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When does feeding get easier? Mixed feeding, snacking, no hunger cues until screaming. Feeling very down. Sorry so long.

(29 Posts)
featherblue Mon 12-Sep-11 18:34:57

I'm really struggling. My DD (12 weeks Wednesday) is mixed fed, not by choice. Some background -- we had a horrible time trying to establish breastfeeding (original thread here ). I had my heart set on breastfeeding and am heartbroken that it hasn't worked out. I'm dealing with some PND because of it and am being seen by the perinatal team.

At this point we are still mixed feeding (breastfeeding, if she will, before every bottle), but I think she will begin to refuse completely soon. She's only spending around 5-10 min bfing before just sitting there and not latching on until I get her bottle. At least she's not screaming every time anymore. I don't believe she gets anything from me at all ? never comes off with milk in her mouth, never hear her swallowing except the early morning feed when my breasts feel remotely full for the only time. I did everything I could to fix my supply problem after her tongue tie was snipped -- pumping 8x/day, constant breastfeeding, babymoon, max dose of domperidone, fenugreek, switch nursing, breast compressions, SNS. It's been our entire life for 3 months.*

The problem now is that I just can't figure out when she's hungry, and she seems to have no interest in eating until she's screaming. She's finding her hands and so constantly has her hands in her mouth, so I can't use that as a reliable hunger cue anymore. She is snacking constantly. Sometimes when I think she's hungry (because she's screaming and nothing else fixes it), she won't take the bottle and I basically have to force it on her by holding it in her mouth for ages until she takes it. Then she calms down. She fidgets and looks around when eating and would like to eat only about 2-3oz at a time. I'm spending my entire day feeding and pumping and I'm at the end of my tether.

For instance today:
4am - BF 8 min, 2.37oz formula (that exact because my app turns mL into oz)
8am - BF 10 min, 2.37oz breast milk
11:20 - BF 5min, 4oz formula/breastmilk mix
12:30pm - 2.69oz formula
2:30 - BF 4min, 1.5oz formula
3:45 - 3.5oz formula
5pm - 3oz formula

I offer 5oz every time, and sometimes she takes all 5. She's been screaming all afternoon. She's in her swing now, finally napping.

Her total intake is normally around 20-25oz/day (plus bfing), so less than the 30oz she's 'supposed' to have, but I'm not worried about total intake. Her weight has been following along the 48th-ish percentile. No problems now with weight after all the initial problems. Intake doesn't change with how much she breastfeeds (some days more than 2 hours total, some days as little as 30 min).

Just wanted to know if mixed feeders/bottle feeders have any advice? Does the 'snacking' ever get better? I always offer more than she wants. I just don't know how to read her anymore, and she seems so unsettled/unhappy. I feel like I've done this to her by forcing her to breastfeed before every bottle. Like she no longer recognizes hunger because I've made her delay it, if that makes sense?

She used to be happy to feed, happy to take a full bottle and then wait 3 hours. It's only within the last 2-3 weeks this has been happening. She started sleeping a bit better at night around the same time (5-6hrs, up for feed, then another 4-5hrs), so I think she's struggling to figure out how to get enough food during the day to fuel her long sleep.

I feel like I can't go anywhere because I can't take enough bottles/formula for the never-ending feeding. And all I think, all the time, is that if I were able to breastfeed it wouldn't matter. She could snack all she wanted and it would be easier to deal with. And then I cry about not being able to breastfeed.

Any advice on how to read her? How to get her to take more so she's satisfied for longer than an hour? On how to get through this period? I'm just really struggling. sad

*please don't offer me advice on re-establishing breastfeeding. It won't work, and it just breaks my heart. My lactation consultant has even advised me to stop. I just don't have the milk, probably never had the milk. I have an underactive thyroid, so that could've been the problem. Or the TT being unsnipped for two weeks screwed my supply up. I won't know until next baby, I guess. sad

Bubandbump Mon 12-Sep-11 19:31:42

Sorry I can't help on the mixed feeding front but just what you are describing is some of the symptoms of silent reflux especially the small feeds and nearly forcing to eat. It might be worth just ruling it out.

