Feeding FAQ: 9-12 months – Formula Feeding

At nearly 11 months my son refuses his milk before bedtime

Tom is one of twins born at 31 weeks gestation. They both had quite severe reflux in the early days, hence a slow weight gain. (Current weight: 6.3kg) They now receive medication and are much improved, but they have never really enjoyed milk.
Tom absolutely refuses to take his 6.30pm bottle. He now screams and turns his head away just at the sight of it. He has three meals a day and is taking solids well. He drinks water well with meals. In the morning he takes his milk happily (6oz). Since bringing tea forward to 5pm about two months ago, he has become upset and starts crying as soon as he is out of the bath. He goes down screaming every night, which is no fun for any of us. He then generally sleeps through to 7am.
He naps well for 15mins at 9.30am and usually sleeps for 2 hours at lunchtime. I have tried dropping his 2.30pm milk but this made no difference to the evenings. I make sure he begins tea at 5pm and has nothing too indigestible at this time.
I feel his problem is more to do with the anticipation of bedtime, rather than hating his milk. His twin, who is the same weight and in the same routine accepts his milk. As bedtime is pretty unpleasant at present, do you have any ideas?

It can be difficult to see exactly what the problem is, when babies of this age suddenly start to refuse to drink their bedtime milk. Are they not hungry? Or are they too tired? As Tom’s refusal coincided with his tea being moved to 5pm it would be worth considering that he is not really hungry for it. He also is probably beginning to use much more energy at this time by crawling and pulling himself up, so he is very tired by the time he has had a bath.
In order to increase his small milk intake, move tea to 4.45pm and offer Tom a small drink of milk from a beaker halfway through the meal. If he accepts this, he will have already increased his intake by 3-4 ozs. If he is able to tolerate cheese dishes, include plenty of cheesy pasta bakes, pieces of quiche and jacket potatoes with cheese. Give him some yoghurt or a small fromage frais with his fruit. All this will add into his daily total.
To stop Tom getting too tired, make bath time 15 minutes earlier as well and see if Tom still reacts in the same way afterwards. Offer him a smaller bottle if he has taken some milk at teatime. Keeping a watchful eye on his milk intake will help him to continue to gain weight, even though he has taken to solids well.
Begin winding down for bedtime straight after tea, and keep everything as calm and quiet as you can. Prepare their room by pulling the blinds and curtains before you start bath time and keep the lights on low settings. Try to discourage noisy, splashing games in the bath (not always easy with two), instead practise some songs they both know and quietly chat about their day. If you have access to a CD/tape player in their room, find a recording of calming, sleep inducing music. There are many available which incorporate soothing sounds such as waves and natural sounds. Use the same recording every day and start it playing as he gets ready for his bath. This should help Tom to associate going to bed with a sense of calm and quiet.
Some babies of this age do protest about going to bed. It is as though they are reluctant to let go of the day. Providing him with a special teddy or toy to be with him in his cot could help if he does not already have a comfort object. Make sure Teddy is waiting for him when he goes into his cot. Creating a bedtime ritual can be soothing to babies who become overwrought at this time. As long as Tom settles to sleep and sleeps well, once over his tears and he is not affecting his brother, this stage will pass in time.

Feeding FAQ: 9-12 months – Formula Feeding

I am concerned that my 9-month-old son is not having enough milk

My son is now approaching 9 months and has seriously reduced his milk intake. As he has never been very good with his milk intake, I have been making sure he takes between 16 and 18oz per day since the age of 6 months (previously he was on about 24-27oz per day).
Recently this is beginning to reduce even more than the minimum 16oz I want him to have. He takes 7oz in the morning: 4oz on his cereal and 3oz to drink. He has been having 4oz at 2.30pm but this is now causing him to refuse his evening meal at 5pm and he is often vomiting after only a few mouthfuls. In addition, the 2.30pm is very difficult to give him and the only person who can manage it is me! At 5pm he has tea and at 6.30pm he is having 5oz. So all in all he stands at 16oz currently but more often than not, it can end up being only 12oz.
Is this a problem? He does have fromage frais and yoghurts by way of puddings, as I figure he needs more dairy if he is going to refuse milk. In addition, a lot of the food I make him contains cows milk, cheese and butter. He is also doing very well on his solids and follows a well-balanced and varied meal plan. Do you think bearing all this in mind that a milk intake of 12oz is too little? I would really appreciate some advice as I am quite anxious about it.

