changing forumula

[bluezephyr]

I'm asking this here because it's more likely some of you have dealt with this kind of thing...but maybe not. I'll try here first!

So, our fd is 6 weeks old and is a neonatal abstinence baby (Mom was on a lot of psychotropic drugs including anti-psychotics). The baby is on phenobarb and was automatically put on a soy formula--Similac--because so few such babies can handle milk products. She had 50-50 breastmilk for her first two weeks before we convinced her doctor to stop that because the drugs from Mom were having a profound effect on her alertness and if they were making her act drugged out, what ELSE were they doing?

Fast forward. Her digestive system is working better--no more running poop. In fact, the soy formula is making her constipated and giving her painful gas. So, her doctors suggested we try a milk based formula. Maybe she outgrew that problem and is ready for that.

First full bottle of Similac Advanced lead to projectile vomiting. So, we stopped. The constipation on the soy got much worse. We were having to do baking soda baths every day, basically helping her poop. Her little tummy was hard and painful and she was NOT happy. The doctor suggested Lactulose to help her out. The kid's older bio brother (with another foster parent) went through a lot of this. He vomited his soy formula too, the Lactulose meant diarreaha and rash, eventually he was put on Alimentum, which he vomited, too, and then rice cereal in it and then reflux meds that didn't help. But, that baby was worse off than this one is, so we have hope.

So, the doctor suggested we first try Alimentum before settle for the soy (since soy seems to be a link in precious puberty among other things). Projectile vomit the second feeding.

So, back on the phone with the doctor. She's out, got the nurse. The nurse pointed out that the feeding she vomited was large (4 oz, she normally eats 2.5-3.5 at a time). We have not been told to do this gradually and have wondered about that, but they don't recommend it. The nurse further told us that many babies vomit some when changing formula and we should test longer.

Well, if we're going to put up with vomiting, we thought, we should go back and test the Advance first since it would be better to have her on that than Alimentum. So we're 24 hours in to gradually switching the formula (first 50-50 now 66-33) and limiting each feeding to 2.5 oz. She's had two incidents of small amounts of vomit (nothing like the full feeding at full force we had before!) But, we don't yet know if this is successful or if we're just torturing every body. Our plan is, if we conclude the Advance isn't working, to then try Sensitive (lactose digested) before going back to the Alimentum.

If you changed formula (international adoption?) was there vomiting? How long did it take to settle down?

If you had a kid who couldn't tolerate milk formula, how did you know?

What would your reaction to projectile vomit on a new formula be?

What is your experience/opinion on soy?

Did you ever have to use the lactulose stuff?

Did you have a baby on Phenobarb and does it effect the baby's digestion?

Do you hang out on any other forums where there might be parents who have answer to these kinds of questions? (I'm aware it's often difficult to talk about formula on mothering...)

(It may be obvious, but I'm not interested in a conversation about why we're not inducing lactation--she may leave our house any day, it's illegal, we don't want to jeopardize things--or inducing and pumping secretly and somehow keeping up supply without a baby at the breast leading to the kinds of behaviors from the baby that would give us away. And we have to use mainstream, not organic, formula because WIC covers it and she may be leaving our house for a kinship provider who will use WIC and all that and so it would be cruel to put the baby through two formula changes)

[queencarr]

Formula changes are rough! When my second child came home at 5 1/2m, we did a gradual switch from his Korean formula to Baby's Own. He did not tolerate it well--severe constipation, tummy pain, gas crying Went back to straight Korean formula. Got him settled down from that episode, and tried GoodStart. He still had some trouble but did pretty well on it, and after a week was ok. He was still very firm/constipated. We did eventually add some benefiber (the clear dissolvable unnoticable fiber powder) to his bottles with our dr's blessing, which worked well to solve the remaining problem. I also fed him lots of yogurt (he was eating lots of solids at that point) for the probiotics. You could add a small amount--maybe a tsp?-to each bottle or a probiotic supplement. When he was a little over a year, we tried to switch to cow's milk; same trouble as before. Goats milk was better, but still needed the benefiber. By 2-2 1/2y he had no issues with dairy at all. Something to note--all the formulas were cow's milk based, and he reacted differently to each of them. It is not necessarily cow vs soy--different milk formulas have different concentrations of whey and casien. I will say the Korean formulas were highly superior to the US in terms of digestibility. For my second adopted child, we brought a suitcase back, and then had a friend continue to ship it to us for about a year.

