6m old / not enough milk at bedtime (Neocate)

[Franks12321]

My little one is 6m old. We’ve had all sorts of issues from CMPA to tongue tie etc. he is my second and I’m a ‘routine’ mum. However, even with a 4h gap, I’ve never been able to get him to take his bedtime bottle properly. He’ll take ‘some’ once my toddler is in bed, on the floor in his room. Then after 2oz he won’t take any more, we then do this cycle: I put him down to sleep, he is fine for 5mins and then SHOUTS for milk (won’t resettle until he has some) takes about an oz and then stops. We repeat this and then eventually he babbles, has a cry and sleeps. My issue is that he typically has 4-5oz and as a result night wakes once. Please don’t bombard me with ‘it’s developmentally normal at this stage’ blah blah… my first one slept through at 11 weeks and this son sleeps through on the few and only occasions he decides to drink his milk before bed. It’s as simple as ‘drinks milk, sleeps till 7am… doesn’t drink milk, wakes anytime between 10pm-1am for a feed. How can I break this cycle and get him to take his bedtime bottle?

Reflux reflux reflux.

Desperate to feed. Feeds for comfort. Milk drunk for comfort triggers reflux. Triggers pain. Triggers need to soothe by being desperate to feed and feeding for comfort which triggers reflux and they cycle goes around again.

Are you thickening the neocate, the amino acid formulas are very thin and can need thickener and potentially reflux treatment too. A switch to one of the other amino acid formulas might help to as they can react to other ingredients. My daughter couldn't have neocate as it contains coconut but thrived on alfamino.

Little and often is usually best for reflux babies. I understand the desire for a routine but I think I would spend a day or two following his cues and build a routine to match that. 4h might be right for some babies others might need 3 or 3.5h. I would find where your baby is and use that to build your routine

Thanks - he’s already on 20mg of omeprazole and seems really happy in the day. Could it still be reflux? I was thickening with carobel but been weaning him off this. Maybe I should add it back in? He’s so much happier on Neocate, although how could I tell if he doesn’t agree with something like coconut. I could try a switch to alfamino, but he had a terrible experience with Pepti milk so a bit scared to swap again. What are your thoughts?

We knew about coconut as she reacted to me eating before we switched to formula

Pepti is a different type of formula as it still contains dairy. Alfamino is in the same class of formula to neocate as it is completely dairy free. If you have recently dropped the thickener I would first look at readding that. Is there a reason you wanted to drop it?

My daughter needed 20mg omperazole, as much gaviscon as we could get in her having a sachet with 9 of her feeds and a third drug domperidone. She's 3 and now on 40mg omperazole, gaviscon in any drinks after 3pm, domperidone and keeping her diet free of allergens. My daughter couldn't have carobel as she's allergic to carob which is why we stuck with gaviscon.

When my daughter was a newborn most of her reflux was during the day but once she could sit up it was worse overnight. She now occasionally refluxs during the day if her reflux is bad but it's almost exclusively overnight.

I think Neocate doesn't taste very nice. Especially if the smell is anything to go by. It could be that he doesn't like it! Not sure what the answer to that is though.

Does he take the other bottles on

Assume if 4hrs on

7
11
3
7 the struggle feed

Can you try feeding downstaIrs? Away from bedroom if somehow he links that

If feeds Ok daytime

Neocate is rank. I did my training reflux (I'm a mn) under a top paed at Portland london and he always said better to drink the milk so add vanilla to it to taste or nequik powder

Then once drinking better to wean off it slowly

So the feeds get worse and the day goes on. None are great but we’ve started solids so that doesn’t seem to matter as he’ll eat food instead, I guess there’s just no alternative to bedtime milk as he can’t have a fourth meal but is up all night if he doesn’t have it. He even wakes up for dreamfeeds

How much vanilla would you add? Thanks

Gaviscon… that’s interesting. I’d been told we wouldn’t need it with the carobel. Do you use both?

You can't use both or at least not with the same feed, you can use gaviscon with some feeds and carobel with a different feed. We tried carobel but my daughter is allergic to it. We started gaviscon at 6 weeks but it constipated my daughter. We tried less and omperazole with little effect and then we tried carobel at 18 weeks and she came up in a rash and screamed so we went back to gaviscon but added lactulose as a mild stool softener.
We had the same result when she had a yoghurt with carob in which is the bean carobel is made from

A good few drops

HEILALA - Alcohol Free Pure Vanilla Extract - With Vanilla Bean Seeds - Hand-Selected, Ethically Sourced & Cold-Pressed - 50ml amzn.eu/d/hW1AwK6

This is a good one. Alcohol free and needs to be extract

Now you’ve all said reflux, I’m realising it’s that. Last night he was awake for an hour from 3-4.30. Only think that settled him was holding him upright. What should I ask the Dr for next if we can’t increaseomeprazole?

A paediatrician referral

You are on an amino acid formula for cmpa, you are on the maximum dose of omperazole for under 2s. You have reached the limit for GP expertise you want to be speaking to a paediatrician.

There are a few other medications that can be given such as the domperidone my daughter is on but these are all off label and can only be prescribed by a paediatrician

As super said a paed will prob add dom as well as omeprazole