It is always an anxious time when a growing baby appears to be taking in less milk than he has been. Now he is nearly nine months old, his milk intake will begin to lessen as he has three solid meals a day. He needs a minimum of 17-20ozs a day but that includes the milk used in cooking and on cereals. By a year the minimum he needs inclusive of cooking is 12ozs so you can see how his solid foods are beginning to replace the need for a lot of milk.

A 125g pot of yoghurt or 30gr (1oz) of cheese can be substituted for 7ozs of milk. As you are making sure that he does have plenty of other sources of milk in his diet, he appears to be well within his daily amount for his age, despite his decrease in the amount he actually drinks.
As he is no longer interested in his afternoon milk you could begin to give him a drink of water or well-diluted juice and a small piece of cheese or small fromage frais at this time and see if he is more interested in eating his tea. By now he should be receiving his breakfast milk and his 2.30pm feed, if he will take it, from a beaker.
Be aware that offering juice or even water too near to a meal time will take the edge off his appetite. Also make sure he has eaten most of his solids before offering a drink to prevent him from filling himself up too much.

Feeding FAQ: 6-9 months – Formula Feeding

My six-month-old daughter has a small appetite for milk

My daughter’s feeding and sleeping patters are going completely off track. We need help encouraging her to eat/drink more during the day so we can eliminate the nighttime waking. She was 5lb 15oz at birth and has maintained a slow but gradual progress and now weighs 13lb 3oz at 6 months. I have assurances from health visitors that she is fine, and she has had hospital tests to check that there is no underlying problem. However, since introducing solids at 22 weeks my daughter’s weight gain has dropped and, at the weigh-in last week, she had only put on 1.5 oz in two weeks – although the health visitor did not seem concerned. Her milk intake is hit and miss. Most days she achieves 20oz (including what is added to solids), but it is a struggle and often she only reaches 20oz by having a feed in the night. I have tried different bottles and, on advice, switched formula to Aptamil Forward, but she will not take more than 4oz at a feed, except the 6.30pm feed when she will happily take up to 7oz. I have also tried giving a small amount, letting her play, then feeding again, but she is not interested. She just appears to have a very small appetite. Progress with solids has been ok but she will only eat with enthusiasm if she is really hungry. I have tried giving a few ounces then solids but she will not eat anything and I now have to leave a gap of at least an hour between milk and solids. During the day my daughter is a very active and happy baby. At 10.30am and 1.30pm she seems genuinely hungry, but a couple of ounces still seem to satisfy her. I have also adjusted the times of feeds, but there is still no increase in milk intake. Bedtime is 7pm and she goes to sleep straight away and, other than the night feedings, will sleep until 7am. I have tried to extend the lunchtime nap, but without success. I stopped giving her baby rice, but she has a wide variety of vegetables and the odd jar, which has been eaten with enthusiasm!
At present she takes: 7am – 3oz formula; 8.30am- 2 tsp baby porridge made with 0.5oz formula and 1 cube fruit; 10.30am – 1.5oz formula; 11.30am – 2 cubes veg, 2-3tsp yoghurt, small amount of water; 1.30pm – 3oz formula; 5pm – 3 cubes veg, small amount of water; 6.30pm – 5-7oz formula; 11pm – 3oz taken reluctantly after being woken; 1.30am – wakes and takes 3-4ozs.
She naps at 9.15-10.00am, 12.15-1.00pm and 4.00-4.30pm.

