Awake "dream" feed

[Alexian28]

My DD was born 5 weeks early, currently 6 1/2 weeks old, formula fed due to no milk supply.  We are on a loose 3 hour easy routine depending on what time she wakes in the morning.  In many ways she's a  typical 6 week old but she definitely has a newborn digestive tract and possible reflux.  We keep her upright for about 20 minutes after eating and use a crib wedge to help the spit ups.  She can currently take 3 oz at each feeding but occasionally wants an extra ounce.  However her little tummy can't hold 4 oz so we're trying to work around this.  She is currently 8 lb.

We've previously tried the cluster + DF but all that eating just kept her awake and made her OT, so we just do a general 3 hour, 7, 10, 1, 4, 7, 10, 2.  She wets plenty of diapers (8-10 a day) and has gained weight well.  The past few days she's acted more hungry in the evening and is awake anyway so we may go back to the cluster although we'd just have to drop it again in another week and a half.

We usually feed her between 10-11 pm (fairly fixed time), 2-3:30 am and 6-7:30 am (depending on when she wakes from hunger but never later than 7:30).  Although she takes to the "DF" it's not a true dream feed for her as she cannot be asleep for this.  If we don't unswaddle her, feed her slowly, burp her and then keep her upright she will spit up quite a bit of her bottle.  The unswaddling and burping, of course, ensures she's awake.  She also pretty much entirely lost her rooting reflex in NICU so she won't take to the bottle asleep.  Is it really that crucial to truly keep her asleep?

Also, any tips to get that little bit of extra food in her tummy that she wants?  NICU was forcing 3 oz down her throat on a 4 hour strict schedule at 3 weeks old and she'd of course spit a lot of this up.  When we brought her home a week later we switched to 2 oz every 3 hours and it helped her a lot.  We slowly bumped up to 3 oz every 3 hours but she's ready for 4 sometimes but her body hasn't caught up yet... but she doesn't really take to clusters!  Growl!

[creations]

Oh I'm so sorry to hear your LO is suffering with reflux and wanting to eat more than her tummy can take   I'm afraid I'm not much help in that area.

As for the non-dream DF.  I do have experience there.  My LO would never take anything in his mouth asleep or awake that he didn't want, no paci, no thumb sucking, no DF.  I continued with the 'DF' just like anyone else but he was always awake for it.  When he was very young I lifted him and changed his nappy which woke him and then I fed him.  He developed an habitual night wake for this feed whereby he woke calmly and quietly before I got to his room to give the feed.  If he hadn't woken before I got there I just waited a few mins and he woke.  I would change his nappy, he would have his milk and go right back to sleep.
With a true DF the point is that baby gets fed without waking up to avoid the wake up becoming habit.  A habit now will need to be broken/weaned later on.  But in the scheme of things it is not the worst habit and not hard to wean later.  I weaned in the same way a DF is weaned, it was quick and painless for both me and DS.
It's worth also noting that not all babies take to the DF which might help you feel a bit less alone.  Where there isn't a DF or a habitual NF the long stretch of sleep will start at BT so the night feed continues to wake you up.  Where there is a DF or habitual NF at around 10.30pm the long stretch of sleep starts after that feed meaning that you will get a longer stretch of sleep between your bed time and the night feed or even through to morning (that is when the other night feeds reduce, not yet).

I hope that helps some

[*Kara*]

My DD never had a DF and wasn't really a big cluster feeder either. 

As Creations mentioned, the DF is done to give you a better stretch of sleep as LO may well wake an hour or two after you have gone to bed for the night otherwise.  There is another reason that LO is meant to be sleeping and that is to prevent the disruption to night sleep that an extra wake from hunger can cause.. the timing of the DF is also important in that baby will be asleep, but not into that complete deep sleep that happens in the early morning hours for most.

Hope this helps

[Alexian28]

Thank you, I guess it's more important that she be asleep than I thought.  She generally woke around this time anyway when we brought her home from NICU, as they initially fed her every 3 hours (midnight, 3, 6, 9, noon) then switched to every 4 two days before her discharge.  It took some wrangling to get her and us settled into a routine.  I do worry about her expecting a bottle at 10 or 11 pm, and I'm thrilled that she only wakes up once during the night to eat. 

