Urgent advice needed: Paediatrician has suggested something and I am so NOT SURE?

[dejags]

DD has recently been very very ill.

As a result the little mite hasnt gained weight very well and is still quite tiny.

She is just under 8lbs at 7.5 weeks. Since bringing her home from the hospital, we have been having a nightmare with feeding.

It goes like this:

DD is hungry - screams for a bottle. I feed her.

One hour later she is screaming for another feed (or at least that's what I think she is screaming for) but I can't see how she can be hungry as I have already given her a huge bottle.

So I give in and feed her again, she falls asleep but she ends up constipated and on laxatives.

If I don't feed her she screams for an hour or so, finally drifts off into an exhausted sleep, then wakes up. The cycle starts again.

In desparation, I called the paediatrician this morning - he suggested putting baby rice into her bottles to thicken it (he assures me that this will not aggravate the constipation and may satisfy her apparent hunger). I was totally shocked, can this advice be right?

Can anybody give me a professional view?

Cylonbabe - breastfeeding is out.

I have had a breast reduction, I was quite succesfully mixed feeding, until DD was admitted to hospital.

The oxygen and nasogastric tubes on her upper lip made it impossible for her to breastfeed as should couldn't open her mouth wide enough.

Thanks for that though.

Most HVs and baby books advise no solids before 6 months. Baby rice is ground up rice. It's a solid. Putting it in milk risks choking. No medical professional currently advises giving babies any kind of sugar. I've never heard of tiny babies being given laxatives. Sounds to me like you're being some very bad and possibly dangerous advice. Call NHS Direct about these things or see antoher doctor I would. Babies do cry. Could be colic. If she is drinking milk regularly and producing wet and pooy nappies she should not be overfed. Perhaps overfeeding is causing discomfort.

Also 8lb at 7 weeks doesn't sound that small to me depending on her birth weight. Both my dds would have been considerably less than this but dd1 born at 6 1/2 lb and dd2 at 5 1/2 and both breastfed. Fed on demand trying to space feeds out to every 3 hours and then increasing this space over time.

Well I know this advice was the norm a few years ago so don't be too shocked. DS had severe constipation as a baby (used to puke when doing a poo with the effort) and in your situation I used to give him watered down formula if he was asking for seconds. It seemed to work. I agree though you should speak again to your Paed and don't assume he is crazy.

Why dont you ask a private clinic nurse, I think most of the Link pharmacys have their own clinics. They should definately be able to answer your questions.

I cant remember the name, I think it is Milkara, it is omega 3 and 6 oils, you can ask your pharmacist, most of the formula milk in SA does not contain these oils, Milkara is a supplement for infants, you ad it to the milk, sure it will help with constipation.

from what I understand dejags it is a way to thicken the milk rather than anything else. My dd1 was v prem and by the time we came home she had a complicated feeding routine f one scoop of this and one of that etc, but one thing was a special thickener to add to her milk to help her keep it down and digests it slower and therefore get the goodness out of it IYKWIM

So perhaps inthis case in SA that is what they are suggesting it for however I don't really know and think you need to understand WHY they are suggesting this

None of this advice is 'the norm' any more Dros. All of the 'experts' now say no solids before 6 months, no watering down formula, no sugar. If you look on any respectable baby nutrition site you will see this advice in black and white. Health Visitors are told to say this also. If they say something different it is about their personal opinion and not medical advice or evidence. Even formula milk companies say this.

I would not give an 8ib baby babyrice.

full stop!am shocked it was suggested!

Are the health professionals actually concerned about your dd's feeding and weight gain Dejags or is it that you just can't work out why she seems unsettled? If its the former you should definitely get professional advice (which can't be given on the phone without your dd being seen) and if it's the latter you should consider whether your baby is actually being overfed, wants attention, has colic or something else.

Tiny babies' kidnies cannot cope with solids and can be damaged by it.

Not giving babies solids in their bottle is the norm in the UK, but the opposite is the norm in other countries. I don't see how giving a little babyrice in the bottle would make the baby choke. By 'hypoallergenic' I suspect the paed means that babyrice is highly unlikely to cause any sort of allergic reaction - I've heard this many times, and never heard anything to contradict it. Nonetheless, I'd be wary of going down this route without trying other options first.

It's difficult to believe that the baby is hungry so soon after her bottle. There may be a link between overfeeding and colic (or is that only breastfed babies?). Also the constipation would nto, I think, be helped by adding solids, rather the opposite. Perhaps the make of formula doesn't agree with her.

I would certainly try water, rather than another ff, but have you tried a dummy? Dummies are excellent at this age for soothing tummy-ache, as well as for comfort. A bottle-fed baby sometimes wants to suck, rather than feed, but doesn't get the sucking satisfaction from a bottle that a bf baby gets from a boob.

Antoher thing that occurs to me - given the trauma that the LO has gone through - do you carry her a lot? Maybe she needs a lot of body contact with you, and slinging her on your chest would give comfort.

what was your babies birth weight?
Is there a slow steady weight gain, no matter how small? Has baby lost weight?, or simply slowing down on growth?

How many hours is baby sleeping in 24 hrs as an infant needs to sleep to grow.

crying after feeding suggests tummy pain, or colic.

