I was afraid it would come to this....ped suggested formula

[PrincessEmilysMommy]

Molly isn't growing. In fact she's losing weight now. She's been getting oil in 3 bottles each day to add calories & fat, yet it isn't helping.

Her Ped just suggested to feed her straight formula for a week to see if that helps. He's always said bm is best, and we've tried many tricks to see if what might work. He said it's the last resort. She is scheduled for blood work, x-rays, ultrasounds, & EKG's next week.

Bfing is very important to me & I don't want to give her formula. He said to nurse her at night & continue to pump so that she can switch back if it doesn't help.

I know formula isn't the devil. But I don't want her to have it. I'm so torn!

[MrsKitty]

I know nothing about preemies health or anything like that...

But isnt breastmilk way higher in fat than formula?

[PrincessEmilysMommy]

I know that everyone's bm is different, and the breakdown even varies at different times of the day.

I want her to grow. I just don't think my milk is the problem.

[Shaunsmom]

I know that everyone's bm is different, and the breakdown even varies at different times of the day.

I want her to grow. I just don't think my milk is the problem.

How old is she? I forgot, at how many weeks was she born?

How many times a day were you/are you nursing her?

What was her last weight and how old was she?

[Amy_G_]

I would hesitate to switch to formula without testing.

WHY would formula help her gain weight, since formula and breastmilk have approx the same number of calories?
unless it's an allergy issue--or celiac disease or other unknown.

Are you using breast compressions to up fat content of milk, especially when pumping?
have you considered pumping the milk and then skimming off the fat from the milk, and adding it to another bottle you've pumped so she gets double the fat. you could freeze the extra foremilk to add to bottles when she's older and you have this figured out.

[PrincessEmilysMommy]

How old is she? 11 months old on the 8th I forgot, at how many weeks was she born? 27 weeks

How many times a day were you/are you nursing her? She nurses on demand & similar to that of a 3 month old. I even block nurse to give her more hind milk.
What was her last weight and how old was she? She weighed 10 lbs 2 oz yesterday. Her highest weight was 10 lbs 7 oz about 6 weeks ago.

[PrincessEmilysMommy]

I would hesitate to switch to formula without testing.

WHY would formula help her gain weight, since formula and breastmilk have approx the same number of calories?
unless it's an allergy issue--or celiac disease or other unknown.

Are you using breast compressions to up fat content of milk, especially when pumping?
have you considered pumping the milk and then skimming off the fat from the milk, and adding it to another bottle you've pumped so she gets double the fat. you could freeze the extra foremilk to add to bottles when she's older and you have this figured out.

She is allergic to milk & soy. I don't eat those. Celiac's will be part of the panel of blood work.

I have done "super milk" before too. No gain. She reached 10 lbs a few months ago & has beed around 10 3 or 10 5 steady. Then she started losing. I do breast compressions the entire time I pump. It helps me to pump more also.

I don't want to do the formula before she's tested. Or after for that matter. I nursed Emily until she weaned at 29 months & she was healthy w/ no growth issues.

[PrincessEmilysMommy]

Would someone post a picture of your refrigerated ebm bottle? I'm curious as to how much fat you have on top compared to me.

[Justicedog]

I think I would bf until the blood work is done, or perhaps all the testing. I'd then likely go half and half with formula and bmilk.

It seems your doctor isn't a formula pusher, so I would really take his advice seriously.

I'm sorry, I know it's disappointing for you. :hug:

[joshsmom]

In my limited experience, to answer pp ?, one reason a pedi might suggest formula over bfeeding is because a baby may be burning more calories nursing than bottle feeding. AGAIN, I am NOT a LC or med person, I just saw this happen with a friend and this was one of the reasons her pro-bf pedi wanted her to try bottle feeding on her FTT baby.

PEM: I'm sorry you have to work through this. I hope you can maintain a good bfeeding relationship and your little one starts responding!

[KatieLou]

We had the same issue with Lilly. I really think my BM in not high in fat. I don't have a pic to share but only the very top had the fat in it. I do know that my best friends EBM had a lot more stuff floating on top than mine did.

Our ped suggest 1 bottle of formula a day to help her out. Saying we would know for sure that she was getting xxx about of calories from the bottle, and not knowing what she was getting calorie wise from my BM. I did give her 1 bottle (soy) a day (at around 1o months old) for about a week. It did not seem to help much though(only a week though) and it upset her tummy. So I switched to giving her 2 bottles of EBM a day on top of her nursings. Still didn't help though. She only began to gain weight when she was weaned and started drinking a next step soy formula. (at 14 months)

(((hug))) I have never delt with a preemie, but I know how stinking frustrating it can be when your baby is not gaining, or is loseing, and you are having to fight to BF.

[Amy_G_]

posting a picture probably isn't going to be accurate to compare to.
the fat in breastmilk varies by time of day and how long since you last nursed.

someone else here went to the celiac diet before testing was complete and their baby has started growing. I think. maybe you should consider that?