The couple of nights that DH did a true dream feed she spit up almost her entire bottle 30 minutes later (we actually filled a bottle with water and poured it out to see what 2 oz looked like!) so this just is not an option. 

I suppose our best option right now is just to wait for her to wake normally from hunger and feed her rather than force the DF?  It's not too big a deal as DH is currently at home and stays up late so I get an ok night sleep for work.  I usually wake up at the middle of the night feed... nothing ticks DD off more than being cold so she yells during diaper changes

[*Kara*]

I would allow her to wake...  I didn't know about BW when my DD was itty bitty... she naturally was down to 2 NFs by 8 weeks and 1 NF by 13 weeks.. I didn't DF and I didn't cluster either.

[Alexian28]

Thank you Kara, you've given me a little hope that we won't screw hew up for life

We've gone back to clustering in the evening as she and DH sleep the morning away (sigh!) so she's a bottle short.  It's actually been nice because she's getting that extra bit of formula she wants in the evening without making her sick.

[*Kara*]

LOL!  No worries, plenty of time to screw her up   Just wait until she is dropping her catnap, you will question your own sanity!

[Alexian28]

Catnaps were a battle from the get-go, we APOP and let her sleep in her bouncy seat in the evening and even that can be hit or miss!  I don't see how some evenings she can be up for 2 1/2 hours.  At least she's angel/textbook thank goodness so if she gets OT it's not a huge deal.

We've let her sleep more the past day or two in the evening to let her wake herself up from hunger.  Lo and behold, she actually does have a hungry cry! 

One of the issues I have (although DH doesn't) is that, since they sleep the morning away, often her 10 am bottle becomes more like an 11 or 11:30 bottle and that shoves the entire rest of the day back, to the point that either "bedtime" is 9:30 at night or she loses a bottle's worth of food.  Would it be better to increase her afternoon and evening bottles by a small amount or just try the DF?  I'm trying to look at the amount she drinks rather than the number of bottles, but I have that magic 8 number in my head that I can't get over.  So no matter how much she's eaten I have this vague notion it's not enough if she's only getting 7 or even some days 6 bottles, depending on sleep and hunger cues.

[*Kara*]

I have that magic 8 number in my head that I can't get over

I don't think my DD has ever had 8 bottles in 24 hrs and she is fine

As a general rule of thumb (some take more, some less), the average is 2 - 2.5 ozs per pound of body weight every 24 hrs for formula intake, so a 10lb baby would have roughly 20-25 ozs per day (including all day and night feeds over 24 hrs).

What does her day look like right now?

Here are some samples of a typical routine for babies her age:
chronological EASY samples, 0-3 months

[Alexian28]

A typical day is something like this, although the time can vary around an hour.  We just settled on this.... yesterday I think.  We were trying different ways to get the formula she wants without making her spit it back up. At each feeding we give her 100 ml (about 3 1/3 oz) of formula.  She drains her bottles but as of yet can't tell when she's full, just when she is hungry still, so we do not offer her more unless she gives distinct hunger cues.  We don't know exactly how much she weighs, but she went from 7 lb 2 oz at 4 weeks old to 8 lb 2 oz at 6 weeks old.  She's now 7 weeks so is probably roughly 8 1/2 lbs.  Age adjusted she is 1 1/2 weeks old but she really doesn't act like it imo.  At 3 weeks old (37 weeks gestation) NICU has her on 3 oz EBM every 4 hours!  We cut this back to 2 oz every 3 hours when she came home as the switch from EBM to the formula NICU gave us made her spit up quite a bit of that 3 oz.  We switched her formula and that helped some but she's very easy to over-feed in terms of stomach capacity.

E: 7:00
A: 7:30-8:15
S: 8:15-10:00
E: 10:00 
A: 10:30-11:00
S: 11:00-1:00
E: 1:00
A: 1:30-2:00
S: 2:00-4:00
E: 4:00
A: 4:30-5:00
S: 5:00-7:00 (this can vary as some evenings she is very awake and doesn't go down till 6)
E: 7:00
A: 7:30-8:00 (bath, cuddles, bedtime)
S: 8:00-11:00
E: 11:00
S: 11:45-3:00
E: 3:00
S: 3:45-7:00

We let her sleep up to 2 1/2 hrs but then wake her for a feed if it's during the day.  The 11:00 pm is not a DF, just a feed her when she wakes feed.  So on this schedule she is averaging 700 ml or 23 1/2 oz of formula, more than enough for her weight, on 7 bottles a day.  Yikes I hope I'm not over-feeding her!  I'm just following her hunger cues, and they are (luckily) quite distinct.

