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Feeding issues (NICUs and formula) - Page 2

post #21 of 33
My son was born at 30 week, he was on breast milk for 6 weeks before they switched him to Similac Sensative, which is milk based but lactose free.

It might be something as simple as they need to thicken your breast milk. Which is simple they just put this jel looking stuff called simply thick in your milk before feeding, and simply thick is absolutely harmless.
And you might be right they might be feeding your baby too much at once time, with my son they fed him too fast and he didn't vomit it up but they would put it in his NG tube and it would run out his nose, not like vomiting, but just run out like he was too full and that was how it was coming out.

They eventually put him on the pump too for an hour.. and that helped a great deal but it seemed to be too much, because by the time his feeding was done there were only 2 hours til his next one. I fought and fought with the doctors to lower the volumn. I am also the one whom demanded them change him to lactose free formula. They say lactose intolerance runs in families and both myself and my other child are lactose intolerant, Hayden would drop his heart rate to around 85 each feeding and sometimes they'd have to stimulate him to get his rate back up. he was on the lactose free for the next 3 weeks without dropping his heart rate one time.

It might be something as simple as your baby is a refluxer, like many of ours, I personally would ask the doctors if it's possible the baby is refluxing. They can do a swallow study, or an Upper GI to determine the reflux issue, and there are multiple medications they can use to help with reflux, my son came home on 2 different ones. IF it is reflux they can put your baby back on your BM.
With BM make sure they use Simply Thick, not rice cereal, there is something in the cereal that breaks down the bm, and also with the NG tube it gets clogged.

Good luck mama, i pray it's something as simple as reflux and easily treated
post #22 of 33
I fought hard with my recent NICU about breastmilk.. They kept giving my daughter formula when I straight out told them ONLY BREASTMILK!!! They kept making up stupid excuses why she needed formula.. Finally they got sick of me and did the breastmilk only and lo and behold she did excellent.. I still get angry thinking about it today... It seems that when you sign that general consent for the NICU that you give them a lot of authority over your child.. Just be very demanding with them.. Read the charts and make sure they are doing what you want and tell them to call you and OK it with you BEFORE they make any changes.
post #23 of 33
It's really sad, and RIDICULOUS, that it's such a struggle to get them fully b'milk fed. I had a nurse come to me in the middle of the night just as my milk was coming in to say she had nothing for the 1am feed and what formula would I give!!!

I told her I'd express every hour to keep off formula but had to play the 'allergy card', that we have dairy intolerance in the family, to be taken seriously. I was a mess the next morning from sleep deprivation and angst. Surprise, surprise, there was plenty to go round anyway - I had bottles in the fridge, so all that stress for nothing basically.

Then we found out around day 7 they'd been supplementing all along with a fortifier. I felt so deceived. That contains milk/ animal ingredients too and I had not given my permission for it AT ALL. We then had that stopped, but really, where is parental choice and consent in all this !?!?!?!
post #24 of 33
Thread Starter 
Well, just like I thought, he does have reflux. They call him a "happy spitter" since he doesn't get upset at all when puking. They started him on Reglan and have been putting rice cereal in a few of his feeds and he hasn't spit up in three days. I am not keen on the rice cereal, however. I had not heard of Simply Thick. I will ask about it. What does rice cereal do to EBM exactly?

I won't be using rice cereal at home - no way. But in the NICU, I guess I'm not as adamant about it because I just want him to come HOME! (where I can feed him what I want, and no cereal.) I'll ask about the Simply Thick today, though.

He is doing well on the breastmilk. He gained an ounce and a half yesterday! He's up to 5 lbs. He took only 15 cc by bottle (he has to use bottles first), but at least he is making progress. He takes 40 cc for each feed through the tube. He's in an open crib and off the caffeine for As and Bs, and only had one minor episode Sunday, none yesterday.

I just want him home! And I won't be able to nurse until he takes more feeds by bottle, so I hope he will catch on soon.
post #25 of 33
Quote:
Originally Posted by krabigirl View Post
Well, just like I thought, he does have reflux. They call him a "happy spitter" since he doesn't get upset at all when puking. They started him on Reglan and have been putting rice cereal in a few of his feeds and he hasn't spit up in three days. I am not keen on the rice cereal, however. I had not heard of Simply Thick. I will ask about it. What does rice cereal do to EBM exactly?

I won't be using rice cereal at home - no way. But in the NICU, I guess I'm not as adamant about it because I just want him to come HOME! (where I can feed him what I want, and no cereal.) I'll ask about the Simply Thick today, though.