Remember that at this point in your baby's life, gaining weight may be just as important as giving her breastmilk.
10 lbs is pretty darned tiny for an 11 month old. Of course, she was born 3 months early so you should be looking at what is normal for an 8 month old, right?

what formula was recommended if she is allergic to milk and soy?
I would ask about a breastmilk fortifier if you haven't already.

block nursing might not be helping if your supply is low(which having a baby not gaining weight, the worry alone could affect your supply). She may need just more of what she's getting, not just the fat in hindmilk. I would do one breast per feeding, and feed every 2 hours like a newborn. you say she nurses like a 3 month old, but there is a LOT of variation in that. What is her normal day like in regards to nursing?

[TheLorax]

I wonder, though, is she growing in length ? Is her head circumference going in the right direction ? Is she progressing with growth motor skills (forget about compared to the 'norms', just in general); does she show a healthy interest in moving about her environment and a desire to move herself ? Does she have periods of active curious engaged wakefulness ?

My kids were not preemies, and were always at least on the charts for weight, however they were off the charts for length (very tall) and didn't gain a whole lot, actually lost a small amount, both of them, between 10 and 12 months. Their weight gain picked up on its own when they were ready to start taking in more solids.

I just think it's important to keep the entire developmental picture in mind because too often all of us, Pediatricians included, get tunnel vision on what the scale says regardless of what the child is showing you.

[KatieLou]

oops.

[KatieLou]

what formula was recommended if she is allergic to milk and soy?


I understand that Neocate is about as allergy free as it comes, formula wise. It is reccomended most on my food allergy board.



http://www.neocate.com/aaa_neocate/251-what-is-neocate.html

Honestly, if I needed to use formula, it is what I would use.

[Tweet]

I'm really sorry:( That does sound extremely gut wrenching.

I wish I had a good answer,but I don't.If it were me, I'd take it very ,very seriously (especially since you know her ped is very pro BF) and do as he suggest and then just pump and pump as much as I could during the day and nurse her at night. At least until the testing is all back. That is very tiny. It may have nothing at all to do with your milk,as you said...but not knowing is why I said I'd lean more towards following his advice directly. It's not something I'd personally be comfortable not following as it's pretty critical, imo. That is just my .02,though

I do hope you do get some answers with the testing! I know how it is very frustrating not having any answers.

[PrincessEmilysMommy]

Nutramigen & Neocate has been used to fortify bottles of ebm for her.

Her length is 22 1/4 inches. I forget her head circumfrence, but it too is well below the charts.

Developmentally she is between 4-6 months

When I say a 3 month old, I meant she goes no more than 2 hours w/o feeding & that's stretching it.

Yes, we compare Molly to an 8 month old even though that would put her birth weight at 4 lbs.

I'm fully prepared to cut out gluten, but I read that testing after elimination can give false results........no?

I block nurse because she's a snacker & had for/hind imbalance issues in the past.

Did I answer everything?

[Tweet]

I was told that cutting it out before testing could mess with the results,too.

[JudyJudyJudy]

I'm fully prepared to cut out gluten, but I read that testing after elimination can give false results........no?
Yes, it can. I'd have the blood test for celiac disease before cutting out gluten. However, even if it shows negative, I would still try eliminating gluten (tests are nowhere near 100% accurate, and, in addition to that, a person can be gluten intolerant without having celiac disease). Also, regardless of the blood test results, I would NOT agree to a biopsy, which is standard for confirming celiac disease.

[PrincessEmilysMommy]

I also wanted to add that at one point she was gaining on bm alone.

I'm just heartbroken. Nursing or even pumping was what bonded me to Molly. I couldn't hold or touch her & often felt more like a visitor than a parent, but I supplied her nutrition. It was the 1 thing no one else but me could do for her.

[TheLorax]

I understand where you're coming from regarding the formula. It's a tough call. If she were developmentally further along I'd suggest offering her as much safe solids (with respect to her allergies) as you could, but I'm not sure if that's safe or reasonable for her yet. Bananas, avocados, things like that that are high in calories and good fat. If she's not ready for that adding some formula may help to push her growth in the right direction, and if you keep nursing she'll get the best of everything.

The only thing I disagree with the Ped. on is to keep nursing at night and first thing in the morning, then let the formula take over during the day. My kids always seemed to get the best "meal" first thing in the morning. Take that for what it's worth.

I understand how stressful weight issues are and how stressful making these decisions can be. Good luck, hang in there.

[TheLorax]

I also wanted to add that at one point she was gaining on bm alone.

I'm just heartbroken. Nursing or even pumping was what bonded me to Molly. I couldn't hold or touch her & often felt more like a visitor than a parent, but I supplied her nutrition. It was the 1 thing no one else but me could do for her.

You're not abandoning nursing if you give her some additional calories aside from nursing, she's going to transition to more solids at some point. Just remember that, you're not weaning her totally if you take this advice, just partially. I know it's a loss to grieve, but do try to remember you're not giving it up totally.

[Tweet]

I also wanted to add that at one point she was gaining on bm alone.

I'm just heartbroken. Nursing or even pumping was what bonded me to Molly. I couldn't hold or touch her & often felt more like a visitor than a parent, but I supplied her nutrition. It was the 1 thing no one else but me could do for her.


I know :(But, you don't have to stop pumping right now and I definitely wouldn't think you'd have to stop with the BM altogether!

