4 mo fussy eater, possibly snacker - please help

[LaraDaisy]

Hi everyone!
I am a FTM to 4 touchy mo baby boy. He has been on EASY since about 2 months old, he is a short napper and currently I need help with his eating as well.
He is in general healthy little boy, he is growing well. He is touchy, he has reflux and gas (i am on elimination diet ( no dairy/gluten/grain/legume/fresh fruit/nuts/fresh vegetables) for couple of months now and it helps but not perfectly), he takes ppi for his reflux.
I do combination feeding, introduced formula about 2 weeks ago as a means to get some more sleep during the night, because end of March he started being a very fussy eater and it is very frustrating to feed him during the day (he eats in 2-3min intervals and then wants to eat after 2hrs and at night suddenly was eating every 2 hrs or sometimes even 1,5 hrs), during the day he often refuses the breast but takes the bottle with either EBM or formula.

Here is his routine (the day before yesterday):
06-35 WU
07-25 breastfeed (was trying to give him breast since he wake up but he did not take it)
08-35 sleep till 10-35 (for his first nap I lay down as well, as he sleeps in a co-sleeper, and after he wakes up at 40min mark I take him and put him next to me in our bed and we sleep another 1hr-1,5hr)
10-35 breastfeed
12-25 sleep till 13-05
13-05 breastfeed
14-45 sleep till 15-25
15-25 breastfeed
16-40 eat again (bottle of 70ml formula)
17-25 sleep till 17-55
19-00 breastfeed + 70ml formula - after that bath + BT routine
19-53 fell asleep (yesterday was not typical day, for the last week I made sure he is asleep at 19-30/19-40)
22-45 DF of 170ml formula
02-15 NF 200 ml formula
and next morning he woke up at 6-15

yesterday:
06-15 woke up
06-55 tried to breastfeed not very successfully
07-10 - 50ml of EBM
08-00 sleep till 10-00
10-00 breastfeed (he was sleepy and it went very well)
11-45 sleep till 12-30
13-30 tried to breastfeed, he ate 1 min on each side
13-40 gave him 50ml of EBM
14-00 gave him 60 ml formula
14-20 sleep till 15-00
16-10 breastfeed
17-00 sleep till 17-40
17-40 breastfeed
19-30 bedtime
22-45 DF of 120ml formula
03-10 NF 170ml formula
this morning he woke up at 6-10 and I tried giving him breast but he refused so the first time he ate was after his first nap - I breastfed him for about 5 min and then gave him 30 ml formula

So, this frequent eating started end of March and first I suspected GS or WW and fed him as many times as he would take the breast, even though it was always very short - 2/3 minutes and very frequent, he was fussing a lot and I had to carry him around while feeding. After sometime my milk supply went up and I started having engorgements and very strong letdowns (he was frequently coughing and gagging and choking at the beginning of the feed), but his short and fussy feedings continued. After couple of weeks of waking up 3-4-5 times per night to feed him I started giving him formula in the evening and at night. So now he sleeps better, but his daytime feeds are all over the place. On top of his short naps (he is a short napper since 2 mo) I feel like we do not have any routine whatsoever.
So, I am really hoping for some help and advice here! How can I make sure he eats better during the day? I have the impression he eats little during the day but has two huge feeds at night. When he eats during the day he pulls off the breast after 10-20 seconds, arches his back and kicks his legs, with bottle it is a bit better - he does fuss a bit, but not so hard. At night and when sleepy he eats better, both from the breast and bottle, though there is a bit of fussing but not too much and it does not interfere with the feeding.
Any ideas/suggestions are welcome!

[MasynSpencerElliotte]

Hi there...I am off doing the morning school run soon so no time for a proper reply but one thing jumped out at me...if he has reflux and is on meds, how long has he been on the same dosage? I do not know a lot about reflux but I remember reading other posts that as they grow the dose needs upping and the back arching/short/frequent feeds seem like discomfort to me. What type of formula is he on?

[LaraDaisy]

Hi there...I am off doing the morning school run soon so no time for a proper reply but one thing jumped out at me...if he has reflux and is on meds, how long has he been on the same dosage? I do not know a lot about reflux but I remember reading other posts that as they grow the dose needs upping and the back arching/short/frequent feeds seem like discomfort to me. What type of formula is he on?

Hi! I suspected that as well, I had an appointment yesterday with the pediatrician and she allowed us to up the dose to the maximum, so starting from today he is on15mg omeprazole per day. I hope it helps. If not she said the next step is to get a special formula (for babies with lactose intolerance) and if that does not help we will have to go to the hospital and be under 24hrs supervision to see what is actually happening with him.
As for formula - I give him BEBA Optipro, it is basic formula from Nestle here (we are now in Switzerland), I started him on BEBA Comfortis which is for sensitive tummies and then tried the regular one and have not seen any difference (except in price
 

[*Liz*]

But you eliminate dairy whilst BFing  . It's really hard if he is getting direct dairy from formula. Makes it hard to know what is working  .

[LaraDaisy]

But you eliminate dairy whilst BFing  . It's really hard if he is getting direct dairy from formula. Makes it hard to know what is working  .

