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Aug 03, 2008
carmarhal
Adoptive mommy of Micah 2/26/06, Caleb, 3/03/07 (26 wk preemie, BPD, Subglottic stenosis, GERD, dysplagia, FTT, DD, texture aversion, ST, Feeding Clinic, PT, OT, Prevacid 30 mg/day, Pediasure & ground table foods), Ethan 2/6/08 (28 wk preemie, BPD, dysplagia, GERD, Prevacid 15 mg/day, Enfacare 22 cal., ST for feeding)
Why won't he eat? Pulling my hair out!
Ethan has been eating less and less lately, and my methods to get him to eat aren't working as well anymore! I'm at my wits' end! He started out eating very well, and weighed 12 lbs 5 oz at his 4 month (1 1/2 months corrected) well-child in June. (He was also taken off his oxygen at the end of May, and his saturation level is good when I check it.) At his next weigh-in a month later, he weighed 12 lbs 9 oz. Needless to say, I was not happy. He has reflux, and has always taken a while to feed, stopping for burps (which often take a while to come), hard to feed when he frequently is constipated. But just over the past few weeks, he has gotten harder and harder to feed. He would eat the first 2 oz and then after I burped him he wouldn't take the bottle again unless I waited a while. Then it got to where I had to walk around to get him to eat after the first 2 oz. The past few days, even that isn't working most of the time. Sometimes if I wait an hour and try again he'll drink another 2 oz., but his speech therapist (for feeding) says we don't want him to become a snacker. I've even tried feeding him when he's sleeping, but then he won't eat at all! I've tried upping the calories, but I'm afraid that's just making him more constipated. His doctor said to try giving him pear juice, but he won't take it! We keep him propped up all the time; he even sleeps in a Tucker Sling. Has anyone had this problem? Is there anything I can do that I haven't tried? Should I just get him a referral to the feeding clinic? Caleb is also very hard to feed, but I'll write about him in another post! None of my children are biologically related to us or each other, so I can't go on past knowledge.
Aug 03, 2008
jedd'smommy
Jessica, Mommy to Jedd, severe reflux, severe food and oral aversions, Finally G tube free!!! VSD repair 4-24-07 (open heart surgery), hypospadias, repaired 3 times and Ear tubes Visit Jedd at his CB site: www.caringbridge.org/visit/jedd
Many children who are not eating well due to reflux are doing so becasue they are in pain. This is a sign that the medicaitons are not working properly. Either an increase in the meds or a new meds needs to be done. This is always what we did with Jedd.

What med are you currently using???

We saw the best results with a PPI, Prilosec. Alot of other have doen well on Prevacaid. They are the two most common PPis out there. You can also use Protnix.

It's good you are workign with a ST. But I know with Jed we got discharged from private ST becasue Jedd was in so much screaming pain we were getting nowhere.

Even our rehab center here that works with Jedd's severe eating issues won't do much until the reflux is under control.

They can however give you exercizes to help make those mouth muscles stronger.

I would also keep a food journal of when you feed, how much is taken, and when and if they vomit. I have also kept how long it takes to eat and any chidl behaviors tha tI see. This hleps the GI/ped/ whoever take things more seriously.

Good Luck.

Aug 03, 2008
michelle&aurora
Aurora born March 17, 2007
3 years, 8 months old
Weighs 25.8 lbs
8 lbs 11 oz at birth.
Recovered Chronic Projectile Vomiter
Prevacid Free since September 08
Egg allergy diagnosed Jan 26/09
Has a Pectus Excavatum
Has an Epipen
Hi, I have a couple things you can try, although you might have already. It's a good thing you have a therapist on board to help you through this. My dd was a horrible bottle fighter as well.

First thing I would recommend is not to stop to burp. Don't take the bottle out until he comes off himself, and then burp him. The thing with acid reflux is that burping can actually cause the acid to come up as well. Reflux and reflux medication also can cause nausea and tummy aches, so it's best to burp him when he comes off, because otherwise even gentle patting can make him feel yucky and not want to take it again. Really, really good back rubbing can get burps out just as well. Having a difficult burper is tough because you *think* they're not eating because of gas, but it *could* be the reflux itself.