As a side note, as horribly disappointed I was when my milk supply dried up, I'm glad I'm not breastfeeding.  Her suck and root reflexes were basically nonexistent when she came home and I would have thought she was full when she lost interest in eating if I couldn't see that she had only drank 10 ml. Just this week she's started chewing on the bottle nipple before she starts eating, is this just developmental?  She only does it for maybe 15 seconds and acts like she's too interested looking at things to eat, despite the fact that she was crying for food just a minute before that!

[*Kara*]

Just this week she's started chewing on the bottle nipple before she starts eating, is this just developmental?  She only does it for maybe 15 seconds and acts like she's too interested looking at things to eat, despite the fact that she was crying for food just a minute before that!

Sounds like it to me... she could just be experimenting with how the bottle nipple feels in her mouth.

So on this schedule she is averaging 700 ml or 23 1/2 oz of formula, more than enough for her weight, on 7 bottles a day.  Yikes I hope I'm not over-feeding her!

It's very hard to overfeed a baby hun, so do not worry about that at all.  I would up her feeds to 4 ozs each and see how she does.. most doctors aim for a 4 oz feed by a month of age, every 3 hrs or so... Given that she is a preemie though, she might take a couple more weeks to get there.  A few days can often be enough for her tummy to have grown to take more food.

What formula are you using right now? 

Her daily routine is fantastic as it is now

[Alexian28]

It's very hard to overfeed a baby hun, so do not worry about that at all.  I would up her feeds to 4 ozs each and see how she does.. most doctors aim for a 4 oz feed by a month of age, every 3 hrs or so... Given that she is a preemie though, she might take a couple more weeks to get there.  A few days can often be enough for her tummy to have grown to take more food.

What formula are you using right now? 

Her daily routine is fantastic as it is now

She is physically unable to handle 4 oz yet; we just upped her 1/3 oz each bottle yesterday.  If we give her 4, she spits up about half an ounce.  I think her GI system is one of the few things that's really gestationally a week old.  The overfeeding I worry about isn't calorie wise, it's size wise.  She has no idea when she is full yet.

We are using Gerber Good Start Gentle.  I selected it for its low sugar listing (Enfamil and Similac have corn syrup as ingredient #1, Gerber has maltodextose as #4), and it's less foamy.  NICU gave us the Similac ready to drink and she hated it and it gave her horrible gas.  She still has it with the Gerber but less, and we're giving her gas drops with each bottle. 

Her routine is great, it's scary actually.  I wonder when it's going to all fall to pieces!

[*Kara*]

I am a huge fan of the Gerber GoodStart formulas myself   Although, it's Nestle GoodStart north of you in Canada.  My daughter has done so well on the GoodStart product

Sounds like a good plan with the feed size... always better to feed less and keep it in the baby!  It could be that she is in a growth spurt too, so just be mindful of hungry cues a little earlier than the 3 hr mark (we had a growth spurt at 6 weeks that saw full feeds every 90 mins for two days!  I was really lucky that she didn't wake often overnight during growth spurts!).

Her routine is great, it's scary actually.  I wonder when it's going to all fall to pieces!

Likely now, since you have said it out loud

[Alexian28]

Yeah I jinxed myself, she slept for one hour from 10 am to 7 pm... how does that happen?!?

We bumped back down to 3 oz formula, she was so spit-uppy on 3 1/3 but she's lasting 3 hours still so we're not worried.  She is already spitting up less.

Thank you for all your help, support and reassurance Kara!

[*Kara*]

she slept for one hour from 10 am to 7 pm... how does that happen?!?

Yikes!  I used to grab the baby carrier if DD was up for a couple of hours... or I would resign myself to the couch to let her nap on my chest (newbies sometimes need that comfort)...