Feeding help with tiny baby

[sparks3]

So, I’ve posted a couple of times regarding Libby and reflux. I’m really stressing out about her eating habits, which are declining.

Quick background: Libby was born with IUGR. She weighed 4lbs 5oz at birth (37 weeks). She dropped down to 3lbs 14oz at one point, and had to hang out in the hospital to get the hang of eating. We BF’d until she hit her lowest weight, and then I started feeding her expressed BM. Fast forward two months…Doc and I decided to start fortifying her BM to 24 cals b/c, while she was gaining, she was only gaining about 4-6oz/week and they wanted to see more like 8oz/week.

She’ll be 4 months next Fri, so in the past 2 months we’ve been fighting with the right fortifier to use, eliminating dairy from both of our diets, etc, because now she’ll take 2oz and start screaming bloody murder. Sometimes she’ll refuse feedings altogether. Other times she’ll get super squirmy towards the end of her feeding. She’ll suck, turn her head and break suction, come back and suck, turn her head and break suction, repeat. We started her on Zantac last week.

I’m at a complete and total loss as to what to do. I tried spacing out her feedings to every 4 hours. Her patterns are not changing. Her 9:30a feeding is particularly rough, and she eats at 5:30a prior to that, so in my mind she should be hungry, right? I really don’t care how much she takes per feeding, as long as she gets her total volume in per day (which should be a min of 18.3oz based on her weight…9lbs). She’s only barely taking her min, and some days she gets as low as 15oz.

Could she not like the taste of the fortifier? Is she really just not hungry? This is my third child. I feel like I should know how to care for her, but I’m a mess! I’ve been pumping exclusively for almost 4 months now, my right nipple has been cracked and bleeding for at least 2 of those months, and I feel like my milk isn’t even enough to sustain her.

What would you do?

(ps, Pedi is scheduling a GI appt, but I haven't heard back from them, yet, and it could take up to 3 months to get in. I feel like I need to be doing something at home with her in the meantime besides eliminating dairy and adding zantac.)

[historygeek]

I have no idea except hugs! Are you burping her a lot during feedings? Mine always got really fussy, would turn away when they had to burp. Maybe try a feeding without fortifier to see if that makes a difference? Take a few deep breaths. Try doing one thing at a time. Like elimiante dairy for a few days, see if that makes a difference. or try zantac first. Give yourself some time to see what makes feedings easier.

[sparks3]

Thank you When she starts screaming or squirming, I do burp her, and it's like once I do that, then she has absolutely *zero* interest in feeding again. You would think that burping would free up some room for her, but she spits out the nipple or turns her head just as soon as she sees it coming!

[kendra76]

maybe she wants to eat less but more often? I would try milk without the fortefier and see how she takes it. hugs..

[JJorn]

When she burps it could really hurt if stomach acid is coming up with it (even if it is just a bit). I would really try feeding her less more often. Since she is already eating every two hours, halve what you are giving her and try every hour. If she does have reflux she might be associating pain with eating so it would be great if you could get a few non screaming/uncomfortable feedings in. Is she at the max dose of zantac for her weight? My DD needed to be at the max dose. If the zantac doesn't work you can also try prevacid - my friend's two kids both needed to be on prevacid since zantac didn't work.

This has to be so frustrating and heartbreaking for you. I really hope that you get this figured out.

[V]

[QUOTE=JJorn;1058692686 If she does have reflux she might be associating pain with eating so it would be great if you could get a few non screaming/uncomfortable feedings in.[/QUOTE]

Big big hugs. I had so many of the same issues with DD. it was the most worrying time for me. I know how you feel. I think the above is the best tip. My DD hated feeding by the end and cried when she saw anything like a bottle of milk by the time she was 6 months old! It was so hard to undo the association.

I wish I could give any tips to help you improve the problems quickly but I found it took time to find the right diet that suited my DD specifically. I did in the end!!

Big hugs again. It's tough.

