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Thread: Motilium, solids and refusing supplements

  1. #1
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    Jul 2017
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    Default Motilium, solids and refusing supplements

    Dear LLLI moms/experts,

    The thread is a bit confusing, a mix of everything, sorry. I was thinking to post in "Solids introduction", but in reality, the problem is more about breastfeeding and supplementing.

    To begin with, I am on Motilium for low supply. I've been EBF till 3 months, really slow weight gain, but good growth and health overall, so pediatrician didn't insist on supplementing. Been trying to pump and supplement with pumped milk from 1 month old, but to no avail. Tried all herbal remedies, not better either. Got the baby tested for ALL possible causes of poor weight gain, found none. At 3 months post-partum suddenly nearly lost my milk, got tested for all possible causes of low supply (thyroid, hormones, breast tissue, etc, etc), but no apparent reason. Seen LC's half a dozen times probably... started Motilium and supply improved NEARLY to the same level as before, but still seems less than initial judging by breast feeling/hardness and number of hours to get to this feeling (or maybe the baby's feeding better, who knows). Was supplementing with HA formula (6-8 ounces per day split at 3-4 feedings) ever since and baby was gaining well: 7-8 ounces per week.
    She breastfeeds 6 times a day and I dreamfeed her 1-2 times during the night (low breast storage capacity, so I'm trying to keep this milk flowing :-)).

    I started with 3 pills (3 x 10 mg, in Belgium here they won't prescribe more), tried to wean to 2, had a rapid supply drop, went back to 3, ordered Motilium online, tried with 6, had a better response, then very gradually weaned till 3 and am still at the same production level.

    Baby started solids at 5 months old (pediatrician wanted us to start at 4 months), only cooked veggies and apple sauce so far, 2-3 times per day, 2 ounces per meal. She LOVES eating solids.

    The baby is few days short of 6 months old today.

    So, initially I wanted to ask for advice how to wean baby off formula by introducing solids. Replacing 6-8 ounces shouldn't be harmful, what do you think?
    And also I wanted to ask if, in your opinion, I should try to wean off Motilium (I'm really scared of going back to 2 pills, because 2.5 months ago it was definitely not enough for me). Or, on the contrary, maybe I should try 9 pills a day which I never tried, and see if I get a better production, then wean off formula this way? But then, I should be looking into weaning off 9 pills progressively, which is another challenge :-)

    Now, suddenly I have a new part of the story, because it's been two days that the baby started refusing SNS. She's already a strong bottle and pacifier refuser, she never took the sipping cup either: she knows how to get milk out, but she won't treat it as food and will just spit it out! I don't know if it is teething, if she's not hungry all of a sudden, but she would take breast and solids, but not formula. I tried giving thawed breastmilk with SNS, and she wasn't big fun of it either...
    I'm worried because despite her good weight gain lately, she's still a shrimp and I don't want to make her fall off charts again.
    I could, of course, believe in miracles and decide that my production went up all of a sudden, but after all my breastfeeding adventures I'm rather skeptical here :-)

    So, now, my main question: what do you think, is it ok to replace 8 ounces of formula with solids (sweet potatoes? introducing yogurt, for instance?) Have anyone done that? Or shall I struggle to make her take these 8 ounces by spoon, preparing porridge with it, or shall I maybe take more Motilium and see if I can produce more (I wouldn't love it to take more meds than strictly needed as a long-term solution though).

    Sorry for a long post and thanks very much for your ideas, mommas!

  2. #2
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    Jun 2009
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    Default Re: Motilium, solids and refusing supplements

    Hi dettcat. some of what you are asking here kind of falls into the realm of medical advice. But here are some general ideas.

    first, I am confused on a couple points. For example:
    She breastfeeds 6 times a day and I dreamfeed her 1-2 times during the night (low breast storage capacity, so I'm trying to keep this milk flowing :-)).
    It sounds like you may have been told that nursing 8 times a day is an unusually high frequency for this age? In fact it is normal and many babies continue to nurse 10-12 times a day or more well past one. Generally the more often a baby nurses the better for milk production.

