SNS for older infant?

Re: SNS for older infant?

• HKDO08 member

  January 2012

  And if someone could recommend the SNS they liked that would be great.  Such as Medela brand, etc.
  

  

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• HKDO08 member

  January 2012

  It's definitely a supply issue.  She really isn't getting much solids because we introduced them a bit later on (7 months).  And there were times earlier when we did solids that we skipped a day here and there of it because of moving.  Weighed feedings are showing only 2-4oz taken in, except the morning feeds show 6-8oz.  And I am not pumping currently.  It's unclear exactly why the supply has dropped - we have moved recently in the past month for a new job and maybe stress?  I have no idea.  Unfortunately I'm not producing enough anymore.  I have been taking motherlove more milk special blend (has helped me in the past several months ago when I had a small dip from an illness), the usual oatmeal, (fenugreek does nothing), drinking plenty of water, and of course putting her breast as often as possible.  The problem is that she is refusing the breast early on in the feed except the first morning feed because she knows it's lower.  And I know that having to supplement her with a bottle is a viscous cycle, but she needs to get nutrients somehow.  

   At this point, she gets two solids a day.  Morning feed consists of rice cereal mixed with 1-2 oz of formula (usually 1oz) with a fruit puree.  And the evening is usually a vegetable puree with fruit or a protein like chicken puree.  The amount of purees is equivalent to 1/2 tub of Gerber or 1/2 of a jar. And I always have her BF/FF first and then give solids about an hour later.
  

   I had a feeling SNS wouldn't work - I can just picture her wild hands grabbing and snapping the tubing.  Or staring at it asking me "what is this thing?!"  Just desperate here.

  It's a pressing issue a bit because she has reflux as well.  And I don't like her losing calories because of her spitting up.
  

  

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• HKDO08 member

  January 2012

  Wow!  What a nice response!  Let me go through here and try to address the questions....
  

  AmyG*:

  ok, if you are able to provide 6-8 oz in the am, that is more than most moms ever make at a feeding.  2-4 oz during the day is also reasonable amount.

  so how often a day is baby nursing?

   She nurses every 3 hours during the day (sometimes there is a 4 hour gap).  She sleeps about 8-10 hours through the night.   She occasionally gets a bottle of formula (I have no stash anymore since we moved to different state) whenever I'm up town running an errand - she'll take about 6 oz.
  

  an average breastfed baby takes in 25 oz a day at the breast, regardless of age or weight, although as they begin to take in more solids, their breastmilk intake may lower to 10-15 oz late in the first year but the breastmilk increases in calories to meet baby's needs with less ounces.

  Makes sense.  So a higher calorie milk could explain less ounces in the weighed post-feeding?  Would that also explain why I am not really engorging with a missed feeding?
  

   if baby is eating once and getting 7 oz, that means baby needs to get 18 oz in the remainder of the day to stay at 25 oz a day.  that would mean if baby is eating 3 oz at a feeding baby needs to eat 6 more times a day.  I'm averaging 6-8 oz to = 7 oz; and 2-4 oz to = 3 oz.  it will vary somewhat, but it honestly doesn't seem like amount of ounces is the issue.

  Nursing more often is one option, especially if baby is sleeping thru the night for longer than 8 hours straight, a dream feed in the first half of the night or a middle of the night feeding may get in more calories.  otherwise fit in at least one more feeding a day.

  Dream feed is not a good option.  Have tried that in the past when my supply dipped before and she doesn't want to feed.  I guess she really likes her sleep!  I've tried nursing her more often, but I'm having a lot of trouble.  She is very fussy at the breast and refuses after a short while.  I have noticed over time the past month that my breasts do not get those "marbles" if I miss a feed or feel much fuller.  I tried not to be concerned about it until I found out her weight (see below).  She did not like hanging out "the boobs for a day" - maybe because older baby?  Wants to play?  I don't know.
  

  be sure any solids baby takes in are only AFTER nursing, since breastmilk has more calories than most baby foods.  consider making any solids extra calorie dense, oatmeal, mashed avocado, breastmilk to mix kind of thing, rather than rice cereal made with water to boost calories higher.   so baby needs to nurse 6-8 times a day and then also take in the solids like a boost or dessert kind of thing.

  Yes - I really do make sure that solids are after.  And I understand that solids are not priority.  As far as grains go, we need to stay with the rice cereal.  She had a possible allergic reaction to oatmeal cereal.  And I always mix the rice cereal with formula to boost it.  I will try avocado - good idea!
  

  Be sure when nursing you are using breast compressions and massage to keep baby at the breast longer and to increase the fat content by loosening fat that sticks to the ducts of the breast.  with a weight problem you may need to nruse on primarily one side per feeding to increase the amount of hindmilk in smaller amount of oucnes, or you may need to nurse on both sides once or twice to ensure baby gets enough ounces.  what you are doing right now will determine what you may want to try next.

  I haven't tried massaging - I will do that.  I have been switching multiple times during a feeding and trying to make her stay on as long as possible.  It's been so frustrating though because she keeps straightening/kicking her legs and being very fussy.  And biting down.
  

  is she on meds for reflux? Reflux meds often speed digestion, and sometimes nutrition is lost a bit thru that.

  She has just been started on Axid last week (more on weight below - but she hasn't gained weight since 6 months so the meds are not impacting it).  She has always had spitup/reflux since birth but she always been a happy spitter and consistently gained weight until this 6-8 month interval.  She was started on Axid at this point because her spitting up as not improved whatsoever despite being able to sit and being older, etc.  We are not optimistic it'll decrease the frequency of the spit up, but giving it a trial to decrease inflammation.  And with the weight decreasing/slowing she seems to be spitting up calories.  She'll actually need to evaluated by GI.  Her spit up is pretty profound.
  

  tell me an example baby weight history, how much is baby losing? how far apart are the feedings, are they all the same time of day or varying times of day? same scale or different?

  Birthweight was 6lb 13oz and has consistently been on the same curve up through 6 months, which she weight 15lbs 4oz.  She now weighs 15lbs at her appointment last week.  Different scale  because we moved and have a new doctor.  But still demonstrates not gaining for the past two months.  Before this appointment (last two months) she has been exclusively breastfed (occasional bottle given - once a week if that) every 3 hours during the day, sometimes 4 hours, so roughly 6 feeds if I am thinking correctly.   
  

  I would suggest a visit with an LC, cause like I said the amount of milk you are making sounds fine to me, unless you just aren't nursing often enough.  with an older baby they get more active and often they fall down the chart percentage wise as they start pulling up, working on walking and becoming more active.  but actual weight loss shouldn't happen unless it's a scale issue.  

  Your post has made me feel a lot better.  And after reading it several times and writing responses and talking with my husband - I'm wondering if we are muddling with something that should have been left alone.  I wonder if really the source of her problem is just the reflux that stalled her weight gain over milk supply.  I just do not understand how my supply could drop since I have been exclusively feeding her without supplementation (until this weight nonsense started).  And I'm wondering with this supplementation we are stuffing her.  She seems more annoyed at feedings and spitting up more.  I think tomorrow I will go back to square one and only breastfeed her and see what she does.  So confused!
  

  

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