Feeding FAQ: 4-6 months – Formula Feeding

Low weight gain and reflux in my 18-week-old daughter

My daughter Alicia is now 18 weeks old. She is my second child. My first is a boy of 25 months called Jacob. Both children were introduced to Gina’s routines since they left hospital. Alicia took very well to the routine. However, her weight gain isn’t in line with Gina’s recommendations. Alicia weighed 6lbs 2ozs at birth and she was born a week and a half early by elective c-section. Her weight came as a bit of a shock as my son weighed 7lb 11ozs and he came a week early by emergency c-section. Alicia has only generally gained on average 5ozs a week. She had one of two weeks where she gained closer to 8ozs. She was weighed at 17 weeks and is now 11lb 3ozs. From the age of 2 weeks she has been exclusively fed on Cow & Gate Premium 1 formula. Around that time we noticed that she was very uncomfortable after being fed and would scream if she was put in her chair or laid on her back. Our Health Visitor said that she was suffering from colic. I found this hard to believe as she would go down to sleep at 7pm and would not wake up other than to feed.
I then read your testimonial about Alice and I realised that Alicia was suffering from reflux. To start off the GP would not believe me as Alicia was not always sick. However when she was sick it came up through her nose and she brought up about half her feed. Eventually the GP prescribed Gaviscon Infant. That has helped Alicia to settle down. However, she has now started to cry again after certain feeds. I’m not sure if she needs to be re-assessed again by her GP. Should I insist that she sees a specialist? I find it very hard when my child is rigid with pain. I also get very confused by what is wrong with her. For example, today after her 2.30pm she started crying around 3pm and didn’t settle until 4pm. She was wriggling in pain and was chewing her hands almost as though she was hungry but after 5ozs I couldn’t see how that was possible. Am I feeding her enough?
I also need some advice regarding the 10pm feed. Alicia currently has 2-3ozs at this time. My son had dropped this feed by 14 weeks. Alicia has been sleeping from this feed until 7am since she was 7 weeks old. Can I now drop this feed? I am a bit concerned as she is still small for her age. Alicia’s daily feeds are as follows: 7am – 6oz; 11am – 6oz; 2.30pm – 5 1/2ozs; 5.30pm – 4ozs; 6.15pm – 3ozs; 10pm – 2-3oz. I am still splitting the 5.30pm and 6.15pm feed because Alicia cannot cope with 7ozs in one go therefore I thought it would be better to split it. She also starts crying around 5.30pm. Should I try and encourage her to take more milk during the day to try and increase her weight gain. I’m just a bit reluctant as she can’t seem to cope with more than 6ozs in one go.
I was also going to wait with regards to weaning her particularly as the guidelines now say 6 months. Also my son has had problems with his stomach since we started weaning him. He has some food intolerances that can cause him to frequently soil his nappy. My only concern about waiting until she is 6 months is that she is showing signs now of wanting solids. She is dribbling so much. Her tops are always soaking wet. She is also constantly chewing her hands. Are these signs?
Hopefully you’ll be able to give me some guidance on my concerns. My daughter is a great example of how routines work and when she is not in pain she is a beautiful child.

I would definitely ask your doctor to refer you to a specialist. This should be done as soon as possible, so you can discuss your concerns over Alicia. There are some specialist milks which maybe more suited to your daughter’s needs which could also help her with her weight gain.

The amounts you are feeding Alicia now are in line with her weight but I would encourage her to have a full 6ozs at 2:30pm, even if she has a 10-15 min break mid feed.

With regards to the 10pm feed, I feel this is important to keep in place until Alicia is established on solids. It’s tempting to drop it at this stage but it really ought to stay there until the solids are established. She needs these 2-3oz to continue with her present daily intake. If the feed was dropped she would need to make up those ounces in the day and as she cannot cope with too large a feed at any time, I think you will agree it is best left in place. Although her brother managed to drop it early, Alicia’s nutritional needs must be met.

Reflux is a distressing condition for both child and parent. I hope you are able to get the best possible help for your daughter.

You can also ask the specialist about the best time to wean her. It does seem that she is showing some of the signs of being ready to wean. The current guidelines specify that it does your baby no harm to exclusively breastfeed for 6 months. These guidelines are based on the World Health Organisation’s recommendations which are obviously for women and babies all over the world. In the UK, the Department of Health upholds this recommendation but acknowledges that all babies are different and that mothers’ needs may differ as well. It states that you should not introduce solid food before 17 weeks as the baby’s digestive system is not fully developed enough until then. Talk to your specialist and your health visitor about introducing some baby rice if you feel that Alicia needs it.