Secondly, my dd liked her formula very very warm. It was tricky to get it just the right temperature. You could try experimenting with that (but I'm sure you already have) :)

Thirdly, while it is intuitive to feed baby in the cradled position, we had much better luck placing her on my propped knees so she was sitting upright facing me.

It's extremely frustrating trying to feed a baby that won't eat!!! The best advice I can give is to feed every two hours, let him drink till he comes off, try again 10 mins later and if he doesn't take it after two tries, wait another 10 mins, try again and after that don't try again until 2 hours. If you stay on a schedule, it will do you both good. He can definitely sense your frustration.

How much does he average in a day? Some babies don't need the "typical" averages. You always want to avoid dehydration, but if you can get him to take 2 or 3 oz every 2 or 3 hours, he should be okay. Definitely utilize your therapist and any suggestions she might have.

If you can get the constipation under control, that might get him feeling a bit better as well. I would talk to your pediatrician and be very adament about his eating. They will likely want to rule out some medical issues before referring to the feeding clinic. I hope things start to get easier soon. Hugs.

Aug 03, 2008
mom2coy
Coyle Eagan. One Year Old. Doing well on Cow's Milk flavored with juice :) Drinking two bottles of Go&Grow daily. Eating solids better but still have rough days. No More Silent Reflux-that I can hear anyway.. but puking again. Zantac 2ML 2X daily.
I too have a food refusal baby rather than a comfort feeder. I 2nd rory's mom in that the recommendation to burp after 2 ounces acutally worsened the reflux for my ds.. @ about 4 mo. i stopped that.

what bottles are you using? & what nipple? you might even have to move up a nipple size. what is he doing when he refuses? clamping or arching away?

as far as the pear juice i'd recommend giving him prune juice instead and putting a bit in the morning and afternoon bottles. i did this while my son was on soy for about 5 wks. it really worked wonders but sometimes causes poo in the tub :)...

also @ 10.5 mo (9.5 mo adjusted) mine is still on 24 cal/ounce and has been since 3 mo. of age. it works well because i only use 5 oz for 3 scoops and i feel better since he usually drinks all of it. he was 4lbs 7 oz and now only weighs 15lbs 9 oz... so i'm glad your little one gained well @ first but it is def. important to keep up on that calories intake of at least 500-600 cal/day or 22-27 oz per day. as far as snacking i have to say that i disagree with that ST. snacking is important for tiny tummies-esp. those with reflux. @ that size my little guy was drinking about 4-5 ounces every 2-3 hours and waking once or twice @ night to eat. now he drinks about 5 oz every 3-4 hours + solids and wakes 1 @ night to eat.

