Mixed fed 3 mo DD - suddenly refusing bottle

[AgruminoMum]

Hi all

DD 3.5 mo have been sucessfully mixed fed 50:50 for the last two months. She had diarrea 3 weeks ago, so following doctor's advice I gave her diarrea specific formula (thicker than normal formula) for about 5 days. Afterwards I reintroduced her usual milk (Aptamil) and she kept cutting down on the quantities and over the last several days has been refusing the bottle very vocally. Also tried changing the milk but that only worked for about 3-4 bottles. She now refuses to even taste the contents of the bottle, so no point changing the milk again.

She is happily feeding on the breast - but the breasts doesn't have enough milk in the afternoon/evening, so this really is a big problem. I have been able to sneak in a bottle or two at night which is my only hope right now... Has anyone experienced similar problems? I spoke to a doctor on the phone who seemed to suggest that DD might be refusing the bottle since she is old enough to understand that she likes breastmilk more...which sound weird - why would a baby put herself on a hunger strike?

Can you just keep breastfeeding until your supply catches up? Maybe just spend a couple of days doing nothing but feeding.

I tried for a long time to increase my supply and it did not work. I am currently producing 500-600 ml, while she needs 800-900 ml a day. I am afraid that if I breastfeed exclusively, DD will start losing weight. Her weight has been stable over the last week (as in - no weight gain), and she didn't lose any weight only because I managed to sneak in a few bottles when she was half-asleep. Unfortunately, she seems more and more against the bottle, so not sure how long this strategy will work...

Are you exclusively expressing breastmilk for her?

Hi Rita - not expressing at all, she is sucking directly on the breast. Did exclusive breastfeeding for the first 6 weeks, but due to poor weight gain, we started supplementing with formula. I was worried initially that she will stop sucking at the breast after we started the formula - but she is really loves the breast. Also my milk appears to have increased but it's still far from being enough. Not clear why I can't produce more though - I eat more than enough, drink a lot, have help around the house, and yet - not enough milk... Did try to express in addition to breastfeeding - but there is nothing left after a feed, and the pump is hurting my nipples, and generally I find it less effective than the baby itself.

Have you thought about a supplimental nursing system? Sorry I'm on my phone so can't do a link, but medela do one if you google it. This way you'll be able to get formula milk into her whilst she's at the breast.

Btw I've never used one but I've seen them around so it might be worth a look at.

Otherwise what bottles are you using? You could try a different brand or even a different teat to see if that makes a difference.

I just wondered where you got the 500-600ml/800-900ml figures from.

Expressing isn't a good indication of your supply or how much the baby is getting - babies are more efficient at extracting milk than any pump as you have found! 800-900ml also sounds like quite a large amount of milk for a breastfed baby - on average they take about 750ml a day I believe, and the amount doesn't increase with age as it would with a formula fed baby.

Eating and drinking won't make much difference to your supply, but putting the baby to the breast more often will.

Rita - have you actually tried this yourself? Because I did - I breastfed exclusively for 6 weeks, holding baby on breast for hours and hours - and yet we were admited in hospital for failure to thrive and spend a week there doing all kinds of tests and exams to determine that the only thing that doesn't work is my breast. And after introducing the formula DD started growing and stopped crying for hours and hours. So I know what the theory says, but I have come to the point to admit that it does not work for everyone in practice.
I know the milk quantities because I have been weighting DD before and after feed, and still do it every now and then to monitor milk production.

Anyway I didn't really want to have another discussion about breastmilk and the benefits, and the supply, and how comes it is not enough, and do we really need the formula...far too many discussions like this on MN. I was just wondering if anyone has experienced sudden bottle refusal after months of successful bottle feeding.

It actually looks like DD doesn't like the taste of formula anymore - I tried feeding her two different types of formula last night and she made a disgusted face. Did try the formula myself afterwards - and yes, I agree, yuk, not nice at all! I also tried giving her tea with the bottle - and she took it. So it seems that it is not a bottle aversion, but that at 3.5 months she is now able to recognize the taste, and has decided she doesn't like it... i guess breastmilk tastes better?

Rita sorry didn't want to sound negative.. I am indeed putting DD on the breast every 1.5 hour now, given that she is hungry and only takes the breast. And would be lovely if my supply finally increases to a sufficient level. I just feel very pesimistic about this due to my initial experience, and I am searching for other solutions as well... don't want to get into the hospital again for failure to thrive, it is an experience to avoid at all costs :(

Rather than it being a problem with your breasts, could it be that your baby has a problem removing the milk efficiently? Feeding for hours and hours and not gaining weight sounds like it could be a problem such as tongue tie, or poor latch. Sorry if you have already ruled this out.