You know, at first I was really devastated when Chloe couldn't nurse. Remember, she was also very early? Anyway, she just couldn'tfor various reasons due to her prematurity.I was so,so upset. I pumped for awhile but just never did let down enough for the pumps so eventually that stopped, too. I did grieve for a little bit, but there are SO many other things that bonded us together and I promise you, we are no less close because of it. In fact, out of all of my kids, we are probably the most "in tune" with each other! My only point is that if it DOES come down to that, and you don't know that it will, there WILL be so many other ways for you two to be very close. And just by being her loving mama, you are already doing so much that no one else in the world could do. Don't forget that.

[HammBugga]

I'm sorry pem. I wish I had some advice but I don't know anything about the subject. I just want to say I am sorry and I hope that there is a solution that is best for you both.

[Meredith]

I think I would bf until the blood work is done, or perhaps all the testing. I'd then likely go half and half with formula and bmilk.

It seems your doctor isn't a formula pusher, so I would really take his advice seriously.

I'm sorry, I know it's disappointing for you. :hug:

I was thinking the same thing. The fact that he/she hasn't suggested formula until now tells me that they're a very BFing friendly doctor, and that when they start suggesting it, it's probably something worth considering, for sure.

Have you considered trying some domperidone to boost your supply? I can't remember if you've mentioned taking it or not.

I'm so sorry things are rough for you. I never had a preemie, but I know how disappointing it is when you try and try, and your baby just isn't gaining. :( I remember how sad I felt when I had to start giving Jett formula because he was losing weight. I'm sorry, PEM. :hug:

[RaisingThemLeft]

I want her to grow. I just don't think my milk is the problem.

That's the tough part. If there was some sort of guerentee that if you just put her on formula she'd grow and start gaining and things would be great, then I'd be all for it. However, you could put her on formula, it may not even help, and then it may be near impossible to get your supply back up or to get her back on the breast. Is there any way that you could try with an SNS instead of with a bottle just to see if the formula itself would even make her gain? I'm sorry. This has got to be really difficult for you. Good luck with whatever you decide. Go with your gut.

[PrincessEmilysMommy]

Hamm, Mer, and JD. I know. He's a great Ped IMHO. He even suggested trying to give Emily some ebm when she was sick not that long ago.

I just would rather wait to try it. If the celiac's test comes back positive, I gave her formula for nothing. If it comes back negative, like Judy said, I would still go gluten free to try that.

Then if those 2 didn't work, I wouldn't mind giving her formula so much.

Like Josh'smom said you spend calories nursing. That's why most micropreemies never become fulltime nursers. Molly wasn't allowed to nurse more than 25 minutes in the NICU for that reason. Same w/ bottle. If she still had anything left after feeding for 25 mins.......in the tube it went.

I'm torn.

[PrincessEmilysMommy]

That's the tough part. If there was some sort of guerentee that if you just put her on formula she'd grow and start gaining and things would be great, then I'd be all for it. However, you could put her on formula, it may not even help, and then it may be near impossible to get your supply back up or to get her back on the breast. Is there any way that you could try with an SNS instead of with a bottle just to see if the formula itself would even make her gain? I'm sorry. This has got to be really difficult for you. Good luck with whatever you decide. Go with your gut.

My thoughts exactly! I have good supply for nursing, but I have trouble pumping. I need my hospital pump back. If I go that route I'll definitely do an SNS

[HammBugga]

Well look at it this way- you can pump during that time and if you do end up getting to nurse again you will have lots of expressed milk for her to have. I forgot to answer your question about the fat content of my milk.... It did vary but usually if I had 5-6 ounces in the fridge, by the next day there would be about 1/2 to 1 inch of fat at the top. There were times though where I would have 4 ounces and half of it would be fat at the top (about 2 inches or so).

[zediseot]

dd was a preemie (but a late term one), and we were also advised that nursing just takes too many calories and not to let her nurse too long.
I've since seen something that suggests it's not true although I couldn't tell you where, but at least with dd, until she reached about full-term anyway that we could get more calories in her by bottlefeeding instead of breastfeeding. But except for the first few days, all of the bottlefeeding was done with ebm.
I don't have any answers but my heart goes out to you. I think you've done a great job with some tremendous odds and I hope you get some answers soon.

[pawprint]

In my limited experience, to answer pp ?, one reason a pedi might suggest formula over bfeeding is because a baby may be burning more calories nursing than bottle feeding.


I've heard that too, but research indicates just the opposite. If I weren't chronically lazy I'd dig up the studies. I will if anyone is interested though.

PEM, have you tried increasing the fat in your diet? Sometimes that helps. I have two huge chunky monkeys but never had more than a half inch of fat on top of the bottle. Usually much less than that.

I'm sorry J. I hope you get some answers soon.

[PrincessEmilysMommy]

Molly's allergic to milk & soy, and every alternative is high in fat. I just had pasta & bread w/ dairy/soy free spread. The spread aone is 11 grams of fat. I'm getting fat to prove it.

[pawprint]

I'm getting fat to prove it.


Like you need that too! I wish I could think of something else!

[cream_city]

I would start the formula right away, per the ped's recommendation. I would pump too. I think a SNS with formula might be a good compromise, since she'll still be nursing (unless the nursing is what's burning so many calories). I'd be worried (as I know you are) that she's losing, and as long as you nurse some of the time I think that she'll continue to.

If it makes you feel better, most babies by 11 mos are eating solids -- so formula isn't that different... (I mean in terms of feeling like bf is important in terms of what bonds you).

