Bottle refusal all day - really desperate for help!

[Waffles80]

I'm desperate for help / advice with feeding my 17 week old twins, who are encountering the same difficulties at the moment. This may be a tad long, but I've tried to include all relevant information.

They are gorgeous babies (of course!), interactive, smiley and a total joy most of the time, but at the moment they won't feed in the day and as a consequence a) I am endlessly anxious, b) they have big feeds in the evenings and night c) they get crankier and crankier as the day goes on.

They were born at 35 weeks and kept in hospital for 10 days. I was desperate to bf but both found it hard to latch so we settled for combination feeding. For practical reasons, though this may have been a mistake in hindsight, we gave them bottles at night and I bf in the day (bf took ages and ages - in the day we could manage this as I had my mum on hand to help). I expressed as much as I could and they had, until recently, 2 bottles of EBM and two of formula. We gave them bottles at 7, 10pm dream feed then they would wake at 2 / 3ish and 5,6 or on a good night 7. This has been the loose routine for the last four weeks or so, although we moved the 7 feed to 6ish recently due to them seeming both hungry and very tired. Often they won't resettle after the 5/6 feed.

Napping has been a problem in the day - they've been very clingy. But we've managed to get them napping independently in the day in the last week or so. They nap for about an hour around 2 hrs after waking, around and hr / 45 mins at mid-day and another shortish nap in the afternoon. It doesn't seem quite enough really, but that's huge progress on their previous napping times.

It is, however, feeding that is causing the biggest issues.

In the last two weeks they were both increasingly fussy on the breast which caused me no end of stress and anxiety. I decided at 16 weeks to move to ff because I couldn't feed them out and about, and their fussiness / refusal to feed was making me feel horrendously low.

I know babies change constantly, but for the last few days they've continued to refuse to feed in the day. I think we were too rigid with our 7pm feed and as a consequence they have negative associations with being bottle fed - we were doing all we could to get them to feed when, in reality, they probably didn't want to feed. They're going HOURS in the day without feeding (12 hours for one of them today, who is around 9llb and the other, who is 10lb14, 18 hours with just two very small feeds - 60 ml and 100ml). Is this even safe at their weight? My HV thinks that over a 24 hr period they are consuming enough, and nappies are frequently wet.

My primary concern is, of course, that they are healthy and well. At their weights should they be going so long in between feeds?

Secondly, my DH and I need better sleep - he is at work all day and shares night feeds 50/50 (we each have a baby in a different room as they were waking each other). He is so shattered and often can't sleep once the babies have gone off because he is worried about work.

So....have I got them into a "feed at night" routine inadvertently? How do I help them through the bottle refusal in the day?

They're so, so cranky in the afternoons and they seem hungry / fractious but after a few sucks they arch their backs / turn their heads / scream when offered a bottle. I cautiously try throughout the day but today they wouldn't touch a drop.

Would really appreciate any advice!

Anyone? (Apologies for length of post)

Reflux?

Do they take a dummy? Swapping bottle for dummy worked with dd1 sometimes.

Feed refusal is stressful. That seems a very long time between feeds to me, I would go to gp to get a second opinion.

Which bottles are you using?

I had very similar symptoms with my 15wo DD and tried various reflux medication none of which worked. Decided to try DR Brown bottles on a whim and she took to them straight away and now downs full bottles. Worth a try?

Reflux was what I was away to suggest as well. My DS didn't feed while awake from about 12 weeks, I could only feed him just as he was about to fall asleep in a dark room. It was not much fun and I'm not sure how workable that would be with twins! Have they been checked for tongue ties as well? It was a really stressful time but even though DS is only 18 months it feels like years ago, it will pass even if it doesn't feel like it now!

Thanks so much for your responses - checked for TT, tried Dr Brown's bottles (in fact, tried different bottles for different feeds - sometimes swapping mid-feed with varying degrees of success!). I thought they had reflux early on - lots of sick / arching backs etc but they moved on from that and aren't sick more than posetting. Gaviscon made them very constipated - should I try it again?