    Also:
    Was supplementing with HA formula (6-8 ounces per day split at 3-4 feedings) ever since and baby was gaining well: 7-8 ounces per week.
    average weight gain at 5-6 months + is typically much slower than 7-8 ounces a week. 7-8 ounces is the typical newborn gain rate, up to 2-3 months, after which it slows, and continues gradually to slow from then on. Is baby still gaining this rapidly? If so, I would suggest you might talk to baby's pediatrician about what is a realistic gain rate goal for this age. It may be baby no longer actually needs so much formula, and in that case there is no need to replace those calories with solids.

    OK, solids for gain issues- Early solids introduction is not always a good answer for poor gain, in part because many of the most commonly served baby foods are not only very low in fat and calories, but contain a large amount of water making them very filling and thirst quenching (leading to less nursing) but not good for increasing gain. Your baby appears to be a fan of veges, and that is great, but not if they are interfering with baby's desire to nurse or to nurse effectively, because they are way to low in fat.

    On the other hand, some breastfeeding advocates (Jack Newman included) have suggested that early solids can be considered or tried for replacing formula supplements in a slow gaining otherwise breastfed baby.
    Unless the recommendations have changed in the last few years (possible) Dairy before one is not typically recommended as I understand (aside formula.)
    But there are many higher fat/calorie foods that a baby might eat that you could offer. Kellymom has a list comparing fat and calories of common foods to the fat and calories of breastmilk. https://kellymom.com/nutrition/start...yfoodcalories/

    Jack Newman knows a great deal about domperidone as a medication for nursing mothers. Have you tried contacting him, or reading his info on this medication? Are you experiencing side effects that are making you want to go off the medication or not increase the dose?
    Last edited by @llli*maddieb; October 28th, 2017 at 10:54 AM.

  3. #3
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    Jul 2017
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    Default Re: Motilium, solids and refusing supplements

    Hi maddieb,

    Thanks a lot for your reply! Very helpful, as usual! Helped me to clarify some things, to calm down and to make up my mind.

    To clarify, I know that it's ok to nurse 10 times a day or more, and that it is helpful for milk production. That is why I'm dreamfeeding during the night. I offer a breast during the day, but it only sums up to 5-6 real feedings, the rest are short "snacks" here and there. You are probably right, I might need to cut down on supplements and see if the baby will be hungrier and more willing fo feed more often.

    For the weight gain: yes, she's still gaining a lot. I was told that it was normal since initially she was underweight, so she's kind of catching up now, when she's supplemented. She went from being way off the charts to almost reaching percentile 10. She is 13 lbs 3 oz at 6 months, which is exactly double of her birth weight. Her doc recommended to keep supplementing her until she reaches what she should weight naturally and slows down on her own.

    Thanks a lot for the link, very useful. I heard about the most nutritious foods being sweet potatoes, bananas and avocados, but it's good to have a table. It makes sense to me now that she cut down on formula. She eats the same amount of calories from her solids, it all makes sense. I'm relieved :-)
    I'll make sure to stick to nutritious ones and not just those that are filling the tummy. As long as she nurses well and only refusing formula, we should be ok...

    For Motilium, I'm sticking to Dr Newman's recommendations that I found. He recommends to wean a pill each 3 days if this doesn't impact the production, till the impact becomes visible, then go back up one pill and stick to this dose for at least few weeks before trying to wean again. From this I figure that
    1. Weaning is recommended and taking a dose bigger than strictly necessary is not.
    2. If one wasn't able to reduce the dose at sone point, it may still be possible to do it later on.

    That's why I thought that I should try and slowly cut down. Now that the gloomiest days of breastfeeding struggles are over for us, I'd like to keep breastfeeding as long as possible, and even better if I don't have to stay on meds for that (for somewhat a next year and a half, hopefully). Apart from that, no, I don't have another reason to go off Motilium and no side effects.

    I didn't try to contact Dr Newman but this could be an idea! However, in these last couple of days the baby is only taking 3-4 oz of formula max, if at all, so if she's gaining well still, it's not worth taking more meds. The times when I was crying my eyes out because I had to start giving her formula are way behind us. She is a big girl now, so if besides her solids she'll have to take a little bit of artificial milk, so be it! She's still mostly breastfed and this is what counts, in my opinion :-) (Of course, if we can avoid formula, even better!)
    I'll try to cut down Motilium little by little, and if it doesn't work, I'll stick to 3 pills. Makes sense?

