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.

thanks carrotcake, I will ask more specific questions when we review in 3 weeks. SHe agreed to leave it for now, at my request, to see how he takes to the new milk first. For example if he's constipated I don't want to concentrate! Also if we are messing around with intake I plan to keep a weeks record of feeds to her so we can accurately calculate what he needs to take, rather than do a rough guess.

I agree with rubyslippers that following a line is fine. Cause for concern is dropping. My dd was about an inch under 0.4 centile but followed the line so her paed/ dietician were quite happy with that

His total amount varies wildly, hence I want to keep a record.

A bad day is roughly(luckily less of these) 5 x 2-3 oz feeds (so 10-15oz)

good day 6/7 x 3-4 oz feeds so 18-28 oz, since he's been on soy, rather than dairy his reflux has calmed right down so getting more and more good days.

He's 4 months and nearly 13 pounds (9 3 lb birth).

She worked out he needs roughly 32+oz to get his needs, or even more if you calculate for his original centile and the weight he 'should' be now.

Centiles, he's gone from just about 75th to below 9th steadily, though has maintained the 9th for a month.

If it gets to that point I would ask her for specific written instructions as to exactly what you should do when making up the feed.

Professor, it would be in terms of weekly 'recipes' calculated for a certain amount of calories, in writing.

Can you see if they can find someone who is expert in dealing with feeding aversions? When my DS went on nursing strike due to his reflux, I muddled through with sleep feeding for months then the association with pain stopped. I should have asked for help but my GP was useless.

I did a bit of research online which indicates such experts existed. You might have to go to a specialist hospital. Seems a better alternative to messing with formula composition.

If it makes you feel better, neither of my babies get anywhere near that amount.

Mine are 8 months, almost, and one baby will take around 20 ounces a day, the other takes anywhere between 12 and 18 ounces per day. They are already on a specific high calorie formula though, which is 22 calories per ounce as opposed to 20 in most formulas.

Igglybuff, I think I'm lucky in that this woman is a specialist for allergies/ baby feeding. Lucky find. I think her plan is to simply boost him up the charts, rather than a long term plan. He is naturally getting better and better feeding himself, he's made HUGE improvements, just not there yet. I guess he still has a small belly as he's never managed much, it's steadily increasing though and some feeds are completely calm.

duncan-is it a high calorie formula or is it something you add? I guess he's not on high calorie as he's allergic to normal formulas.

If he is allergic to dairy/soya are you happy that he is tolerating the nutrimigen? Many dcs with dairy allergy cannot tolerate nutrimigen and do much better on Neocate.

I know I will be shot down here but have you discussed early weaning? (not at 16 weeks but possibly earlier than 26) but some babies do much better on solids.

www.med.umich.edu/1libr/pa/IncreaseCaloriesenfacare.pdf another link with increasing powder.

My babies have Nutriprem 2 which is a special formula prescribed for catch-up growth for premature babies.

You say that he doesn't look skinny. My (excellent HV) looked at my dd2 who on paper looked underweight and said not to worry as she looked healthy.

I am quite slim and tall and she said chances are that dd2 was the same. She is 18mo now and fine (although still on the skinny side)

I wouldn't add extra milk powder because of the risk of dehydration.

So he was born on the 75th and has gone steadily down to the 9th?

I wouldn't like to presume I know more than a dietician/paediatrician, but I always thought that it was pretty normal to be born on a different centile to the one they end up following. In DS' case for example he was born on the 2nd but went up to just under the 25th which is where he's hovered ever since.

As I said though I'm not in any way an expert, it just sounds odd.

I am wondering though what they propose you do if these extra-concentrated feeds give him constipation or he becomes dehydrated? I assume he won't take water either?

Whelk, only just starting nutrimigen, it may be crap. He's been on soya...and has developed a soy problem too.

Discussed weaning and she's very reluctant before 6 months, said his gut needs time to recover/ mature. I'm discussing this again the next appt.

Glad to hear he's getting better. My DS also has a small capacity for feeds - he's never taken more than 4/5 oz from a bottle, only eats small portions of solids and when he started to go longer at night between feeds, couldn't cope with taking a big feed in the morning.

Are the calmer feeds at certain times of the day?

He loves water thankfully, sadly he'll have it INSTEAD of formula though so I limit it. Even if he's refusing milk he'll take water, so at least I know he's not dehydrated.

She wants him on the 50th, I asked about 'finding a centile' but she felt it was too 'disproportionate to his weight' 96th/9th.

To be honest, I just don't know.

I think the calmer feeds are more luck, he'll be calm but if he so much as coughs or spits up a little that's it, he looses it. It's a bit pot luck if he mis-swallows or something or chokes. He had 4oz today then suddenly really flipped, rigid screaming, hard to calm. The day before same time he had 3oz just fine.

I would just phone to clarify.

This does not sound like some random rubbish advice, but a carefully thought out plan for your baby.

But I would try and have another conversation about it if possible asking about the dehydration issue.

What a nightmare you must have had a really stressful time.

My dd was born on the 98th pc. She is now 13months old and has been tracking the 9thpc for about 6 months.

The paeds are not at all worried about this, just content to see her following a line roughly. Certainly not trying to push her up a line.

They have stressed to me repeatedly that the weight you are born at does not determine the size of toddler or adult you are going to be. They said it is not uncommon for a big baby to have a period of 'growing down' as they find the line they 'should' be on.

If your baby looks a nice size, his health is improving and he is tracking a line (even gaining weight slowly) I wouldn't be attempting to make him fatter esp not from concentrating his feed.

I know this is not the same as my experience but to 'want him on the 50th' just doesn't make sense.

I suppose if you doubled the amount of powder in the feed, fed him, then let him drink water, it would be as if the formula had been made up normally, IYSWIM.

Does the paed have any tips for overcoming his aversion to coughing/spitting? Is he on any medication?

I'd be worried that this aversion might carry over to solids, especially when moving to lumps. My DS struggled with lumps for ages - he didn't reject them but used to arch his back and tip his head to one side when swallowing as it hurt him. He's ok now though but was stressful!

Hey strawberrycake - so happy for you you've found a good doctor. I agree that this may all seem scary to us but she is the expert. I might second the checking by phone just to be on the safe side as it does sound soo odd to all us non experts.
I had a proper little snacker who liked to go on milk strike (no allergies though, the two combined must be really hard) but things have improved massively no weaning is in full flow. So, hopefully, at 6 months there will be a light at the end of the tunnel for you!

DS1 used to take about 1-2oz every couple of hours then throw it up with his relux. Never drank anywhere near the recommended amounts. I think some babies drink more than others....I was always amazed how he ever grew.....Hope you get some good advice and things improve for you all soon