Feeding FAQ: 4-6 months – Formula Feeding

My daughter of 5.5mths has taken to solids well but it is a struggle to get her to take 20ozs of milk in a day

Until six weeks of age my daughter was fed with expressed breast milk. This was due to latching problems in the early days as a result of early medical problems. My supply began to dwindle and by 11 weeks my daughter was fully formula fed. Once the change from breast milk to formula began to take place my daughter became a fussy bottle feeder and had problems with constipation. Due to this condition I was advised to switch formulas twice as lactose intolerance and colic were suspected. On further medical advice from the pediatrician who had cared for her at birth I changed her formula back to Aptamil from the soy based formula and commenced weaning, which had been advised by a GP on call. My daughter weighed 6kg at the time and was 4 months old. Once back on Aptimel my daughter began to drink formula again but in same manner as before, i.e. often difficult to get her started, drinks a bit then cries. I began to wean her using the Contented Weaning Guide and she really took to solid food. As an added bonus she now has a stool movement almost every day.

I’m now at the 4th day of month 5 to 6 of weaning and she really enjoys solid food. However there are still difficulties around her bottle feeding. Most days I have to really press her to take her bottle or she would not get 20 ounces of formula. Her first feed is generally ok, although sometimes she has to be coaxed. From her second feed onwards however it can be hit or miss. Occasionally she’ll open her mouth and take the bottle without difficulty, more often however she will close her mouth or cry when she sees it, however if I persist and she gets started she’ll take anything from 2 to 7 ounces. She usually wakes between 7am and 7.30 am and so has her 1st feed around then. However she can easily refuse her second bottle at 11am if allowed to but will happily take her solid food. I find myself making excuses such as she’s teething or she had a big feed last but I seem to be always making excuses. Over a week ago she was refusing a lot of bottles but taking solids and after 3 days of this I brought her to the GP who diagnosed a sore throat and prescribed an antibiotic. Today is her last day taking the antibiotic but she is still difficult when it comes to taking her formula. At her 1st feed today she took 8 ounces with 1 break. I haven’t started breakfast yet as she is not showing signs of hunger before her second feed and don’t want to make the feeding even more problematic. At her second feed she took 1.5 ounces then started to cry and push the bottle away and it took another 40 minutes and many attempts (accompanied by crying and pushing away) to get her to drink another 3.5 ounces. After this she took 4 to 4.5 cubes of sweet potato, swede and green bean very easily. But the length of time feeding took will either push back her 3rd and 4th feed or make her less hungry if I deliver them on schedule. I would really like some advice on what to do. I’m considering cutting out solids to see if that increases her hunger for formula. I don’t want mealtimes to be a fight where she cries and I try to coax her as I feel this is very unhealthy in the long run.

Her feeding is usually at 7.30am 6-8ozs; 11am 4-6 ozs followed by solids, 2.30pm 4ozs, usually taken with a break of about 30 minutes in the middle, 6.30pm 7ozs, with 3ozs extra used to make up her baby rice. Again this feed is taken with a break mid feed. On most days her intake is 20ozs or less. I feel to get anymore milk into her I have to really coax and persevere with the bottle. She weighs 15lbs.

My daughter naps at 9-10.30am, 12.30-2pm and 3.30-5pm. She settles at 7.30pm and sleeps until 7am.

It can be very distressing and worrying when you feel that your baby is not taking enough milk in the day, and feed times become a time of stress for you both.

As your daughter has had issues with constipation since moving onto formula she may well associate drinking with the pain she experienced over those weeks. When a young baby receives milk into the stomach it causes a reflex action to occur in her lower digestive tract. This usually results in a baby pooing either during or fairly soon after a feed. Switching to formula from breast milk can often cause constipation. Unfortunately for your daughter she suffered badly and it was not alleviated easily. The pain she may have felt when trying to pass a poo could have occurred as she was being fed, hence her reluctance to drink from her bottle. The association with being uncomfortable whilst drinking still remains. At least the weaning process has settled her system into being more regular and comfortable for her.

