Need some feeding help.

This might get long!

Our girls are one month today. Since they were born we were told that when they eat, if they're finishing the bottle to increase the amount in the bottle a little so that they can eat more if they want it. Right now, I put 4 ounces into their bottle (after formula there's 5 ounces total in the bottle)- sometimes they finish the whole thing and sometimes not. However, I consistantly put that amount int here just because I never know when they're going to want 2 oz's and when they will want 5 oz's. Since day one they've eaten every 3 hours, sleeping or not- 1, 4, 7, 10, repeat. I constantly set my alarm for them to eat and even they're sleeping I woke them up to eat.

Here's the problem(s):
We have a vomiting issue. HUGE. So bad that they usually vomit everything they eat within an hour after they eat. We had their stomachs checked last week for pyloric stenosis and it was negative. Doctor says they have reflux and are on Zantac for it (I only agreed to put them on it because they both lost 2oz's in 3 days). However, the vomiting has not gotten better. I've tried feeding them less (giving them a consistent 3oz's at every feeding), but most times they're still hungry after they finish. So it's kind of a catch 22. If I only feed them 3oz's, they're still hungry- every time they eat anything they vomit afterwards. How much should they be eating? They're 8.1 and 7.4lbs.

Another issue. My best friend told me that I should try this- feed them a constant 3 oz's at 7am, 10am, 1pm, 4pm, 7pm, and 10pm- then in stead of waking them up to feed at 1am and 4am..let them sleep from 10pm until they wake up and feed them then. How do I do this? How long should I expect them to sleep? Any tips?

I'm so new to all of this and I feel like I've been doing it all wrong this whole time.

TIA!

 

It sounds like it could be a formula intolerance? What kind of formula are they on? I think you are doing the right thing feeding them every 3 hours. 5oz is a lot for babies that small, especially if they are vomiting it all back up.

 

QUOTE(becky5 @ Apr 4 2009, 09:31 PM) [snapback]1259391[/snapback]
It sounds like it could be a formula intolerance? What kind of formula are they on?


That's what I thought too! They're on Nestle Good Start Soy. Last week we tried Enfamil AR (anti-reflux) and it was so thick and it didn't change much. The doctor told me not to change from the Good Start and let's see how the zantac works.

 

QUOTE(Kaie05 @ Apr 4 2009, 10:34 PM) [snapback]1259395[/snapback]
That's what I thought too! They're on Nestle Good Start Soy. Last week we tried Enfamil AR (anti-reflux) and it was so thick and it didn't change much. The doctor told me not to change from the Good Start and let's see how the zantac works.

Have they been doing the vomiting from the beginning? If so, I would switch them to Nutramigen or Alimentum. It's expensive, but it's hypoallergenic, and you should know within a few days if it's going to help them or not. Zantac is going to do nothing for the vomiting. It will only help the pain associated with it.

 

I dont think that you are doing anything wrong. I agree with Becky about a formula intolerance which could suggest a potential milk allergy. Although it does sound like their reflux is not under control. Did you see a Ped GI for the pyloric stenosis test? If not, I would see one about the reflux. Derek had awful reflux. He was my major spitter upper. He also tested positive for a milk allergy. H Tyler had silent reflux. We put them both on the Alimentum even though Tyler did not show the allergy signs. They were on Prevacid and thickened feedings of 2 tsps of rice cereal per ounce of formula. We kept both upright for at least 30 mins after each feeding and they slept upright in bouncys and swings for the first 3 months. Maybe those are a couple of things that you can try.

Once we got on the right formula (Alimentum), the Prevacid, and the thickened feedings we finally got it under control and things got much better. :hug:

ETA: about the Alimentum.

 

BTW, the AR is still milk-based, so it won't help them if they have a milk-intolerance.

 

Oh, and I also thickened with rice cereal from about 2 weeks on, and it greatly helped with spit-up. 2-3tsp per oz. I would only make one change at a time though, so you know what is working.

 

If they're already on soy formula and starting Zantac, I think you're good for now.
We find our boys eat widely varying amounts, too. What we do (so we don't waste formula) is start the bottle wth a smaller amount (e.g. if they ate 3-5 oz, we'd start with 3) and then just get a refill if they're still hungry.
Sounds like you're doing well and you might just have to wait to see what meds work. Hugs and I hope things get sorted out soon!

 

Are they vomiting or just spitting up? Mine had quite a lot of spit-up but didn't really vomit. They were given 4 ounces every three hours and we tried to get them to finish it each time but sometimes they just couldn't. The best thing we did for eating, sleeping, everything really was get them on a schedule and that included a pretty rigid eating schedule - we fed by the clock, even in the middle of the night.

 

You've gotten a lot of good advice already. If they seem hungry after only 3 oz, I'd continue to offer 5 oz each feeding. Are you able to get burps out of them after each feeding? You could try to feed 2-3 oz, stop and burp, and then feed the rest. I also think keeping them upright in a swing or bouncy chair for 30 minutes after feedings might lessen the spitup.