btw.. does he vomit or have silent reflux?
Aug 03, 2008
carmarhal
Adoptive mommy of Micah 2/26/06, Caleb, 3/03/07 (26 wk preemie, BPD, Subglottic stenosis, GERD, dysplagia, FTT, DD, texture aversion, ST, Feeding Clinic, PT, OT, Prevacid 30 mg/day, Pediasure & ground table foods), Ethan 2/6/08 (28 wk preemie, BPD, dysplagia, GERD, Prevacid 15 mg/day, Enfacare 22 cal., ST for feeding)
Thanks for the replies. Ethan is taking 15 mg Prevacid daily, and no other medication at this time. We just upped his dosage 2 weeks ago from 7.5 mg a day. He's using the Dr. Brown's bottles with the #3 nipple. His ST had us move up to #3 because he was working too hard with the thickened formula (nectar consistency). His rejection method varies. Sometimes he just turns his head away or pushes with his tongue. If you keep the bottle in his mouth, he'll just let the formula pour out of his mouth instead of swallowing it. Sometimes he'll cry and shake his head back and forth to keep the bottle out, or he'll push it away with his hands or cover his mouth with his hands. This last bottle, I tried michelle&aurora's method of holding him, but he just looked at me with his mouth open and the bottle sticking out of it and wouldn't latch on. I usually hold him at almost 90 degrees, with his head at my shoulder. He drank 3 oz. of this last bottle before pushing it away. He doesn't act like he's in pain. He hardly ever cries unless he's hungry or having a hard time pooping. He'll sit there with the bottle in his mouth and smile at me while I'm freaking out that he won't drink it!
Aug 03, 2008
nicholas'smom
I agree with the not burping until his done. my little one does much better with this. Of course, when he burps, he typically refluxes (but usually he swallows back most of it). Still has to be unpleasant. He is as you put it "a snacker". He seems to do much better with 2-3 ounces every 2 hours. (He is about 3 1/2 months) He seems to spit up less. My pediatrician recommended trying to get him to eat 4-5 per feed and to go longer but I just don't agree for my lo. Whenever he tries to take more (4-5) he usually ends up spitting the extra back up. I let him lead with how much he wants and when. I also agree it is a good idea to try to keep a log of how much he eats when and his behaviors. Sometimes, if you look at the day as a whole, your lo is doing better than you think. It is also helpful to decide if different times of meds or different meds or doses may be needed. I kept a log on the computer and it was amazing to see the entries get smaller and smaller as he did better.
Aug 03, 2008
jedd'smommy
Jessica, Mommy to Jedd, severe reflux, severe food and oral aversions, Finally G tube free!!! VSD repair 4-24-07 (open heart surgery), hypospadias, repaired 3 times and Ear tubes Visit Jedd at his CB site: www.caringbridge.org/visit/jedd
hhhhmmmm, I wonder if he's not hungry form an issue called DGE or delayed gastric emptying. It may be worth bringing it up to a GI to get their opnion.
Aug 03, 2008
mom2coy
Coyle Eagan. One Year Old. Doing well on Cow's Milk flavored with juice :) Drinking two bottles of Go&Grow daily. Eating solids better but still have rough days. No More Silent Reflux-that I can hear anyway.. but puking again. Zantac 2ML 2X daily.
Thanks for the replies. Ethan is taking 15 mg Prevacid daily, and no other medication at this time.

i remember when mine was on a dose that high he began eating less. others, including michelle, have experienced "decreased" appetite while on prevacid.. maybe you can split the dose am/pm to see if that helps.

He's using the Dr. Brown's bottles with the #3 nipple. His ST had us move up to #3 because he was working too hard with the thickened formula (nectar consistency). His rejection method varies. Sometimes he just turns his head away or pushes with his tongue. If you keep the bottle in his mouth, he'll just let the formula pour out of his mouth instead of swallowing it. Sometimes he'll cry and shake his head back and forth to keep the bottle out, or he'll push it away with his hands or cover his mouth with his hands.

this is EXACTLY what mine did when he refused to eat. to a tee. He was Teething. it could be ( i hate to say it) entirely possible- mine began teething 2 wks before his 1st tooth came in @ 5 mo. adjusted. it was hell, pardon my french. i'll never forget the 1st 4 teeth. he refused his bottle so much i was so worried all the time. i used to call DH every day telling him our son only drank 12 ounces! then, after about a week and a half he started getting up @ night and eating more frequently-this was about 3 days before his tooth would pop thru. then he'd eat well for a few weeks and then start again. he has 8 teeth now and 2 more on the way. our pedi always dismissed it ( i brought him in all the time back then for weight checks).. whenever mine is sick or teething he flat out refuses food and bottles. and, being that he is already FTT it is very frustrating/scary.

This last bottle, I tried michelle&aurora's method of holding him, but he just looked at me with his mouth open and the bottle sticking out of it and wouldn't latch on. I usually hold him at almost 90 degrees, with his head at my shoulder.

this is how i fed my DS then too.. the NICU method..

