Inconsistent bottle feeds - not emptying bottle, hungry after 30 minutes

[meirsmom]

Hi all, have been directed here by anna from the Sleep section. I have a 5 month old son for whom we started PUPD/s-p 3 weeks ago and he has recently started responding well.

My lactation has been a problem right from the start, and till about 1 month ago my breastfeeding provided him about 50% (guesstimate) of his dietary reqmt and formula the other 50%. However few weeks ago my lactation dropped even further, and his reqmt shot up, and he's now quite disinterested in the breast. So I pump first thing in the morning, and I get about 5-6 oz. Any other time of the day if I pump, I get hardly 1-2 oz.

So I offer him breastfeed + formula during all day feeds and only formula during night feeds (so that I know for sure his tummy is full and he can sleep well).

This is how it goes:

Morning feed: Breastfeed + 2 oz EBM
Afternoon feed: Breastfeed + 2-3 oz EBM + 2-3 oz formula
Evening feed: Breastfeed + 4-5 oz formula (Sometimes he gets really hungry before his nap and takes 2-3 oz more. I'm not able to estimate correctly how much he should have. More on this below.)
Late evening feed: 5-6 oz formula
Midnight feed: 4-5 oz formula
Sometimes there's an early morning feed of 3-4 oz formula

Now here's the problem: he is on an AES routine, though on advice on this forum I'm trying to move his E time at least 15 minutes before his expected S time. What has happened in this process, is he's started splitting his feed - he will have 50-60% of the bottle 15-30 minutes before his S time, and the rest (and more, sometimes, esp. in the eve) right before his S time.

This completely throws my attempt to consolidate his feeds and I get confused about how much he really needs.

Any suggestions? Thanks in advance!

 

[Lolly]

Hi there!

Can you give me a run down of your day with timings please? At 5 moths I would expect him to be able to go 4 hours between feeds with formula, maybe slightly less on breastmilk as it digests quicker. You feeds look like there are more in the afternoon/ evening so if you caqn give a detailed day for me I can see better - include nap times too please!

If you are feeding him and then he is having another feed right before sleep it sounds to me like he is using the feed to get sleepy/ or to sleep and he is then snacking so not properly hungry for the next feed.

A bottle feed should be done in 20 mins really, babies will take what they need in that time. What flow teat are you using with him?

Laura

[meirsmom]

Hi Laura, thanks for responding so promptly! Really struggling with this so could use the advice.

Here's a typical day's routine:

Wake up: 10 am
A: 10 to 11 am
E: 11 to 11.15 am (Breastfeed + 2-3 oz ebm)
Wind-down: 11.15 to 11.30 am
S: 11.30 am to 12.15 pm (1st nap)
A: 12.15 to 1.30 pm
Bath: 1.30 to 1.45 pm
E: 1.45 pm to 2 pm (Breastfeed + 2-3 oz EBM + 2-3 oz formula)
Wind-down: 2 to 2.15 (Sometimes another small feed just before he goes to sleep)
S: 2.15 to 4.15/4.30 pm (2nd nap)
A: 4.30 to 6 pm (Sometimes takes a part-feed in the middle of this)
E: 6 to 6.15 pm (Breastfeed + 4-5 oz formula)
Wind-down: 6.15 to 6.30 pm (Sometimes another small feed just before he goes to sleep)
S: 6.30 pm to 7.15 pm (3rd nap)
A: 7.15 to 8.45 pm
E: 8.45 to 9 pm (5-6 oz formula)
Wind-down: 9 to 9.15 pm (Sometimes another small feed just before he goes to sleep)
S: 9.15 to 9.45 pm (4th nap)
A: 9.45 to 10.45 pm
Bedtime routine (also part of A time, actually) 10.45 to 11.15 pm
E: 11.15 to 11.30 pm (5-6 oz formula)
Wind-down: 11.30 to 11.45 pm (Sometimes another small feed just before he goes to sleep)
S: 11.45 pm to about 4 am
Dream Feed at 4 am (4-5 oz formula)
S: 4 am to 10 am (sometimes there are a couple of night wakings during this stretch, for some of these we need to pat him back to sleep, and for some he self-settles. Nowadays very rarely does he demand a feed at this time)

The above is indicative and varies depending on nap length and wind-down time - sometimes we leave him in the cot to wind-down and he goes to sleep within 5-10 minutes with shush-pat, sometimes he takes upto 30-40 minutes.