[tapir]

If you want to PM me feel free, if there are details I don't address here...
My kid had GERD and failure to thrive and milk/soy intolerance and it was kind of a nightmare for a while until we got it all figured out. (She's perfectly fine now!!) For starters, yes she may not like the taste of HMF so try breast milk without it. If she eats that fine, there are other options for fortifying that you can use instead. Zantac only works for like 75% of kids with GERD, and it tastes like crap. So she may also be getting food averse from that. If she is not better after a week on zantac, it isn't working well enough and it's time to discuss a change to prevacid or prilosec (both prescription, once a day, and like 98% likely to work). Also upright positioning (wedge etc) after she eats. OT/feeding evaluation may help if all else fails. Hang in there-since she was full term (37+ weeks) she will do fine regardless of size, and she will catch up. Also remember that the target amounts kids gain in a week are not prorated for being small. So we would like an 8 pound kid to gain 8 oz a week, and a 4 pound kid to gain 8 oz/week. But for the smaller kid it's twice as much work, KWIM? This too shall pass...

[anonsouthernbell]

perhaps try dr sears elimination diet? Also, you could wear her for naps to help keep er upright....

[emma1978]

From personal experience (with my ds), fortifying bm does not work well. I wish it did, but my ds largely did not like bm with any formula powder mixed in. He ate much less of it. I eventually gave up and only did bm as he ate much more that way. He did not have reflux (or maybe silent obe) but was always very small (below all growth curves for weight).

[macksmom]

First of all to you and Libby. I am sure this is very stressful!

Sorry if this is a totally naive question - could you/have you tried stuff like gripe water, gas drops, probiotics, etc? Also have you tasted the stuff yourself? I always taste test what my kids will eat Syd was prescribed Zantac and it tastes horrendous! I only gave it to her like 2 times. I wasn't sure if reflux was even her issue and it wasn't bad enough to make her suffer through this awful tasting medicine 2-3xs/day. She was doing what you described - just at the boob. I think it was partly an overactive letdown. I am not familiar with bottles but is there a different type or nipple you could try? Maybe it's coming out too fast or too slow? I think Syd's problem is gas really. I have been using gas drops and just recently made my own "gripe water" out of fennel tea, chamomile tea and ginger. I just gave her a bit tonight and it seemed to help with her constant spitting up and irritability. You could add something like that or probiotics to her bottle and see if things go better. Just as reflux could turn her off to eating so could gas or stomach pains.

What does her poop look like? Is it mucousy? What color is it? I guess a fortifier may mess with it but lots of times you can tell what a breastfed baby's issue is by their poop consistency or color. I know Syd is frequently fussy when her poop is green as opposed to yellow.

I hope you figure it out!!!

[runningmomofmany]

I'm sorry! My second baby was failure to thrive, and I have had a couple babies with colic/reflux so I know that anxiety over feeding.

I have a few thoughts, I don't know how valid, but I'll put them out there.

Do you know what cause the IUGR? Was that the Dx just because she was small? Is it possible that whatever caused her to be small then is still a factor in her size now
Pp said this too, but is it reasonable to expect her to gain 8 or even 4oz a week? One of the rules of thumb "they" use is the double birth weight by 4m, which she has accomplished! And then triple birth weight by a year.

Can you try giving her just the breastmilk without the fortifier and see if she tolerates that better? Maybe she would eat less more frequently. If she ate 2oz 9x a day that would be the 18oz, which is just a guideline. Some 9lb babies will eat less, some more.

The fussing during feeding really is the most worrisome part, it is good that she is getting a gi work up. I have a friend who had a preemie with a feeding aversion. They eventually put the NG tube back in and only had him eat "fun" stuff as part of his OT. It sounds like a scary and extreme option, but it lowered the stress level for them a lot. Do consider that maybe she is just done ones she starts fussing though.

You will figure this all out! Just remember that she *is* growing, she has doubled her birth weight already!

[sparks3]

Thank you, Ladies, for all of the advice and helpful info! I really appreciate it! It’s so nice to be able to talk with a group of women who have BTDT, or have even been in similar situations. I feel a little better today, but sometimes I just feel so frustrated and helpless. Yesterday was definitely one of those days. This morning was a little rough, too. After sleeping from 8p to 7a, she only took 3oz and was struggling to get that last oz down. Feeding her is a very agonizing process for her and myself. I try so hard not to show stress or anxiety, because I think she picks up on that, but I admittedly had a nice cry this morning after her feeding.

