Feeding FAQ: 4-6 months – Formula Feeding

How can I get my 4mth daughter to take better feeds especially when we are out, now her reflux is being controlled?

From birth my daughter was always very good at feeding and would finish every bottle, until she got to approx 10 weeks when she started to take less and less, and then would start to scream, shake her head and flatly refuse to take the bottle, her body would go stiff; eventually after this performance at every feed she may take a couple of ounces. But when offered water from the same type of bottle with the same teat she would drink this immediately but the moment we swapped bottles, even before she tasted the milk she would start to scream, she was never sick and the moment you stopped feeding her she was completely happy again. The heath visitor suggested she may have reflux and we were referred to the GP who agreed that this could be the problem and put her on Gaviscon, we tried this for 1.5 weeks but it made no difference and the problem seemed to be getting worse, (in the meantime we had also tried different teats and bottles). We went back to the GP, as she was dropping weight, and showed her exactly what happened when we try to feed her, she was shocked and couldn’t understand how she would take the water and referred us immediately to the hospital. At the hospital they also decided that it must be reflux and put her on Ranitidine, they said that after a few days she should be back to normal. She did start to take more feed gradually but then started to drop oz’s again, I spoke to the doctor after her taking the medicine for 7 days and she said for 48hrs don’t try to force her, just let her take the amount she wants from each bottle and then she may realize she’s hungry and start to feed. She has now started to feed better, we don’t have the screaming anymore, but each feed is hard work and she never seems comfortable when having her bottle and she will never take all of her feeds fully and has gone from taking 30oz a day 4 weeks ago to taking 20-28oz if we are lucky now. I wanted to know if you think a baby with reflux should be acting this way with her feeds, or if you have any suggestion?
But the real problem is if we go out she will not feed all, she may possibly take 1oz, so we have resorted to not go out around feed times because we feel she cannot afford to drop this amount of milk when she is already not taking enough, so therefore this has become very restricting and we never seem to be out of the house for more than 1hr.
She also will not sleep any more than 35mins at a time and when she wakes she absolutely screams (she never used to do this), so the midday sleep is a nightmare, sometimes I can get her back off after 20-30 minutes of battling for another 35 minutes. (I feel like most days I spend 2hours in a dark room!) This has been going on every day for over 5 weeks, I have tried catching her when she is stirring, I have tried letting her cry for 5-10 minutes then re-settling her and repeating, I’ve tried letting her sleep in her bouncy chair, swing chair, but nothing seems to work. I would be quite happy for her to have another nap after her 2.30 bottle, but no matter how tired or grumpy she is, she will not go back to sleep until around 4pm, and then between 5-6pm she is so grumpy I seem to be continually holding her.
Please could you give me some advice because at the moment I feel like I am in a vicious circle and never being able to go out to enjoy things with my baby because I am constantly worrying while we are out is she going to feed/sleep.

Although your daughter’s problems with reflux are being helped with medication she may take better feeds if she is fed little and often. Most reflux babies seem to take more milk this way. This means you will need to split her feeds, which will help her take more milk overall during the day but without getting too distressed and uncomfortable.

When she has her first bottle at 7am let her have 3-4ozs and then give her a 20-30 minute break. You may like to get her washed and dressed at this time, or give her a time of sitting in her chair, so she begins to digest her feed. Then offer her the remaining half (i.e. 3-4ozs) around 7.30am.

Her morning sleep is not long, due to the sleeping problems you are having. But it should not affect her too much by this age as the nap only needs to be 45 minutes’ long at the maximum.

Offer her milk at 10.30am and again give her 3-4ozs. Let her have a time of kicking on the floor if she likes to do this and then give her the rest of her feed by 11.15am. Before she settles down to her lunchtime nap offer her a top up. Although you may feel that it is not hunger causing her to wake, even 1-2ozs at 11.50am could help her get over the 30-minute point and be able to settle for a longer nap.

At 2pm divide the feed again, leaving 20-30mins between each part.

As your daughter is tired and miserable between 5pm and 6pm put the split feed back so she has milk at 5pm and then a break before her bath. Give her the rest of her feed once she is ready for bed.

There seems to be no mention of a 10pm feed in your notes. This feed is not usually dropped until a baby has been established onto solids for at least two weeks. Your daughter may be very tired at this time and only take 2-3ozs but if you offer it to her as a “dream” feed, so she hardly wakes, it will add to her total overall daily intake.

By giving these breaks and split feeds your daughter should be able to take at least 30ozs a day, if not more. Getting in odd ounces now and again can seem fiddly but it should help her generally to cope better with a larger intake of milk.

On the days when you want to be out over a feed time, or part of it, why not give her the first half at home and then offer her the second part of her feed within half an hour or so. If you use an insulated carrier, and make sure the feed you are taking with you is no more than an hour old, this should not be too difficult to arrange. It may mean making up one feed into two bottles but this is worth it if it means you can get out a little more.

Until your daughter is a little more settled with her feeding it may be an idea to try to do most of her feeds at home. This can seem restricting but in a week or so, if you use the above method, her intake should have increased enough for you to be able to take her out more. Some babies of this age can get very distracted when feeding so, if possible, feed her somewhere quiet and away from a lot of activity.

The time that your daughter was beginning to have trouble with reflux probably coincided with her sleep cycles changing. This happens around 10-12 weeks of age. A baby begins to come into a lighter sleep after 30-45 minutes. In order for the lunchtime nap to take place, it will take persistence on your part to help your baby learn to settle back again into a deeper sleep. At the other two naps in the day it should not be such a problem.

By offering her a top up before settling at 12 midday she may be easier to settle back when she stirs. Take a look at the article on the Lunchtime Nap on the website. It may mean a period of you taking her out in her pram and walking for the first hour of this nap. Just remember that whatever you decide to do it must be consistent, in order to work. It may mean two weeks of a daily walk, or ten days of letting her cry down as she learns to settle again, but whatever you do decide to do, carry on with it, even if you feel it is showing no signs of improvement. Many mothers will tell you that, suddenly, the lunchtime nap falls into place once they have tried a way to consistently improve it.

If your daughter is in her cot at home make sure she is well tucked in. Her Moro reflex may still wake her when she is in her light sleep. If you use a sleeping bag, place a sheet over it and tuck it well down each side of the cot.

While she still fights sleep at lunchtime, try taking her for a walk early in the afternoon once her bottle is finished. She is more likely to doze off for 20-30 minutes in her pram at this time than be settled back into her cot. You could then let her have another catnap in her chair towards 5pm, to prevent her becoming too tired by bath time.

Use a wedge under her cot mattress or rolled towels even when in her pram so she lies at an angle, not flat. This will all help her be more comfortable should her reflux still continue to bother her.