I really wasn't trying to tell you about the benefits of breastfeeding either, just trying to come up with some ideas to make it work if your dd is refusing formula.

No tongue tie and latch is good. In fact, DD is very fast at sucking out the milk now. But a hungry one month old baby doesnt know much - so would continue sucking on empty breasts for hours, or scream when removed.

You say that babies only need 750 ml of breastmilk a day - where did you get this number? I keep referring to 800-900, because that's the amount of formula they would normally have a day. If 750 ml is enough, I might be closer than I thought...

Regarding breastfeeding - I feel that there is not enough information on how the whole process works. We are told to put baby on breast all the time, but it can't be that mechanical. I am sure stress level in mothers does influence the production, yet nobody talks about this. The only advice is eat, drink and rest enough...

Hipp Organic tastes the nicest IME. Tryed SMA White with DD3 as it is now the only veggie one I think but it tasted truely foul.

I don't know if stress affects production but it definitely affects my let down no question.

zzzzz, happily, eating drinking and resting have zero effect on quality and quantity of breastfeeding/breastmilk , though I know there are strong beliefs otherwise....Big Myth, however. I am sorry to correct you on this and on other stuff, but it's important that the OP and anyone else lurking has good info.

There are not 2 different charts. The current chart in use in the UK is based on data from breastfed babies, which contrasts with the previous (obsolete) one which was based on babies whose feeding was not differetiated, though there would undoubtedly be many ff babies in the data sets. However the difference at 3.5 mths (age of OP's baby) is virtually nil - it's only really in the 2nd half of the 1st year that ff and bf babies start to diverge significantly.

The calorie content of breastmilk and formula milk is more or less the same (allowing for the difference between different samples of breastmilk which may well reflect the difference in fat content - but over 24 hours research shows that calorie content of formula/breastmilk has little difference). Babies who are breastfed may need less volume of breastmilk because the formula takes up calories in being digested. Whatever....no one can say what volume any individual baby needs at any one time.

It is fine to feed very frequently, and this is the normal physiological pattern for human infants, and if the milk is being transferred effectively increases the volume of milk taken in by the baby, and this allows for growth.

'Super hydration' is not needed for breastfeeding and in fact deliberately over drinking has been shown in research to reduce the amount of milk made.

Agrumino, sorry about your problems - you have been through a lot. I think it would help to speak to someone knowledgable in person. Not sure what sources of support you have explored - they can outline your options.

Mixed feeding 50-50 almost always means a reduction in milk supply and an eventual disappearence - it is very unusual for anyone to maintain a supply long term on this. Your dd almost certainly needs the formula in some form or other, at least some of it - your figures of how much you are producing and how much you need and what the shortfall is sound very prescriptive to me, so you could certainly check these out again, but with a real life person trained and qualified in breastfeeding support.

Thanks everyone... I am indeed seeing a paediatrician tomorrow, but decided to post this thread to check if anyone has experienced similar bottle refusing problem.

It is all really confusing. DD actually seems content and alert, and not crying from hunger - which is confusing given that I know she is having about 50 ml per 2 hour feed in the evening (in the morning about 100 ml per 3 hr feed). She should be hungry, yet she seems to have decided it is ok. She gets a little bit more upset (but nothing like the hungry crying during the first month) in the evening - but still refuses bottle.

tiktok - I know that mixed feeding 50:50 is supposed to eventually lead to decrease milk supply and eventually stopping breastfeeding either due to that or to baby starting to prefer the bottle due to faster flow. Yet, exactly the opposite is happening to me. I have been doing 2 months of mixed feeding, and DD was happily drinking litres of formula. Yet, my milk is currently more than when she was 6 weeks old (we measured for days) - perhaps it is due to her sucking more lately, and also to me being less stressed than in the beginning. Also, she kept decreasing the formula intake over 3 weeks, and she is now refusing to take it at all (my guess is due to the taste, and not to bottle aversion, as explained before). I am now measuring milk supply again (weighting before and after a feed). It is no longer stressful as I don't take it emotionally (it was very emotional the first time) but as a scientific experiment. I did manage to feed her a bottle at 5.30 am this morning while she was asleep, so this is my only strategy right now (before the doctors come up with other ideas). I should be able to squeeze in 2 feeds of 150 ml at night, which should make up for the shortfall. Again - would be lovely to have sufficient milk supply - but I am more or less pessimistic about it.

p.s. would be lovely to have some real scientific research about how our breasts work. There is too much urban myths out there and not clear which ones are actually true. I no longer trust LaLeche League (far too political/religious), or WHO (guidance geared towards third world countries with limited access to fresh water), NHS (too political)...

agrumino - test weighing (weighing before and after a feed) is not usually considered to be an accurate way to measure intake, sorry. One reason is that most scales cannot calibrate to a sufficient degree of accuracy.

