Some advice on dropping a bottle please

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DS is 7 months and has been self feeding since 5.5 months.  He took to solids very well and very quickly and as a result cut his milk intake and now takes just about the minimum requirement (differs each day, I do count his formula used in breakfast porridge but I don't count other dairy although I know it does count.  he has between 500 - 600ml per day).
He had been on 3 hr milk feeds up until 6 months because with silent reflux he never could manage to go 4 hrs and have bigger feeds.  At 6 months the milk feeds naturally extended to 4 hrs because the solid feed come between.

Now on 4 bottles plus a DF roughly 7am, 11/11.30am, 3/3.30pm, 6.30pm (BT), 10.30pm (DF)
And has solids meals at roughly 8am, 12.30pm, 5.00pm.

Thing is I never know how much he is going to take at each feed and I feel like I ought to be doing something to get a handle on this.  I almost always offer 180ml partly because this used to be a full bottle for him (would almost finish at BT and DF which were the easiest feeds for him taking reflux into account, usually less during day though) and partly because he has carobel thickener in his milk and to measure it I need to make 90 or 180ml bottles (although I sometimes guess on an amount now), also if he finished a smaller bottle (say 90ml) and wanted more it takes me a while to make it due to warming the milk adding the carobel and waiting for it to thicken so obviously I want to avoid this.

He takes the first bottle about 30 min after wake up, sometimes he will have a good 150ml, other times won't take more than 30ml (breakfast porridge will have about 100ml so I feel confident he gets his milk this way.  On the days he takes a good morning milk feed I give something else for breakfast)
The 11am bottle he asks for and will start to really fuss if he has to wait and then rarely takes more than 90, sometimes only 20ml.
The 3pm bottle he takes between 30 and 150ml
BT bottle 90 - 150
DF bottle 90 - 120 (I now only offer 120 here as I am gradually weaning)

I realise that sometimes it will depend how much solid food he has eaten as to what his appetite will be for the next milk feed but I'm offering around 350mls per day more than he will take and it seems so disorganised to be making big bottles for him to just have a little of it rather than fewer good sized feeds.  I never let him snack on milk when he was younger but feel like that's what is now happening at times.

Anyone have any advice please?
Should I cut the 11am bottle?  Maybe offer a little sugar-free biscuit snack and a sippy cup with 30ml of milk instead?
Should I just continue as we are at the moment until the DF is weaned and see what the state of play is then?
Or am I doing this milk and solids thing completely wrong?

[Lolly]

Personally I would get rid of the DF first and then see how things are. Most babies are on 4 bottles until around 9/10 months and your routine looks great for his age!

I do know how you feel about the variation in feed size - I have poured vats of formula down the sink over the years Unfortunately even if you dropped a bottle there's nothing to say he would get more predictable!

Laura

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Thanks Laura.  It's good to know that I'm doing ok as I was thinking back to when he was tiny and his Nana would burp him for 45 min half way through a feed and then continue feeding him - she was teaching him to snack - I told her off many times as it was me literally left 'holding the baby' that wanted hourly feeds once Nana had gone home.  These small feeds have reminded me of that so I did need the reassurance to continue.

Much appreciated.

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DS seems to be taking less and less milk.  I don't think he's reaching his 500/600ml per day which I think is the 'requirement'.  His solid feeds are good, he self feeds (mostly) and enjoys his food.  I know people say that with BLW they don't take in much food at first but he took in a decent amount from day one of solids and now seems to be eating for England.
I'm not sure if I should offer less solid food so he will take more milk?
Or should I rely on dairy in solid food and offer more?
I'm unsure about increasing the amount of cheese offered because of the salt.  He loves natural yogurt which would be another source of dairy but I don't want to give too much as I suspect it makes him refluxy.

[Lolly]

Maybe you need to drop to 3 daytime bottles to get bigger bottles into him?