During the second half of the first year, a baby will slow down in the weekly weight gain. At your daughter’s age, the average gain is 3.5 ounces per week. With her small daily intake of milk she is gaining more slowly than this average, but this seems to have always been the pattern. It appears that her best feeds are those in the evening and night when she is not receiving any solid food near to them. Although you have been advised to put your daughter on to Aptamil Forward, you should be aware that second stage milk is much heavier and takes longer to digest than first stage milk. As your daughter has always had a small appetite, the combination of having this heavier milk alongside solids is possibly the reason for her cutting back on quantity. Discuss this issue with your doctor and ask if he considers it a good idea to put your daughter back on stage one formula at the 7am, 11am and 2.30pm feeds She may then be willing to drink more at these feeds. Until her appetite for solids increases at lunchtime, don’t increase breakfast. As she is having breakfast at 8.30am she is not really hungry at 10.30am. She is then taking just enough to top herself up and is not inclined to increase her solids at lunch. When protein is introduced, you need her to eat enough once her milk feed has been dropped. Hunger could also be the reason for her being unable to sleep longer at lunchtime.
If you are able to increase her overall daily intake by making these changes, you will be able to cut down on her night feed, which in turn should help her to be hungrier at 7am. Until she is feeding better in the day, keep the feed at 11pm, even if only small, as you will then know she is not likely to be waking from hunger in the night and you can settle her using cool boiled water.

Feeding FAQ: 6-9 months – Formula Feeding

My daughter of almost 7 months is absolutely refusing to drink water

My daughter Ione is almost 7 months old. She was 71b 3oz at birth and currently weighs 151b. She is fed Hipp Organic Formula at 7.30am (6oz), 2.30pm (4-5oz), 6.30pm (7-8oz) and solids at 8am (half a Weetabix plus fruit purée/Ready Brek/baby cereal), 11.30am (7 cubes consisting of fish/chicken/turkey/pork with various vegetables plus yoghurt or fruit) and 5pm (7 cubes of vegetables plus a banana). She is fed 70% homemade and 30% commercial food.
She wakes at 7.30am, naps 9-9.45am, 12.15-2.15pm and has a catnap in the afternoon if required. She settles herself at all nap times and goes down at 7pm and has slept through consistently since she was 9 weeks (I have not needed to go to her once!).
My problem is that Ione will not take water I have tried 2 different beakers and tried buying diluted water (Heinz) and adding orange juice. She acts like it is poison and keeps her mouth firmly closed. When I pretend to drink from the beaker she will sometimes copy but most of the water will get spat out!
She is never constipated, seems to wee fairly frequently and doesn’t seem to be suffering healthwise. However, her lack of fluids worry me as her solids increase and her milk decreases.
Please help! Many thanks.
Miranda

Ione has been taking all her milk from a bottle and now is being offered water in a beaker. Unless she took water from a bottle in her first few months, she has to get used to two new ideas. It will take time, but persevere and keep offering her water every day. It is often easier to offer a very small amount of water in an open cup rather than giving it in a spouted beaker. Ione needs to learn how to sip water rather than suck it. All the spouted beakers require sucking. The ones with a valve inside which prevent leaks need a very strong suck to receive any fluid. This can be a cause of frustration in babies.

As you have noticed, Ione does not appear to be lacking fluids even though her milk needs will begin to decline. She will begin to need less fluid as she gets bigger so as long as you offer her water everyday she will gradually learn how to drink it.

Feeding FAQ: 6-9 months – Formula Feeding

My 6.2-month-old son is refusing his milk feeds but is unhappy and waking early

For the last month, my son has started refusing almost all milk feeds. He is offered a 7oz bottle at 7am and will only drink 4 to 5oz. I will then use the remaining milk to mix with his breakfast which is a whole weetabix. At 11.45am he will eat lunch ( I use all the recipes in CLB of Weaning). He will take 5 cubes of a savoury such as chicken risotto. He is offered another 5oz bottle at 2.30pm and will refuse the entire bottle. I give him his at 5pm; he eats half of it (I offer him five cubes of cauliflower cheese). He is then offered a bedtime bottle from which he will only drink 2-3ozs. At present he weighs 18lbs 5ozs.
By day he sleeps for 1 hour at 8.30-9.30am and another hour at lunchtime, between 12 and 1pm.
All this has resulted in early wakings and a very unhappy, unsettled baby. And I really do not know what to do next.

