Baby won't accept breast nor formula - help!

[jayh87]

My baby started training for breastfeeding last week. His suction is pretty strong, but I noticed that nothing seems to come out of my boobs, and he would grown very frustrated, even though I know I have milk and can hand-express it with ease. The pediatrician came to examine us and saw that my nipples are very short. Not inverted, but short nevertheless. He laches and does his best, but it's hard for him. It doesn't help that he is still mildly dependent from extra O² and gets tired.

So we are complementing his diet with formula... Which he would eat at first but now refuses and promptly vomits it after drinking like half the cup. He lost 85 grams.

I'm at my wits end. We tried every breastfeeding position. I tried a nipple shield that is supposed to help with short nipples. I tried increasing the supply, and tried to hand express on his lip, and pinch the nipple to put it directly in his mouth. The lactation consultant came when I ask and spent an hour trying to make him eat, and he won't. He vomited on the Fonoaudiologist when she said she could feed him the formula that I couldn't. Idk what to do anymore, the professionals couldn't help me nor Google.

Edit: baby is now 35 weeks

 

[clstan]

@jayh87 This probably isn't helpful, but I ended up almost exclusively pumping because my son was not efficient at nursing. No tongue ties or lip ties. The lactation consultant estimated he was only getting 5-10 mL from me before giving up.

But pumping worked out pretty good. There's an Exclusively Pumping subreddit if you want more support with it.

We also used informal peer to peer milk donations. There's Human Milk for Human Babies but I had better luck just posting on my personal Facebook page with my struggles and three people came forward with their milk. I couldn't pump enough on my own. But informal milk donations does have its risks.

My other suggestion would be to reach out the hospital where your baby was in the nicu at. They most likely have a dietician on staff that can give suggestions. Even though my son had not been in the NICU for a few months, I messaged them about formula recommendations and they were happy to give me advice and recommendations.

 

[bringmetothelight]

@clstan This here: If you plan to breastfeed you should start pumping this will maintain your supple baby can have it easily and when they are stronger you can again try latching… I pumped for my nicu baby till they were 2.5 months adjusted and then slowly they shifted exclusively to breast… it takes time and patience and effort but you can do it

 

[gisellemartinez1]

@clstan I ended up exclusively pumping for 15 months. r/ExclusivelyPumping was an absolute life saver for making it that long. I wouldn't personally recommend peer to peer milk donations for a NICU kid though, and many NICUs won't accept it.

 

[clstan]

@gisellemartinez1 Oh no, if they're still in the NICU, I also wouldn't recommend peer to peer. I would only recommend it once they're out and are not as immunocompromised. Unfortunately, official milk banks are often unobtainable due to cost and scarcity.

I combo fed with my own breastmilk, donor milk, and formula. It was during the height of the formula shortage and despite pumping 8-11 times a day, I wasn't producing enough milk. I had this wonderful donor who donated to us every other week and she really saved us. I ended up being friends with her afterwards and I'll always be grateful for such an intimate gift.

 

[nickmanwithaplanb]

@clstan I came here to say this. Not that you have to be excited that this is an option OP, but it is a possibility many people don’t know about because lactation consultants and pediatricians don’t really present it.

My little one never latched and we didn’t have a lot of obstacles stopping us. He just didn’t. I got on an exclusive pumping schedule and we’ve been doing great! He’s gained a ton of weight, I get to know exactly how much he’s getting, still getting breastmilk, everyone can get in on the fun of feeding him…etc. there’s a sub (r/Exclusivelypumping) if you want to come check us out. It’s a great supportive community.

Again, not saying this is what you should do or don’t have the right to feel frustrated. It’s so frustrating. But might be something to think about!

 

[sirsteve]

@jayh87 The obvious third option would be expressed breastmilk in a bottle. Have you tried that? I’d also recommend doing a weighted feed with some breastfeeding sessions. They aren’t super reliable but can give you some idea of what your baby is drinking.

How old is your baby currently? It can be quite hard for premature babies to get the hang of feeding. Doesn’t necessarily mean something devastating, they may just need more time. Before desperation sets in I’d ask for a conversation with the NICU doctor or nurses and ask how they are these setbacks and how they intend to deal with them.

 

[jayh87]

@sirsteve I tried that, but the issue is I produce very little (he eats like 45ml and I make 15ml tops). I was hoping that when I started breastfeeding it would increase, but since I haven't been able to do that, no success lol. I also don't always have time to pump or hand express like I used to because it takes soooo long to feed him since he keeps refusing, and by the time we finish I have to comfort him for a while. Sometimes he just spills it all or vomits and I have to change all his clothes, then he gets fussy for a long time. I'm choosing to use the little time in between those horrendous feedings to sleep and eat

I will suggest to the nurses that we weight him before and after. It surely would give me some peace of mind to know how much he is actually getting.

He is 35 weeks, but born at 31+3 I was told he had fetal suffering while in the belly and didn't grow as much as he was supposed to, so he acts more immature than he is. Apparently they were not very concerned when I brought up he isn't eating one way or another, until they saw how much weight he lost. Now idk

 

[sirsteve]

@jayh87 I don’t think it’s realistic for a young NICU baby to increase your milk supply by nursing. They’re just too weak to do that. That’s why moms who want to breastfeed a NICU baby need to exclusively pump.

35 weeks is still quite young for feeding in the NICU. In our NICU the earliest they started with bottle / breastfeeding is 34 weeks and then only if they are on low flow. It would be highly unusual for them to get it at this time. Even our 29 weeker couldn’t do that (even though he was pretty much a champion feeder and went home at 37+6 without a NG tube).

What I find confusing; doesn’t your baby have a NG tube anymore? Because you mention losing weight. At this point it would be expected that he doesn’t drink full amounts, so anything left can be given through his tube after the feeding. Don’t they do that at your NICU?