Good luck -- my thoughts are with you.

[pawprint]

I (unless the nursing is what's burning so many calories).


You're going to make me look it up aren't you? This is simply not true.

[PrincessEmilysMommy]

Would you mind finding it Paw.

I hear gulps. I know she's satisfied when she nurses. I've given her ebm bottles mixed with 14 extra grams of fat. I don't think it's my milk. I think she's not absorbing it or something.

I'm not starting it tonight. She's sick. She has an infection in both ears and wants nothing to do w/ the bottle. The ped knows this too. When she's sick, she will only nurse.

[pawprint]

Sure PEM. I have it in a handout from a session I saw done by two local IBCLCs. I'll dig it out.

[joshsmom]

I defer to the great and knowledgeable Paw!!

[Amy_G_]

It shouldn't take that long to do bloodwork and I hope they are checking for all allergies. You mention soy and dairy, but what about other things in your diet?

You mention
"Nutramigen & Neocate has been used to fortify bottles of ebm for her."

I would say you've already tried formula and it didn't work. I mean you did formula AND breastmilk, which should be double the nutrition, fat and calories and it didn't do a lot, now did it?

[KerryS]

In my limited experience, to answer pp ?, one reason a pedi might suggest formula over bfeeding is because a baby may be burning more calories nursing than bottle feeding. AGAIN, I am NOT a LC or med person, I just saw this happen with a friend and this was one of the reasons her pro-bf pedi wanted her to try bottle feeding on her FTT baby.

I think the concern is probably that she's not producing enough breastmilk.

I haven't read all the responses yet, so I apologize if I duplicate anyone. I'll tell you what I did for my FTT baby.

I started taking domperidone. I was taking as much as 240 mg/day (40-60 mg every 4-6 hours). All supplementation was given through a homemade nursing supplementer at the breast. I started with 24kcal formula, and only did that for about a week before switching to donor breastmilk (see my sigline - there are milk donors who are on allergenic diets). I only gave supplement AFTER nursing for a full 20-30 minutes on each breast, with compression. I pumped for 10 minutes after feedings for a couple months, in order to boost supply.

When he was getting the most supplement, I was giving him about 12 oz/day. I was able to decrease that as he started eating more solid foods, and we stopped the supplementation at around 7-8 months, when he was eating enough solids to make up for 250 or so calories that the 12 oz of supplement provided. I was only able to use the nursing supplementer until he was about 4-5 months old, when he became too distractible. At that time, supplement was given by dad via bottle while I was at work, plus one 4oz. bottle at bedtime on the nights I didn't work.

Hopefully something here is useful to you. Supplementation is appropriate when a baby is losing weight. However, it must be done while also preserving the breastfeeding relationship, and unless Molly has an inborne error of metabolism (PKU or galactosemia) I see no benefit to stopping breastfeeding and switching to formula.

[KerryS]

posting a picture probably isn't going to be accurate to compare to.
the fat in breastmilk varies by time of day and how long since you last nursed.


This bears repeating. From 8 weeks until a year, the ONLY time I pumped and stored my milk was at night, at work. I had only a very thin layer of fat, with very gray, watery looking milk. A couple weeks ago I worked a day shift, and the milk I pumped had a much thicker layer of fat, and was much less watery looking. I didn't fully realize until that day how variable fat content was in milk. I certainly opened my eyes.

[ChristmasTree]

can they take a stool sample? seems to me that would be the simplest thing to could do to check her absorbing abilities.

[Amy_G_]

Get a time line for how long it will take for testing to be done.
If it's a short time(I'd think it could be done 1 week or less) then don't change anything except nurse on one side per feeding, don't block nurse, and pump after feedings to ensure your supply is still going strong.

If it's gonna be weeks, get a second opinion (lol)
or consider a week of formula and weigh ins and then give pumped milk with weigh ins for a week and then maybe go back to nursing with weigh ins for a week and see what made the bigger weight gain.
but then again if it was going to take 3 weeks before blood testing can be done, I'd probably find a different doctor.

Are you under the care of specialists or "just" your regular pediatrician??

[PrincessEmilysMommy]

There will be stool tests as well. I apologize for forgetting to mention that one.

I do know the fat content changes w/ many things. I saw a news segment where a NICU was sending ebm out to be tested and the changes the milk had from time of day, to lack of rest, and many other variables was astounding. But all of them had a high enough caloric content.

I also know that things can change, but I never had any nursing issues at all w/ Emily. She ate and gained perfectly. She was a straight from the tap girl. The only bottles she had was when she was in the NICU under the lights. That was for 2 days only. And those were straight ebm.

Kerry, I don't think I have a supply issue. I know I have a hard time pumping, but that has only been since I gave up my Symphony pump.

I have 2 let downs while she nurses (that I can feel) and when she falls asleep and lets go (or I pry her off) milk runs down her cheek. I see and hear her swallow throughout her nursing sessions. I had supply issues when she first came home. I believe I sabbotaged myself w/ that one. That's when I contacted you, and I was back to normal w/ 4 days.

She has a slew of tests to be done. They're scheduling her x-rays, ultrasounds, and EKG for the same day. I'll ask how long results take, but she hasn't had it done yet.