I would go for the dummy suggestion and trad ways of helping a colic baby, warm baths, massage with fragance free talc, or oil and infacol infant drops.
Prop up the cot at head end as this helps control acid feedback in infants tummy.

That said I wouldnt rule out the need to change formula, but this needs caution as its not advised to chop and change formulas.
If this slow weight gain, and poor bowel habit continues it may be a sign of food intolerance.
Or its worth considering acid reflux , if thats the case
Make an apointment with the doc, just to allay any fears you have in this area.

In case you have lots of allergies on both sides of the family , its worth being aware of the three main symptoms of classic food allergy in infants under three months.

1 poor sleep pattern ( an inability to sleep for a prolonged period)
2 poor weight gain
3 ezcema

I really hope that the above is not your baby , as its not fun AT ALL>

hopefully this is all just a bout of a baby telling us that his tummy is still very immature, and only time will help.

good luck

dejags - I personally would not give baby rice in a bottle. Although she is small she has been very unwell so the low weight is to be expected. She will be hungry because she is amking up for lost time when she was ill, however I would not give her feeds too close together. I would aim for 2-3 hourly with water in between. Is she on a first stage milk? If so, keep her on it. If she is on a second stage milk I would switch her back to 1st stage. Second stage milk constipated babies. I would also definitely encourage her to take a dummy. It is going to take some time for her to settle again after being in hospital too. Try cuddling her skin-toskin. That is not just for breastfed babies. Glad to hear she is home.

Thanks for all the advice.

The reason the Paed suggested the babyrice in the first place was to "weight" down the feed. This would be try and keep it down and prevent any pain related to reflux. He is not keen to put her onto anti-refulx medication at the moment - she had soooooo much medication in hospital that he wants to give her system a chance to recover with as little medicine as possible. She is still on singulair and serotide though.

The Clinic Sister did a home visit this morning and agreed with me that:

1. it's very unlikely to be hunger, she starts screaming in a very pained shortly after the feed.
2. we both suspect reflux as she is comforted by being upright

So we have agreed:

1. NO baby rice - she agrees that this isn't the best course of action (in our case)
2. I am going to try gaviscon for 2 days, if there is a discernible improvement, then we'll know that it's very likely she is refluxing.
3. If she is, I'll let the paed decide on the best course of action
4. If she isn't, I am going to change her milk.

Your suggestions have all been fab. Thank you. Unfortunately she doesn't tolerate water very well - she sucks so vigorously that she chokes. She gets plenty of cuddles - sleeps on me most of the time and I have just bought a sling too.

Should also point out that she is on Pegicol - it's a milk additive which encourages bowel movement, but in a different way to a laxative.

So onwards and upwards.

Am glad you're getting some support Dejags. Hope it's all sorted soon.

I've only scanned through the previous postings so apologies if this has been suggested already.

Could she have an allergy to milk? Some paediatricians are more adept in certain areas than others - I know this from first hand experience as ds and dd have been in and out of hospital. It's definitely worth getting a second opinion.

Thanks GWU,

She is already on Lactose Free milk.

I think, in the case of our paediatrician, it's a regional thing rather than a problem related to speciality.

Giving baby rice to help with reflux, seems to be widely accepted in South Africa. Our paed has a neonatology speciality so I am in no doubt to his ability. I was rather questioning the validity of his suggestion.

If you don't think that your baby is hungry have you thought that it could be colic or similar. My second baby cried a lot and was very unsettled. I took him to the doctors for colief at about 7 weeks as I was at my wits end. In the end it turned out that he had silent acid reflux - where the flap at the top of the stomach is not formed so usually babies are sick all of the time but sometimes, as in my baby's case, acid crept up his windpipe and caused him pain. I found out since that these babies also like to drink a lot of milk as it neutralises the acid and gives them relief (a bit like gaviscon). My baby started off on infant gaviscon which is a powder that you put in the milk - but then went on to take ranitidine (anti-acid).

He is now 18 months and still requires mediciation for it.

Hi Willmouse,

that's exactly what we suspect (see my earlier post).

DD's paediatrician doesn't want to put her on Rantinidine because she was recently hospitalised on lots of meds (16 different meds at one point) and he wants to give her system a break.

Do not wish to be alarmist - I found out that ds2 had reflux when he had a "fitting episode" and stopped breathing. This happened about 5 times before my husband self diagnosed him on the internet and we finally got somewhere. I think that if you suspect it you should do something about it.

It is a difficult one as they can't tell you whether they have got excess acid but you know from experience how painful it is and wouldn't impose it on anyone for the word.

Have you got your cot propped up? Also I would definitely buy a baby sling/carrier - we never got around and carried him around for months like idiots!

dejags, glad to hear Carys is home.

No experience of reflux, but I do seem to remember watching a 'Baby Whisperer' where she had a special teat for the bottle to help with acid reflux - I'll have a look for it for you.

Ok, I think they are these - she seemed to get good results with colicky babies, but as I say, I don't have any hands on experience with them.

Thanks Tortoiseshell.

The Haberman feeder is actually a supplementing system used widely by women who have had breast reductions (you can simulate breastfeeding with the correct attachments).

Unfortunately there is more chance of me falling pregnant by wind pollenation than of finding this product in South Africa. If I get it posted, Carys may well be weaned by the time it arrives, the postal system here is less than reliable .

Really kind of you to link it for me. Ta