It sounds really rough that the feedings are so difficult and that you don’t get any time in between. I know I personally did only 2 feedings a day and then kangaroo care in between. My husband then did the same at his visiting time. Any other feeding sessions were done by the nurses. Though at that time they only offered oral feeding for about half his feeding times; otherwise it would be too tiring. I think the feeding schedule shouldn’t compromise your personal care and sleep, and not your pumping times either. I would ask the nurses for clarification of what exactly they expect from you in this regard. Do they really want to offer oral feedings at all times and do you need to be the one to do it every time?

I also find it a bit worrying that your little one finds oral feedings so hard right now but that you need to offer so often and continue for so long. We always had to cap feeding time at 10-15 and later on 30 minutes because otherwise it would be too exhausting for him. NICU babies can sometimes get an issue called oral aversion. It’s a problem where they dislike getting stuff in their mouth. The cause is usually unpleasant oral experiences, like ng tubes but also unsuccessful feedings. It can really interfere with feeding but also with eating solids later. I would want to clarify with the nurses if this is really the way they want you to feed your baby. Because in our case when he wasn’t feeling it for that session we would just stop and give his milk through the ng tube, and try again the next time.

 

[jayh87]

@sirsteve So apparently all that's left to do for him is learn how to feed consistently, either by breast or bottle, and to breathe without the o². So they just took both tubes out. The O² is occasionally put back because even though he only needs the minimum amount he still I saturates without it. But the NG tube is totally a goner.

It might be different for other people but in my country and the hospital we are in, the lead doctor makes a plan for all the babies and the nurses and parents just follow. Our "plan" is trying to stay with O² off as much as possible and gradually decrease dependence on it, and on the feedings I'm expected to breastfeed for 20 minutes and then make him drink from a 45ml bottle of formula, as much as he can. But since it's been a battle every time to get him to start sucking and then another battle to make him drink the formula, it takes much longer than it should. It's not that they make me spend that amount of time, but the goals I'm supposed to reach end up taking that amount of time, if this makes sense

 

[sirsteve]

@jayh87 I see! Yeah that’s a pretty different approach to what I experienced. Here they only take the ng tube out once the baby has mastered feeding. In our case it was the day before discharge. Out of interest, what country are you in?

 

[jayh87]

@sirsteve Brazil

 

[cavalier83]

@jayh87 Ok, so here’s what I think you should consider. Always pump after breastfeeding and be pumping at least 8 times per day, about every 3 hours. It’s very important not to force your baby to take a bottle, this can cause a feeding aversion. Feeding aversions happen when the baby starts to associate negative feelings and experiences with the act of eating. It can cause him to refuse the bottle altogether and even vomit. You could also try a different kind of formula - something hypoallergenic. Research cue based feeding. Advocate for this strategy with your doctor. I wish you the best of luck!

 

[razel]

@jayh87 Hi mom! You’re doing great already. Since he’s vomiting, it makes me think he may have reflux or is swallowing some air when he’s feeding. Maybe getting evaluated by a feeding therapist or possibly assess for tongue tie. An SLP or pediatric dentist will be able to assess for that. If the vomiting doesn’t stop- maybe a GI. The suck swallow breathe coordination doesn’t always emerge until they’re term, he may just need a few weeks of practice you’ll get there! Good luck!

 

[jayh87]

@razel Oh, he has lots of hiccups and gas too, so this might very well be the issue. Poor little guy :c I'll address that then

 

[joyp]

@jayh87 My biggest piece of advice is to take your time and take it slow. It took my baby 2 weeks to figure out breastfeeding, he would latch but fall asleep immediately. A nipple shield really helped him, I think because it has a similar texture to a bottle nipple. Preemies take time to figure it out and their mouths are so small and breasts are so big for them that nursing can be really tough. Can you pump bottles and mix the formula into your breastmilk as a fortifier? Then he won’t be having straight formula which maybe doesn’t agree with him. He also may be vomiting from stress so only give him a small amount from the bottle at a time and work up to it more slowly.

I strongly recommend only trying for 10-15 minutes and then taking a break/using a bottle or tube feed until the next feed. I’m surprised that the NICU staff would try for an hour or push him so much when he is still on O2 and gets tired easily. When my baby fell asleep trying to nurse, I wouldn’t wake him up, I would just cuddle him, sing to him, and let them turn on a tube feeding while I held him. One of our NICU nurses told us that babies who are pushed too hard and made too tired can actually develop an aversion to breastfeeding/bottles. So take it really slow and keep trying in short bursts. I’m sure he’ll figure it out as time passes and he grows.

Eta: my baby was 36 weeks when he figured out breastfeeding. He was just too sleepy prior to that.

 

[qwx]

@jayh87 How old is baby now?

 

[ashley2011]

@jayh87 Can you try pumping milk and bottle feeding? If he won’t take that bottle either, you can fill a syringe and feed him directly in his mouth until he figures out breastfeeding for himself. Sometimes it takes a while and is horribly frustrating. Hang in there.

 

[goldladyslipper]

@jayh87 Try wearing Medela Therashells with the small holes in your bra. They draw your nipples out. After a while of nursing your nipples will change shape. Mine used to be flat and sure aren't now. Also using a hand pump before nursing to get letdown and latching baby when the milk is flowing can help an impatient baby. Also make sure your baby isn't tongue tied. When you try a bottle does he kind of chomp it? Does it leak at his mouth?

 

[jayh87]

@goldladyslipper He doesn't chomp it... It does leak, tho. But the Fonoadiologist examined him and said he isn't tongue tied. I have those shells! I was worried though because here they are called excess-milk collectors and I thought it meant they would reduce my production. I can't afford to decrease it, it's pretty low already. If they don't, I'm happy to use it.