To answer some of the questions: She’s currently taking 1mL of Zantac, twice a day. I’m not sure what the dosing is…the only thing I could find is here, and it says dosing for a 10lb baby should be 1.5-3mL per day. We do use gas drops with each feeding, because she does have gas as well, sometimes. I haven’t tried probiotics, yet, but that’s definitely worth a shot, too! I haven’t tasted her BM/Fortifier mixture, but I have smelled it. That’s why I’m wondering if she doesn’t like the taste. It does smell pretty awful. We currently use a latex nipple (Gerber first essentials), which is pretty much the same as what they use at the hospital. I used the same brand/style last night, except it was for 4 months + (so I’m assuming faster flow), and that made no difference. She’s not acting like she’s choking or anything when she’s eating, and her suck is strong when she does suck. Sometimes she just nibbles. Her poop is like a pudding consistency, and is a yellowish brown in color. No real difference there, except the smell has gotten worse! Her IUGR was caused because of my high blood pressure. The pressure in her cord was high 30weeks onward, and finally reversed the day before I delivered. She grew well until about 30 weeks, and then those last 7 her growth was minimal.

I do agree, she has doubled her birthweight, and to me she is definitely growing. No one has given me a clear-cut answer as to what they would like to see with her growth. Her growth chart looks great to me. DS1 had IUGR as well, but was 3 months early, so naturally he was always under the chart. His own curve looked great, though, so they were never worried. I think b/c she was term, they expected to see her make up for her loss in utero once she was born, and that hasn’t really happened. She’s still in the 0.6% for weight. I do know that 15oz a day is not cutting it, and she had another 15oz day yesterday. She has only gained 2oz this past week (I have a scale at home).

I am going to go ahead and do the elimination diet recommended above (I’ve already eliminated the dairy and even soy portion), and I’m going to stop the fortifier for a few days. That way, if she has any food sensitivities, that should become apparent. I’ll continue with the Zantac, because I don’t want to change too many things and not know what helped/didn’t help. It’s tough to tell if the Zantac is just not working, or if she’s already developed an aversion to eating b/c of the pain she associates with it.

I called the Nurse this morning. I found that the Doc had not scheduled the referral to the GI specialist, yet. After pouring my heart and soul out, and of course giving her the low-down on everything, she said she’d send the Doc a note (he’s out today) and have my appt with the GI Doc scheduled by Friday. I told her that I was not willing to wait longer than a week to see the GI Doc, and if things get any worse this weekend, I’m just going to take her to the Riley ER (Children’s hospital). I do not want to get to the point where she’s dehydrated.

Thank you again for all of the support and information. I’ll keep you guys updated!

[V]

By confessing all the things I realise i did wrong, I hope to help somehow?!

1. I tried to force feed my dd. I didn't think I was, but I did. Her reluctance to feed in the morning after nothing all night and dry nappies were when i tried the hardest. I was so scared she would dehydrate or worse. It's the worst thing I did. She self weaned at 6 months and she has never touched a drop of milk since. Cried at the bottle and will still to this day get upset if offered milk. Seriously.

2. I kept food diaries for months. Every ml, every day. I charted her weight gain continuously. I starred at those numbers more than I did my temp charts when ttc! I don't think it helped. I become so obsessed with what was 'wrong', not eating enough, rather than what was right..she was still eating some and gaining weight albeit slowly despite all my efforts.

3. My worries clouded my better judgement... I look back at dd baby pics and it amazes me how well she actually looked in reality when all I saw at the time was a hungry and unsettled baby - I became convinced she must be hungry given lack of intake. I now see she was still thriving. I wish I hadn't worried as much... So much easier said than done.

I don't know how this might help, but I just know how alone and confused i felt... And the tough days were pretty horrific! Just wanted to share a little more of my experience to keep you company lol. Take care

[ClarisseMarie]

and more !!!!

Liam had severe reflux issues as a baby, so I know how frustrating that part of it can be. I remember many days he'd be screaming instead of eating, and I'd be crying too, and it was just so hard to go through! I'm so sorry you are there right now!

Some of the other ladies suggested feeding less in ounces more often. That is the only thing that worked for him. He was nursing, so I don't know exactly how much he was getting, but he would nurse for about 5 minutes total every 1.5 hours or so, and that was pretty much the entire first 6 months of his life! I also wanted to add that some babies do better on Prevacaid if you don't have success with the Zantac. I don't know if your doctor mentioned that already or not. It's much stronger, from what I understand, but if you do a google search you'll find countless stories of people who had much more success with Prevacaid. Liam took Axid rather than Zantac, and yeah, that stuff is nasty! It was a fight to get him to take it. I tasted it one day and figured out why. Anyway, I do remember it takes 1-2 weeks for that stuff to start working, so hopefully the Zantac will be a big help!