He is doing well on the breastmilk. He gained an ounce and a half yesterday! He's up to 5 lbs. He took only 15 cc by bottle (he has to use bottles first), but at least he is making progress. He takes 40 cc for each feed through the tube. He's in an open crib and off the caffeine for As and Bs, and only had one minor episode Sunday, none yesterday.

I just want him home! And I won't be able to nurse until he takes more feeds by bottle, so I hope he will catch on soon.

I can't believe they're putting cereal in his bottles!!! Have they tried reglan or zantac for the reflux? I'd also insist that he's at least allowed to suckle at the breast. Actually, I'd demand a lactation counselor and tell them that you will be nursing. I nursed my twins when they had feeding tubes. If they nursed for more than 15 minutes, we didn't give them their tube feeds at all. Sometimes we'd give half, sometimes we'd give it all but they were always allowed to nurse first.
I'm sorry you're having to deal with all of this. I hope he is able to come home soon.
post #26 of 33
Thread Starter 
He is on Reglan for reflux. Honestly, I think that is what is helping him rather than the cereal. But like I said, I really just want him home - I won't be feeding him cereal at home, so I just want to play the game and get him OUT of there asap!

If I can get them to use Simply Thick, that would be nice.

Unfortunately, their policy is that they don't contact the LC or do any nursing until he takes half of his feeds by the bottle. (Their rationale is that nursing at the breast takes a lot of work and they don't want him to lose weight.) I am sure I could fight it, but I just want him home! He is struggling with the bottle as well.

I do want to nurse him, not just bottle feed EBM, but I just want him out of there!

The hospital in general pretends to be BF-friendly, but I found that even when I had my healthy, full-term DD, that bottles were heavily pushed.
post #27 of 33
you can make it clear that you want nooo formula--it's your right to do so. fwiw--lactose isn't the problem! bm has tons of lactose, so humans wouldn't have survived if this were the case. it probably is a volume issue. it will clear up soon, as his tummy gets used to things. but they are increasing his risk of food allergiies. we dealt w/similar issues w/both our boys and nicu protocol.

mrsfru

congrats!!!
post #28 of 33
I would go direct to the lactation consultant if you can ask for her through the main hospital switchboard. I know what you mean about wanting him home, but the fight to get off bottles and back to breast could well be far more difficult.

I'm sure it's proven that b'feeding is less stressful. Maybe someone else here has some references for this that you can take in. I spoke to a nurse who was pro b'feeding to find an up-to-date study stating fortifiers are not necessarily a good idea and she helped me get my case reviewed.

I'm worried if I don't fight whilst they are in there that I'll struggle more once they are home. It's a very tearful time though. Sometimes I feel sick because I don't want to have to query anything else/ have to stand my ground on another point. As if we don't have enough to process already, kwim !!!!!
post #29 of 33
Quote:
Originally Posted by krabigirl View Post
Well, just like I thought, he does have reflux. They call him a "happy spitter" since he doesn't get upset at all when puking. They started him on Reglan and have been putting rice cereal in a few of his feeds and he hasn't spit up in three days. I am not keen on the rice cereal, however. I had not heard of Simply Thick. I will ask about it. What does rice cereal do to EBM exactly?

I won't be using rice cereal at home - no way. But in the NICU, I guess I'm not as adamant about it because I just want him to come HOME! (where I can feed him what I want, and no cereal.) I'll ask about the Simply Thick today, though.

He is doing well on the breastmilk. He gained an ounce and a half yesterday! He's up to 5 lbs. He took only 15 cc by bottle (he has to use bottles first), but at least he is making progress. He takes 40 cc for each feed through the tube. He's in an open crib and off the caffeine for As and Bs, and only had one minor episode Sunday, none yesterday.

I just want him home! And I won't be able to nurse until he takes more feeds by bottle, so I hope he will catch on soon.
Technically Rice Cereal in breastmilk does not work because the rice cereal is broken down in breastmilk and turns back to a thin liquid over time instead of thickening the milk like it does with formula. I'm surprised they'd even try rice cereal in breast milk. Most doctors know that you can't do that with breast milk. It sounds like these doctors know next to nothing about breast milk unfortunately. Something like Simply Thick is the only thing that you can do to thicken breast milk. Also, have the doctors not considered putting him on a safer reflux med like Prevacid or Prilosec that doesn't cross the blood brain barrier? Have they talked with you much about the possible neurological side effects of Reglan?
post #30 of 33
Thread Starter 
No, they haven't talked to me about the effects of Reglan. I'll ask today. I have read some bad things about it if it's taken for more than 6 months.

