Feeding FAQ: 3-4 months – Formula Feeding

How do I have a feeding routine with my 3.5 month old who suffers from reflux?

I have always tried to follow the schedules, but firstly I could not properly breast feed, then my son suffered horribly from acid reflux in his first 2 months. After his first week of treatment with Zantac, he was angelic. His schedule just fell into place. Then things went very wrong and he continues to buck and thrash when I try to initially give him his bottle. He will settle after a few minutes, but then he has exhausted himself so, that he can barely take 4oz at a time. The only time of day that is predictable is from 5 pm until about 4-5am. He can manage the schedule and with a split feed, can take 6-7 oz at dinner. I have been back to work for a week now and the nanny confirms the same. He struggles to eat and it is affecting his sleep. Naps are not much longer than 45mins. This bucking and wriggling also shows up when he is tired. When he has had enough and is tired, he will cry/scream. Walking and jostling will settle him only briefly. If I were to try to lay him in his crib at this point it would be an all-out fit. Some days he sleeps 3-4 hours, some days only 2-3 hours. He has been chewing his hands since he was 8 weeks and it is getting worse, but no teeth are breaking in.

My son is a lovely baby, giggling, generally happy and easy going, but we struggle to get him to feed and sleep on any schedule. His early months I tried to accomplish errands when he was wake and he sometimes spent short spurts with the nanny. Currently I drop him off to the nanny at 8am and collect him by 5.30pm. The nanny has to drop of my niece and nephew to school between 8.15-9 and pick them up from 2.30-3pm. So my son’s only “quiet time”, alone with the nanny is from 9am-2pm and I have my doubts that she tries to follow the schedule as strictly as I do. I also know that my niece and nephew scream down the house playing in the afternoon, so it is quite hectic.

He feeds at 4-6am: 2-4ozs, 7-8am: 2+ozs, 10.30am: 4-6ozs, 1pm: 2-4ozs, 2pm: 4ozs, 5pm: 2ozs, 6.15pm: 4ozs, 10.30pm: 4ozs. Water is given throughout the day when necessary, he takes around 4-6ozs daily. He weighs 12+lbs.
He naps at 9.45-10.45am, 12-1pm, 2-3pm. He is settled at 7pm.

Babies who have problems with reflux do better with smaller and more frequent feeds. They are also easier to feed when they are relaxed which is probably why your son feeds better later in the day and at night.
If your son has not had a check up recently, get one booked in straight away as his medication may need altering to help him not to be in such discomfort when feeding.
To help his intake, try feeding him 3ozs at a feed and then let him have a 15-20 min break whilst sitting in a fairly upright position in his chair. He needs to be at an angle but not in a “v” shape as this will cause his stomach to be constricted and cause him further discomfort. Offer him another 2-3ozs after this break and see if you can get his daily intake up to nearer 30ozs which is the average for his weight.
Watch how much water you do give him because if you give him too much at the wrong time of day could take the edge of his appetite and so he will only want a small feed when it is next due.
To help him settle better at lunchtime offer him a top up before going down so he is not likely to wake at 1pm through hunger. Even an extra 1oz given at this time could help him have a better lunchtime nap.
Babies with reflux can be calmed by using a dummy to suck on. This could be used either in his break or after a feed if he is showing signs of distress. Sucking on a dummy can help saliva production. As this is alkaline it has a neutralizing effect on some of the stomach acid as it comes up. You could possibly replace some of the water given to him throughout the day with a short time sucking on a dummy, especially if a feed is due within an hour.
When winding him rub, rather than pat, on the left side of his back. Rub gently in circles and then upwards as you hold him upright on your shoulder. This will help to keep the oesophagus as straight as possible to help him wind without too much added discomfort.
You may find it also useful to use a dummy to help calm him ready for his naps so he is not going down over tired and upset. At least 15-20mins before his nap is due he needs to be taken to where he will sleep and the same calming routine set in place. This could involve a change, some quiet holding in an upright position and offered a dummy. Looking out of the window and talking quietly about what you see will help him relax. Pull the blinds and curtains and settle him in his cot before he is too tired and begins to fight sleep. Getting him into his cot before he becomes too tired should help him to settle better and hopefully sleep for longer. With other children around it is not always easy to notice that a baby is showing signs of tiredness but as your nanny is alone with your son at the times of his morning and lunchtime nap this should not be too difficult to put a calming wind down time into place.
Make sure that he sleeps on an angled mattress. This can be done by raising the feet at the cot end using thick books or telephone directories or rolled towels under his mattress so his head is higher than his body. You can buy special wedges to fit under a cot mattress which do the same thing.
Dealing with reflux and the problems it brings is difficult. Keep working on improving the feeds which in turn may help the sleep improve and as the months pass your son should begin to grow out of this distressing condition.