Your son’s early waking could be due to both not enough milk by day but also through falling asleep exhausted at 6.45pm. As he is not seeming that hungry for his breakfast milk he may also be taking in slightly too much solid food against his milk needs. Obviously when a baby seems to be uninterested in milk you begin to use milk to mix with his foods or offer cheese and sauces to help his intake. If he prefers solids to milk he will cut back on how much he drinks when offered formula. To get this balance right again you will need to make some adjustments to his solid intake. The effects of this are felt right through the day so adjusting each meal should help his intake overall.
As you have noticed a decrease in the amount of milk given at 7am and used the rest to mix up cereal, your son will be having quite a big breakfast which could be one of the reasons that he is cutting down on his milk later in the day. Offer him his milk and then half a weetabix mixed with some of the milk and maybe some grated fruit to help sweeten it.
Also cut down how much he eats at lunch by one cube and see if this makes him hungrier for his next feed. You could try giving this nearer to 3pm to see if he will take more.
Again decrease the amount of solids you offer at tea. Try dishes such as jacket potato and vegetable soups as well as cheese based sauces. Overfeeding at teatime is the usual reason for cutting down milk at bedtime.
With this slight decrease in solid food overall, your son should begin to enjoy three good milk feeds a day. Once he is taking better feeds by day, his total amount of milk needing to be about 20ozs, which includes milk used in mixing and cooking. Begin to increase the amount of solids offered but do so very gradually so he doesn’t begin to cut back on his milk again.
Also be aware of overtiredness as this can make a baby not want to feed properly. By evening your son will be very tired as he wakes at 1pm and is only sleeping two hours throughout the day. Giving him a small catnap of 10-15 minutes in the afternoon whilst out in his pram may help this, if he is not sleeping nearer to two hours at lunchtime. He may fall into an exhausted sleep by 6.45pm which is resulting also in the early mornings.

Feeding FAQ: 4-6 months – Formula Feeding

My son is 19 weeks and has suddenly and drastically reduced his milk intake

My 19-week old son sleeps well at night (from about 8pm to 7am), although I have to wake him and give him a full feed at 10-11pm. The problem is that up until three weeks ago he was taking 6-7 oz at each of his five milk feeds. However, over the space of about five days, he began to take less and less, and was down to about 2-4 oz from each bottle, except the last one at night which he usually finished. Nothing seemed to work to get him to drink his milk again – he would cry if I even brought the bottle near his face. I decided to try mixing some with baby rice and he took that fairly easily. Over the last two weeks I have introduced solids three times a day after his milk feeds in an attempt to try to get him to eat a bit more. He is almost exactly the average weight for his age, and takes his naps and sleeps well at night. What I am worried about is how to get him to drink enough milk. He seems much happier eating his solid foods than taking his bottle, and I always offer the bottle before the solids – he is still on five feeds a day. Why would a baby take against the bottle? Is it a mistake to have introduced three solid meals a day so quickly?

Joel’s sudden uninterest in milk could be down to lack of hunger. Often a baby suddenly just is not so hungry at the times he has been following for the past few months. Rather than trying to get him to take the bottle and meeting with resistance, wait for 20 minutes or so, engage him under his gym or on a play mat and then offer it to him. If he then takes more than he has been, you have solved the problem. The fact that Joel cried when he saw the bottle would seem to point to this.
Although Joel is sleeping well at night now after 10pm, his dramatic decrease in daytime milk could well cause him to start waking in the night needing more milk. As you began solids when he was 17 weeks old, the way they are introduced and the quantities given are very important. If you follow the plan laid out in the Complete Guide to Weaning, you will see that at his age he should still be getting most of his nutritional needs from milk, with the solid foods just being tastes of different vegetables and fruit and a little bit of filling from baby rice. Solids at this age are very much in addition to his milk not a replacement for it. Between five and six months he will begin to decrease his milk intake slowly as the solid food begins to replace it and more milk is used to mix cereals and add to sauces.
As a rough guide, by five months a baby should be taking 3-4 tsp rice and 2 tsp of pear puree at 6pm. At lunch he should have 3-4 cubes of a suitable vegetable.
Although he appears to enjoy his solid food, having too much without enough milk as well could cause him to become constipated. At his age he needs at least 20ozs a day of milk.
If you begin to structure Joel’s solids in guidance with his age, he should begin to accept his milk feeds again.