The problems with frequent feeds started before I gave him formula, so I did not suspect it.
You think I should stop formula for a while and see?
Right now we are having another difficult eating day, ate ok upon wake up but it is 4 hrs later and I cannot get him to eat longer than 1 minute for more than an hour now... I am so frustrated... Never thought that problems with BFing can start after 3 months, everyone says it is the first 3 months that are the most difficult, but for me the first moths were the easiest - he latched well and ate well and liked to be at the breast. Now I am just one frustrated momma.

[MasynSpencerElliotte]

What about the back arching etc? Did that start before or after starting formula? How much does he get? My DD3 was able to tolerate Nestle Goodstart even though dairy did bother her, not sure if it is the same - here it is made of just whey, not casein and is more broken down than normal dairy based formulas.

[LaraDaisy]

He started arching his back before I introduced formula. That is why I do not suspect it. I give him 2 to 3 bottles per 24hrs, for DF (170 ml), NF (170 ml) and sometimes during the day (50-100 ml) after trying to give him the breast.

[MasynSpencerElliotte]

If he is taking in 12 oz formula overnight plus 3 oz or so in the day that might be part of the issue...if I recall right recs are 24-32 oz if total formula fed so he is getting half the minimum at night so kind of reverse cycling. As well, with mixed feeding it is a fine balance to keep supply up - did you go straight into that many formula feeds or do it gradually?

[LaraDaisy]

he is getting half the minimum at night so kind of reverse cycling

I have fears that he indeed takes most of his calories during the night from the bottle because it is easier or less uncomfortable.
I started with 1 bottle for DF and then added the night feed as well. Before introducing formula I always pumped nad gave him EBM for DF, as he was falling asleep on the breast. And I still pump at that time.
As for supply issues - it is hard to tell with him not taking proper feeds, sometimes I feel like there is not enough, sometimes I have to pump to relieve discomfort.

[MasynSpencerElliotte]

What about offering a bit less for the nf and see if the morning feed improves at all?  I can totally see where he would not be really hungry for that feed if he had formula a few hours prior - it takes way longer to digest than bm. 

I guess if you think of it this way - if he gets 12-15 oz of formula and is only wanting 12-15 oz of bm to make up the difference then spread that over 5 daytime feeds it isn't too surprising feeds are short as that breaks down to 2.5-3 oz per bf (I realize this varies just giving a breakdown!) and at this age they get quite efficient ao he could be getting that in a few minutes. When he refuses the breast for the bottle it could just be he is drinking it because it is easy not necessarily because of true hunger...it goes down without much work that way so often the full signal takes some time to kick in!

[LaraDaisy]

What about offering a bit less for the nf and see if the morning feed improves at all?  I can totally see where he would not be really hungry for that feed if he had formula a few hours prior - it takes way longer to digest than bm. 

I did that couple of times and he woke up asking to eat at 5 and then at 6-30 when he wakes up for the day he again is not hungry... But the last two days I changed - I gave him DF at 22 (before it was almost at 23) abd he was clearly hungry in the morning: he was grabbing the nipple like crazy, but still sucking for 10 seconds and then pulling away arching his back and again and again. And this has been his feeding pattern most of the day feeds, only once or (very rarely) twice during the day he sucks non stop for 2-5 minutes and I tried really hard to find a pattern but with no result, I still have no idea what causes him to eat better or pull away constantly.

When he refuses the breast for the bottle it could just be he is drinking it because it is easy not necessarily because of true hunger...it goes down without much work that way so often the full signal takes some time to kick in!

During the day I only give him bottle if there was no permanent sucking on the breast for 2 or 3 minutes, and I give him 30 to 60 ml at once and sometimes he refuses the bottle or does not finish it. Then I understand he is not hungry.

[MasynSpencerElliotte]

How has it been the last couple of days? Has the dose increase helped any?

[LaraDaisy]

Hi! I have had mixed results One day he is hungry in the morning, the next day not so much. So for now I am trying to relax about it all - the schedule, the frequency of eating and sleeping, after all he gains weight steadily and overall seems content!
Since yesterday I am also trying something different. During the day I try to breastfeed him and if he does not take the breast, I pump and give him a bottle of EBM which he takes well - it does take some time to first pump and then feed him but at least I am less stressed because of his popping on and off the breast and I can see how much he eats ('cause with the on and off popping I was always not sure if he had enough).
I think I will do it for several days just to take the pressure off me and then we'll see. But now I have a very strong suspicion that on top of having some discomfort from reflux he is too lazy to breastfeed or he just prefers the bottle.
and thank you very much for your help!

[LaraDaisy]

Hi Heidi, just wanted to let you know that after 7 or 8 days on new increased dose of reflux meds my LO has gotten better and now if i manage to give him his meds first thing in the morning, then he is breastfeeding much better during the day! It is not perfect everyday, but it is a great improvement!
and happy mother's day!

[MasynSpencerElliotte]

Great update! So glad the med increase is doing the trick...Happy Mother's Day to you too!