We are feeding them in a darkened room, swaddled, asleep and doing the quick dummy swap. It's grim - I don't want to leave the house!

The plus side is that night feeds are not such a nightmare and they are calm and feed easily.

I keep being told they will feed when they are hungry, but it's just not sitting comfortably with me.

Thanks again for the pointers.

Reflux isn't just vomiting though. Google silent reflux. Dd2 had it and did like your little ones - feed refusals in day, easy feeds during the night when dozy.

There are other and better meds than gaviscon though.

Things will get better.

I spoke to our usually brilliant GP, who has suggested speaking to the HV...who didn't seem to think there was a problem! I might see if I can get her to come and see a feed; I
it just can't be right that a baby totally refuses to feed and becomes hysterical when fed! (Never mind two, in tandem.)

I really wasn't confident about the Gaviscon. What else did you try or have prescribed pommedeterre?

We ended up on omeprazole but there is also ranitidine that many babies take. GPS are not good at this. I eventually managed to time a screaming feed refusal moment with a docs app and she sent me straight to a and e!

Cannot imagine silent reflux x2 by the way, you are a superstar!

Thanks again for responding - really do appreciate it.

HV came round and saw a 'feed' (well, saw the babies being offered a bottle then screaming wildly!) - thinks that because the babies look so well, are alert / playful etc then we don't need to worry just yet. Weight gain is good though both are still small. She's speaking to local children's hospital for further advice - said normally she would suggest a&e if feed refusal lasts more than 8hrs, but as we can get them to feed if we rock them to sleep, a&e might "laugh at me" / dismiss me as loony first time mum.

She suggested we try spoon feeding - this did not go down well....again, both babies went bananas! They cry as soon as there is milk in their mouths but love sucking a dummy.

Her view was we shouldn't do the sleepy feeding in the day long-term, as they won't learn to feed properly. I pointed out that they would starve otherwise and she said that yes, actually, the priority is to ensure they do feed.

Suggested trying some baby rice with them to see if it stimulates their appetites. I'm quite against this really as it's not as nutritious as milk and the last thing I want them to do is fill up and be even less interested in milk. She did say just to try a tiny amount. I'll try it, but imagine they'll respond in just the same way as when offered milk.

HV also wasn't convinced it's reflux as they don't scream after a feed (in the night when they feed well, or in the day when we manage to give them a sleepy feed, or a "stealth feed" as my OH has been calling it.)

Thanks again. Will see how we get on over the next few days... So far today hasn't been a good day. They fed well at 10pm, had around 110mls each at 3am, again at 6am, and managed about 60mls each at 11am. It's driving me crackers - babies are supposed to like milk! My mum has taken them for a walk so I can have a bit of a break eat a whole packet of chocolate fingers

It sounds so stressful waffles. This is very much what my DD was like and she would also be ok after feeds and would feed when she was half asleep. The doctor thought silent reflux but I was never convinced but as the dr brown bottles worked I suspected it was more colic.

Your twins sound just like mine. Have you given MAM anti colic bottles a go?

Have you tried changing there milk? Maybe to Aptamil comfort or something like that.

I'm just wondering if the milk they have during the night is what causes their discomfort during the day as it is processed through their system.

Whatever way you look at it I say it's the milk because what else would it be?

I would also recommend heavily diluted peppermint tea ( obv caffeine free) if they burp and fart after having it that would suggest digestive discomfort. If they won't take it in a bottle give them 5 ml in a syringe.

Although it's not common here it's used in the Turkish community and I can honestly say it worked wonders for my dd and myself when I have trapped wind!

That absolutely describes my DS! Your HV sounds useless! My son is 91st centile for weight but he still has silent reflux at 18 months, them being an ok weight/generally healthy doesn't mean they don't have reflux. I would take them to A &E if the GP is not willing to help.
There is a brilliant reflux group on Fb you should join, they are very supportive. It makes me so cross that GPs/HVs just fob off mums when it comes to reflux. You know your babies better than anyone, don't let them tell you you just have to put up with it!