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.
Regards
Michaela

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.

Feeding FAQ: 4-6 months – Formula Feeding

Henry is four months and irritable between feeds, and too sleepy at 10pm

Henry is four months and he is more irritable between feeds, whereas before he was content. Up until the last week he has been contented between feeds, happy to sit in his chair and ‘play’ with his toys, only crying for food and sleep. However, he now seems to cry more in between feeds, I find the afternoons difficult as he is now tending to cry until he is picked up. Up until now we’ve deliberately tried not to hold him for lengths of time to avoid this problem occurring! I wake Henry at 7am, and he normally wakes happily. Again, up until recently, he was sleeping through from his last feed at 10.15pm to 7am, but he has been crying out (I wouldn’t really say he has been waking up completely) sporadically during the last week. When waking him at 9.45/10pm for his last feed (which we’ve started to bring forward from 10.30pm as per CBB instructions during the last 10 days) he seems to be in such a deep sleep that he doesn’t open his eyes and starts to scream and cry. The routine to waken him, which he has always responded to well up until now, is for me to unbutton his sleeping bag, turn the light and radio on low, and I potter around until he is awake. We leave him to cry, but he seems to get himself in such a state that we end up picking him up to cuddle him. This works two ways – he will either open his eyes, stop crying and be fine, or he’ll continue to keep his eyes shut, and cry until he eventually wakes. Once he is awake from either method he is always seems happy. I feel I’m waking him when he doesn’t want to be! But according to the CBB routine he must still have this feed until he is 4 months (which he now is) and on solids (which he isn’t). Why isn’t he finishing all of his feeds? Prior to Christmas I could guarantee Henry would finish each bottle. Now though after 5oz he gets distracted and sometimes will not take any more, or he’ll finish the bottle but it’s a struggle, he tends to keep putting his fingers in his mouth. This seems to be the opposite signal to what you would expect if he was ready for weaning. Is it because he isn’t satisfied by milk alone? – but surely if that was the case he would still finish the bottle? I look forward to your advice on these points.
Regards
Sarah

Henry is beginning to need a little more stimulation between feeds now that he is 4 months old. His vision is much better than in the early weeks and his hand to eye co-ordination is much more refined. Encourage his development with some different forms of entertainment. Does he spend a lot of time on the floor? Does he have a baby gym which will encourage him to grab and pull on the toys? Give him time on his tummy, which will strengthen his neck muscles and prepare him for crawling. If he has not spent much time on his tummy up until now, he needs plenty of encouragement, with short spells throughout the day. Help him to push up on his forearms by placing a baby mirror or eye-catching toy in front of him.

When he is on his back, roll him from side to side to encourage him to begin to move himself. If he wants to, let him “stand” whilst you hold him upright and he will probably bounce with his legs for a short while. Although rightly, you want Henry to amuse himself for periods of time, he needs different places to “play”, not just in his chair. Try to vary his position and view throughout his waking times.

Waking babies at 10pm can sometimes be difficult and it is easy to think that they are just not interested in feeding. Whilst he may be able to cope without much of a feed now, cutting it out too soon often results in babies beginning to wake earlier in the morning or going back to needing a middle of the night feed. Until he is well onto solids he really needs the amount of milk he is taking in 24hours. As long as he continues to settle well after the 10pm feed and need waking at 7am, it would be better to carry on the way you are. It can take a good 15-20mins before a baby wakes at this time. But it is well worth letting him come round properly, even if you feel he is distressed about being woken, as he will then feed well.