I wish I had more advice and could make this go away for you. As the other ladies have said, this WILL pass. I know you know this, and it's easy to say that for me now, and not much help while you're IN the situation. But I remember sometime around 7 months we just woke up one day, and Liam didn't spit up a single bit. He had a few regressions. And most babies get better much sooner than that! Our pediatrician said 6 months is usually when infant reflux ends and we kept waiting and waiting, convinced that he was going to have it for the long haul. But he didn't. And, as I said, his case was pretty bad. He would just scream for hours on end, poor little guy.

Please do kup!

[sparks3]

By confessing all the things I realise i did wrong, I hope to help somehow?!

1. I tried to force feed my dd. I didn't think I was, but I did. Her reluctance to feed in the morning after nothing all night and dry nappies were when i tried the hardest. I was so scared she would dehydrate or worse. It's the worst thing I did. She self weaned at 6 months and she has never touched a drop of milk since. Cried at the bottle and will still to this day get upset if offered milk. Seriously.

2. I kept food diaries for months. Every ml, every day. I charted her weight gain continuously. I starred at those numbers more than I did my temp charts when ttc! I don't think it helped. I become so obsessed with what was 'wrong', not eating enough, rather than what was right..she was still eating some and gaining weight albeit slowly despite all my efforts.

3. My worries clouded my better judgement... I look back at dd baby pics and it amazes me how well she actually looked in reality when all I saw at the time was a hungry and unsettled baby - I became convinced she must be hungry given lack of intake. I now see she was still thriving. I wish I hadn't worried as much... So much easier said than done.

I don't know how this might help, but I just know how alone and confused i felt... And the tough days were pretty horrific! Just wanted to share a little more of my experience to keep you company lol. Take care

I know how hard it is to see these things while you're going through it. While in the moment, the panic of your baby not thriving tends to get the best of you. I think that's natural. Last night, I told myself that she'll eat what she eats. I wasn't going to get upset. If she was hungry, she'd wake up and eat more in the middle of the night. Now, with that said, I think two of my three kiddos (she being one of them) have that missing hunger chip. BUT, I was going to just try and go with it for one night. Of course, she only took 2.5oz at 5:30p and 8:30p, but she did eat. I have been doing the same as you did with the charts. I plot her weight at home, I've started a log of her feedings (mostly for the Pedi/GI doc, but I'm constantly looking at it). I'm starting to become a bit neurotic. Thank you for the reality check. I remember with DS1 I focused so much on getting him to gain weight and to reach milestones, that I didn't really get to enjoy his infancy, and it was over in a flash. I'm sorry that you went through this with your LO, too. It's SO hard!

and more !!!!

Liam had severe reflux issues as a baby, so I know how frustrating that part of it can be. I remember many days he'd be screaming instead of eating, and I'd be crying too, and it was just so hard to go through! I'm so sorry you are there right now!

Some of the other ladies suggested feeding less in ounces more often. That is the only thing that worked for him. He was nursing, so I don't know exactly how much he was getting, but he would nurse for about 5 minutes total every 1.5 hours or so, and that was pretty much the entire first 6 months of his life! I also wanted to add that some babies do better on Prevacaid if you don't have success with the Zantac. I don't know if your doctor mentioned that already or not. It's much stronger, from what I understand, but if you do a google search you'll find countless stories of people who had much more success with Prevacaid. Liam took Axid rather than Zantac, and yeah, that stuff is nasty! It was a fight to get him to take it. I tasted it one day and figured out why. Anyway, I do remember it takes 1-2 weeks for that stuff to start working, so hopefully the Zantac will be a big help!

I wish I had more advice and could make this go away for you. As the other ladies have said, this WILL pass. I know you know this, and it's easy to say that for me now, and not much help while you're IN the situation. But I remember sometime around 7 months we just woke up one day, and Liam didn't spit up a single bit. He had a few regressions. And most babies get better much sooner than that! Our pediatrician said 6 months is usually when infant reflux ends and we kept waiting and waiting, convinced that he was going to have it for the long haul. But he didn't. And, as I said, his case was pretty bad. He would just scream for hours on end, poor little guy.

Please do kup!