do you try and feed him on a schedule or do you wait for hunger cues? do u feed him after wake-ups or before sleeping? does he wake @ night to eat? OMG, he is so cute! hmmm. he's only 4 mo. adjusted? what is dysplagia?
Aug 03, 2008
elysabethsmom
Sharon, Mom to Elyse, 17 mos (15 mos adjusted-preemie). Zantac/Elecare. History of: Respiratory Distress Syndrome with ventilation/CPAP/cannula, tpn, n/g tube, PDA, jaundice, apnea, bradycardia/tachycardia, severe anemia, blood transfusion, reflux, Sandifer's Syndrome, intestinal malrotation, hemangiomas, MSPI, feeding issues. ICU inpatient 53 days! 2 surgeries, 2 UGIs, barium enema, pH probe, endoscopy. Developmentally on target now! PIC: Yobaby Beard
Photobucket
Hi! I am a preemie momma too, she was a 31 weeker. We have had feeding issues since birth and Elyse is now 14 mos (12 adjusted). I KNOW what you are going thru! Despite the meds or dosages of her reflux meds, she never got better with her eating except during growth spurts. We have to bottle feed her sitting up facing away from us. It has always saddened me; she won't look at us when she eats so we don't have that intimate connection that most moms get when feeding.

I agree with Jessica, ask about DGE. Unfortunately for us, none of the DGE drugs worked for her, but they do work for other babies. My dd still drinks 5 oz or less, usually 3-4 at a time and she is 14 mos. We get between 5-16 ozs of formula down her in 24 hours and I am constantly worried. Just wanted to let you know I know how it feels. When she was really little she would actually pretend to be asleep!!! and when I took the bottle out of her mouth she would open her eyes! As she got older she would fling the bottle away, turn her head, clamp her mouth shut, etc.

You know, no one mentioned MSPI, you might want to ask about that (milk soy protein intolerance), it can cause reflux. The hard thing about preemies is that their LES is SO immature compared to a term baby. Elyse was arounf a year before her puking lessened to rarely (from a zillion times a day before).

Aug 03, 2008
katiesmommy
Tracey, mom to Katie diagnosed with GERD at 3 week.

HI! Katie started out as a good feeder and then started to refuse to eat. She would also only eat a few ounces and then not take anymore. Out of desperation one night I turned on the TV and placed her on the floor in front of it, flat on her back and she ate more than 2 oz!!! We have done this ever since as I think the TV is a distraction so she will keep sucking since she has something to "do". I know that flat on the back is bad for the ears but after 2 months of her not gaining weight I will try anything!

I also agree to keep a food/behavioral journal. I write down the time she ate and how much she ate. I also write down if she threw up, refluxed, choked, bad mood, good mood etc. so that I can see how she is doing. I don't remember from one day to the next so it is great to have something written down to refer to.

Katie does really bad on pear juice! It really makes her puke and she is not a huge puker. Sugar water is supposed to have the same effect but I don't think it is as acidic; the extra vitamin C really does a number on her tummy!

Aug 04, 2008
carmarhal
Adoptive mommy of Micah 2/26/06, Caleb, 3/03/07 (26 wk preemie, BPD, Subglottic stenosis, GERD, dysplagia, FTT, DD, texture aversion, ST, Feeding Clinic, PT, OT, Prevacid 30 mg/day, Pediasure & ground table foods), Ethan 2/6/08 (28 wk preemie, BPD, dysplagia, GERD, Prevacid 15 mg/day, Enfacare 22 cal., ST for feeding)
Okay, they're all asleep, so I've got a minute! Ethan had ST this morning, and his therapist is going to talk to the Dr. about a GI and swallow study. We've been adding Thick-It to his formula because he was choking like my other preemie was before his Barium swallow showed he was aspirating (that's what dysplagia means). He is a puker, but less since his Prevacid was upped to 15 mg. I've been giving it to him 1/2 in the morning and 1/2 in the afternoon. He absolutely will not eat at night after 9:30 or 10:00. He refuses the bottle, and if you just stick it in his mouth he just keeps on sleeping and doesn't suck at all. He's 3 months adjusted (due Apr 30), and in most other areas is doing very well. I just can't get him to eat enough! I started yesterday letting him drink until he pushed the bottle out and then burping him, and he got in 2-3 oz. before needing to burp. I've also started keeping track of his feeds. He seems to do better with 2-3 oz. followed in a couple of hours by 4-5 oz. Unfortunately, he still only got 20 oz. for the whole day yesterday!
Check with your
doctor first!