Laura

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I'm concerned that even if I drop to 3 bottles he still won't increase his milk, but just decrease even more.  I'm offering milk in a sippy cup too but he hasn't got the hang of it just yet.  I thought his day feeds would go up as the DF has been cut to half what he had up to 6 months although actually he's done that himself in the last couple of weeks.  I 'm bottling out of reducing it further because I keep thinking it's one of the few times he will take milk in.

I'm probably worrying over nothing.  Maybe don't have enough to keep me occupied!!

[Lolly]

How is the reflux? Could that be playing a part in his reduced desire for milk? We actually dropped to 3 bottles at 8 months with my refluxer because she was refusing bottles in the day and I was struggling to get 20oz into her. It may not be the case, but worth a thought - they don't always show really obvious symptoms when meds need tweaking.

He could be teething too, that often has an impact on their milk intake but not solids as it hurts to suck more than gnaw!

Laura

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Yes i have been concerned about his reflux the last week or two.  He started sicking up again, several times per day (although not today or yesterday).  He has silent reflux more so than bringing back up but it was the development of sickiness and discomfort at around 4.5 or 5 months that started us on meds.  He was poorly last week though, wheezing which got worse and had meds (steroids) for three days which could have thrown him off.  And teething too yes!  He's dribbling a LOT the last couple of days, this is something he did a lot prior to the reflux meds, everyone told me it was teething but he didn't dribble at all for weeks on the meds even when he cut two teeth so I wonder if it is reflux.  anyway (sorry waffling), I asked the doc to check his reflux dosage on monday incase it needed to go up for his increased weight gain and age but he said the dose is fine.  I'm not 100% convinced.  He's stopped taking his 2 hr morning nap too and we had hundreds of NW over the weekend (usually zero, possibly 1 NW if he has bright red teething cheeks and wakes in pain).

There's so many variables.  Suppose I am just trying to 'control' what I can (ie milk/solids) as so many things that might be disrupting him are out of my control (reflux/wheezing/teething!)

Laura, when you dropped to 3 bottles did she take the same total amount over the day or less/more.  Did she seem to be 'more hungry' for it due to waiting longer?

[Lolly]

What meds and dose is he on? What's his weight? Teething does make reflux worse.

My DD took more on 3 bottles than she did on 4 bottles. The two day time ones were really hit or miss, sometimes only 1oz or 2oz, when we moved those to one bottle just before her nap she took 6/7oz and with her morning and bedtime bottles it got her up to just about 20oz a day.

Laura

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He was 16lb 6oz about 2 wks ago.  He's on Ranitadine 0.43ml.
I've discovered he will take more milk if it is chilled.
When he was newborn I combination fed (planned to bf but lots of problems there) breast fed, and bottle fed expressed bm from the fridge and formula from the fridge.  As I had read babies will take cold milk I didn't see the point in warming it if he took it, also meant that if he finished a bottle I could get him another oz no problems as we didn't ned to wait to warm.  Worked great. (apart from my mum telling me off for not warming it and saying this caused the reflux, warmed it for 2 weeks andit made no diff to the reflux so went bakc to chilled).
Anyways...been warming for a while now as the carobel milk thickener says to warm the milk, I think it makes the carobel dissolve and thicken the milk better.
But tried him on cold milk yesterday (left to warm in the room for a short while but didn't actually heat) and he was much more enthusiastic.  Perhaps the cold is nice on his sore gums too.
I was so pleased about him taking more milk I gave him more at the DF instead of less!  That won't wean it!

Do you have experience of carobel?  Do you think it thickens cold milk?

[Lolly]

No experience with carobel I'm afraid, we used a reflux formula.

He is however on a very small dose of ranitidine for his weight. At 16lbs hes about 7.5 kg and the 2-4mg per kg range for 150mg/ 10ml ranitidine is 1ml - 2ml x2 per day. If the meds are that same strength then he's not even getting 1mg per kg. I really doubt that dose is doing anything for him. We started with 2mg per kg for my kids but they both needed the full 4mg per kg for it to be effective, DS had it 3 times a day by the time he was 1.