Thank you, Heather. Poor Liam. I'm so glad that has passed for him! Sounds like it was awful for both of you!! I will try to feed her less, more often, too. I totally glazed over that, but I think you're all right about that.

[kellyowens]

I tried mixing bm and alimentum once...*nasty*!! Adam wouldn't take it...I tasted it and didn't have to wonder why (I could barely get it past my nose to taste)! He also wouldn't take dairy formula at all even though he was dehydrated/hungry (I've heard the argument that if they're hungry enough they'll eat...not so sure that's true).

She seems to be growing well (the recommended is 1oz/day from 1-3months and .5oz/day from 3+months). I guess I'm confused...if she's growing fine and she's not dehydrated why the hmf and not formula. Is it because of the reflux? How severe is the reflux...is she having significant vomiting that might contribute to slow weight gain? I would have thought they'd try the formula first and if that didn't work *then* move to hmf.

Is she latching to the breast at all? Would it be possible to start her feedings off that way so at least she's getting something in? I would totally eliminate the hmf...feeding without it is better than her not feeding at all!

Oh...wanted to mention too...I did give Adam pedialyte. His pedi recommended it at first because he was dehydrated and said I could go ahead and continue giving it to him as well as the formula until my milk supply was adequate (to offer it together you'd have to mix the formula with water first and then add the pedialyte...you can't replace water with pedialyte...not sure how it would work with the hmf). Maybe something to ask the pedi about?

In regards to food intolerances, I've had to eliminate quite a few foods with my last two babies (may want to google Multiple Food Protein Intolerance...MFPI). I eat a very bland diet but it's adequate and nutritious, lol, probably a lot healthier than I'd be eating otherwise ! Honestly, I've found it's easier just to eliminate the most common allergens than to do an elimination diet because it can take up to 2wks for a food protein to be completely eliminated from your milk...by my calculations my LOs would have been over a year old anyway by the time I got it all figured out !

I definitely recommend Prevacid.

Hang in there Momma (((HUGS)))!!! Thinking of you! Praying you get the GI visit ASAP!!! KUP!

ETA- Is she still on the soy-based fortifier?

[sparks3]

Thank you, Kelly! I was hoping you'd pop in. I knew you had a lot of experience!

I tried mixing bm and alimentum once...*nasty*!! Adam wouldn't take it...I tasted it and didn't have to wonder why (I could barely get it past my nose to taste)! He also wouldn't take dairy formula at all even though he was dehydrated/hungry (I've heard the argument that if they're hungry enough they'll eat...not so sure that's true).

The Nurse did mention that she's had a lot of babies dislike Soy formula. That is what we're currently fortifying with. So, there may be something to that.

She seems to be growing well (the recommended is 1oz/day from 1-3months and .5oz/day from 3+months). I guess I'm confused...if she's growing fine and she's not dehydrated why the hmf and not formula. Is it because of the reflux? How severe is the reflux...is she having significant vomiting that might contribute to slow weight gain? I would have thought they'd try the formula first and if that didn't work *then* move to hmf.

From birth to 2 months, she gained a total of 2lbs 9oz. So, she was gaining closer to 1/2lb a day. That was when we started fotifying her BM with Enfacare. Enfacare was really tough on her, so we switched to Gentlease (I had switched to a high fiber diet, myself, around the same time and thought that may have been contributing to her issues.) From 2-3 months, she gained 1lb 10oz, so roughly 0.9lbs a day. That was with fortified BM. BUT, about 2 weeks ago, she started refusing feedings. Last week I took her to the Doc, and that was when he wanted me to eliminate dairy and put her on Soy formula for the fortifier. He also added Zantac. She's always been a spitter, and has always had reflux (arching back, crying, etc.). It's just gotten worse to the point that she's not wanting to eat. BUT, at this point I don't know if it's the pain, the taste of the fortifier, etc.

Is she latching to the breast at all? Would it be possible to start her feedings off that way so at least she's getting something in? I would totally eliminate the hmf...feeding without it is better than her not feeding at all!

She does latch. That might be something I can try, too, but then my neurotic self wouldn't know how much she was getting. Maybe that would not be a bad thing.

Oh...wanted to mention too...I did give Adam pedialyte. His pedi recommended it at first because he was dehydrated and said I could go ahead and continue giving it to him as well as the formula until my milk supply was adequate (to offer it together you'd have to mix the formula with water first and then add the pedialyte...you can't replace water with pedialyte...not sure how it would work with the hmf). Maybe something to ask the pedi about?

