4 oz takes over 40 min for 2 month old?

[ENMS]

DS is 2 months old today.  Feeding has been complicated for him from the beginning - he was tongue tied, got it clipped, then he had reflux, it is much better now but feedings are still long and complicated. He chokes while feeding, cries every time he burps, and it takes white noise and complete isolation for him to drink more than 2 oz (I have to feed in his room with the white noise on otherwise he just cries).  He has been prescribed Domperidone to help with choking during feeds but it has not helped at all.

I was looking into potentially changing nipple size on his bottle because he feeds for such a long time, and then in the FAQ's I came across the thread on Dysphagia. I haven't had time to read all of it yet, but here are my answers to the 5 questions in the first post.

1) Does he eat better when he's sleepy?  Yes definitely
2) How long does it take to feed him? 45 min for 4-5 oz during the day, 10-15 for 5 oz at night.
3) Does he scream and when he sees the bottle/before he starts to feed?  We had to stop BF because he screams when he sees the boob. As of yet, with the bottle he is ok at the beginning.
4) Does he seem fussy while he eats vs. after he eats.  While he eats now, previously was after as well but reflux meds cured that.
5) Is he congested or had any other respiratory problems.  He's been congested for 10 days now, not getting better nor worse.

How do you know when it's time to change nipple size? I was thinking (hoping) this might be the issue?

We're seeing the ped tomorrow so I will speak to him about dysphagia but I figured I'd first check into changing nipple size...

[ENMS]

I think I have my answer about changing nipple size... DS just had his first night feed and he drank well and fast - so I guess the nipple is not the issue then. Hopefully the ped is helpful tomorrow and we can do some tests for dysphagia.

[ZacsMumme]

Hugs Hun, I have asked around for some BTDT or knowledge on dysphasia, hopefully someone will have something or you...in the meantime good luck with the ped visit. Let us know how you go

[flutie]

I can't offer any support about dysphasia, But send vibes for your appointment...hope you find out whats going on with your little guy...its been a tough start.  When I read your title, I was initially thinking nipple size too.  When ds is ready for a change it takes him forever to eat, it is alot of stop and go, as well as some clicking/suction like sounds.  He also fed better at night during theses times...I always thought it was because he was drowsy and relaxed and therefor didn't get as fustrated.  Tough call....if only these little guys could talk!?

[ENMS]

He also fed better at night during theses times...I always thought it was because he was drowsy and relaxed and therefor didn't get as fustrated.

Interesting Lisa... hopefully that is the case with DS then! I have bought some faster nipples yesterday, will try at his second feed of the day!

Tough call....if only these little guys could talk!?

Agreed!!! 

[Fiver]

No experience, but how did the appointment go, Elise?

[ENMS]

The doctor told me to cut all dairy from my diet and prescribed Alimentum to replace the formula he was getting.  He said dysphagia was a possibility but in his experience, MPI was more likely.  So funny though because a lot of the symptoms he doesn't have, but he thinks it might still be the problem here. I'll go back next week and we'll see if this works out or if we need to go to the next possible cause on the list!

I'm kind of mad at myself because it's been a little while that it was suggested to me on the CRC board to cut all dairy, but I didn't end up doing it.  So I'm doing it now, but if I would have done it earlier, maybe BF would still be working out for us.  Anyhow, I'm still pumping and he's getting about 90% of the time my milk, so maybe if he gets better there's a chance to start again, otherwise well, I did what I could and what I thought was right at the time.

Thanks everyone for your support!

[Fiver]

If you're still pumping there's every chance you would be able to get back to directly from the breast.  Hope this is the answer x

[babymunkey]

Anyhow, I'm still pumping and he's getting about 90% of the time my milk, so maybe if he gets better there's a chance to start again, otherwise well, I did what I could and what I thought was right at the time.

Hugs hun, in my book you did the right thing and still are so dont be sad about it As Amanda said you could still get back there - I "weaned" #h back from a bottle start to BF  - hope it goes well this week,

H

[ZacsMumme]

I'm kind of mad at myself because it's been a little while that it was suggested to me on the CRC board to cut all dairy, but I didn't end up doing it.  So I'm doing it now, but if I would have done it earlier, maybe BF would still be working out for us.

hun you did what you had to do at the time....it's very hard to see through the fog with an unsettled baby. I also didn't try cutting dairy as soon as I should have. In the end it made no difference but at the time I just couldn't get through that period that way.