AlwaysRocking Mon 12-Sep-11 19:35:43

Not sure how helpful I can be but didn't want you to go unanswered. I stopped bf at 4 weeks and understand how sad it makes you feel. FWIW it sounds like you did everything you could to improve your supply and I think you should be proud of yourself for carrying on mixed feeding this long.

In terms of pratical advice on bottle feeding, my dd was like yours at that age. She only ever had a few ounces and used to fight the bottle. What worked for me was to give her a dummy for a minute to calm her, then swap it for the bottle and she would keep sucking. Depends how you feel about using a dummy though. She is 19wo now and has just the last couple of weeks started taking more at each feed. I do try and distract her if it's not been long since a feed and she seems to eat better with slightly longer gap between bottles so maybe worth a try?

Hope things work out and please don't be hard on yourself.

featherblue Mon 12-Sep-11 19:55:32

bubandbump - I believe she has reflux. She brings up a lot of feed after and also brings up curdled milk up to two hours after a feed. Until now she's been a 'happy chucker' so doesn't seem to mind. She's been prescribed Infant Gaviscon, but it made her so uncomfortably constipated that we decreased it to a half a packet per feed. Do you think it's worth asking the GP to prescribe ranitidine? Do you know if it has the same constipation side effects? She was so unhappy with the constipation.

Alwaysrocking - I'm trying to look on the bfing and be proud we've made it this long, but I'm having a hard time. Working on not being so hard on myself.

I would be happy for her to take a dummy, but she won't take it. She just rolls it around in her mouth. I'll give it a try next feed to see if it distracts her enough. I'm glad to hear that things have improved with your DD. I'm hoping things will settle down soon. It's relentless.

RitaMorgan Mon 12-Sep-11 20:16:39

Was she ever checked for tongue-tie? It can cause reflux symptoms as well as breastfeeding problems.

Cow's milk protein intolerance is also fairly common in babies and can cause reflux/refusal to feed.

F1rstT1meMummy Mon 12-Sep-11 20:58:26

I find my dd will only take an avent dummy. mam ones make her gag and she cant hold onto the tommee tippee ones.

You have done amazingly well to get this far, and i realise it is hard but dont be so hard on yourself.

Bubandbump Mon 12-Sep-11 21:15:48

My DD has silent reflux caused by intolerances including cows milk proteins, however the sleeping ok at night seems more like pure reflux - not that I am an expert. There is a reflux support thread on here which it might be worth you posting on as some people have a lot more experience with feeding refusal than I do, as my DD is the opposite and likes constant feeding to stop the acid hurting.

Also, my DD seems like a happy chucker when it comes out, it's just the 'silent' bit ie. most of her sick is regurgitated and reswallowed. It's that bit which causes her the discomfort.

DD is on ranitidine and while she was constipated on gaviscon, she seems ok with this and is on a fairly hefty dosage.

schmee Mon 12-Sep-11 21:26:09

A bit off the wall but could it be a sleep issue rather than a hunger one? If she is crying but not hugely hungry then she might take a snack rather than a proper feed, which would cause her to need to feed again quite soon.

What is her sleep pattern like during the day?

featherblue Mon 12-Sep-11 21:48:57

RitaMorgan - she had a posterior tongue tie that was snipped at two weeks. Part of our never-ending breastfeeding saga. I had her checked again a few weeks ago, and it hasn't regrown. And breastfeeding is painless now.

What are the symptoms of cow's milk protein intolerance? She's had top-ups of Aptimil from 3 weeks old-ish, so I'm not sure if it would start being a problem now. Though she's had the throwing up issue the whole time.

F1rstT1meMummy - Unfortunately she won't take the Avent ones, but maybe I'll try another brand. The only only she'll attempt to suck on is one my mom bought her at Whole Foods. It's much longer than the others. Guess I'll keep trying her.

