Almost eight months still refusing formula by day

[roxannesmum]

Hello again
Little man will be eight months on the 15th.  This is a problem we have been struggling with since December when I stopped bf.  After trying many formulas he is now on neocate since January.  He was on ranitidine too and for a couple of weeks he would take bigger day feeds (6oz max).  Then he went back to his usual ways of only feeding at night and pretty much refusing bottle all day. He is now on omeperazole and is generally a much happier boy for the last two weeks or so.  However he still won't feed during daylight hours!  He is pretty good on solids now after gradually introducing foods on advice of dietician (dairy free).  He may take 2-3 oz before completely refusing the rest of the feed if I'm lucky. This changes come bedtime he will usually take 6 or 7 oz at bedtime feed again at dream feed (5 or 6 oz) an then at leas one more night feed of up to six oz. usually between 2 and four. After this he won't feed. At wake up between six and seven I offer him a feed and he usually completely refuses it but will have breakfast. I offer another feed after his morning nap he may have typically 2 or 3 oz, but will then happily have lunch a while later.  U offer another milk feed after his pm nap quite often this is completely refused, but again he will happily hav e solids at tea time.  Am I offering too many feeds do you think? What's normal for a baby his age?? Should I try to stop the night feeds or is it reasonable for him to still have then at his age?

[*Kara*]

Night feeds are not expected unless baby doesn't drink milk during the day

We need to shift things around...

But first, what dose of Omeperazole is he on?  Weight?  It could be that his dose isn't high enough to effectively control his reflux.  Let's rule that out first.

[roxannesmum]

10mg about 8kgs.  Last night we didn't give him the dream feed although he does usually wake before it now , he didn't so we left him and he slept til 4 am and then took only 4oz. He stirred a few times before waking up at six and then only had 1.5 oz this morning

[*Kara*]

I have called on the medical types here for dosage info..

Was referred to this: http://refluxrebels.com/Acid_reflux/Acid_reflux_medication.html

Here is the info:
Dosing PPIs:

Prilosec and Zegerid (Omeprazole)

Less than 3 mths: 1.5 mg/kg 2-3 times daily (3-4.5, g/kg total)
3 to 6 mths: 1.25 mg/kg 2-3 times daily
7 mths and older: 1 mg/kg 2-3 times daily

So, your dose should be 8mgs given 2 or 3 times each day (30  mins before a feed of course).

Does he just have a single dose of 10mgs?

[ZacsMumme]

Hi Hun,

Do you think he is in discomfort? - does he show any reflux symptoms ATM other than not feeding well...and what does he do when you try to feed during the day?
Reflux 101 - General reflux information
As kara mentions the dosage he is on is a low/moderate dose. It could that the medication needs to be increased to ease the discomfort from the reflux. A moderate dose is typically 15mg and high 20 mg. once on a good dose that controls the acid it is less likely the dose will need to be increased.

Can you post your day - ie time and volume of each feed, timing and est amount of solids (and what solids) and when you give meds?

Hugs

[roxannesmum]

Up until about ten days ago he would be unhappy ALL DAY LONG and spend the majority of his time crying, the last week or so he has seemed better so I hoped things were looking up, he's not screaming all the time now at least.  It used to be the case that he would have announce nor so of a feed before back arching screaming and refusing the remainder of the feed actually he would throw his whole body back as he got older, he's not like that so much now just refuses it after 2-3 oz max if he will take it at all.  When he started on neocate and ranitidine I started feeding him in his room immediately after he woke up from a nap to try to get him while he was still drowsy this worked for a while but doesn't anymore. Then I think the ranitidine stopped working hence I asked the gp to try omeperazole. In actual fact he prescribed 5 mg to be mixed with water but this was impossible as the tablets are 10mg and don't really dissolve so its impossible to accurately give half also he would just spit out the solution so i have been putting a whole 10mg tablet in a spoon of porridge at breakfast and he usually will swallow it like that.
As for other symptoms he will choke or gag a few times during each feed, when he will actually feed at night.  He has a more or less permanent runny nose and cough and raspy sounding chest. He still spits up occasionally too including solids. 