Also I used to put diluted fennel tea in DSs milk, similar to the peppermint suggestion above. Another idea would be to keep them on the same milk but use Carobel. It is a milk thickener, bit like Gaviscon but without the constipating effect! You can buy it in some chemists but I buy it on Express Chemist online/Amazon. You might have to go up a teat size if you make the milk thicker though.

They won't 'laugh' at you in the hospital. The triage nurse I saw is still one of my favourite people in the world, ever. Glad you have your mum on hand for help.

Agree with you rice is unlikely to help. Comfort milk definitely worth a shot?

Do they make funny gulping noises after feeds when laid flat?

Hi again. Thanks again for suggestions. Still battling on with difficult day time feeds...bit at least they are feeding.

HV tallied up amounts and says both are mostly at the bottom end of what they should have, or just below, every day. Has scrapped baby rice plan. Says to go to A&E on Monday if problems persist over the weekend. Outrageous that this is our only option. Considering seeking a private consultation as waiting for NHS referal might take forever.

No gurgling noises and usually quite content / sleepy after a feed . Going to try comfort milk.

Nappies are very wet, but stools are much thicker than normal (reflecting change in diet probably? V yellow and pungent).

Thanks again everyone.

Sorry if this has been suggested, I don't think it has. Are the teat sizes correct? They might be working too hard to get the milk and getting frustrated.

At this age I found moving from 3 to 4 hourly feeds was good for the routine. I would also try to not feed more than the dream feed at 3am feed. Then nothing until the morning. That is sufficient at 17 weeks and those weights.

Also to add, DS was a very sicky baby and I suspect a bit of reflux. His middle of the night feeds were calm and he'd just rouse, eat and then straight back down again. The daytime was a different story. If he had the choice he'd have had a small snack every now and again and that's about it.

I can only conclude now that he didn't like milk much as solids were a hit and still are at 2.3.

Thank you, that's helpful. We've changed teat sizes - up to size 2. Would you suggest 3s? They seem ok on the Tomee Tippee bottles - or, rather, they resist all bottles equally at the moment and TT are easiest to clean!

Feeds are every three and a half hours as usually takes at least half an hour to settle them and get them ready to feed. They usually take about 120-150 for the dream feed, and wake at 2.30/3 for a feed - amount varies but not more than 150. They're never that hungry in the morning, wake up at 6.30ish and want to kick about / play. So we do that before feeding at 7ish.

Weights are now 9.14 and 11.7, which is good, because I was worried this would really have an impact. Babies, eh? Law unto themselves.

Those of you with experience of this, firstly, how long did it take to pass (I know, all babies are different but somehow it'll help to know) and secondly, how did you feed out and about? Or did you just time things to be at home?

Might try the "little and often". Yesterday DT2 (the smaller one), had several feeds of 50/60ml.

DS improved massively when he was about 8 months old. He was very easy to get off bottles at 1 year old and still just has a cup of cows milk at 2.3.

I just made sure that there was a lot of cheese, milk and yoghurt in his diet as this counts toward the required ounces.

I think that the 3s could be worth a go. If they choke and don't get used to them, you can put them away until they're ready.

DS never took more than 120mls, even when he was only feeding 4 hourly with 5 feeds in the 24 hour period. Just not fussed. He was little, dropping down the 9th centile after being born on the 50th. He's still quite slender now though.

Tried the 3s, didn't make much difference really - although made feeding quicker!

Still having to do the dummy swap for all daytime feeds. If you put the bottle to them awake they scream and turn their heads away still.

I don't feel like it's reflux. They don't seem to be in pain other than when they get a bit windy. It's an aversion to feeding. Once they actually get going they're ok. That said, my larger twin has had more crying episodes over the weekend - sort of colicky screaming for 20min periods which require lots of rocking and shhhhhshing to resettle.

It's totally infuriating and the HV doesn't seem to see it as anything other than an inconvenience for me. Gaaaah!

She advised against changing the milk. They currently have Cow&Gate. Attempted Aptamil Comfort at wkend but even with size 3 teats they just couldn't / wouldn't suck.

Try another normal milk? Another Comfort milk?