I would go back and see your Dr to discuss his meds to be honest. He could be drinking the milk better cold because he's finding it more soothing.

Laura

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Laura, thanks.
I messed up and didn't say he has it 3 times per day, so it's a total of 1.29ml per day.  The strength on the bottle is 75mg/5ml (so same as you mentioned 150mg/10ml).  But beyond that I'm not sure how I work out what mg he's getting or what he should be getting.
I'll call the paed and find out about the dose again.  Seems pointless asking the GP again, the last one told me the hundred or so NWs we had during those steroids was due to me feeding him too close to BT...but I've fed at BT for 7 months and never had NWs like that plus if I don't feed at BT then he's going to NW hungry and I can't just not feed a hungry baby which means I'd feed in the middle of the night which defeats the object of not feeding at BT.

Although he is definitely teething, ramming his fist in his mouth, ramming soft toys and his muslin etc in and oftentimes even making growling 'ow' type noises which are muffled by the cloth too.  He's getting calpol for the pain.

Off to DF now, and I've gone for the slightly increased bottle again I'm soft and like the idea he is getting some milk and comfort, we'll wean another time!

[Lolly]

That's still a small dose, the max he could have at 7.5 kg is 2ml at each dose (so twice a day is normal). A total of 1.29ml a day gives him 18mg of the drug a day when he could be having up to 60mg.

Here is a link to a NZ site, you will need to scroll down the page a bit and click on the bit that says you agree to their terms to see the dosage schedule. http://www.reflux.cryingoverspiltmilk.co.nz/medicaltreatment/dosageschedule/

Laura

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Thanks Laura that's really helpful x

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Not sure if I should start another thread really, but it's kind of a continuation of the original post...

Day time feeds are better now that I'm giving cold milk.  Still on 4 per day (plus DF). He's taking roughly 60 - 90, occasionally 120ml in the day feeds (not getting any of those 20ml feeds now).  The reflux seems to have settled so perhaps it was the teething making him worse, I haven't increased his meds dose but he seems ok.

But weaning the DF isn't going as planned.  He had gone down to 90ml on his own, then I dropped what I offered to 90ml and he seemed fine with it, drained the bottle (or almost) but didn't fuss for more.  After a few days he seemed to take a little more at his morning bottle.  Then I dropped to 80ml and again he drained the bottle but didn't fuss for more...but then EW at 5am hungry.  Several days of 5am wakings and I'm shattered.

Before starting to wean the DF, for a long time we've had EWs but over several months I'd gradually got it to more like 6 - 6.15am (with the odd 5.15 here and there) and I didn't have to get up until 6.25 (when the alert turned higher pitched, not crying though) but these EW were never hunger, they were 'I've finished sleeping, now bored, need to get to some toys, come pick me up!'.  If I tried to feed he'd either push the bottle away or take 20ml and push it away.  So I take him to play, and around 30 - 45 min later give the bottle.  Depending on wake up this would be 7am or maybe 6.30 (always try to get close to 7 but without him getting distressed).  So I don't really understand why he is now waking at 5am ravenous.  Has he hit a growth spurt or have I done this by cutting 10ml from his DF?
I've now upped the DF to 120ml and last night he drained it, didn't fuss for more but woke early and was still ravenous.

I'm not sure what to do now.  Weaning the DF is mainly selfish reasons (I admit it, I would love to be able to go to bed early just once a week to keep myself energetic for him.  As I'm on my own there is never an opportunity for an occasional lie in) but if he's going to wake early then it defeats the object of it and I'm now getting less sleep than I was before.

He has a long AM nap because we have no opportunity for him to get a long PM one (gets 1 or 2 short ones) and his first A time is around 3.5hrs so I don't think he can be finishing his night sleep then.

I'm not sure if I should up the DF even more to try to get the wake up back to after 6am or maybe try to drop it cold turkey and go with the NWs for a few days and try to cut what I offer at each of those?
What do you think?

(sorry I know it's a long post for this question!)