My bio child was intolerant to several types of cow's milk formulas--and landed in the hospital as a result (although he tolerated cow's milk based human milk fortifyer mixed with my breast milk in the NICU). They had me gve him warm pedialyte for 24 hours to give his gut rest and then went back to breastmilk only, but I had to remove dairy frm my diet as it had sensitized him.

So from those experiences, I have 2 suggestions. Talk to the dr about a trial of warm pedialyte to allow his body to recover from all the stress. It will also help with the terrible constipation. Then try Good Start. Here, it is a WIC formula, although it may be a prescription one. The gimmick about comfort proteins is true--my understanding is it contains mainly whey, which is easier to digest (and is the main protein in breastmilk) and more broken down other proteins, like the predigested ones (like alumentum, etc).

[onewayoranother]

Is it projectile vommit or spit up? Have they considered any medical reasons for it? Have they considered pyloric stenosis?Could it be not so much that she's constipated but with the vommiting, liquids aren't being absorbed?

My bs had really bad reflux and we had him on Similac sensitive r.s as the advanced made him too gassy and he would spit it all up. However, he started projectil vommiting @ 3.5 weeks whenhe was on bm & sim adv 70/30. Turns out he developed pyloric stenosis & needed surgery. Post op we hired a ppdoula & were able to get him on 90% bm but it was a major failure & his reflux was justt too bad. He also had to be fed an ounce every waking hour as we had to build his belly size up to more food. I don't think he ate more than 3 oz a feeding until he hit 6 mos.

We never tried soy as I personally would have gone to goats milk b4 soy. We tried goodstart and it gave him the nastiest green poo. But I know a lot of moms are very happy with it. We are now on Similac sensitive but personally like the Target generic of it better. Plus it is way cheaper.

As far as his milk issues, he was just really unhappy and uncomfortable when he was on the Advanced. Taking him off of the lactose made a difference within a few feedings.

Again, i just wanted to stress that frequent spitting up is fine and but projectile vommitting really should be looked into beyond the formula. They become dehydrated so quickly. We literally went from spit up to projectile vommitting to being admitted for the ps secondary to dehydration in a 30 hour period. Keep a real close eye on it!

sorry 4 typos. Dh gave me a break so I'm typing in tub, lol.

[Polliwog]

I don't have an answer, but I'll send Heatherdeg a PM and see if she can help you. She's had some drug exposed babies and babies with special formula needs.

I'd also suggest posting at www.fosterparents.com. There are tons of people there who've been in similar situations.

I do have a thought. My first foster baby was born drug exposed but was a typical baby. However, she did MUCH better on liquid formula instead of the powder. I did both Ready to Feed and the liquid concentrate. WIC paid for them with a doctor's prescription. For some reason, the liquid is creamier and some babies do better with it. She came to me using that formula and I don't remember the exact reason. But, she was able to use Similac (which is our local WIC brand) as long as it wasn't the powder.

[queencarr]

I had another thought about reflux, so I came back to share that. I had forgotten that, but I heard similar about the liquid formula, too.

You will want to watch for reflux symptoms--arching back and crying during feeding, poor sleeping, pain crying when laying down, in addition to the spitting up. Do not let the dr's tell you your baby will outgrow it--there is medication and there is no need for them to be in pain. You can do positional changes, but I firmly believe in meds for reflux. Untreated reflux can cause longterm damage that requires high dose meds to heal and can cause long term feeding problems and oral aversions/feeding issues.

Can the phenobarb slow digestion, that could be an issue as well. Hope you get it figured out.

[EFmom]

We changed formula with our internationally adopted kids. We did it gradually, by mixing bottles that were part the original formula and increasingly more the new formula.

My younger daughter had some constipation issues that were alleviated by using a low-iron American formula to make the switch, as iron is constipating. As time went by, we were able to switch her to the regular stuff.

Both kids used milk-based formulas.

[bluezephyr]

Wow! Thanks everybody. I will go join the foster parent board, too, just to see.

I didn't know back arching during feeding was a reflux sign. She arches her back when we burp her and just afterwards, but usually not while actually eating...?

We seem to successfully have her on the new formula--now to see if it changes the problems! I'll ask her doctor about the liquid ready to feed and see...

Thanks again! It's a big help just to know we're not crazy