At her weight and age taking 20ozs is the daily minimum requirement. Providing she is gaining weight steadily – at her age this should be around 5ozs [150gr] a week which begins to drop after 6 months to 3.5ozs [100gr] a week – she is taking in enough milk for her needs. It is just the struggle to do this on a daily basis which must be frustrating for you.

One thing you may not have tried is using a different bottle and teat. Avent teats are made of silicone which is fairly firm. There are bottles on the market manufactured by NUK which is a German make. Latex teats are available for these bottles. As well as their orthodontic shape, they are much softer and often more acceptable to some babies. The bottles can usually be found in independent chemists as well as in some larger chain chemists. The narrow necked ones come with the latex teat, although they are more messy to make up the feed. It would be worth buying at least one of these and seeing if it helps your daughter take her milk without such a fuss.

Now that you are well into weaning your daughter you can also use a little formula in her food. Already you are using milk to mix her baby rice which is adding 3ozs to her daily total. You can help boost her intake by mixing an ounce of formula into vegetables before pureeing. As she is reluctant to take milk from a bottle, adding it to her food is a good way to proceed. Once she is over six months you can begin to use cheese and yoghurt, both of which will boost her intake.

Now your daughter is taking 4 cubes or more at lunchtime you can begin to use the “tier method” of feeding. It is described on page 25 of the weaning book. You may have been reluctant to do this if you thought that your daughter would fill herself up with solids and not accept the second part of her milk. The reason this method is introduced in the fifth month is so your baby will gradually cut down on the milk taken at this feed, and be ready to drop it altogether when protein is introduced at six months. The milk feed is then replaced by water or well diluted juice. Offer your daughter 2ozs of milk at 11am and then wait until 11.30am before giving her half of her solids. Try her with her milk again and then finish up her solids. She may not take a great deal more at this time but may be more willing to accept her bottle without such a fuss. If formula has been used to mix her vegetables to the right consistency this feed should be around 5-6ozs overall. Have a look at the question and answer on page 35 of The Complete Weaning Guide for more about feeding in this way.

The feed at 2.30pm is often a smaller one so by giving your daughter a break in the way you are already doing, although it means the feed is rather prolonged, is the best way to go. Let her have a free kick mid feed. Encourage her to roll from side to side and let her spend some time on her tummy. This will all help her use up some energy and perhaps not have such a struggle when offered the rest of her feed around 3pm.

You could also split the 6pm feed. Take a look at the question and answer on page 33 in The Complete Weaning Book. Although the problem described is not the same as yours, by offering your daughter two thirds of her milk followed by her rice and fruit at 5.30/5.45pm, and then waiting until after her bath to give her the rest of her milk feed, you may help her take a good feed at this time.

Your daughter is sleeping well at night which shows that although her milk intake is on the low side she is not hungry. If she was, early waking may well happen. She also sleeps well in the day so her needs are being met.

Because you are aware of her need for the right amount of milk it is easy to be tense and stressed at feed times. This will be apparent to your daughter who has never found it easy to take a bottle, whether due to her early problems with constipation or not. Sensing your tension may make her reaction to the bottles more extreme. Trying to remain calm and positive whilst offering her a bottle is important. In your notes you state she takes her first two ounces and then has a break, in her chair. The rest of the feed is taken in her chair with you chatting and smiling. This is a good way to help her. You may also find it helpful to have a CD of nursery rhymes or children’s songs playing as you can sing along to them whilst feeding her. This should relax you both. Sometimes walking from to room holding her whilst offering her the bottle will also help her to drink more. She will be distracted by the movement and what she is looking at so may be less likely to put up such a fight each time.

Your daughter has had a difficult start in life but once she is fully weaned you will be able to use milk in many ways when preparing food for her. She may always find drinking milk not really a pleasure although, if she does still associate her bottle with discomfort, her reluctance may disappear once she is weaned to a cup.