There is plenty of scientific info about how breastfeeding works - try this:

www.howbreastfeedingworks.com/

Not sure your criticisms of the other sources of info are justified, to be honest. LLL is deliberately non-religious; WHO guidance is for all; don't see politics in NHS info at all.

Argumino Have you looked at Dr Jack Newman and the Kellymom. They seem to be the more quoted people on MN. I especially like Kellymom, everything I read on there seems to be backed up with articles and peer studies. I tend to go with what Kellymom states more often than not these days.

Also it could be that as she's been decreasing the formula she's been upping your supply slowly. Does she seem happy coming off of the breast?

There is a section on kellymom about increasing your supply, I don't know what you did before. But there is stuff on there about switch nursing, going on the pump for a few minutes after a feed (not to get anything out but more for the stimulation to get your body to increase the milk supply).

I do hope things get better for you.

There's a section on Kellymom regarding how much milk breastfed babies consume. The average is around 25oz a day (750ml) with a range of 19oz-30oz in different babies, and this is stable from about 1 month until weaning - the amount of breastmilk a baby needs doesn't change with age/weight as it does with formula. I think this is because the fat content of breastmilk changes over time, whereas of course formula is exactly the same product all the time.

I am absolutely not talking rubbish :) I will post references tomorrow. I have them coming out of my ears, as mumsnet regulars know :)

Very few scales outside a laboratory can weigh to 1g accuracy. Most scales for sale for use by HCPs in a clinic would not claim anything like that - scales need calibrating, regular servicing and weighing is something you need to be trained in. Test weighing is not a good indication of breastfeeding effectiveness for several reasons.

Charts in the UK are all the same now - and my point about divergence stands anyway.

You are misunderstanding foremilk and hindmilk. Babies do not usually drink 'right to the end'. It is not inherently exhausting to feed often .

You haven't upset me. What does perturb me, I suppose, is someone talking from experience and assuming that what they have read or experienced is a general truth - 'cos that can be misleading. You spoke from your experience in exactly that way - experience is fine and sharing experience is fine but it has limitations.

ZZZZZ - tiktok is a trained NCT breastfeeding counciler and as such she has to have fed at lest one child exculsivly for at lest 6months, if I remeber the critira correctly. In fact all volantry orginisation who train pear supporters and councilers ask that you have personal experiance in order to do the training.

I learned in my helper training and it's shown more and more to me every day as I help women that personal experance can be good in making a women feel like she's not the only one. But being objective and giving correct information so that a women can make her own choices baise on the research avaible is acutally far more improtant.

Even if you have scales that are that acutrate unless your in a control enviroment lot's of things could effect the weight on the scales by a couple of grams. I'm a trained Physicist so should no a thing or two about measuring acuratly.

zzzz, I am sorry if I came across as aggressive - gosh, I have read my post again and I can't see it! Baffled as to why you think my careful, polite, and neutral tone should come across that way :(

I have had years of breastfeeding experience with my children, don't worry about that :) I am an NCT breastfeeding counsellor and concerned that mothers get good info as well as encouragement and support to breastfeed, and I'm aware of the myths around.

You talked about measuring to within '1 g' - possibly a typo? 10 gram increments do not mean that scales will do that accurately, though....only top quality, professional-quality, precision-scales, calibrated and serviced regularly can be relied on to do that.

You didn't make it clear you were speaking from experience only - your first post stated quite categorically that eating, drinking and resting have a 'huge impact' on breastfeeding quality and quantity and it is not only untrue, it is also very undermining to breastfeeding....someone with problems that need addressing in a different way could go off down the wrong track completely! You went on to share other info that was incorrect - I am sure all this was well-meant, but so was my post correcting your info.

Here's some references (some of them are articles which have references in them):

www.analyticalarmadillo.co.uk/2010/07/foremilkhindmilk-and-lot-of-confusion.html

www.kellymom.com/bf/supply/foremilk-hindmilk.html

www.lalecheleague.org/NB/NBMarApr04p44.html

www.ncbi.nlm.nih.gov/pubmed/9746642
this is
Breastfeeding: Unraveling the Mysteries of Mother's Milk....1996 but a classic overview showing maternal nutrition, lifestyle eg rest, stress, is not a factor

There are no studies I have seen comparing bf with regard to rest alone - but there are a few looking at stress and mood (and finding no difference).

However, the fact is we know that historically (meaning over 100,000s of years!), mothers in general work a lot more and rest a lot less than we do these days, and it makes perfect sense for lactation to remain robust and unaffected by mothers' 'lifestyle weaknesses'.

I have a lot of references but don't want to bombard you, but if you want more, let me know :)