Cereal & Bottle Ratio - Help Wording My Thoughts...

[blandino]

I have previously posted about a 12 week old with failure to thrive. He has seen the doctor and then diagnosed with hypothyroidism. They were trying rice cereal and different powder combinations to see of that helped with weight gain.

However, mom sends his bottles prefilled with just the powder ingredients and we add water. We were told that they are supposed to be 6 ounce bottles. Yesterday it didn't look like a lot of powder in the bottle, so I measured with a scooper and only counted two scoops. Texted mom and she said it was supposed to be a 6 ounce bottle, I made it following her directions and today it's back to three scoops I think there was just an error.

HOWEVER, during our conversation she shared how they are making the bottles. She said the current ratio is 2 scoops of formula - 1 tablespoon rice cereal - 6 ounces of water. Per doctors orders.

Today, I was thinking about it - and whenever I have had to add cereal to a bottle, it is always on top of the formula made with the standard ratio. And I know it is dangerous to dilute formula, especially when a child is having weight gaining issues. I would be doing 3 scoops formula - one tbsp cereal - and 6 oz water.

I want to send a message to the DCM (DCD picks up, and I feel more comfortable having this discussion with DCM). I just want to let her know that that's very different from any conventional wisdom, and that maybe there was a miscommunication between her doctor, and I just mentioning it to be safe.

This is what I have so far... "Hi DCM. Today I was thinking about the conversation we had about DCB's bottle mixture - and I don't want to overstep my bounds - But typically when you add cereal to a bottle, you do it on top of the formula made with the (1 scoop to 2 oz ratio) and not in place of the formula. The formula cans actually warn about diluting the formula. So i was just wanting to mention that there may have been a miscommunication there, as it is not standard practice. Obviously I am not pediatrician, but it just struck me as odd and I want to doublecheck"

I don't want to offend her, but also don't want to let it slide, since it is so vital to DCB's well being.

[melilley]

My daughter had severe reflux and we had to add cereal to her bottle. I can't remember how much, but it was to be added in addition to the correct amount of formula to water ratio. I would tell her what you said and if she refuses, I would request a doctors note stating what the ratios should be! If this child is failing to thrive you would think that they would want to add the cereal in addition to and not in replace of!

[Meyou]

My dd had cereal added for reflux as well and it was in addition to a normally prepared bottle. This doesn't sound right to me at all. I would definitely say something to mom and get her to check.

[familyschoolcare]

I would just say since bottles will be mixed differently than the can of formula says you need a doctor note so that you know nothing was lost in translation, and not even mention that you think the current ratio might be wrong. Make the doctor do the explaining if mom is mistaken.

[LaLa1923]

Here we would be required to have a docs note. Your right though about the formula and cereal. It's on top of. You want to add not replace. I added 2 tsp. box says 1-3

[Willow]

I would require a note detailing the child's diagnosis and the care plan associated with remedying it.

If you are on a food program and claiming this child's feedings you also need to have the doctor fill out an alternate diet statement detailing these changes.


I would not admit the child back until I had them. FTT is an unbelievably serious and life threatening diagnosis, definitely not something with any wiggle room. The parents need to be clear of the liabilities involved with any non-compliance on your end.

[nannyde]

I would tell the mom that from this day forward she is to bring a container of formula and a box of cereal and that you will make the bottles on site. I would not allow any premade bottles. It's dangerous and you are liable if it is done incorrectly.

Get a doctor's order for the exact amount and the frequency of the bottles and do it yourself.

There is a very very good chance that this mommy is doing this intentionally. I would not be a party to that in any way. On your clock it needs to be done properly as per doctors orders.

[Willow]

There is a very very good chance that this mommy is doing this intentionally.

I didn't want to say it but that's where my brain went too.....



Add to it it would be easy for a parent to claim to doc this can't possibly be an issue of merely being underfed by mom and dad because the child spends x amount of hours at daycare every day....without disclosing the fact that she's still the one controlling the feedings when the child is with you. She could easily be telling doc baby is eating 6 oz a feeding by you when in fact you're only feeding him a fraction of that.

No way would I be leaving myself to potentially be thrown under the bus like that or further risk the child's health.



Point blank and in writing notify them that:

1 ounce of prepared formula averages 24 calories, so by removing an entire scoop baby is losing close to 50 calories a feeding.

1 tablespoon of rice cereal averages 15 calories.

They are pulling 50 calories and only replacing them with 15 far less nutrient rich calories.

With how many feedings he should be having a day they've basically got him on a diet depriving him of 100's of much needed calories a day. If he indeed has hypothyroidism to boot this practice without a doubt would be making him lose weight even faster and could very well threaten his life.

[daycarediva]

There is a very very good chance that this mommy is doing this intentionally. I would not be a party to that in any way. On your clock it needs to be done properly as per doctors orders.

That's where my mind went as well. I would require a dr's note before he comes back monday and then request that a week's worth of formula and cereal be brought to you and YOU will make the bottles from start to finish.

That poor little guy.

[nannyde]

I would also find out if the child is on WIC. If the Mom is receiving free formula there is a chance that she is trying to make it last for the whole month or that she is selling off part of it.

