Breastfed baby barely feeds!!

[Pod86]

My son is 4 months old and for the last 2 months his feeding has been getting worse. It started with reflux symptoms - vomiting, crying, pushing away etc. Dr prescribed gaviscon and omeprazole.
His weight gain slowed - born on 75th and gradually dropped to just below 25th.
We were referred to CAU at hospital. They checked him over and confirmed reflux (possibly CMPA) and sent me home with dairy free formula for top ups......but he won’t take a bottle!!
Things got a little better, but now he is barely feeding again. He doesn’t cue for feeds, other than having his hands in his mouth, but he always has his hands in his mouth.
Today he went 5.5 hours without feeding and STILL fought a feed!
I am so distressed by all this. It’s ruining our early bonding time and impacting on my relationship with my toddler. I’m scared he’s starving but he doesn’t cry or cue for food.

How incredibly stressful and worrying for you.
Is he still being regularly monitored? Do you have to do weekly weight in ? Can you check with your health visitor?
Can you go back to the hospital that started meds ? Can you ask fr paeds
Dietician review regarding his nutrition and weight ? Does the hospital or is there a local specialist feeding clinic for this?
Also worth chatting with them about if possible to introduce early solids and if that wold be appropriate.

So when he was born you ebf and for the first two months he fed as would be expected and was gaining weight, or he was never a good feeder? Did he ever cry for food?

Normal poos?
Is his mouth ok? Have you checked it for thrush which I understand can be really painful.
His jaw ok?
Ear infection?

When baby does feed can you hear/see that baby is drinking? Is there a time of day that baby feeds best? Could you recreate these conditions again throughout the day? Is baby easily distracted?
Does baby show signs of dehydration or illness? This sounds stressful for everyone, if it continues then could you go to your local NCT group to see the breastfeeding peer supporters or breastfeeding councillor? They might be able to signpost you to local support.

If they're worried about CMPI/A, did they suggest that you try going dairy free for a couple of weeks?

Sorry, I had to cut a lot of detail as it wouldn’t let me post. Some additional notes:

• Visited NCT breastfeeding group (very helpful, watched a feed and thought he didn’t seem hungry, so that reassured me for a short while)
• He’s VERY easily distracted (has an older sibling) so tried feeding in a dark quiet room as nighttime feeds are better (occasionally helps, but not often and not convenient with a toddler at home)
• Currently has approx. 8-10 wet nappies a day and maybe 1 poo per day/every other day. Poo is normal
• Fontanelle not sunken
• Born with tongue tie, so painful feeding initially. Had it divided and fed beautifully until around 8 weeks. Lost just 3% initially but gained it back straight away
• Was being weighed regularly but now discharged as they saw nothing wrong with him. Weighed him in clinic last week and he’d droppped again below 25th but toddler was having a tantrum so couldn’t speak to HV
• I’ve been dairy free for approx. 7/8 weeks
• Considering trying baby rice this weekend when he turns 4 months

Things that haven’t been mentioned to me:

• Thrush - I cant see anything in his mouth? Are there any other symptoms?
• Jaw pain - how would I get this checked?
• Ear infection - he’s had his temp taken at every check, I guess they ruled that out?

Shriek, regarding his early days feeding, after the tongue tie was cut he fed brilliantly (or so I thought), but turns out at his 6 week check he was already down to 50th. She said it wasn’t too concerning as babies ‘find their line’, but if he dropped again we’d have to look at formula top ups. In the early weeks I used to use his hands in his mouth as his cue to feed (never rooted much), but since about 2 months his hands are permanently in his mouth! So I’ve been giving teething gel too incase it’s hurting him to feed

Does he seem to show interest and pull off?

Does he feed batter if sleepy?

Do you offer the other side if he refuses one?

Have you tried walking around and carrying while feeding?

Strong let down can be a sneaky issue and they're clever at this age, they avoid it when they can. My first was like this at this age but was born below the scale and settled at the 25th, however at 4 mo was sooooo nosy he'd pretty much reverse cycled.

This one still gets fussy with my letdown at 6 mo. It can cause reflux too.

Have you tried any laid back nursing?

*better

Neurotrash yes he opens his mouth, latches on and then almost instantly pulls off again. He’s also now started trying to put his fist in his mouth while feeding - I’ve tried two different teething gels, but so far no change.

I’d say he stays on better when sleepy (his feeds are usually better at bedtime and during the night) BUT he falls asleep quite quickly.

Yes I always switch if he’s fussing on one side. Sometimes that gives me a slightly longer feed. I have tried walking around/bouncing, but not recently. Maybe I’ll try that again. He’s doesn’t feed well in a sling though, I’d have to carry him.

Yes I think my let down might be quite fast - sometimes he pulls off, sometimes he’ll drink through it. But I’m getting g scared that my supply is diminishing now due to such small/infrequent feeds.

Went to the Drs again today as he had a really bad day today and he’s advised me to start weaning.

Yes, he doesn’t do well with laid back feeding either! He’s a nightmare!!

Have you tried putting him upright on you? Sounds like he gets overwhelmed have you tried expressing it off and feeding it by bottle, where he'll be more in control?
This will help your supply too.
It makes sense he's better at night as milk supply normally slower at night.

How are you giving the omeprazole and what is the prescribed dose? Sounds like he's learnt not to feed as associates it with discomfort. My reflux baby was the opposite and was constantly snacking on my boobs at this stage but never taking a full feed. It only got better for me when I got the medication right and moved my daughter onto neocate. My baby also refused bottles but eventually accepted a Minbie to start with and then I moved onto mam bottles. Persistence is my only advice with this. Try mixing the omeprazole in a few drops of boiling water to turn it into a paste. Then add it to a spoonful of pear purée to give to your baby. They should have it about half an hour before a feed. I give it in the morning. Also if you are breast feeding remove all dairy from your diet.

Have you tried offering him the bottle to hold himself it maybe a messy disaster but getting anything into him at this stage is important. If he is interested in food like his sibling he may be an early eater.

Hi op I wish I had more time to reply right now. I've just read this and think it's worth reading - introducing solids isn't necessarily going to help.

Mine was unbelievably distracted at that age and hated feeding. I had to walk around with him and lie down to feed, side lying, often when he was sleepy too. He did get better at 5-6 mo at feeding in the day.

https://m.huffingtonpost.co.uk/amy-brown/look-at-him-watching-you-bb_17886590.html

I rate Amy Briwj very highly; I know a bfing paediatrician and a nutritional scientist who know/ work with her.

Early solids is only recommended for those babies with definite family allergies eg peanuts.

Regarding CMPA - was his skin bad? Was this based only on reflux? Any difference with going dairy free?

Strong let down and tt can definitely cause symptoms that could be confused with CMPA. There's normal physical reflux too which is a total pita. Strong let down plus tt (and with tt you can have a high pallet which makes it even harder to latch) can be quite challenging (been there got the t shirts twice. Plus over supply.)

There's a very big oral motor stage at 4 mo; I found it hard to tell with this one if he was hungry or not.

Good point about what dose the omeprazole is at. The potential range is pretty big, and if not on the top whack might be worth a trial of it.

My baby was like this as I had low supply and she was incredibly frustrated.

Has someone checked your sons tongue tie?

My sons tongue tie was divided but has since developed 'significant scar tissue' meaning that it needs to be redivided. The reason it was picked up is that the 'quality of feed' at my breast has deteriorated.