I noticed that Henry is still using a one month teat. This could be the cause of his disinterest in feeds. He is having to work too hard to get the milk out and gives up before he has finished. Buy one pack of the next size and see if things improve. If he still seems to lose interest I suggest you try a Variflo type. This teat allows him to feed at his preferred rate without him having to work too hard, or be choked by too fast a flow. It sometimes takes several tries with different sizes and types to find one to suit him.

Henry also is of the age when he can become easily distracted in a feed, especially once his initial hunger has been satisfied. Try to keep feed times quiet, possibly away from the bustle of the household. Concentrate on him, resist using the phone and try to use the time to relax yourself and have a quiet time whilst feeding.

Henry sounds a happy baby who is doing well, he is beginning to grow up a little now and has different needs from a younger baby. If you sense that weaning is approaching and you decide to wean before six months because he seems ready, discuss the options with your health visitor.

Feeding FAQ: 4-6 months – Formula Feeding

I think 18 week Alicia’s reflux is making her hysterical twice a day

I have some concerns regarding my daughter. She is 18 weeks old and she has two instances during the day where she can get quite hysterical! The first instance is after her morning nap. I wake her at 9.45am, gently rousing her without immediately picking her up. She is content for about 15 minutes then she starts crying and is only consoled by holding her over my shoulder. I would like to try and get her closer to an 11am feed but I am worried that she’s getting hungry. I don’t want to feed her too early as I want her to sleep well at lunchtime.
She is woken at 7am and given nearly 7oz of milk. The second instance during the day where she is really unhappy is between 4 and 5pm. She actually gets quite hysterical and I don’t know what is wrong with her. She takes 5½oz at 2.15pm. She also has 6-7oz of milk at 10.45-11am. She always sleeps well during her morning nap and always has to be woken up. Her lunchtime nap generally goes well but sometimes she wakes up and cries for 20-30 minutes. I never go into her and hope that she will settle herself back off. The only problem with this is that her brother of 25 months is in bed in the next room and I’m concerned he’ll be disturbed. Alicia is given a split feed at 5.45pm and 6.15pm of 7ozs as she cannot take it all in one go. We have just dropped her 10.30pm feed as she was down to 2ozs. For the last 5 days she has slept from 7pm to 7am and doesn’t wake up crying for her feed.
She weighed 6lb 2ozs at birth and now weighs 11lb 9ozs. She has only put on 6ozs in the last two weeks. The problem is that I cannot physically feed her more food. After 6ozs of food she starts griping with discomfort and looks in pain. Alicia, I believe, suffers from silent reflux and her GP has only just agreed to refer her. She is on Gaviscon Infant however I have noticed recently that she is bringing up milk again.
Should she be drinking more milk? Why is she so hysterical during those two times each day? Does the strict routine suit her or is she unwell? Can anyone help as her GP and HV are very reluctant to give me advice? Do I need to start weaning her? She chews her hands all day and her tops are always soaking wet!

I hope by now that you have a referral to a specialist. Reflux is such a distressing condition, and I can only sympathize with you over the reluctance of doctors and health visitors to give advice. Once her medication is sorted out I really feel things will improve for you, but times are difficult for you now.

I would suggest that you begin to feed Alicia at 10.30am at the latest. From my experience of reflux I find feeds spread out with a break of 10-15 minutes mid- feed can really help. Once she is really awake but before she starts to cry, begin the feed and then stop for a nappy change halfway and give her some time sitting in a baby chair to allow the first part to settle. Then offer her the second half by 11am.

I think her crying between 4-5pm is due to tiredness. Is it worse on the days when she has woken during her midday nap? Babies can be quite hard work at this time of day and need constant distraction. This is not easy when you are caring for your son as well and at this time of day need to prepare his tea. Do you think you could get her to have a short nap between 4.30 and 5pm? Has she a musical mobile over her cot which could amuse and calm her?