She's under the care of many. That's why the Ped took his time this weekend, and waited until today to make decisions. However the Neonatologist she sees is very pro bfing. She actually said to me that if Molly can get bm until she's 2, it would make a world of difference to her.

Does anyone really know of someone who's milk wasn't high enough in calories or fat, for a fact?

I'm off to bed for now. Feel free to continue w/ your advice, I really appreciate it right now.

[Macabe]

I don't have any advice but it sounds like you have good people here to work through this with. I want to lend my support. Also, I want to say that I never get anywhere near the fat layer that Hamm gets. Mine tends to be 1/8 to 1/4 layer for a 4 oz bottle, and DD is a bit of a porker, too.

I'm sorry this is so hard.

[zediseot]

This bears repeating. From 8 weeks until a year, the ONLY time I pumped and stored my milk was at night, at work. I had only a very thin layer of fat, with very gray, watery looking milk. A couple weeks ago I worked a day shift, and the milk I pumped had a much thicker layer of fat, and was much less watery looking. I didn't fully realize until that day how variable fat content was in milk. I certainly opened my eyes.


Absolutely. This is timely because DH actually called me at work yesterday to tell me that there wasn't enough fat on one of the bottles of breastmilk I had left! I told him to use it and not worry about it.

I would be highly, highly surprised if this were an issue of caloric or fat content of the milk itself.

[pawprint]

Okay PEM, you can never say i don't love you. Instead of tearing my file cabinet apart I actually called the IBCLCs that did the session. One I spoke to at length and is off digging up a whole slew of resources as we speak. I'm going to pm you though. :)

[Earthmama]

I just wanted to pipe in to offer you my best wishes & encouragement.

I didn't realize that my Lily & your Molly were born within a day of eachother. (Lily was born Jun 9) Of course, their actual age isn't so close.

I feel for you. You have gone through so much & continue to be an awesome Mommy to your little ones.

Hugs & healthy wishes.

[Babyblue]

If she is getting adequate amounts of breast milk then I see no point in switching to formula. Can you weigh her before and after nursing with out changing her diaper to see how much she’s getting? If she can take in the same amount of ounces in breast milk that she can in formula then there is no such point in switching.

Also if its an allergy type thing formula could very well make things much worse by hiding the symptoms and giving you false test results.

[Justicedog]

Can they test your milk?

[pawprint]

I will say that the IBCLC I spoke to mentioned that it sounds more like an absorption issue than a caloric intake issue. Hence formula wouldn't be of any help.

[pawprint]

Okay woman, I typed you a pm for a half hour and your box is full. no wonder people hate me, lol. i emailed it to you at your pem yahoo address because i was scared to go looking for the other one and lose that whole post! let me know if you don't get it!

[Amy_G_]

Paw,
I'd like to see a summary of what you sent in PM/email if possible? It might help some other mom some day with a similar question that "nursing uses up more calories than baby gets while nursing"

[ChristmasTree]

PEM, one other thing that i was curious about...Her developmental delays? Is PED concerned about those? If it is a malabsorption issue, which it sounds like it is, then that would be the reason for her delays. what do you think?

[ima062002]

She is 11 mo and bf only? Or is she eating solids?

[tata]

PEM, know that I am in your corner cheering for you and Molly. I don't have any advice, but wanted to say that I will keep you in my prayers.

[Tweet]

PEM, one other thing that i was curious about...Her developmental delays? Is PED concerned about those? If it is a malabsorption issue, which it sounds like it is, then that would be the reason for her delays. what do you think?

I believe the dev delays are due to the fact that Molly is a micro preemie. PEMcan confirm that, but that's been my understanding and she has therapy as well.

[JudyJudyJudy]

PEM, I thought about something else. Since Molly has been on so many antibiotics, she might be allergic to mold and yeast and/or have yeast overload. While she can be tested for the allergies, unfortunately, most conventional doctors won't even acknowledge the possibility of the yeast overload. I'd love to tell you that a yeast-free diet is easy, but it isn't. However, it certainly has helped me to feel better.

[Amy_G_]

Judy, even if it's not yeast/mold, I'm not certain they've done a full panel of "regular" allergy testing. Often weight gain issues are related to an allergy of some kind rather than malabsorption. But doctors just don't really understand/credit that an allergy would be "so bad" and not be anaphylactic in nature.

PEM have YOU ever been on a very strict diet to remove all common and not so common allergens? Of course a kid could be allergic to something like corn and corn is most everywhere--high fructose corn syrup anyone?

As for introducing solids, if the micro premie is delayed by 3 months, they might not be developmentally ready for solids, even though they should be close to the level of an 8 month old. single food solids might be a way to help gain weight, but would have to be introduced very carefully if allergies are suspected.

[JudyJudyJudy]

I agree, Amy. When I started doing my own version of an elimination diet, it was very frustrating at first. I found more and more foods to which I was allergic. I can tell a huge difference in my health since eliminating many of my allergens.

[Tweet]

Good point about the allergies. Cayden's are not at all life threatening, but I'll say that since we've eliminated his allergic foods he has gained almost 10 pounds. Hewas not ever FTT,but he did not gain what I call "well". Part of it was a growth spurt, but I firmly believe that it is also because of the elimination of the foods he was sensitive. And as an aside, he is doing well with 2 foods we were able to reintroduce :)

[PrincessEmilysMommy]

Okay PEM, you can never say i don't love you. Instead of tearing my file cabinet apart I actually called the IBCLCs that did the session. One I spoke to at length and is off digging up a whole slew of resources as we speak. I'm going to pm you though. :)

I got your email. I'm going to read it after this post. Thank you so much!