Usual day give or take-
0630 wake up refuse formula or maybe 1oz
0730 porridge 2 tablespoons with 1oz formula mixed in and omeperazole
0930 nap
1130 ish offer feed on wake up this is usually most successful up to 4 oz maybe
1230 lunch 1/2 jar ready made food same as tea and 1 tub fruit purée(3oz I think)
1430 nap
1600 offer another feed on wake up usually refused maybe takes 1 or 2 at most
1700 solids 1/2 jar of chicken rice veg usually or similar and 1 tub of fruit purée
1800 bath
1900 usually will have at least 6oz up to 8 right before bed
2240 5 or 6 oz dream feed (although he sometimes wakes for this earlier always goes straight back to sleep)
0200-0400 usually wakes for at least one more feed up to 6oz

He feeds well as long as he's sleepy! Even in the day when I can see he is clearly hungry he will start and then stop after a couple of ounces.
He is gains ok now I think he did lose a small amount if weight before he started on the neocate, although he's still quite tiny. He is very active crawling for a month and pulling himself up already

[ZacsMumme]

I assume no solids are given at have wheat, milk, soy, nut or egg in it? (Just checking)

I think because he feeds at 2-4 he not hungry at 6.30 I would maybe try giving nothing till 7-7.30 and make this the milk, then try solids after that. That said, it's not a lot of solids anyway which may be why you get the good feed at 11.30

I guess you have a similar problem to us really. Neocate tastes like rubbish. Solids taste good and they keep it down better. So baby likes solids (go figure right) problem is solids can upset tummy, cause constipation and sometiems make the reflux worse so baby feeds at night to get what they need.   how are his poops?

IIWM I guess I would first see if an increase of meds is possible and then trial that to see if it helps. You should see a change in a week. Then I would try to juggle solids/milk so that you feed when LO is defiantly hungry. I cheat sometimes when at is be fussy and add a bit of prune juice to the bottle to sweeten the milk so he will take it.

Have you tried a variable teat? - sometimes these help if LO is frustrated with flow? 

Sorry a ramble really...I am thinking out load

[roxannesmum]

I do keep trying him with the formula and have tried giving it to him later after he wakes up in the morning but he won't have it, on the rare occasion where he hasn't had a night feed he still won't have a morning feed.
I have recently started giving him wheat trialled it before and it seemed to upset him but this time he has been on no worse anyway but the other things no he doesn't have. 
We have a paed appointment on Thursday that we have been waiting for since December what kind of dosage how many times a day do you think is appropriate? Or do you think a different medication would be better or a different formulation he currently has the 10mg tablets. Thanks for any help x

[ZacsMumme]

I would just ask for a med increase because he is showing reflux discomfort and not feeding well. This is of course if you think this is the case. A moderate dose is 15 mg a high one is 20mg. PPIs are typically the best medication for acid reflux so the med itself should do the job

If you give 1 dose a day then it needs to be great enough to cover the 24 hrs. If you split the dose in 2 each dose needs to be high enough to work. Some people have more success with splitting, some all in 1 go.

I would try to give him the med before you feed really. Ideally it is given 30 mins before food, ie first thing in the morning, and if split then 2 hrs after ~3 feed

[roxannesmum]

Hi had our appointment on Tuesday not Thursday as I thought but luckily I realised and got there in time! She was great and agreed to up the omeperazole to 20mg so he has been on that since Tuesday.  He seems to be picking up his day feeds a little fingers crossed but he is still waking usually around df time and sometimes again for another feed. Last night he woke at midnight from 7pm for a feed and then through til 6.25 and he actually had 4.5 oz this morning which is great for him hope it's not a fluke! Hope things continue to improve. I have another question though what should I reasonably expect from an 8 month baby feeding wise? Ideally how many bottles should he have and what about df nf and so on? I know I am offering too many feeds and need something to aim for thanks x

[*Kara*]

Look at the top of the Bottle Feeding forum - I posted sample routines there.  He should be on three bottles, no DF and no NF provided he is doing well with solids.  If not doing well with solids, either a DF or NF, but not both.

[ZacsMumme]

Great he is feeling better and feeding more

[roxannesmum]

I took a look at the sample easys too just wondered if people left out the night feeds!!!

[roxannesmum]

Ohhhh sorry just saw what you meant great will take a look