15 weeks old and still won't feed properly!

[Multibean]

We'd really, really appreciate some advice - DH and I are at a total loss of things to try and it's getting desperate this end.

I have a 15 week old and since she was very small she has struggled to feed easily. I was desperate to BF and after 7 weeks of misery exclusively BFing, we eventually progressed to FF on the advice of the Health Visitor. However, after a short spell of feeding slightly better from the bottle than from me, and a change to Dr Brown's bottles (very colicky / windy baby) which saw a brief improvement, DD has regressed to how she was to start with. She doesn't seem to want to stay on the teat for any length of time, thrashes her head around, chews on it, chokes, and pulls it out, then cries for the bottle. Rinse, repeat indefinitely.

At first we put it down to wind, and me not making enough breast milk, but now she's bigger it seems the wind is easing, although teething has started (cruel fate!). She does also seem to get easily distracted - although I can't help thinking that's because she's as bored of this drama as we are! I'm convinced it's also causing her to wake up in the night again, as she doesn't feed efficiently enough to properly fill her up. She is also very slow to gain weight, despite taking in 10% more FFs than her weight says she should!

The issue with this is we feel we've tried pretty much everything. She's not tongue-tied, she doesn't seem to have reflux, thrush or anything else physiologically wrong. She can suck and stay on the bottle on rare occasions. The HV has recommended different milk and teething gels and powders, none of this worked either. We've tried cranial osteopathy, which seemed to coincide with the brief improvement I mentioned above, but for the last month we've been back to square one, waking every 2-3 hours nightly to feed (she slept beautifully 10 til 6 before this regression) and TBH we're all at breaking point. Please, if anyone has any other suggestions as to cause or remedies I'd be grateful! Even knowing what could be causing it would help me, in terms of keeping my patience in the 2am feeds that now take 45 minutes...

I have a 20 week old with reflux who at one point fed like that. When you say she doesn't seem to have reflux is that because she isn't sick? Have you considered silent reflux where the acid goes up and then down again? Often eating hurts so they chew on the bottle for comfort and eating can be soothing but then it hurts again? Is the thrashing about worse after eating. They generally like to almost eat constantly. I feel for you.
They don't settle when they can't eat enough and it's a horrible vicious circle of exhaustion. Is she in pain a lot of the time?

Also how is the weight gain? Has she dropped centiles ? I would take her to the gp and if they aren't helpful go to A&E. the way to get the medics attention is weight and growth.

Can I ask who checked her for a tongue tie? It would be good to get a second opinion from someone qualified - many HV / GP etc just don't know what to look for. The link below woud be a good starting point.

www.analyticalarmadillo.co.uk/2011/04/tongue-tie-hidden-cause-of-feeding.html

Hi Neverending, thanks so much for your response! At wits end really. No, doesn't seem to be silent reflux either. She's very calm after eating and between feeds and now we've banished the majority of the wind she seems to be (generally) content and pain-free.

Poor you - I know reflux can be awful sleepwise and listening to the pain must be hard for you.

She dropped centiles only at the very beginning (from 25th to 2nd in 3-4 weeks). The tongue tie's been checked by 4 or 5 different people - HVs, midwives and GPs. Plus she's got a very long tongue and sticks it out all the time! Thanks for advice, I keep thinking I'm going mad but this just doesn't seem normal.

Next step doctors I think - I'll go over both tongue tie and silent reflux again to make sure.

Really push the doctors - sometimes they are not helpful - try and get a referral.dont be afraid to go to a&e either - can speed up process.

Thanks Neverending, that's a good idea! I'll push doctor too.

Ask for a referral to a speech and language therapist who specialises in this area. It sounds like a sucking issue. A SALT can recommend different ways of feeding which might help her to stay on the bottle.

A posterior tongue tie is another possibility but it seems that has been ruled out. (babies with posterior tongue tie can often stick their tongue out but may not be able to lift it to the roof of their mouth, cup it round a breast/bottle/finger and sustain sucking). If you still think it could be this maybe ask a lactation consultant to evaluate if you have a drop in clinic somewhere, they will still see bottle fed babies.

Speech and language therapist is a good idea - been the most practical help with my child for sure. Talked sense.

:(

tongue tie can't be ruled out on the basis of being able to stick tongue out - it's to do with how the tongue moves, if it is able to lift upward and compress the areola/ bottle teat. It is usually diagnosed by feel, so don't trust the diagnosis if all the HCPs have done is look in her mouth.

I second the idea of a SALT referral.

Are there any sings of atopic reactions/ allergies - eg eczema, dry, sore skin, diarrhea?

Re the sleeping, it is v common for them to regress
Sadly! Google 4 month sleep regression.

Thanks everyone, I will speak to the GP and try and get a referral. It could be a sucking problem, as you say. Ragusa, yes she does have dry skin (I have atopic eczema and some allergies, and her father is also allergic - both of us respiratory, not food-related). What could this mean?

I was wondering whether she had a milk allergy or intolerance - not to lactose, but to cow's milk proteins (it's called CMPI). You say that the HV has recommended different milks - have you tried any hydrolysed formulas like pepti or nutramigen?

CMPI can cause feeding difficulties and also faltering growth. The fact that both you and DH have atopic conditions slightly raises the likelihood of this being at least in part a milk issue.

Even breastfed babies can be exposed to (and react to) milk proteins if their mum consumes dairy.

Hi Ragusa, thanks for that, food for thought! No, we haven't tried hydrolysed milks. She has stopped doing this recently though (last 3-4 days) and is feeding relatively normally again! So frustrating not to know what is causing this. Changing milk is worth a try definitely though - thank you.