Bubandbump - she doesn't seem to be in pain after she finishes eating, though. Does that not rule reflux out somewhat, even if she's bringing up curdled milk later? She just took almost 5oz. I added a full packet of Gaviscon to it. Maybe I'll go back to the GP and ask for a trial of ranitidine.

schmee - her sleep in the day hasn't been great since she started sleeping a bit better at night. She sometimes takes a long (2-3hr nap) but not always. She takes little catnaps (ie 30-40min), but I'm not sure how long she should be sleeping during the day if she's sleeping so much at night? Nor how to make her go to sleep if she doesn't want to. The swing will put her to sleep for a bit, but she wakes back up.

She's screaming again now. sad I'm so worried she's in pain. But then when you distract her, she stops. I just don't know what to do. Thank you everyone for the ideas.

swanriver Tue 13-Sep-11 10:19:45

featherblue, you poor poor thing. You will get through this. My dd had reflux but she wasn't allergic to cow's milk and did much what you describe (slept well at night) not good at settling in day.
This is what I did, having gone through much the same trials and tribulations over the same time period. The charts, and feeding schedules did my head in completely as did the sterilizing, and pumping and everythign that interfered with me just bonding with the baby, cuddling her and living my life with her.
I would throw away the breast pump, and all the expressing equipment, and concentrate on relaxing time, (go out for walk if necessary, with park benches, cafes, friends houses as part of your day) with the baby, offer her the breast when she's hungry over a period of a few hours. Decide you are going to offer medium (3x 4oz)bottles of formula at certain set times of day, say mid morning, and early evening rather than topping after every feed, and see how that goes. That worked very well for me. Feed whenever you want in between, whenever she cries, but at least you know you have milk on tap, which is I imagine what you are feeling sad about, not being able to comfort her by bfdng, easy access etc. See how that goes. You may find she feeds more at night, but that is good for prolactin levels and will boost your milk production generally. If is a disaster, and after two days, things are no better and this has increased your anxiety, make a decision to move over to bottle feeding, and BE HAPPY.

swanriver Tue 13-Sep-11 10:24:22

Ps. Forgot to say that reflux issue means they do want to suck constantly, but they are often tired and don't know it, so think they are screaming for food, but actually just desperate for sleep. That was my daughter's condition. I held her upright after feeds in sling, another thing which was impossible if I was going to do the pumping expressing lark...

Also go for instant ready made formula at this stage so you have one less problem to deal with and can concentrate on relaxing with baby.

swanriver Tue 13-Sep-11 10:38:15

P.S. My SIL had a severe breast abscess and was forced to give up bfng at 7 weeks, on consultant's advice. I thought she would be gutted, (as I had loved bfdng so much, and SIL had been really very good at it in terms of supply etc) but she said to me that it was such a relief to get past all the problems and just ENJOY the baby, and get out with her, instead of suffering those hours painfully feeding hidden away from people, worrying about all the problems with feeding. So whatever happens, whether you continue to partially bfd or decide to go over to formula, it is your relationship with baby which is most important for your baby, and please please please realise how much happiness you will find, even if you are feeding formula. You have not failed her, she needs you for more than just calories. Just concentrate on all the precious little smiles, and cuddles and whilst letting yourself acknowledge what a painful experience last few months have been, don't let go of what a good experience you can have from now on. P.P.S. Baby really does not know the difference between one sort of milk and another, it only knows the difference between happy mum and sad mum.

featherblue Tue 13-Sep-11 14:04:41

swanriver - thank you for that. I do think that there will be some sort of relief when she finally refuses the breast completely, because at least then we can move on. I was feeling slightly better about it, but this constant feeding, when using bottles, is just really dragging me back down. And I think that I've ruined her first three months of life with this constant battle. I know intellectually that I haven't, but emotionally I'm struggling with it.

As far as only offering the breast, I just feel like I'd be starving her. If I even try to wait 10-15min after she comes off the breast to give her her bottle, she screams with hunger. She was weighed before and after a feed after she had her tongue tie snipped and only took in 2ml during a 40-minute feed. I think her sucking (or my supply) has improved since then, but the thought of continuing to force her to only drink 2ml of breast milk from me and wait to eat until certain times of day is not a happy one. She basically gets all of her nutrition from formula/EBM, and breastfeeds for my want to breastfeed. And sometimes for comfort.