Can they test your milk? They could I believe. But they'd have to send it off somewhere, & I don't think insurance would cover it.


PEM, one other thing that i was curious about...Her developmental delays? Is PED concerned about those? If it is a malabsorption issue, which it sounds like it is, then that would be the reason for her delays. what do you think? Well her therapist seems to think that some of her delays are due to her weight. There is only so much a baby that's so small w/ such little muscle mass can do. However her speach delays are common w/ micro's. She's making progress & tolerates our working w/ her so that's a good sign.


She is 11 mo and bf only? Or is she eating solids? She has yet to have any solids. I did let her lick my banana. I think developmentally she's ready though.


PEM, I thought about something else. Since Molly has been on so many antibiotics, she might be allergic to mold and yeast and/or have yeast overload. While she can be tested for the allergies, unfortunately, most conventional doctors won't even acknowledge the possibility of the yeast overload. I'd love to tell you that a yeast-free diet is easy, but it isn't. However, it certainly has helped me to feel better. You know I wouldn't dout it. I think there have been 66 days of her life when she hasn't been on abx & thats it. I'm going to mention this as well.


Judy, even if it's not yeast/mold, I'm not certain they've done a full panel of "regular" allergy testing. Often weight gain issues are related to an allergy of some kind rather than malabsorption. But doctors just don't really understand/credit that an allergy would be "so bad" and not be anaphylactic in nature.

PEM have YOU ever been on a very strict diet to remove all common and not so common allergens? Of course a kid could be allergic to something like corn and corn is most everywhere--high fructose corn syrup anyone?

As for introducing solids, if the micro premie is delayed by 3 months, they might not be developmentally ready for solids, even though they should be close to the level of an 8 month old. single food solids might be a way to help gain weight, but would have to be introduced very carefully if allergies are suspected.
She's never had allergy testing done. The false results under the age of 2 is why. The NICU determined her milk allergy, and it was obvious as things got so much better after they sucked her tummy & I went dairy free. They soy came about a few months ago. Again distended tummy & painful gas.

I think she IS developmentally ready for spoon feedings now. Her Ped seemed to think she would get more of what she needs from bm & was waiting until after testing to add solids. ??

[PrincessEmilysMommy]

I also wanted to add, while her weight seems alarming, it's more about the growth curve her ped said. If she were 10 lbs & gaining, even slowly, that would be fine.

Her gains stopped about the same time her stool pattern changed. I believe I posted here about that. Her suddenly having far less frequent stools (from 6 a day to 1 every 8-10 days) & the really stinky gas. When she does stool, it's horrid. The smell is truly enough to clear a room.

[_Viva_]

I'm sorry, Jaime. I hope you find some answers soon.

[Coconuts71]

I assume she's too old for Pylorc Stenosis to be considered?

[Babyblue]

the foul smelling stool sounds like an allergy type thing to me:(

[Nipple_nectar]

I assume she's too old for Pylorc Stenosis to be considered?

Pyloric stenosis sets in very quickly and is accompanied by projectile vomiting, does she keep most of her feeding down?

I tend to believe this has nothing to do with your milk either. I hope the tests reveal something concrete for you soon {{{hugs}}}

This is just a hunch but if you Molly is anything like my babies, they would stay on one side forever, settling for non-nutritive sucking at times when if I switched to the other breast, they would start actively sucking again, are you still block feeding? Maybe it is as simple as offering both breasts at every feeding? Also, are you doing breast compression while you nurse?

I would recommend topping her off after each nursing session, with any expressed breastmilk from the previous session, via a finger feeder. The beauty of a finger feeder is that it delivers calories with very little effort, calories/ energy spent. It can be used with a sleepy baby with very little sucking action.

This will also reinforce her latch and help her develop a stronger latch. Preemies are notorious for a shallow or weak latch and using a BFing friendly feeding alternative www.kellymom.com/bf/pumping/alternative-feeding.html will preserve your BFing relationship.

Are you pumping after each feeding? This will ensure that even when she is sloppy with her latch, you can retrieve the all important hindmilk and give it to her at the very next feeding.

Have you been using an artificial nipple/bottles to give her the supplements you have been using? I would not recommend bottle feeding at all while there may be transfer issues. I would strictly use an SNS or a finger feeder.

I also agree with you that returning to a hospital grade pump will be beneficial, you can also look into angled horns, they are known for increasing pumping output: www.pumpinpal.com

[PrincessEmilysMommy]

I assume she's too old for Pylorc Stenosis to be considered? I had to look that up. She doesn't vomit though. She has reflux, but that's the only thing we have under control.


the foul smelling stool sounds like an allergy type thing to me:(
I thought so too. When I mentioned it to the ped he didn't think much of it, and when I mentioned it here, no one thought much of it either, so I thought I was over thinking things.


The Ped called a bit ago. He has her scheduled for her first round of blood work Friday morning. They need a good bit of blood for the testing so it will be done in 2 appointments 5 days apart. We'll get our papers for the other tests as well.

