Very difficult feeding 3 month old....

[Ambinsi]

Hello ladies,
I am having lots of difficulty feeding my almost 3 month old DS. We have had a lot of tummy troubles and I don't know what to make of our current situation.

Some history:
At about 2-3 weeks of age I noticed signs of reflux. Having experienced this with my DD I asked the doc to put him on the medication immediately - I didn't want to see him suffer and I know from past experience that painful feeds can result in long-term feeding issues. So he went on Axid and seemed alright. A few weeks later we had to increase the dose, he seemed alright again. A few weeks after that he started having major problems. I thought it was reflux so we switched him to Prevacid. After no improvement, it turns out he was allergic to his formula and is now on a special prescription-only formula. He's been much better and much happier but feedings are still very difficult and I no longer know what to make of it.

We were putting cereal in the bottle for the reflux (highly controversial, I know, but recommended by doc and this worked very well for my DD). Since that thickened the formula I went to a level 2 nipple, which I had to do with my DD. She was on a level 2 very early b/c the formula was too thick for the level 1. It was too fast for DS so we lessened the amount of cereal and went back to the level 1. He was doing alright but is getting fussy again so we tried the level 2, thinking maybe he was getting frustrated on the level 1. I had to increase the cereal b/c it was too fast.

Basically, he takes the first half of the bottle with no problem, then stops. I usually burp him at this point and give him a short break but when I try to resume feeding him, he either pushes the bottle away with his tongue or moves his head. If I force the issue he fusses. Sometimes he'll eventually finish the bottle with some jiggling but its always a struggle. VERY rarely he'll take the whole bottle no problem. I feel terrible....I feel like I'm forcing it and I know I'm really coercing him to eat. BUT - he's 3 months old and should be able to take more than 2-3 oz at a feed, no? Soon he should be moving to a 4 hour EASY and how can that happen if he's not taking full feeds?? I'm also doing a DF at about 10:45 pm and he's still getting up at 4am. I think he should be able to go longer than this but he can't because he's not eating enough during the day. The obvious answer would be to increase the daytime bottles but I clearly can't get him to drink more.

I am so confused, I don't know if its the cereal, the nipple flow, the reflux, or what. I feel like I've tried everything...a few weeks ago I started at square one, no cereal and a level one nipple and we went from there. I don't feel like things have changed.

Please help!

[*Kara*]

So you are no longer putting cereal in the bottle, correct?  Of course, this isn't something that I can recommend as it is a known choking hazard - not to mention, could cause painful tummy issues for a baby who isn't ready for cereal yet.  There are thickeners for liquids that are safe for babies. 

So, does he have reflux at all or was it just the allergy?  What is the allergy/intolerance?  Milk protein, lactose? What formula is he on now?

A DF plus two NF's is fine for a baby his age, so you are golden with only having one feed - especially with such a big stretch from your DF.

The 4 hour EASY switch is at 4 months, so you have a ways to go yet

It is quite likely that he has developed an aversion from the earlier feeding issues - that can take a few weeks to get over... in the meantime, never force or coerce him into eating.. this will only make the issue worse and cause both of you more stress.  Take things one feed at a time - you will both get there hun.

HUGS.

[Ambinsi]

Thanks so much for your reply Kara.

To answer your questions, yes, I do believe he has reflux. He was showing signs very early. The back arching, the crying on the bottle...I attribute that to reflux. A few weeks after all that, the constant spitting up (regardless of how long it had been since he drank) and the blood in the poop started. That we now know what the formula. Am I 100% sure??? No, of course not, but since the reflux is so common and I saw the same signs that I saw with my DD at around the same time, which seemed to subside with meds, I think he does indeed have it.

The allergy was an unfortunate coincidence. I didn't suspect an allergy because he was on a hypoallergenic formula (Alimentum). My DD was on the same formula due to issues and I thought I'd avoid some of the drama I had with her by putting DS on this formula from day 1. Unfortunately he fell into the 5% that can't tolerate it but I didn't even think that was a real possibility, so I never thought it could be the formula. He's now on Nutramegin AA, which is special order and prescription only. He's doing a million times better on it - happy and no more vomiting....but still difficult feeds. I'm not sure if the allergy was milk protein or lactose. The Alimentum is normally for babies who have trouble digesting milk and even that was too much for him. I have no idea, I'll ask the doc.

I know that the cereal in the bottle is highly controversial and I was against it at first with my DD but it made a world of difference for her. My doctor never mentioned any other thickener, I'm not sure why. I've tried to back off the cereal with DS and it seems to make things worse. So to answer your question, *am* still putting cereal in but I've been experimenting with the amount. I know the recommended amount per ounce for reflux babies and we're not putting in as much as we have been told we could. Just enough to make the formula so he can drink comfortably, no more.

What gets me is that the first half of the bottle goes off without a hitch. Once he needs a little break, its a struggle after that. Can he really be getting full after only a couple of ounces?? That just doesn't seem to make sense to me.

[flutie]

Hi there,  i could have written the exact post as you.  DS is almost five months, with "controlled"  reflux and we are having the same issues.  I hate the thought of feeding him right now as I inow what a struggle it is going to be!  The only thing that sort of works for us is taking a break and waiting to finish his bottle when he asks for it....kinda messes up EASY but we are nowhere near to even thinking about routine right now.  Hope you see an improvement soon....it is so stressful when feeding isn't going well.