You're right that part of what makes me so sad is that I don't have breast milk on tap, ease of access and the comfort + food that bfing gives. I get panicky about not having formula to feed her when she gets hungry. I was a mess during the London riots (we live in one of the riot-hit areas) as I can't feed my own baby in an emergency.

I'm trying to get over everything, and the punishing schedule doesn't help. I probably should put away the pump, but I feel like it's the only thing keeping my supply up since she barely breastfeeds anymore. I'm just feeling stuck.

Today has been much better than yesterday so far. She breastfed for 6min, then had 3oz of formula at 5:45am, then had 5oz formula at 9am, then bf for 13min plus 4oz EBM at 12:15, and now she's asleep in her swing. I used Infant Gaviscon in all of her feeds, so maybe that has helped. I think I'll go back to the GP next week to ask about Ranitidine if the constipation comes back with the extra Gaviscon.

swanriver Tue 13-Sep-11 14:22:14

If you stopped pumping, you might find that she takes the milk from your breast instead, as automatically there will be more there ifysim...I think that's what's so negative about pumping as the next feed is automatically less bountiful... in the short term I mean..and as you say she now associates bottles with bounty not breast. All your time is being taken up doing something that is making you exhausted, and that will not help your supply, as I found.

Please, please stop taking note of what she is consuming, and how much more milk she takes after a breastfeed, it is not good for morale at all. As you say she is throwing up after a feed anyway, she might be taking more than she wants.

You have not ruined first three months of her life, truly you haven't. If you read MN you will realise how many people have had horrendous first months with their babies, yet their relationship went on to prosper. Just you have to come to terms with it, that's the important thing. I spent a long time feeling incredibly angry and upset that my baby had been hungry (this was ds1 actually) and when it came to dd (second baby) I was determined not to let the same thing happen, and concentrated on trying to enjoy her whether it meant topping up or not.

swanriver Tue 13-Sep-11 14:25:21

P.S. It won't be long before she needs food as well as milk, and you could be panicky about not having food to feed her if you think about it, and runnign out of mashed banana etc...There are shops all around with formula, stock up, put loads of cartons in the buggy, anything that sets your mind at rest.
TAKE CARE.

featherblue Tue 13-Sep-11 19:56:02

Thank you for being so kind. I know I have got to, got to get over it. I'm working on it.

She does seem to prefer when my breasts feel 'full' (only at the night feed), so maybe I'll take a couple of days off the pumping to see how it goes. I can always start again if my supply deteriorates further. I haven't decided whether I want to continue to give her EBM once she refuses the breast.

I know it's not logical to worry so much about not having enough formula. My mind just automatically goes there at the moment. I always have way more than I need with me. Ugh just have to let it go.

Gwlondon Tue 13-Sep-11 20:54:07

For me it took three months before it got easier. A lot of people have given up by now, but please don't!

When breastfeeding becomes established my understanding is that the process switches from hormone driven to supply and demand.

For me, my breast feel full in the morning but less full by the evening. It doesn't matter though, as when your breast is less full it has more of the fatty milk. So the baby will still be satisfied.

If you can afford it I would speak to a lactation consultant. She will be able to help you. Watch you feed your baby. Take a full history and really problem solve for you. I don't know about mixed feeding but they will.

I struggled establishing breastfeeding. Lots of blocked ducts. Now it is going well, my baby is 4 months old. I got a lot of help, but the lactation consultant really made a difference.

Websites that were recommended to me:

www.kellymom.com/index.html

www.askdrsears.com/topics/breastfeeding

www.breastfeedinginc.ca/

featherblue Wed 14-Sep-11 10:46:58

Gwlondon - thank you for the links and encouragement. Unfortunately, it's now not 'if' I give up, but 'when'. My DD is not willing to breastfeed for very long (ie 5 min) and will probably refuse soon. I've had three months of desperately trying to get her to EBF, and I just don't have enough milk, despite how rare it is. She had a posterior tongue tie that wasn't snipped for two weeks, so that could've been the problem with my supply -- not stimulated right at first, so never able to recover, but I also have an underactive thyroid (though medicated adequately), which sometimes can cause problems with supply. I guess I won't really know which one until next baby, though at least I'll be well-armed for tongue-tie issues.