LOL, that's funny that the rice doesn't do anything to thicken the breastmilk. So there's no point? It seems like the reglan is what is helping him, then.

I know that direct bfeeding is easier than pumping/bottle feeding. I went that route with DD, so it's important that I can bfeed from the source this time. I just want him out, though, but I'll discuss an appt with lactation soon so I can start. I plan on working with an LC that I know when he finally gets home. I'd be a bit more relaxed then as well - the NICU is hard to relax in - I can barely let down to pump at bedside, even with a privacy screen.
post #31 of 33
I am so sorry you are going through this! My baby is thriving with Simply Thick and Prevacid just as one example of how to handle reflux...Reglan is considered "more serious" and not a first choice in my NICU...
Are you doing Kangaroo care? That really prepares baby for breastfeeding. My NICU had us kangaroo first, then we did "lick and learn" sessions where we kangarooed and I held him skin to skin with him nuzzling my breast/nipple (not trying to latch or force his mouth near my nipple). This just gets them comfy and familiar without using energy or stressing out. In the beginning they had me pump at the bedside right before so I would be empty and any sucking would be "non-nutritive" There is so much you can do to prepare for breastfeeding even if they don't want you to actively breastfeed! Good luck, I hope this helps. Kangarooing is the most important (according to our NICU LCs)
post #32 of 33
I haven't been to this board in a while (2 years) because it's still hard for me to talk about my son's NICU time. I just wanted to offer my support and a couple of the things we did.

My son was born at 30w5d and spent 2 months in the NICU...the first month was just to finish developing/growing, the second was because he developed a bone infection. I had to be rather blunt and direct with the docs and nurses regarding our wishes/latest medical research....and it wasn't something I thought would've been necessary. Being a teaching institution, I would've thought they would've been more up-to-date, but they weren't. (My husband and I are both in medicine.)

Luckily they never mentioned formula. But we did have other issues.

Breastmilk doesn't thicken with rice cereal because of the amylase in breastmilk....it breaks down the rice cereal....so the rice cereal just ends up as filler....less nutritionally/calorie dense....therefore not ideal for preemies who need as many nutrients/calories per mL as possible.

I'm not sure that Prevacid is FDA approved for neonate preemies....at least it wasn't 2 years ago. We had to wait until he was 4 months old to use Prevacid....but I agree that it was better than the Reglan. They might have started using it "off-label" or it may be approved now. You'd just have to ask.

My son wasn't a spitter and so the reflux was always questioned by the docs...but he was clearly miserable after feedings if he was laid down too quickly afterwards, or if he was fed too much at one feeding....you could even hear the liquid slosh back up into his throat! So for him keeping him upright was the best solution. When he came home I would wear him upright in a sling or wrap after every feeding...and at night would prop him up so he slept on an angle.

We had the same struggle with nursing/bottling. Eventually it became the fight I gave up on (in the NICU). I let him come home bottle-fed....and we learned to nurse at home without the other NICU stressors....it took about a month....and I still had to pump because I was producing more than he could nurse...but it was nice not to have to make a bottle in the middle of the night. We only have 1 LC in the area and she is not affiliated with the hospital he was born at....so I had to hire her services after he came home.

I did have to fight for Kangaroo care....and I wondered whether it was worth it...but I have talked to several Neos in other areas/states and all unanimously agreed that it IS worth it. I would try to KC him every visit....and when he came home. He only rooted a couple of times during KC and one of those times he was with my husband! My husband's eyes got sooo big!! It was funny!! But he definitely brady'd less during KC.

As much as you end up feeling like a pain-in-the-ass, it's best to speak up and question. Even now I wish I had spoken up more...and as it was the docs avoided me.

Good luck and hang in there!

(And FYI, our biggest issue became the IV antibiotics for the bone infection....they wanted him hospitalized for the whole 6 weeks. My DH and I couldn't do that...esp since the bone infection was a result of him being there in the first place! Luckily, the peds surgeon was on our side and fought with us to get him home.)
post #33 of 33
I would also push to get them to stop the formula. It is your baby so it is YOUR decision on how you want to feed the baby. My daughter was a nicu baby and was given formula because I didnt' stand up for her and I think she wouldn't have had as many problems with reflux if I had. Giving him formula will only make the problem worse and not better. s: Just keep pumping and keep up the good work...and put your foot down you are allowed to.
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