[Lolly]

Only drinking a few oz and refusing the rest is typical uncontrolled reflux behaviour really. How much prevacid is he on and how much does he weigh?

I would stop the cereal too really - there are other non-food thickeners available and maybe a switch to something like Simply Thick would be better.

Laura

[Ambinsi]

I appreciate everyone's comments...

Laura, to answer your questions he's on Prevacid but here's the deal. He was taking the solutab, I believe the dose was 15mg (mg???) to 1ml water. We were doing that and he seemed fine AS LONG AS he swallowed the entire dose and anyone who has dealt with this knows that can be a challenge. It took me awhile to get a technique down and find the right syringe where it doesn't all get stuck at the bottom. But I digress....so he was doing the solutab but due to insurance issues, which is a very long story, we wound up getting it compounded in liquid form. He's finishing one bottle of this, and I have another bottle and then after the first of the year I can go back to the solutab. Come to think of it, I HAVE noticed a difference since he's on the liquid. I was all excited thinking it would be easier to administer but I don't think he's doing as well on it. He's taking 1ml of the liquid.

As for his weight, he was 12 lbs 13 oz at his 2 month visit and he's due for his 3 month visit after thanksgiving, so I'm not really sure what his accurate current weight is.

Interesting that you think this is a reflux issue....now that you're mentioning it I do think he was doing better on the solutab. Hmmm.

I did talk to the doc today, I called after another frustrating feeding. He suggested that we do a dose of Axid at night and the Prevacid in the morning and give that a few days. I asked him about other thickeners and he said to stick with the cereal and while I appreciate everyone's advice and know that many are anti-cereal, I'm going to defer to him on that one.

Thanks for your help.

[Lolly]

I bet the difference is with the meds, the compounded liquid is very unstable and deteriorates quickly. This link is to a NZ site which explains about the suspension http://www.cryingoverspiltmilk.co.nz/wp-content/uploads/2011/09/OmeprazoleSuspensionLetter.pdf

I understand sticking to your Drs recs with the cereal, just watch how it dissolves. It tends not to dissolve evenly and causes clumps which is why it's a choking hazard and not as effective for thickening feeds as a non-food thickener or a reflux formula (which you can't use because of the cow's milk). You need to watch for constipation as well, rice cereal is noted for this and constipation will make the reflux worse.

{{HUGS}} hope the added axid helps.

Laura

[Ambinsi]

Thanks Laura. I am going in for his 3 month well visit on the 28th and I'll discuss alternatives to cereal then. Today I spoke with my regular doctor's brother. He is also great and he's helped us tremendously throughout the ordeal with the formula allergy. I do like him a lot and value and trust his opinion but he's not the doctor I usually see. So I'll get my regular guy's opinion on that when I go in.

I am looking forward to the first of the year when I can go back to the solutab. I didn't realize the connection until you mentioned it and it got me thinking. It makes a lot of sense now. I actually might look into the cost and see if its worth it just to pay for it  

[*Kara*]

Oh hun - such a terrible thing when insurance issues can make meds unattainable   So frustrating!  I hope it isn't too expensive to get the solutabs... it does sound like that could be the key!

If it doesn't work out, I hope the extra Axid makes a change to your little man...

[Ambinsi]

Yes Kara, its extremely upsetting. I am going to be looking into the cost of the solutab tomorrow.  I might just buy it. I know its expensive but I might have no choice. I can't imagine going on like this for another month and then some. We are all suffering

[*Kara*]

Huge hugs to you and baby... Have you tried contacting your insurance company to say that the solutab is much more effective and that the suspension isn't not working for your LO?  Then they may agree to pay for it with a doctor's letter?

[Ambinsi]

Its not exactly that they won't cover it in general....its that our family gets a set amount for the year and we've already hit the max. My daughter was on Alimentum formula until she was over a year old (until about June), that was covered. Now my son is on the Nutramegin AA, also getting that covered. Those two things alone were a HUGE chunk of our total. Plus all the other little drugs here and there (prenatal vitamins while I was pregnant, antibiotics, I was on a blood thinner injection during my whole pregnancy, etc etc etc). So we're maxed out for the year. As of January 1 I can get it covered again.

But it doesn't matter, I went to the pharmacy and and paid for it...$175 for a 30 day supply. And that was the generic!!! But it doesn't matter, the thought of going on like this until January made me sick. Hopefully this does the trick.

[*Kara*]

Ouch.  Stupid annual maximums!

I agree though - totally worth the expense for wee man to be happy and feeling good

[Ambinsi]

Well.....just wanted to update. Today was day 3 of the solutab, we're still doing the extra dose of Axid at night (which I forgot last night, grrr) and I see a huge difference already. He's eating better, finishing bottles, sleeping better, etc. He still takes breaks on the bottle and feeding him does take a bit longer than I feel it should, BUT the difference is amazing and it has to be the solutab + Axid as that's the only change we've made.

I am so glad that I came on here to talk to you ladies....talking it out and typing it out and thinking it out helped me realize that the meds were the problem, and the info you provided gave me the confidence to make the switch. I'm out $175 but I'd pay every cent I have for a happy, healthy baby.

Thanks so much.
xo

[Lolly]

That's great! I'm really glad things are improving and I hope you can keep him on the tablets. This kind of story makes me very greatful for our NHS!

Laura