  4. #4
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    Default Re: Motilium, solids and refusing supplements

    until she reaches what she should weight naturally and slows down on her own.
    and what weight is that? If a baby is being overfed, their gain rate is not likely to ever slow down to "natural" levels. Right now, she is gaining "unnaturally" fast for this age. My point is not that your baby does not need supplements, my point is that 6 month olds have a wide range of "normal" weight and over-supplementing is a more common problem than under-supplementing. Since your baby is gaining so rapidly right now, that fact might help you feel more confident reducing supplements at least somewhat.

    Yes everything you mentioned trying makes sense. I also would tend to agree that encouraging longer term nursing is more important than "exclusive" (no formula) breastfeeding, at least in any case where that is what mom prefers as well.

    As far as weaning off meds- I do think that the general idea with any medication is that ideally, no one is ever on any medications when they are not needed. (or on a higher dose than needed.) But if you are not experiencing side effects, then I would think there is unlikely to be any rush to get off the meds either, but of course that depends also on what the long term effects of taking a medication might be, and I do not know that as regards motilium.

  5. #5
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    Default Re: Motilium, solids and refusing supplements

    Quote Originally Posted by @llli*maddieb View Post
    and what weight is that? If a baby is being overfed, their gain rate is not likely to ever slow down to "natural" levels. Right now, she is gaining "unnaturally" fast for this age. My point is not that your baby does not need supplements, my point is that 6 month olds have a wide range of "normal" weight and over-supplementing is a more common problem than under-supplementing. Since your baby is gaining so rapidly right now, that fact might help you feel more confident reducing supplements at least somewhat.
    Well, I'd say that roughly the same percentile that she was born with (around 30), or at least, going above percentile 3 :-) I know that she was gaining fast these last months, but seeing her weight climbing to the curves instead of being somewhere way off-charts is what makes us moms (and doctors) happier.
    Honestly, she's still a shrimp for her age so I wouldn't worry too much about overfeeding this baby. But you're totally right, knowing that she was gaining very fast makes me feel better about reducing supplements.

    On a side note: is it common that baby kicks and scratches my face while nursing? Why do they do that? Lately she's really hurting me. Her arm and hand is in the constant motion, grabbing my cheeks, trying to get into my eyes, pulling my lips or hair. I start being afraid of nursing
    The fact that I need one hand to keep SNS tube in place so that she won't pull it away doesn't help me to protect myself. She'd do it though even if she nurses without the SNS. I wonder if she wants to tell me that she's tired or that she doesn't want to nurse any more.
    By the end of our last nursing session she bit me on my nipple. Then I tried offering her the first breast again in case she was still hungry, she tried it for half a minute and bit me on the second nipple.

  6. #6
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    Default Re: Motilium, solids and refusing supplements

    Hi sorry for late reply, I have been sick and not on the computer much.

    So for the scratching and flailing, I would suggest experiment with positioning changes? Often this is misplaced kneading behavior, so maybe help her find the breast (unless that causes more issues for sns.) If that does not work, can you give her your hand of a stuffed animal or something like that to hold and grab? Also there were times I had to cut baby's nails like every other day, and file them.

    I really do not know what to say about catching up on weight gain. I'll be honest, it never made sense to me. Sometimes the amount of catch up some doctors expect is just not realistic. A baby can only grow so fast. And are you certain babies birth weight was entirely accurate? If baby is gaining this well and baby is at 3% on chart, my guess would be your baby's "real" curve is much closer to 3% than 30. There is nothing wrong with that. Some people are just smaller. Some babies grow much slower and grow faster later, and are still healthy. It is all about genetics (and even that is not as cut and dried as what the parents look like) and not food (unless of course the person is literally severely malnourished.) I must have recommended the book My Child Won't Eat to you by now, I personally found that book very helpful in getting a better understanding of what is normal when it comes to growth and what growth charts mean.

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