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Thread: Poor weight gain and feeding

  1. #1

    Default Poor weight gain and feeding

    Hi all,
    I'll try to keep this short but it could be a long post!
    My lo is 7 months old, corrected he is 4 months old as he was 3 months premature. Development wise he is doing well and on track for a 4 mo old and he is also a happy boy which is amazing. He is still struggling with his lungs a little bit as he is on a very very low flow of oxygen.

    We are struggling with weight gain. He went from being 50th percentile to 3rd over the span of 2 months. At first I thought it was just issues with our previous bottle but he is still not gaining well although he was consuming better after the bottle switch.
    Currently he takes expressed milk with formula added in it(as per doctor instructions). He also takes in 2 night time feeds. His consumption is not great and is decreasing (he went from about 680 ml of this mix to as low as 500 ml).

    Does anybody have any recommendations for how to increase his feeds? I already try to feed him every 2-3 hours during ththe day, but he does reject the feeds (swats and turns his head away, spits out milk, pushes bottle out of his mouth with his tongue, etc). I offer him more when he does eat, until he does it not Same thing again.

    If anybody has any advice regarding weight gain or feeds please let me know! I really don't want him to struggle again since he had a pretty rough go his first 3 months.
    Other things I've condiderd are me cutting out dairy, or changing the formula we are adding to his milk.

  2. #2
    Join Date
    Jun 2009
    Posts
    10,746

    Default Re: Poor weight gain and feeding

    Hi, I have a few questions. First, what makes you think dairy is part of the problem?
    Is baby nursed as well as bottle fed? It is unclear. Do you mean baby is breastfed only at night, and bottle fed only during the day?
    How many times total each 24 hours does baby eat? How much is baby offered in each bottle? Does baby every appear to want to eat more often?
    Have you tried giving bottles via paced bottle feeding, or NOT using paced bottle feeding if that is what you usually do?
    Tried cup feeding? (Open cup)
    Tried a sippy cup?
    Is baby ever given straight water, or anything aside from breastmilk or formula?
    Does baby use a pacifier much?
    If baby is nursed as well as bottle fed, are the feeding issues with both the bottle and the breast? More with one or the other?

    My very limited understanding is that any baby who has had interventions involving the mouth or face are at a higher risk for sensory issues/oral aversion. This could be unhappiness with anything coming toward their face, or going into their mouth, or touching their lips etc. This would of course include most premature babies who have been fed with feeding tubes, or been on ventilators, or been suctioned repeatedly etc. So it probably makes sense to see if there is an oral aversion here than could be treated with therapy. I am sorry this is not my area at all, I just know this is a concern with babies who have needed interventions that involved the mouth or nose- the face- in particular.

    I realize your baby is only 4 months adjusted. So, I am not sure how this applies in your case. But fyi, it is fairly typical for a baby to go "down percentiles" somewhat and for rate of gain to slow after 4-6 months of age. So I wonder if some of that may be happening. Also, if baby was eating a great deal in the first 2-3 months, baby may actually normally eat less after that.

  3. #3

    Default Re: Poor weight gain and feeding

    Quote Originally Posted by @llli*maddieb View Post
    Hi, I have a few questions. First, what makes you think dairy is part of the problem?
    Is baby nursed as well as bottle fed? It is unclear. Do you mean baby is breastfed only at night, and bottle fed only during the day?
    How many times total each 24 hours does baby eat? How much is baby offered in each bottle? Does baby every appear to want to eat more often?
    Have you tried giving bottles via paced bottle feeding, or NOT using paced bottle feeding if that is what you usually do?
    Tried cup feeding? (Open cup)
    Tried a sippy cup?
    Is baby ever given straight water, or anything aside from breastmilk or formula?
    Does baby use a pacifier much?
    If baby is nursed as well as bottle fed, are the feeding issues with both the bottle and the breast? More with one or the other?
    .
    Hi, thank you for your reply. I didn't consider any sort of aversion before, but you never know. I wouldn't have guessed he had one because he never struggled with bottles in the past.

    In response to your questions- re dairy- it was just an option that I hadn't tried yet, his eyes are a little swollen so I was trying to link it to an allergy of some sort.
    He is bottle fed only using pumped breastmilk mixed with formula. He has about 7-8 meals per day, he is offered 3 oz (90 ml). Sometimes he will eat only 1 oz, sometimes up to 4 oz (mostly before bed though). He sucks ok his hand and anything he can get a hold of. I offer him a bottle about every 2-2.5 hours during the daytime. I've never tried a sippy cup or anything other than his bottle. He couldn't nurse a full feed via Breast which is why we don't breastfeed (because of his breathing issues). I've also never tried water, or anything other than milk and formula. The doctors wanted us to wait until he was 6 mo corrected to introduce any other foods. He has no interest in a pacifier.

    What did you mean by paced bottle feeding?

    Thank you

  4. #4
    Join Date
    Jun 2009
    Posts
    10,746

    Default Re: Poor weight gain and feeding

    Ok, since baby is struggling with bottles but it is a new thing, I would suggest:

    Maybe temporarily separate feedings so they are either formula or breastmilk? That way, maybe you can rule out one as the issue? Then, depending on the result:
    Try a different formula
    If your milk is stored in the fridge or freezer for any length of time before feeding but after you express it, taste or smell it after defrosting to see if there is a soapy odor or taste. This could mean you have an "excess lipase" issue. This does NOT make the milk unsafe in any way, but it can cause SOME babies to refuse the milk. If this is maybe the problem, there is a remedy.
    Try a cup or sippy
    Try a different feeding method. Here is info on paced feeding. This is typically suggested for babies who are also nursing, but in fact this can be a much less stressful way for any baby to take a bottle: http://www.llli.org/docs/00000000000...astfedbaby.pdf
    and https://www.youtube.com/watch?v=UH4T70OSzGs

    Ask your doctor about having baby assessed for oral aversion. This is something that can crop up or worsen later is my understanding.

    You also may want to have baby tested for low Iron or other factors that may create poor appetite.

    Unless giving up dairy is not a hardship for you, I really would doubt that has anything to do with baby's poor intake. Very severe allergies can cause poor gain, but in that case baby would be eating enough but not gaining. If I am understanding is correct, your baby is not eating enough and that is why baby is not gaining(?) If you do take dairy out of your diet, of course you would also need to switch to dairy free formula. Be careful to be sure you are still getting good nutrition. This article explains how to do a dairy (or other food) elimination without starving- go to the bottom: http://www.breastfeedinginc.ca/conte...gename=doc-CBB

    A helpful book for now and the future is the book My Child Won't Eat. When parents are concerned about intake, they tend to panic a bit and do things that may make matters worse. This book will help you understand if your babies intake and gain is normal or not, and how to avoid making the issues with intake worse.
    Last edited by @llli*maddieb; September 8th, 2015 at 10:08 AM.

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