I will def bring this up, too!

In regards to food intolerances, I've had to eliminate quite a few foods with my last two babies (may want to google Multiple Food Protein Intolerance...MFPI). I eat a very bland diet but it's adequate and nutritious, lol, probably a lot healthier than I'd be eating otherwise ! Honestly, I've found it's easier just to eliminate the most common allergens than to do an elimination diet because it can take up to 2wks for a food protein to be completely eliminated from your milk...by my calculations my LOs would have been over a year old anyway by the time I got it all figured out !

Thank you for this tip!

I definitely recommend Prevacid.

And this one, too.

Hang in there Momma (((HUGS)))!!! Thinking of you! Praying you get the GI visit ASAP!!! KUP!

ETA- Is she still on the soy-based fortifier? Yes.

[kellyowens]

LOL, I've often joked it'd be nice if we had ounce markers on our breasts or baby's tummy so we could know *exactly* how much they were getting ...of course, you're probably right, it's likely we'd be even more neurotic about it !!

As long as she's having wet diapers (I knew Adam was dehydrated when his morning diapers were dry/barely wet) you don't have to worry about dehydration but if her diapers seem drier than usual and she seems sleepier/less responsive (Adam regressed...over the course of 3days he became floppy like a newborn at 4months) then I would start pedialyte right away (I used the flavored kind because he wouldn't take the unflavored...not my preference but it was better than a hospital stay and IV fluids).

I would really consider scrapping the hmf and switching to either a hydrolyzed formula like alimentum/nutramigen or an amino acid formula like neocate. Maybe latch her onto the breast for a few minutes each side (keeping feedings small was a great suggestion!) and an hour later supplement with 2oz of formula (approx. 100cals/5oz bottle). Do that 3x/day (doing a formula feeding before bed kept Adam satisfied longer and we slept better) and the rest of her feedings can be the pumped bm (if she wakes at night I would just latch her on and let her nurse for as long as she'd like since night time feedings are kind of "optional" by 4months ). Stay on the same pumping schedule to keep your supply up. I know it's a lot of work which is what makes it so frustrating but hopefully if she'll take it and start gaining you can reduce pumping sessions and eventually when she starts solids you can reduce her formula intake (barring any issues the GI visit may uncover...hopefully nothing though!!).

And one other thing...LOL, I want to preface it by saying I have *never* done this with any of my other kiddos before but I really felt it was the right thing to do in Adam's case (I hope I don't get blasted for suggesting it ). I added 1tablespoon of organic whole grain rice cereal to his 4oz bottle of formula (used "Earth's Best" brand). He's not on formula anymore (he's 7months) but he gets 3T of the whole grain oatmeal cereal mixed with GoodBelly juice (we're still battling thrush) in the morning and 3T of the whole grain rice cereal with GoodBelly juice before bed. It has helped with the reflux *incredibly*! He rarely spits up and seems to absorb the irritating acid so it doesn't reflux and cause the pain. I would prefer to use homemade oatmeal and rice but it doesn't seem to work as well (obviously it wouldn't work at all in the bottle)...he spits it up .

Anyway, it was hard for me, I had to give myself "permission" to do what was needed for Adam even though it went against what I wanted and what I had always done before .

Adam was 7lbs 8oz at birth and 11lbs at 4months when I started supplementing...he was on one 4oz bottle of pedialyte/day and two 4oz bottles of alimentum (w/ 1T rice cereal/bottle) in addition to bfing every hour for a week. After that we did two 4oz bottle/day for a month and then one 4oz bottle/month once he started solids at 5months. By 6months he had gained 2lbs/month and was 15lbs so we stopped the formula entirely .

(((HUGS)))...I know it's hard...Adam is my 7th baby with food intolerances and reflux. Three were considered "failure to thrive"...it stinks...I envy moms who can just latch their babies on, eat whatever they want, and their babies thrive...no supplementing, no meds, no long days trying to figure out what's wrong or long nights comforting LOs in pain...sigh !

I'm thankful though that they are all now healthy, growing children . It has been worth it!

[Racegirl766k]

So, I’ve posted a couple of times regarding Libby and reflux. I’m really stressing out about her eating habits, which are declining.