I would also have to talk DIRECTLY to the doc about adding cereal. This baby is way too young to have cereal. I would need a doctors order to do the cereal. I would never take the parents word for it. I would also need a signed consent allowing me to have full access to the child's medical records and that both myself and the doctors office were allowed to talk freely at any time.

If the mom refused ANY of this: me make the bottles... full dr's consent for communication... and a note for the cereal addition and formula amounts with MAXIMUMs and as needed feedings in addition to the regular feedings... I would term immediately.

I would take charge of this kids feeding in my home completely. I would not allow the parents any decision of what I do and I wouldn't make decisions based on their declarations of when and what they have fed the child. I would start my feeding cycle when the kid came in the door.

I would also require a full spare can of formula in the pantry at all times. I would require ALL cans of formula and boxes of cereal be sealed when they come into my house. No partial or open cans or boxes.

There are way too many failure to thrive cases where the parent is doing it intentionally. They are doing it for money (to save money or make money on free cans) or they are doing it because they have something crazy going on in their head about their kid becoming fat. Some do it because they like the attention of having a sick kid....

Whatever the reason.. the parent is the first thing to look at. If the kid keeps formula down and eats well on your clock it should be gaining weight. If the parent is mircro managing it and making "mistakes" I would be suspicious. The parent with mental issues can do a LOT that comes back onto you especially with spiking the formula with non formula filler stuff or shorting the premade bottles. Make sure there is NO room for their mistakes and let them know that while in your house, the child will be free fed and they will provide everything you deem the child needs.

[LaLa1923]

I would also find out if the child is on WIC. If the Mom is receiving free formula there is a chance that she is trying to make it last for the whole month or that she is selling off part of it.

I would also have to talk DIRECTLY to the doc about adding cereal. This baby is way too young to have cereal. I would need a doctors order to do the cereal. I would never take the parents word for it. I would also need a signed consent allowing me to have full access to the child's medical records and that both myself and the doctors office were allowed to talk freely at any time.

If the mom refused ANY of this: me make the bottles... full dr's consent for communication... and a note for the cereal addition and formula amounts with MAXIMUMs and as needed feedings in addition to the regular feedings... I would term immediately.


I would take charge of this kids feeding in my home completely. I would not allow the parents any decision of what I do and I wouldn't make decisions based on their declarations of when and what they have fed the child. I would start my feeding cycle when the kid came in the door.

I would also require a full spare can of formula in the pantry at all times. I would require ALL cans of formula and boxes of cereal be sealed when they come into my house. No partial or open cans or boxes.

There are way too many failure to thrive cases where the parent is doing it intentionally. They are doing it for money (to save money or make money on free cans) or they are doing it because they have something crazy going on in their head about their kid becoming fat. Some do it because they like the attention of having a sick kid....

Whatever the reason.. the parent is the first thing to look at. If the kid keeps formula down and eats well on your clock it should be gaining weight. If the parent is mircro managing it and making "mistakes" I would be suspicious. The parent with mental issues can do a LOT that comes back onto you especially with spiking the formula with non formula filler stuff or shorting the premade bottles. Make sure there is NO room for their mistakes and let them know that while in your house, the child will be free fed and they will provide everything you deem the child needs.

I sent you a pm on FB about your infant schedule

[Country Kids]

Big, big question-how in the world do you guys get the doctors to talk to you? Dr.s in our area are very tight lipped and the patients have to sign off on things in order for them to talk to you and then it HAS to be a family member that is on the sheet.

I went round and round with drs. when my mom was in the hospital about this. They would give me NO information and I was her only daughter!!!! They kept giving all the info to the SO who for some reason they thought was her husband no matter how many times I told them he wasn't, I was her next of kin.

[blandino]

"Hi DCM. Today I was thinking about the conversation we had about DCB's bottle mixture - and I don't want to overstep my bounds - But typically when you add cereal to a bottle, you do it on top of the formula made with the (1 scoop to 2 oz ratio) and not in place of the formula. The formula cans actually warn about diluting the formula. So i was just wanting to mention that there may have been a miscommunication there, as it is not standard practice. Typically it would be 3 scoops formula + 1 scoop cereal + 6 oz water. Obviously We are not pediatricians, but it just struck us as odd and I wanted to double check.*

A scoop of formula is 50 calories, and a tbsp of cereal is 15. So by eliminating one scoop of formula, and replacing it with cereal the bottle is losing 35 nutrient dense calories. So it seems like it would be doing more damage than good. So if that is what your pediatrician wants DCB fed, then for DHS we will have to have a doctors note stating that the formula to water ratio needs to be changed for his bottles.

DCM called the nurse, and she was wrong about the bottle measurments. And was very grateful that I brought it to her attention. Bottles will be prepped using the correct ratio now.

THANK YOU LADIES for making me feel super confident in confronting her. DCB will be better off for all your help.

It is funny because we used to make bottles at daycare, but thought it was less responsibility to have the parents make them - that easy we couldn't be held responsible for what was in them, however this has changed my mind.

[Willow]

Excellent outcome, that had to be a really tough one to confront.....

To be on the safe side it wouldn't hurt to be extra vigilant and document every feeding and amount, at least until this peanut is out of the woods health wise.

[daycarediva]

I still question the adding of cereal. My ds was a preemie and we added calorie (and nurtrient rich) formula to increase the calories, per the NICU specialists guidelines.