Concentrating feeds, adding extra powder

[strawberrycake]

16 week old DS had his appointment at the hospital today (very good, answered a lot, prescribed nutramigen). He's shot up in length (96th centile) and his weight is now steadily bumping on just about the 9th centile, hasn't crossed a centile for weight for a while. His weight gain is a bit slow, his intake is a little off, but much better. The dietician/ pead talked about adding extra powder to his feeds to bring him up to the correct amount of calories/ a little more to put his weight back to the original centile. I'm open-minded but this advice just seemed odd. What are others feelings? Is rapid weight gain good? Could it overload his gut? Is it common advice? Basically they calculate his needs, his intake, then adjust the water/ formula mix so he gets more calories in less milk. He is happy, very alert and developing well. People are surprised when I tell them about height/ weight as he doesn't look skinny, lean, but not bony or outside the range of what you'd expect a baby of his age to look like.

I'm open-minded as I said, I just wondered if anyone has experience of this.

BTW as a side note, they reckon he has soya and milk allergies, milk severe, soya pretty mild.

Oh also to clarify, the woman was very good and it was a good appointment, I'm not doubting her abilities/ knowledge. Could not fault.

Surely you are meant to make up the bottles as per the guidelines and adding extra powder isn't that. However I am not a paediatrician, just a mum.

That was my gut feeling pinkbasket, but I'm also a mum, whilst she's medically qualified. IT's hard!

You must do what you feel is best. Can you ask her again what evidence she has that this is safe and will actually work when it is not recommended to add extra powder?

This is shockingly incorrect advice. Adding extra powder can dehydrate babies. I suggesr you complain about her to stop her advising this to others.

I'd love to read evidence I guess, she did seem to know what she was on about. ARGH it's difficult!

Just offer him a correctly made, additional bottle of food

I wouldn't add extra powder to feeds

www.cowandgate.co.uk/feeding_and_nutrition/formula_bottle_feeding/article/how_do_i_prepare_a_bottlefeed

5th bullet point says "adding too much or two little powder can be harmful"

ruby-it's a long story but he's a poor eater who is prone to refusing feeds, he manages half to three quarters of an ideal amount, despite frequent offerings. He also eats mini feeds. He'd turn blue with rage before he consumed any more.

I wouldn't do this, too much poweder to water can dehydrate and constipate babies. I would also suggest offering more milk.

If you were BFing you wouldn't be able to add more calories, you'd just feed more often wouldn't you?

:)

sorry, xposted with you

Finally found this

pediatrics.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=pediatrics&cdn=health&tm=120&f=10&tt=14&bt=0&bts=0&zu=http%3A//staff.washington.edu/growing/Nourish/Concform.htm

'Both Ross Labs and Mead Johnson have written instructions for making altered caloric concentrations of their formulas. Contact your formula company representatives for this information.'

Some babies eat little and often

Some guzzle huge feeds

They're all different

If you were breastfeeding you wouldn't be able to see what he was taking ....

Also, it's not so much daily food intake as the overall over a week

If you have to offer a bottle every couple of hours or so with a few ounces in then,that must be better than offering an incorrectly made up feed?

I second pinkbasket - my gut feeling would be not to do this. I would ask her for written evidence it is safe. And/or contact the formula manufacturers for another opinion.

Feeding him is a bit like trying to feed the average nine yr old a plate of sprouts every 3 hours, if that gives you an idea of the reaction you get.

Could you try a diff formula, maybe neocate? Seems to be a bit more likeable than nutramigen (although my two are fine with nutramigen).

If you've found evidence to support her opinion then fine - she is the expert!

Sorry ruby, but just to make really clear. EVERY day his TOTAL amount of milk is far below the recommended amount. He refuses feeds more than 4/5 hours apart by screaming until he's blue/ thrashing around/ sucking then spitting it everywhere/ generally going ape shit like you're trying to poison him. I feed him either when he's half-asleep or by swapping his dummy for a bottle and hoping. I agree with her on that bit. It's probably linked to the fact eating has caused him pain since birth.

Except in my house as my 9 year old loves sprouts!

Don't do it, just keep going on with what you feel is best.

That sounds very difficult for you all ...

I just feel uneasy about the advice

I would call her back for some clarification TBH

Actually I'm feeling better, google 'altered formula mead johnson calorific' and found links finally. Just took a while.

Feeling more reassured it's safe, but not sure about idea of 'fattening up' a child quickly. He's healthy and happy, maybe he's just that shape. ITt's hard. Agreed for now to monitor him with 3 weekly reviews before doing anything else, which I think is fair.

ruby, that's how I describe, just 'uneasy'. We're going to review him, but I can see logically that he will not rise through the centiles eating as he does, I'm not sure how bad it is for a baby to be a little underweight. Why do they want them to fatten up? How does it help them? I've always been skinny, as is his Dad and we're fine and healthy.

My GUT feeling is don't do it. You get crap BF advice from a very many HCP so there's no reason why you would not for FF babies. Having a medical degree/training does not make a person a baby feeding expert.

HOWEVER, this is a person who you say is both a dietician AND a paed, so they SHOULD know what they're talking about. Given the unusual situation it may be that the rules need tweaking.

You are right to query this. Normally this is completely the wrong thing to do as it causes, as has been mentioned, babies to have too little water in their diet.

My recommendation is this:

• Contact the NCT breastfeeding line. The counsellors are highly trained in EVERY aspect of baby feeding, not just breastfeeding, and are extremely informed and up to date about formula feeding.

• Contact the manufacturers of your formula and ask their opinion.

• Go back to your HCP and confirm that you understood right, expressing your concern about dehydration.

That woud be my suggestion, anyway.

Following a line is ok isn't it?

If he has fallen through a lot of centiles is a worry of course and should be investigated

My DD has always been on the 25th centile - She is just petite (from birth)

I would've thought you would be prescribed fortifier to add or a high calorie alternative prescription milk instead. Maybe you could ask paed about this instead?

I would be concerned about constipation with higher concentration of formula to water

Just curious, what is his total amount in 24 hours?