Quick background: Libby was born with IUGR. She weighed 4lbs 5oz at birth (37 weeks). She dropped down to 3lbs 14oz at one point, and had to hang out in the hospital to get the hang of eating. We BF’d until she hit her lowest weight, and then I started feeding her expressed BM. Fast forward two months…Doc and I decided to start fortifying her BM to 24 cals b/c, while she was gaining, she was only gaining about 4-6oz/week and they wanted to see more like 8oz/week.

She’ll be 4 months next Fri, so in the past 2 months we’ve been fighting with the right fortifier to use, eliminating dairy from both of our diets, etc, because now she’ll take 2oz and start screaming bloody murder. Sometimes she’ll refuse feedings altogether. Other times she’ll get super squirmy towards the end of her feeding. She’ll suck, turn her head and break suction, come back and suck, turn her head and break suction, repeat. We started her on Zantac last week.

I’m at a complete and total loss as to what to do. I tried spacing out her feedings to every 4 hours. Her patterns are not changing. Her 9:30a feeding is particularly rough, and she eats at 5:30a prior to that, so in my mind she should be hungry, right? I really don’t care how much she takes per feeding, as long as she gets her total volume in per day (which should be a min of 18.3oz based on her weight…9lbs). She’s only barely taking her min, and some days she gets as low as 15oz.

Could she not like the taste of the fortifier? Is she really just not hungry? This is my third child. I feel like I should know how to care for her, but I’m a mess! I’ve been pumping exclusively for almost 4 months now, my right nipple has been cracked and bleeding for at least 2 of those months, and I feel like my milk isn’t even enough to sustain her.

What would you do?

(ps, Pedi is scheduling a GI appt, but I haven't heard back from them, yet, and it could take up to 3 months to get in. I feel like I need to be doing something at home with her in the meantime besides eliminating dairy and adding zantac.)

Thank you When she starts screaming or squirming, I do burp her, and it's like once I do that, then she has absolutely *zero* interest in feeding again. You would think that burping would free up some room for her, but she spits out the nipple or turns her head just as soon as she sees it coming!

I'm sorry your having problems with Libby! I feel like I could have written a lot of you first two post though! I told you on our FB group page about how Makenzie got fussy like you described Libby being, but changing her nipple seemed to help. Well now Brooke is doing it also, and changing her nipple hasn't helped a bit. I think yesterday I got her to take 15oz, which is not even close enough to the recomended amount for her weight (13lbs) and today is looking like it's going to be even worse...

It's really frustrating for me since they both used to be awesome eaters, but about 4-5 weeks ago they kind of stalled out and have both started eating less and less week by week now. Hopefully we can both figure out what the heck is going on with our little ones and eating soon!!!

[LanceBabe]

Hugs to you and Libby. Nathan was born with IUGR as well, weighed 3 lbs 5.6 oz at 35 1/2 weeks (placenta was not working properly and started separating from the uterine wall; thank GOD Erin was already in the hospital when that happened and they were able to get Nathan out quickly). Other than that, though, our experience was much different than yours. While he was in the hospital, he got EBM and did quite well. However, the doctors advised Erin NOT to breastfeed, or to breastfeed only once a day, so of course her milk dried up rather quickly once he got home. She is still upset about that to this day. Nathan had reflux and had problems with formulas until we put him on Gentlease. The reflux was still difficult, but at least he did gain weight well. I hope Libby starts doing better for you soon.

[sparks3]

Okay, ladies. We had a GI appt today, and I just want to say that you should all have your PhD, because I knew nothing more leaving the appointment than what I already knew (from you) when I walked in!!

On a more serious note, though, Libby does indeed have reflux. The Doc actually watched her eat, and saw that she stopped after 2oz and started screaming, turning to suck, then screaming, and repeating. Doc told me to take the bottle away and to give her the paci because she was not hungry...she just wanted to suck. It makes absolutely zero sense to me that a baby who has not eaten in 4 hours and who typically takes 3-4oz per feeding, within the past two weeks now only takes 2 oz and then is full. But whatever. Our instructions: Libby is to eat smaller amounts more frequently (as soon as she starts crying I am to take the bottle away and offer paci), she’ll stay on zantac, and I am to wake my 8p-5a sleeper in the middle of the night to feed her. “This should make up for whatever she doesn’t take during the day.” In all seriousness, I was actually thinking about waking her, but she’s such a darn good sleeper. If that’s what she needs, though, that’s what we’ll do!

