Refusing feeds in the morning, now eating over night again - help!

[primarypete]

Hi
 
Our baby (Austin) had been breast fed with expressed milk up until 3 months. He had been regularly taking 160ml-200ml each feed (3 hourly). He had been sleeping through (on breast milk from 8pm to 6am) from 10 weeks.

We had to switch to formula feeding at 3 months and after a day or so the pattern began: More and more he would refuse part way through a feed (it started at 120ml ish and is often now down to 70ml). It seemed silent refluxy (he suffered from refulx earlier but it had gone by 3 months) he stretches his back out pushing with feet (not arching), goes red, grunts and pushes the bottle away. This happened most in his morning/early afternoon feeds and he didn't have a problem with his 7 & dream feeds. We tried feeding less frequently and moved to a 4 hour routine. This made little difference. It's like his body couldn't process the food in the morning (I know it takes longer for formula) to make way for more food as he never cried for food at this stage (he would always let us know before). We added a dream feed which he demolished 200ml every time and carried on sleeping through (even though his total over the 24 hours had gone from about 900ml-1000ml breast milk to 700ml-800ml formula).

He is now 16 weeks old and things have got worse. He is on Ranitidine 1ml x 3 a day (a high but not top dose for his weight) and signs of silent reflux seem to have gone pretty much but the eating problem still remains in the morning and i'm not sure it ever was reflux?! In the last few days he has suddenly started to take massive amounts in the afternoon/evening and started waking every three hours during the night for food. E.g. Yesterday had 270ml at 3:30pm, 50ml at 5:30pm (split feeding pre-post bath) 190ml after bath, 200ml at 10pm, 200ml at 1:30am, 100ml at 4:30am and then at breakfast (7:45am) he ate 40ml. It is not sleep regression (yet) as he goes back 5-10 minutes after feeding in the middle of the night and gets himself off and stays asleep till the next feed.

It's like he is on a 4 month growth spurt. All other spurts he has been on he has ate loads more during the day and carried on sleeping through. I'm just very concerned this could end up with him being used to eating at night, needing to eat at night and undoing all the hard work we have done with sleep training (he gets himself off without even a shush or pat most times during the day and will mantra cry at night but then get himself back) and also kill our energy...

It also sounds like it's his body in the morning that is the root of all this - just don't know how to get him eating again then. Any help would be very gratefully received.

[Lolly]

It could be the 4 month growth spurt but it could be reflux. Reflux tends to peak at around 4 months and the feeding better at night is a pretty common thing (which is also why he's not hungry first thing in the morning). Which formula is he on - are you thickening it? I would get his meds reviewed, it may be he needs the ranitadine upped to the max for weight or he needs a PPI instead now.

Laura

[primarypete]

Thanks for the reply. We have just changed to aptimil comfort and so far so good, it's thicker and will help if milk protein is the underlying cause of the reflux. Will be back to med staff ASAP if it gets worse though

[Lolly]

The Aptamil comfort won't help if milk protien is the issue as it's a cow's milk based formula. It will help if lactose intolerance is an issue as it's a lower lactose (milk sugar) formula but lactose intolerance in babies is rare, milk protien intolerance is more common and you would need a hypoallergenic formula if that is the case.

It could be the fact that it's thicker is helping, both mine were on a comfort formula for a while and eventually moved to a reflux formula and meds.

Laura

[primarypete]

Thanks again Laura - it says on the comfort box that it has partially broken down whey protein to help make digesting the milk easier?? I don't think it's an allergy but could, as you say, very likely be an intolerance. The good news is he has carried on doing ok on it whatever the reason - has been taking a decent amount in his first feed each day - just his second that is tiny. Can't complain if it stays like this (which it never does!). Anyway, will see how it goes for next week or so, Hopefully if things get worse we can tweak his ranitidine or speak to paed in 3 weeks about omeprazole if he is mainly refluxy in the morning (im on it myself and I'd def want to avoid him having it if possible as it has some nasty side effects & is not pleasant to come off. All in all, roll on weaning!!

Please let me know if I am understanding the protein thing wrong!

[Lolly]

The comfort formulas are easier to digest but they are still a normal/ regular cow's milk formula the specialist formulas you can only get through a pharmacy. The partially broken down whey and lower lactose content is just easier for little digestive systems to cope with and the aptamil comfort contains a stool softener too. For babies who are milk (and often soy) protien intolerant this wouldn't be enough, they need a hypoalllergenic formula like Nutramigen which has the protiens extensively broken down or a formula like Neocate which is an amnio-acid based formula and contains no cow's milk at all.

See how the comfort formula goes, I have 2 refluxers who weren't MSPI so it doesn't always follow. If you need to increase the meds and that doesn't help enough it would be worth trying the hypoallergenic formula though. I've been on omeprazole and had no side effects at all with it - just shows how different we all are!

Laura

[primarypete]

Thanks again Laura - went well all day yesterday but his bedtime
Feed became the nightmare one, he hardly took any then started screaming as he knows it is part of his bedtime routine same pattern today so far (consistent 150/170ml feeds). Not sure what to do if he can't take his bed feed again. Poor little man