[Amy_G_]

If the reflux is under control, does that mean she's on meds for it?
many of the reflux meds cause foods to move thru the digestive tract faster. This may cause some malabsorption issues in a normal baby, but don't usually cause issue. It might become a more serious issue with a micropremie.

As I mentioned, and NN did--stop block nursing. nurse on one side per feeding, I don't think doing both sides each feeding will help, because she'll get more foremilk. But then again, foremilk has a laxative effect, and contains the most amount of nutrition and fluids, so she may need more foremilk if her poops are too solid.

babies need a balance of formilk and hindmilk to be healthiest, which usually means one boob per feeding, unless your supply is low, or latch is poor, and then it may mean both sides per feeding, pumping and feeding pumped hindmilk at the next feeding.

what kind of oil were you adding to her bottles for added calories.

what was she eating, what was the nursing pattern when her stools changed? was that when you were using the formula additions to your milk, block nursing, or giving oil? Is there anything different that relates to that time period when the stools changed?

[ima062002]

If you think that she is developmentally ready for solids I would introduce nutritionally dense solids with lots of healthy fats rather than introduce formula. I wouldn't pick banana but avocado instead. Hummus would be another one; you soak garbanzo beans (with a bit of baking soda which makes them extra soft) then boil for a while, puree and season with a bit of lemon, some salt and garlic. Fish is another one. IF you get some haddock or cod and bake it at 375 in the oven for about 20 minutes (I make it in aluminum foil with a drizzle of olive oil, a squirt of lemon juice and some fresh rosemary, yummmm) you can mash it up in its juices.

I would refrain from adding oil to her bottles. I've learned with my son that this can actually have the opposite effect on weight gain. Especially flax seed oil.

If she's grown on your milk then it is most likely not the issue. See through here though for hidden hindrances to a good supply: http://www.breastfeed-essentials.com/hindrances.html

[PrincessEmilysMommy]

If the reflux is under control, does that mean she's on meds for it?
many of the reflux meds cause foods to move thru the digestive tract faster. This may cause some malabsorption issues in a normal baby, but don't usually cause issue. It might become a more serious issue with a micropremie. She's on Axid. She's been on it for about 9 months she's too small for much else.
As I mentioned, and NN did--stop block nursing. nurse on one side per feeding, I don't think doing both sides each feeding will help, because she'll get more foremilk. But then again, foremilk has a laxative effect, and contains the most amount of nutrition and fluids, so she may need more foremilk if her poops are too solid. I nurse 1 side per feeding & pump on the other side. If she nurses for less than 10 mins, I nurse on that side again the next time. She's very much a snacker. Her stools aren't solid, just stinky.
babies need a balance of formilk and hindmilk to be healthiest, which usually means one boob per feeding, unless your supply is low, or latch is poor, and then it may mean both sides per feeding, pumping and feeding pumped hindmilk at the next feeding.

what kind of oil were you adding to her bottles for added calories. Safflower oil. 1/2 teaspoon 3x per day

what was she eating, what was the nursing pattern when her stools changed? was that when you were using the formula additions to your milk, block nursing, or giving oil? Is there anything different that relates to that time period when the stools changed?[/QUOTE] That's just it, nothing changed. The Safflower oil was added w/in the last 3 weeks. Otherwise there have been no changes. She gets no solids, and I've eaten nothing new. Trust me on that one!

[Indigo]

If you think that she is developmentally ready for solids I would introduce nutritionally dense solids with lots of healthy fats rather than introduce formula. I wouldn't pick banana but avocado instead. Hummus would be another one; you soak garbanzo beans (with a bit of baking soda which makes them extra soft) then boil for a while, puree and season with a bit of lemon, some salt and garlic. Fish is another one. IF you get some haddock or cod and bake it at 375 in the oven for about 20 minutes (I make it in aluminum foil with a drizzle of olive oil, a squirt of lemon juice and some fresh rosemary, yummmm) you can mash it up in its juices.

I would refrain from adding oil to her bottles. I've learned with my son that this can actually have the opposite effect on weight gain. Especially flax seed oil.

If she's grown on your milk then it is most likely not the issue. See through here though for hidden hindrances to a good supply: http://www.breastfeed-essentials.com/hindrances.html

I would not introduce solids in a situation where there is concern. This is adding something else to the mix that is not necessary to deal with in this equation. Also you never start with a multi-ingredient solid off the bat like Hummus.

[PrincessEmilysMommy]

Pyloric stenosis sets in very quickly and is accompanied by projectile vomiting, does she keep most of her feeding down? Yes, she keeps her food down. We may have a reflux episode once a week & it's not severe.

I tend to believe this has nothing to do with your milk either. I hope the tests reveal something concrete for you soon {{{hugs}}}

This is just a hunch but if you Molly is anything like my babies, they would stay on one side forever, settling for non-nutritive sucking at times when if I switched to the other breast, they would start actively sucking again, are you still block feeding? Maybe it is as simple as offering both breasts at every feeding? Also, are you doing breast compression while you nurse? She doesn't nurse to the point of NNS. I always hear swalowing. Even when she's sucking in her sleep. If I offered both breasts I don't think she'd get much hindmilk, which caused her to have an imbalance in the past, also w/ no gains. I do compressions while nursing & pumping.


