Baby appetite

[SB87]

Hi all,

We are a couple with a 4 month old baby. He was born at 37 weeks weighing 2kg. At the last weigh just over a week ago he was 4.33kg. He gets breast milk via the bottle (we want to track how much he drinks).

Here's the issue: he only drinks enough about 15% of the time (those times are perfect). The other times he stops early we get him to burp with lots of difficulty, then he only manages to get about 2/3s of the way through the bottle. This becomes a vicious circle where we spend up to 90mins trying to get him to drink more, then when it comes round to the next feeding, we think he is hungry but probably not enough to finish the bottle and the cycle continues.

We have tried just letting it go after 30mins and hoping next time will be better. We also think he isn't engaging properly with his lips so is getting a lot of air.

Yesterday we thought we made a breakthrough where all but the last feed went well, but today it is back to the routine of one frustrating feed after another. Given he is already needing to catch up ground, we are worried he will fall off the growth curve he is currently on, let alone catch up on the normal range.

Any help or tips to imrove this will be greatly appreciated!

Best,
Sean

How much is he actually taking in each 24 hour period?

Yes how much milk is taking? Is he following his weight curve ok or is he dropping?

Also what teat size is he on? He could be getting frustrated. Fast flow teats are for 4 months and up so if you’re still using newborn ones then this would be one of the first things I’d try. If he can’t handle the fast speed it’ll be obvious so it’s worth a shot.

So on a good day, when they happen, he will take 710, average was increasing but we seem to be stuck around the 620-640 mark. The day before yesterday was a terrible 520. Then yesterday he seemed to be taking 120 each feed so we were hoping we could move to 6 feeds a day.

But when he is having bad feeds, sometimes we only can get 30-40 out of him in the beginning, and then only after an hour or more another 40 or so, so it starts to feel like 14 feeds a day rather than 7.

@LakeShoreD we had the newborn one, then we moved to a size 2 (3-6 months) at three months. The frustrating thing is that he is capable of feeding well, we just don't see it often enough.

about the weight curve, he is following the 2.5sigma line ish. But the last measurement was lower than expected.

How are you determining "enough"? Volumes of breastmilk don't increase like formula does and may be different.

Am determining enough as per 150ml per kilo per day, roughly in line with a few places I have read, an example here:
momjunction.com/breast-milk-calculator/

But I have never seen less than 150ml per kilo per day, quite a few places say more than that.

Those calculations are based on formula and not expressed breast milk.

This is up to date, to my knowledge:

kellymom.com/bf/pumpingmoms/pumping/milkcalc/

It is still recommended to feed on demand, even when bottle feeding. Aiming to go to 6 feeds in 24 hours is likely to be unrealistic and could cause health issues as the baby is being put on an unnatural schedule and potentially encouraged to take more milk than they really want/need at any one time.

Babies' growth is not expected to be exactly linear (e.g. to a growth chart line). I am not familiar with sigma charts but for centiles for example, it's common for them to dip over and under "their" centile line. Or to hover between two centile lines and be at any point between the two. Only if a baby's growth crosses two lines (for centiles) is there considered to be a concern. They tend to grow in spurts which means if you measure weight often the line will look "wobbly" - for this reason it's recommended not to weigh too often, if the baby is otherwise well. That is to say, one measurement lower or not following the curve isn't necessarily a cause for concern. Ensure you are checking using the WHO-2013 or WHO-2006 growth charts as well, as these are based on breastfed babies and therefore reflect patterns of growth typical to babies fed on breastmilk. This includes a slow-down in weight gain at around 4 months. If you are using older UK charts or CDC charts sometimes these have a different pattern which doesn't include this slowdown. That can make it look like breastfed babies are losing weight when this is not the case.

I'd recommed you seek personalised advice from a health visitor or lactation consultant (they can help with exclusive pumping/bottle feeding expressed milk as well as breastfeeding) as they will be able to actually examine your baby which you won't get with advice from online forums.

Thanks for the link. I think we are referring to the same charts, just depends on the interpretation. The sigma is just the full width half maximum of the normal distribution. So the one sigma line is between the 16th and 84th percentile.

We are in the process of speaking to the specialist but that takes time. Just to say also that the 150ml is on the low end of the range because the calorific content of formula is higher. But in any case even using the calculator he often falls outside the low range.

Like I say we are in the process of speaking to a specialist. Was hoping here for some tips and tricks to stop him getting air while he's drinking.