before.

I've been taking fenugreek, double pumping after nursing (when I can, I'm home alone and baby doesn't always let me but I do what I can for 5-15 min) and eating oatmeal.  I also, per her advice, started nursing every 2.5 hours in the day and whenever she asks for it at night (most nights still every hour...I've been SO fatigued).  I even got mastitis last week with a fever and as if I wasn't tired before, that really knocked me out.   

My milk has not really gone up.  I have to think that me not getting rest at night is counterproductive to what I'm doing in the day.  But I think my milk at night has been a little better. I've also been pushing solids 3 times a day to help get more calories in and last night, FINALLY, she only woke every 3 hours, so maybe it's working on that front?  Still feel like it's too soon to say.

A few days ago her weight was still exactly the same.  I have a scale at home and I *think* she's gained 3 ounces since her last weigh in. I really hope so. 

So I'm still having major issues with sleeping because I'm trying to adjust my EASY to EAEASY but honestly, she was falling asleep right after the 2nd E so I would just be so desperate for sleep I'd put her in her crib. After a week of this she started ONLY wanting to sleep if held.  Now I feel that we have a new problem.  I've been really trying to wake her so I can do PU/PD and get her back to self soothing, BUT now what's happening in the day is she'll just wake and then stay awake and skip that nap.  No matter how long I try.  She just skips it.  And skips the next nap, too.  And now we're at a point where she's almost never napping during the day because I'm trying to make sure she doesn't fall asleep while nursing. 

I'm at such a loss.  What do I do?  This is basically my EASY now.

8am-E-Nurse then solids while I pump.
       A-1 hour 45 m I go on my walk for 15 min.  Sometimes this varies and I start it closer to 2 hour 0 min
10:30E-Nurse at 2 hour 30 m
        S-Try to get her to sleep in crib but she cries and wakes up and PU/PD fails so I give up and go to A time.
        A-1 hour 45 m I go on my walk for 15 min.  Sometimes this varies and I start it closer to 2 hour 0 min
12:00E-Solids then Nurse at 2 hour 30 m
        S-Try to get her to sleep in crib but she cries and wakes up and PU/PD fails so I give up and go to A time.
        A-Feed Solids now. 1 hour 45 m I go on my walk for 15 min.  Sometimes this varies and I start it closer to 2 hour 0 min
2:30 E-Nurse at 2 hour 30 m
        A-1 hour 45 m I go on my walk for 15 min.  Sometimes this varies and I start it closer to 2 hour 0 min
5:00 E-Nurse at 2 hour 30 m
        S-Try to get her to sleep in crib but she cries and wakes up and PU/PD fails so I give up and go to A time.
        A-Solid and A time until bath routine starts at 6:45pm
7:00 E-Nurse and put to bed with PU/PD around 8:00pm

(Here's where I can have her wake every hour to every 3 hours and I just go in an nurse her and put her back in her crib.  I've been trying to make sure she's not totally asleep after nursing but it hasn't always happened. Some night she'll just wake fully and we're up 2 hours straight when I just nurse her again and then just as she's drifting to sleep I put her in her crib, again, desperate for sleep).

Its been so hard for me to get on the computer but I'm really going to try to do it so I can see what you suggest because I feel like I still need help and am lost here.

Thank you so much in advance.  You really help me feel not so alone in this.