As regards weaning, it does sound as if Alicia is beginning to show signs of being ready to wean. I know in our last reply to you we explained why the guidelines have changed. I think weaning at this age should be discussed with your doctor, or better still at your specialist referral. There are specialist milks which can help with this condition, they are slightly thickened but obviously need medical diagnosis before being prescribed. They could well help Alicia feel more satisfied after each feed so that weaning need not begin just yet.

One of the symptoms of reflux is excessive drooling. As you say it is difficult to give Alicia more milk at each feed but she sounds as if she is getting hungry now. I hope this has gone some way to giving you some hope. Reflux is a subject which we are bringing to light, but unfortunately there is still a long way to go before it is more widely acknowledged in some professional circles.

Feeding FAQ: 4-6 months – Formula Feeding

My 5.5 month son will drink from a beaker but is not taking enough

Having had to return to work I have introduced Wilfred to drinking from an “AnyWay Up” beaker. This took him some time to adjust to but he will drink from it. However after nearly three weeks, he is still not taking enough formula through the day and is roughly one feed down. He was weaned at 4 months following the weaning book. He presently weighs 10kg.
After no sleep problems since he was 10 weeks old, I am now experiencing Wilfred waking at 5am. Today it was 3.30am and 5am. He will go back to sleep but only by sleeping with me. I tried giving him some milk in a beaker this morning to see if he was hungry or thirsty, but he refused.
I am concerned that he is in nursery and still not getting all the milk he needs by day. Should I try re-introducing the 10pm feed to ensure he gets enough?
Wilfred is having a breast feed at 7.30am and 6pm. During the day he is taking 90-120mls of formula at 11.30am, although this is the feed most likely to be refused. At 2.30pm he takes 150mls formula, most of which I get down him, but it takes ages.
His solids are 4 tsps porridge cereal mixed with formula and 2 cubes of peach; 2 cubes sweet potato, 2 cubes parsnip and 2 cubes courgette; 4 tsp of baby rice with 2 cubes pear.

In order for Wilfred to take more milk, try using a softer spouted beaker. There are plenty available on the market with spouts which are more like a nipple or teat. They are marketed as “bottle to cup” trainers and even though Wilfred probably has not had a bottle, he should find them easier to cope with. Sometimes it can be a bit of trial and error finding the right beaker for your baby.
The cup you mention is fitted with a valve to prevent spills, but he needs to have quite a strong sucking technique to get the milk out. Many babies older than Wilfred have difficulty with these valves when first using a beaker.
It may help Wilfred to have half his milk at 11am, a short break before his solids at 11.30am, and then be offered the rest of the milk. This “tier” method is used to get him ready to drop this feed when protein is introduced. He should begin to cut back a little on the milk as his solids increase at this time.
Now that you have returned to work and are only feeding Wilfred two feeds a day, be aware that your supply may have gone down. This is not uncommon when only two feeds are being given. Your days must be busy and you will have no time to rest during the day. If you feel your supply is not good, check after the 6pm feed by offering him a top up with 1-2ozs of either expressed milk or formula. If he readily accepts this you will know that your supply is low.
As Wilfred has begun to wake in the night and not always taking his minimum requirement of 20zs a day, you could try waking him for a feed at 10pm. By breast feeding him then, you will help boost your supply. If it is possible to express whilst at work, that also will help your supply to satisfy Wilfred’s needs in the morning and evening.
Once you are confident that your supply is still alright and Wilfred is taking more milk by day, decrease the 10pm feed by 5 minutes every few nights. Once he has begun to sleep through again for several nights in a row, you can stop this feed altogether.
When he wakes in the night try offering him water to settle him. This with a cuddle may help him settle back alone. Again we are sympathetic that you need your nights sleep if you are working by day, but it is worth trying to get him to settle alone rather than with you at night. This could quickly become a habit.
As Wilfred has also been weaned, it is important to get the balance of milk feeds and solids. He must not cut back too much on his milk yet. Structuring his increase of solids correctly is crucial as some babies will take more solid food than needed, and as a result cut down on their milk intake. Look at the case study of Polly in The Contented Childs Food Bible p78 which explains further ways to help you breast feed whilst returning to work, and also the introduction of solids in the right amounts.