Also, I don't think you need to wake them to feed in the night anymore. They might still wake every 3 hours at this point, but you never know when they might go longer between feedings and the sleep would be nice!

 

Too answer the questions from everyone:
I've heard of the Almentum- just didn't think I should try it since it's hypo allergenic. They've been on soy since they were 2 days old because of just spitting up. We tried the trice cereal in their formula and it helped just a tiny bit, but they seemed to have problems digesitng it.
We burp them once for every ounce they eat. The vomiting has been going on for about 5 days now, and keeping them upright after feedings doesn't matter much. Once we lay them down they vomit almost always. Thanks so much for all the replies already.

 

QUOTE(SC_Amy @ Apr 5 2009, 02:43 AM) [snapback]1259408[/snapback]
If they're already on soy formula and starting Zantac, I think you're good for now.

I will politely disagree with this and say that I agree with Becky in that the Zantac wont stop the vomiting it only helps with the pain associated with it. You didnt mention the arching and screaming symptoms of reflux so maybe you arent seeing those, just the vomiting and losing weight. So, I would be more inclined to think that there is a formula issue going on. I would give the Zantac through the weekend and if its no better I would call the Ped and ask what formula you should try besides the A/R since that is milk based as well or see if you can get a recommendation to see a Ped GI.

QUOTE(JessiePlus2 @ Apr 5 2009, 02:50 AM) [snapback]1259424[/snapback]
Also, I don't think you need to wake them to feed in the night anymore. They might still wake every 3 hours at this point, but you never know when they might go longer between feedings and the sleep would be nice!


I think that I would still wake them as they are losing weight and I would want to make sure that is correcting itself before I let them sleep for longer periods.

 

QUOTE(Kaie05 @ Apr 5 2009, 02:57 AM) [snapback]1259433[/snapback]
Too answer the questions from everyone:
I've heard of the Almentum- just didn't think I should try it since it's hypo allergenic.

and keeping them upright after feedings doesn't matter much. Once we lay them down they vomit almost always.


Personally, I would try the Alimentum and I would sleep them upright. Ours slept in a bouncy or a swing.

 

QUOTE(DATJMom @ Apr 4 2009, 09:59 PM) [snapback]1259435[/snapback]
I will politely disagree with this and say that I agree with Becky in that the Zantac wont stop the vomiting it only helps with the pain associated with it. You didnt mention the arching and screaming symptoms of reflux so maybe you arent seeing those, just the vomiting and losing weight. So, I would be more inclined to think that there is a formula issue going on. I would give the Zantac through the weekend and if its no better I would call the Ped and ask what formula you should try besides the A/R since that is milk based as well or see if you can get a recommendation to see a Ped GI.
I think that I would still wake them as they are losing weight and I would want to make sure that is correcting itself before I let them sleep for longer periods.


Actually, the doctor pointed out the arching that they do. They do it quite often, and as far as screaming- they don't scream or cry too much while feeding. They only cry/fuss if they're in their car seats or fussing in their cribs. OH, I don't know if this matters but..the only way we know that they are usually done vomiting for the time being is when they get the hiccups. Once they get the hiccups after vomiting they are usually ok to sleep for a while.

 

I agree, let them sleep in a bouncy or swing to help reduce the chances of vomiting. I would wake them up if they are losing some weight. You are doing what you can by burping after every ounce. I remember changing to Alimentum but it took a couple of days to start working completely. My DD did worse on the soy and that is why we switched to the Alimentum. Call your pedi and see what they say.

 

QUOTE(Kaie05 @ Apr 4 2009, 11:11 PM) [snapback]1259446[/snapback]
Actually, the doctor pointed out the arching that they do. They do it quite often, and as far as screaming- they don't scream or cry too much while feeding. They only cry/fuss if they're in their car seats or fussing in their cribs. OH, I don't know if this matters but..the only way we know that they are usually done vomiting for the time being is when they get the hiccups. Once they get the hiccups after vomiting they are usually ok to sleep for a while.


I remember breathing a sigh of relief when they got the hiccups because I knew they were done. :hug: Not sure if your doc mentioned this, but a lot of babies that have issues with milk-based formulas, also have issues with soy formulas.

Something else that I thought of. All of my babies were refluxers so I have lots of experience unfortunately! My first two would overeat because it was soothing to them, it helped to mask the pain I guess. Hannah would do it to the point of puking up her whole bottle. She was the one that did great on the Nutramigen.

Here's what I would do:

Change to Nutramigen/Alimentum
Keep up the feedings every 3 hours around the clock
Keep giving the Zantac
Burp them often
Keep them at an incline ALWAYS

Try that first, and if they are still spitting up, I would think about adding the rice cereal again.