I was working with a lactation consultant, and she thinks it may be time to stop. sad

Gwlondon Thu 15-Sep-11 23:12:17

sad poor you. You have really been though it. It is hard. Good luck.

Gwlondon Thu 15-Sep-11 23:15:52

Sorry featherblue I hadn't read the last paragraph of your post properly.

featherblue Fri 16-Sep-11 08:23:01

Don't worry gwlondon. Sorry if I sound defeatist, I've just reached the point now where I have to learn to let it go rather than hope for it to turn around.

Her eating has been a bit better the past few days since I've been putting gaviscon in every feed. But she's really constipated. sad GP appt this morning.

narmada Fri 16-Sep-11 21:53:02

Gosh, you have really been through the wringer. You've done so brilliantly to get as far as you have.

If you do stop breastfeeding you should not feel at all guilty. Only you can decide what you want to do. But please be kind to yourself. It's really important you get better from your PND.

With DD, I was an ardent breastfeeder, however DS has been on formula since 6 weeks or so as I was very poorly (PND like you) after his birth. He is totally fine and makes sure he gets his cuddles and mummy-time in other ways. Honestly, your baby will be fine and please don't forget that the vast, vast majority of babies in the UK are bottle-fed. Also, there are advantages - presuming youj have a partner, he or she can do a night feed and you can get some (probably) much needed sleep.

Gaviscon does constipate, it's well known for it (although not a listed side-effect) - you could try carobel instant powder (made by cow and gate). Does the same job but less constipating.

I would definitely check out the cow's milk protein intolerance lead. What you're saying does ring bells there. Symptoms include food refusal/ only eating v small amounts at a time, either diarrhea or constipation, skin rashes, nasal stuffiness, vomiting (commonly, curdled milk-like globules hours after a feed), , stomach cramps. Oh, and screaming - lots of it. If the cow's milk does turn out to be an issue, then there are prescription formulas that you can use where the cow's milk is broken down and more easily tolerated - aptamil pepti is one, neocate is the most important (completely cow's milk free) but also the worst tasting.

narmada Fri 16-Sep-11 21:55:30

PS I do know what you mean about the 'not having enough formula' and fear of running out thing. But.... it will only be another 3 months before you will be able to plug any hunger gaps with food if you're caught short. Really, honestly, things become so much easier at about 6 months of age when weaning gets going.

featherblue Sun 18-Sep-11 12:11:05

Thank you narmada. I'm starting to feel slightly better. I was started on medication, which seems to be helping. Of course now I'm panicking about the tiny amount that gets through breast milk, even though she's only getting around 3-4oz of breast milk (plus small amount she gets directly) every day. But I would like to be able to tell her that I did everything humanly possible to keep breastfeeding/getting her breast milk. I think I would feel much better about the whole thing if I managed to express until 6 months. I'm only expressing twice a day (night/early morning feed and first morning feed) to limit her exposure to the antidepressant, so I think I can probably keep that up.

The GP has started her on Ranitidine and given lactulose for the constipation. Hopefully it will disappear now that we've stopped the gaviscon. If the ranitidine doesn't work, I guess I'll push to try the prescription formula. She has seemed a bit more settled since starting the ranitidine, so hopefully that will work.

narmada Sun 18-Sep-11 13:48:11

That sounds like a plan*featherblue*. I was on antidepressants while breastfeeding my DD - I fed her for 2 years while on the ADs all the time - and she has turned out just fine and dandy! The SSRI thought to have the lowest transfer rate to breastmilk is sertraline (LUstral) - if you're already on an SSRI drug (examples include citalopram, fluoxetine, seroxat) it is relatively easy to swap to another drug of the same class. YOu may find that as the antidepressants really start to kick in you will feel far less guilty about using formula too - really, you have nothign to feel guilty about anyway! But feelings of guilt are part and parcel of PND.

Really hope you start feeling better soon and get to enjoy your babe.

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