I would recommend topping her off after each nursing session, with any expressed breastmilk from the previous session, via a finger feeder. The beauty of a finger feeder is that it delivers calories with very little effort, calories/ energy spent. It can be used with a sleepy baby with very little sucking action. She was "topped off" for a period of 4 weeks. No gain. It was by bottle, and she wouldn't take much at all.
This will also reinforce her latch and help her develop a stronger latch. Preemies are notorious for a shallow or weak latch and using a BFing friendly feeding alternative www.kellymom.com/bf/pumping/alternative-feeding.html will preserve your BFing relationship. Molly has a great latch. When she was younger she got a little lazy on her latch & the Ped put a hold on bottle feeds. She was back to her good latch in no time. We nursed & worked hard in the NICU w/ the LC there. I don't mind giving her bottles now. Trust me she'll drop her botte in a heart beat if I pulled out the boob. I also don't feel it's a volume issue. I know she's getting milk. I see & hear it.
Are you pumping after each feeding? This will ensure that even when she is sloppy with her latch, you can retrieve the all important hindmilk and give it to her at the very next feeding. I don't always pump after , but I will if it would help.

Have you been using an artificial nipple/bottles to give her the supplements you have been using? I would not recommend bottle feeding at all while there may be transfer issues. I would strictly use an SNS or a finger feeder. She gets bottles. Her latch on the bottle is great too.
I also agree with you that returning to a hospital grade pump will be beneficial, you can also look into angled horns, they are known for increasing pumping output: www.pumpinpal.com I didn't know that. I'll get some definitely.

[ChristmasTree]

I also wanted to add, while her weight seems alarming, it's more about the growth curve her ped said. If she were 10 lbs & gaining, even slowly, that would be fine.

Her gains stopped about the same time her stool pattern changed. I believe I posted here about that. Her suddenly having far less frequent stools (from 6 a day to 1 every 8-10 days) & the really stinky gas. When she does stool, it's horrid. The smell is truly enough to clear a room.

i wish you could take her to the mayo clinic. all of this is so hard for you i know. you are a strong Mama. Hang in there!

[Camille]

I have no advice, and am just stopping in to give you hugs. ((((hugs)))) T&P for you and your little one. :)

[MommytoLuke]

I'm going to assume when you say you fortified her EBM, that was making it 22 cal? Because that's what we did for Luke's EBM until he was about 6 motnhs old, and then a gain around 9-12 months when he stopped gaining weight for 3 months.

Don't worry, you can still pump and nurse, he just wants to add those extra calories to get her back on track. You are lucky to have such a BF friendly doc!

Good luck and keep up updated!

[Amy_G_]

I'm going to assume when you say you fortified her EBM, that was making it 22 cal? Because that's what we did for Luke's EBM until he was about 6 motnhs old, and then a gain around 9-12 months when he stopped gaining weight for 3 months.

Don't worry, you can still pump and nurse, he just wants to add those extra calories to get her back on track. You are lucky to have such a BF friendly doc!

Good luck and keep up updated!

The average calorie content of human breastmilk is 22 calories per ounce.
If you fortify it with formula, you'ld be making it more than 22 calories per ounce.


If she's going to give any solids, it probably can wait til after testing. then they should be solids that are more than 22 calories per ounce.

[PrincessEmilysMommy]

Molly has had 24, 26, & 28 calorie bottles of ebm. She gained ok w/ those at first. Then stopped.

The ped isn't saying to fortify again, he's saying straight formula.

[Amy_G_]

http://www.kellymom.com/nutrition/vitamins/babyfoodcalories.html
has a list of some common food calorie content.
something that might work if there are no allergies, would be to give baby brown rice cereal with a bit of dry powdered formula stirred in and mixed with breastmilk instead of water. that might bump up calorie content higher than avocado at 46 calories per ounce.

[MommytoLuke]

Gotcha. Thanks for the clarification. :) I don't have any advice for you other than what the other posters have given.

Good luck, I hope she starts gaining. I will send some chubby baby vibes her way~~~~~

[Maret00]

Have you tested your milk? Hospitals that have a lactation center will test you breastmilk so that you can see how many calories it has. Also I would continue breastfeeding then give her an oz or 2 after you are done nursing that can help get her bigger faster and once she is bigger she will nurse better. Nurse first then bottle if you think she needs it.
Good luck!

[Kassandra]

PEM, I think I'd want to know exactly how many oz a day Molly is getting before I'd jump on the formula bandwagon. Formula has the same # of calories as BM. If there is a certain # of oz the doc wants Molly to ingest in a day - then that's what I'd concentrate on.

You can rent a baby scale from a local IBCLC (or she may loan it to you for free as was my experience). Weigh Molly in a clean diaper before and after each feeding and keep a log of the # of oz she ate (end weight - beginning weight = # oz eaten).

It's tedious and time consuming, but doing it put my mind at ease when DS was having weight gain and latch issues. I just wasn't confident that he was getting enough from me.

I did this for 4 days and it put my mind at ease that my milk supply was fine. We fixed the latch and he gained fine there after.

If she's getting enough oz per day, then I'd probably wait for the test results. Your milk was fine for Emily - I can't imagine that it wouldn't be fine for Molly.

I know this is so hard. My heart goes out to you - I hope you get some answers!

[KerryS]

I agree with Kassandra.