I did try just straight BM without fortifier, and it didn’t make a bit of difference to her. Doc said that she’s in pain from the burn, so as soon as her hunger is satisfied in the least bit, she stops. We don’t want her to develop a bad association to eating, so that’s why I’m supposed to stop feeding when she starts the suck/cry pattern.

I feel like if I would have pushed for meds when she was smaller, we could have avoided this. I know “every baby has reflux to a degree”, but I also have seen both extremes with my boys and I should have pushed harder.

Anyway, Kelly, thank you for all of the advice! I will definitely keep it and use it within the next few weeks before we go back to the Doc for a follow-up.

Kim, what is going on with our sweet girls?! Remind me, are they on meds for reflux at all? I wonder if that may be bothering them. Or, if they are on meds, if they need a dose adjustment. Hopefully you can take something away from this thread! Keep me posted!

Thanks, Lance.

I'm so thankful for this board! Y'all are awesome!

[anonsouthernbell]

and Ty for the update!

[loveNmybelly]

Our dietician recs probiotics for any baby that has reflux. You can purchase it in a powder form and put it in her bottle. Alot of docs will rec fortifiers and she does not thing this is good or needed. She rec bm. It is natural and the least likely to upset baby. She does rec elimination diet. But NEVER to stop nursing b/c any formula will be way worse than bm. Alot of moms think that baby isn't tolerating their milk but in fact it is just a protein or item in their diet NOT the bm. Feeding more often and less amts is something she often recs. And def try feeding her every 3 hours during the night. Until a baby is over 12 pounds she says they should always have night time feedings, keeps their blood sugars up and helps them gain. That amt of time is too long for a tiny babe to not have bm. Try eliminating the fortifier but increasing night time feedings, will probably have much better results. Hope it gets better soon!

[loveNmybelly]

Also...directing from the breast would be best for a reflux baby! if she will latch that would be best!

[sparks3]

Thank you, loveNmybelly! I think macksmom recommended probiotics, too. Where do you guys get them? We have a health store in town that I was going to check out. Hopefully they have it. Does the powder have a taste to it? Do you know its name by chance?

And thanks for the 12lb night feeding tip! I did not know that! My older two fed throughout the night until they were one, but they woke on their own. I've never had a baby that sleeps!! I've been waking her twice, so she's getting 17oz per day, which is much closer to her 18oz min.

[JJorn]

I hope that the feeding less more often and waking at night really helps. Her reflux should hopefully get better as she grows so keep that in mind. Big hugs! I know how awful this can be.

[preciousnd98]

Thank you, loveNmybelly! I think macksmom recommended probiotics, too. Where do you guys get them? We have a health store in town that I was going to check out. Hopefully they have it. Does the powder have a taste to it? Do you know its name by chance?

And thanks for the 12lb night feeding tip! I did not know that! My older two fed throughout the night until they were one, but they woke on their own. I've never had a baby that sleeps!! I've been waking her twice, so she's getting 17oz per day, which is much closer to her 18oz min.

I used Floristor with DD when she had bad diarrhea. I got the kid version at Walgreens. I don't believe it has any taste as I mixed it with Pedialyte and Olivia never seemed to notice.

[Irish-Eyes]

There's an awesome infant probiotic called FloraBaby which you can get in a health food store (it's in the refrigerated vitamin section). My pedi swears by probiotics for all the little ones.

[sparks3]

Thank you for the probiotic suggestions! I'm going to our local health food store today to see if I can find some!

Out of curiosity, I looked up DS1's 4-month weight (he was born 3 months early, at 1lb 15oz). Yeah, he weighed 9lbs 2oz at 4 months...Libby weighs 9lbs 5oz. So, she is gaining slowly. Yesterday she took 17oz (as opposed to 12oz on Fri and 15oz Sat), so I think things are moving in the right direction.

Seriously, I can't thank you guys enough!!

[Racegirl766k]

Kim, what is going on with our sweet girls?! Remind me, are they on meds for reflux at all? I wonder if that may be bothering them. Or, if they are on meds, if they need a dose adjustment. Hopefully you can take something away from this thread! Keep me posted!

I think the twins is a combination of things at this point. 1) their reflux, which their not on meds for since it's not severe enough most days. 2) the longer she goes without pooping (she goes at least once every 24 hrs) the fussier she gets about eating and 3) I think she is teething :'(