We do what we can to get through. Hindsight is just that. Please try not to beat yourself up about it. As H says you can wean back if you need/want too.

So glad you are making progress. It can be slow.

[amayzie]

Hi Elise- I was reading your posts above and thought i'd give you a couple of hints as far as managing things if dysphagia is an issue- It sounds like there's a lot of things going on, but some adjustments in positioning might help with dysphagia and reflux.

-One thing i'll suggest is to try and hold your little guy a little upright when feeding him, so not lying down flat. This means that he can control more easily the fluid coming into his mouth. You can get bottles that are angled that are great for this, but a regular one is ok as long as you are careful that the air isn't getting to him.

- You said you changed nipples, that;s a great idea. Perhaps with the faster flow he isn't working as hard to actually suck the milk out, and so can concentrate on drinking and swallowing.

- With the teat, can i suggest that you try something other than an avent teat, that can be a really tricky teat for little ones with swallowing issues. A narrow teat is usually the best bet, and is also good if you are looking to go back to the breast- The avent teat and lots of wide ones mean that the LOs often end up chewing on the end to get milk rather than sucking efficiently

- Offer your little one plenty of breaks- if you feel he's getting overwhelmed pull the bottle out and let him rest. He might do better with half a bottle at a time with a half hor break or so in the middle.

- Make sure your guy is well supported during feeds- it might help to swaddle him so that his arms and legs are supported. You don't want him flailing all around. You also don't want his head extended back, you want it as neutral as you can. This helps protect his airway- think of when you do CPR, you put the persons head back to open the air way to do the breaths in. We want the opposite when feeding a baby.

These are all the suggestions i can really give you online at the moment i think, but there are other strategies that can help if you see someone in real life. If you are still concerned about the swallowing issues, try and get an appointment to see a qualified speech pathologist/therapist with experience in paediatric dysphagia. Most of the time in australia you need to access one at a large hospital, rather than just community health.

ANYWAY- Hope your LO is doing better- most of the positioning suggestions above will also work for reflux... Let me know if you have any other questions!

[ENMS]

Thanks Katy!!

We're doing not bad with the choking lately... I am feeding him upright already. I'm using playtex drop-ins, we used to be on Dr Brown's but I got really fed up with the washing... I can't say there is a difference though between one and the other - if anything it is slightly better lately. I had changed to a fast flow but switched back to the slow flow because the milk was dripping out of his mouth. I can't say he was choking more or less with it, but maybe I should give it a fair chance and try it again. Here in Canada we don't seem to have the medium flow one - that's weird, I think they have it in the US.  They also have the variable flow one for thicker liquids, not sure if I should try it or not? I think the LO controls the flow so it might be better? If anyone has tried them and can let me know I'd appreciate it!

- Offer your little one plenty of breaks- if you feel he's getting overwhelmed pull the bottle out and let him rest. He might do better with half a bottle at a time with a half hor break or so in the middle.

That's a great idea, I'll try to do that tomorrow... we've just extended his A time to 1h20 minutes so it should give us a chance to cut the feed in half... with 1h-1h05 of A time it was almost impossible since he can take up to 45 minutes to feed!

it might help to swaddle him so that his arms and legs are supported

Maybe that would explain why he feeds better for his NF... I don't unswaddle him at night.  I will check tomorrow the head position to make sure it's not extended back.

Thanks for your tips, I really appreciate it!

[ENMS]

Katy - what about thickening the milk, did you do it and did it help?

[flutie]

Hi Elise,  Glad to hear you are seeing a slight improvement.  We are in Canada and are using Dr. Brown's (I agree they are a pain to wash!!) standard size bottles.  They come with 3 varying speed nipples.  DS could not handle the level 3, but does well with the level 2 nipple.  It took him a good two days to get used to it...he too was dripping milk, sputtering etc.  But now that he is used to it can down his bottle in less than 10 minutes.

[ENMS]

Thanks Lisa. I guess I'll give a longer try to the fast nipples this week-end, stick it out for a good two days and see how it goes. It didn't seem to worsen the choking anyway.

I loved the Dr Brown's bottles but really could not do it anymore, it took me 30 minutes twice a day to wash them, there are so many parts!