If the day's naps have been longer and/or if he's slept 11 hours at night, he skips the 4th nap and goes straight to bedtime.

I know the bedtime is really late, but we've tried bringing him to a 7-8 pm kind of timing but it hasn't happened so far, and DH and I are wary of radically changing what seems to be his natural bedtime. We hope over the next couple of months he'll himself pull it forward.

We are using Dr. Brown's teat no. 1, because he already has a bottle preference and we don't want to make him prefer the bottle even more with a higher-flow nipple. I guess we will have to move to no. 2 sooner or later, though.

Fyi he was born 7 lbs and is gaining weight fantastically well, is in top 3% on height and weight, so no worries there. 2 weeks after birth his weight had dropped dramatically so we had to give him more formula than I'd have liked (because I wanted my lactation to ramp up, which was taking time), but since then we've followed a completely baby-led approach.

Reeeally long post, thanks for your patience!

[Lolly]

That's a complicated day!!

I think you need to space these feeds and sleeps out more evenly. His first A time is 1.5 hours, at  5months he should be doing at least 2 hours which is why you only get a 45 min nap, he's UT.

His second bottle is less than 3 hours after his first bottle, if he eats at 11am, the next feed should be at 3pm, feeds should be about 4 hourly at this age. If he has had a breastfeed and then 4-6oz top up I would think he has had plenty - the average bottle feed at this age is about 6oz. The trouble with bottle feeding a breastfeeder is that they will pretty much always take what is offered hungry or not because bottle feeding is so easy. How much do you offer to him in a bottle?

Have you ever tried a dummy/ paci with him? Maybe the pre-nap feeds are because he has a need to suck for comfort rather than actually being hungry.

Your bedtime is late, but so is your wake-up, have you tried getting him up earlier in the morning and setting his day from there?

I'll think about this some more, school run time now!

Laura

[meirsmom]

Hi Laura, thanks for responding.

Yes, I guess it is complicated, but he does go to sleep every 2 hours, so to that extent there is an established routine.

I've taken your input to extend his morning A time by 15 minutes. Last 2 days his morning naps have still been 45 minutes, will wait and watch over next few days to see if they increase to 1 hour.

I offer him 3 oz for morning feed, 4 oz for afternoon feed, 5 oz for evening/late evening feed. He generally leaves 20-30 ml in the bottle.

I have started trying to space out his feeds to 4 hours. I did 3.5 hours yesterday and will move to 4 hopefully in the next few days.

We have consciously not used a dummy/paci, though I agree he needs to suck because he's sucking on EVERYTHING, but I don't want to introduce a dummy at this stage because now is when we should anyways be phasing it out, right? Am trying to introduce a lovey (a beanie cow) which hopefully he can suck on if he needs to.

Last few days he's started sleeping at 9 pm, then stirring at 11.30/12 for a 4 oz feed (we pick him up and feed him before he's fully awake, so kinda DF), then waking up at 3.30/4 am (which used to be his one big midnight feed earlier when he used to sleep around 12) at which time he's having only 2-3 oz so am guessing this is a habitual waking and not hunger, right?

Will appreciate any pointers on how to manage his feeds better, esp how to consolidate them into fewer bigger feeds. Thanks!

[Lolly]

When he breastfeeds how long is it for? Is he actively sucking for that length of time? How much do you get when you pump for him - it looks like you are offering 6oz of EBM a day?

With the paci it's your call obviously, I was very anti them until I had my first We ditched my son's at 4.5 months and my DD had hers until she was just over 3. They both had lovies too but I actually preferred them sucking the paci rather than the toys, they are easier to clean! If you do get a lovie make sure you get more than one the same.

The way to space the feeds is just to hold him off for as long as you can, start at the beginning of your day and feed him. Then get him to wait as long as possible until the next feed, as close to 4 hours as you can. That does mean not topping him up just before sleep though as it won't help. If he can get to 3.5 hours you feed him and then make him wait for 3.5 hours before the next feed, a bit longer if you can. You carry on like that keeping the time between the same or slightly longer if you can until you get to 4 hours.

If he can only do 3.5 hours before he gets distressed then keep it to 3.5 hours for a few days then extend to 3.75 hours.

If he has had 4+oz after a breastfeed he won't be hungry so crying before setting for a nap probably isn't an indication that he needs another feed, it could just be what he needs to do.

Laura