Weaning too early

[Pestle]

I've got a tiny (tiny, tiny) 5 1/2-month old. She's had great head control since she started at 3 months. She was not taking a bottle until she started care, and we had a challenging first month as she adjusted. Now she does fine on the bottle but still just 1-3 ounces per feeding.

The parents put her on solids a couple of weeks ago. I don't know how many different foods they introduced. Now they've pulled her off everything except for oatmeal because of digestive upset. They left her with oatmeal today and verbal instructions to feed it to her once in the AM and once in the PM. What I didn't realize until I dug into her bag to deal with a diaper blowout was that they also left a tub of formula with written instructions to mix it with the milk at a 1/3 ratio.

That doesn't make sense to me. Why not reconstitute the formula with water and add it to the milk? Is adding the formula directly to the breast milk common?

As far as the oatmeal goes--and any solids--she's got a wicked tongue thrust reflex. This is pointless and it's just creating a mess.

When they pick up today, I'll ask them for clarification about adding the formula to the breast milk. I want to tell them that I'm not going to feed her any solids, including the oatmeal, until she outgrows her tongue thrust reflex. Is that how you'd handle it?

I am ASSUMING there's a supply issue and that's why weaning is being rushed and formula is being introduced, but I'm going to find out from them at pick up if there was a doctor who had input on this decision and how it's being executed. I've had one who went on formula due to a supply issue and added rice cereal to it due to aspiration, but they didn't introduce solids early.

[Pestle]

FYI, tongue thrust reflex was the struggle to get her on the bottle, too, and it's how I know she's done after an ounce or two. She usually feeds twice--1/4 to 1 ounce, then pushes the bottle out and goes berserk if I keep offering it, and then once I change her or give her some tummy time she'll take a few ounces.

[Leigh]

I've got a tiny (tiny, tiny) 5 1/2-month old. She's had great head control since she started at 3 months. She was not taking a bottle until she started care, and we had a challenging first month as she adjusted. Now she does fine on the bottle but still just 1-3 ounces per feeding.

The parents put her on solids a couple of weeks ago. I don't know how many different foods they introduced. Now they've pulled her off everything except for oatmeal because of digestive upset. They left her with oatmeal today and verbal instructions to feed it to her once in the AM and once in the PM. What I didn't realize until I dug into her bag to deal with a diaper blowout was that they also left a tub of formula with written instructions to mix it with the milk at a 1/3 ratio.

That doesn't make sense to me. Why not reconstitute the formula with water and add it to the milk? Is adding the formula directly to the breast milk common?

As far as the oatmeal goes--and any solids--she's got a wicked tongue thrust reflex. This is pointless and it's just creating a mess.

When they pick up today, I'll ask them for clarification about adding the formula to the breast milk. I want to tell them that I'm not going to feed her any solids, including the oatmeal, until she outgrows her tongue thrust reflex. Is that how you'd handle it?

I am ASSUMING there's a supply issue and that's why weaning is being rushed and formula is being introduced, but I'm going to find out from them at pick up if there was a doctor who had input on this decision and how it's being executed. I've had one who went on formula due to a supply issue and added rice cereal to it due to aspiration, but they didn't introduce solids early.

Adding formula directly to the breast milk may be a way of boosting calories. Mixing it with water first would not allow as many calories into the feed.

[Cat Herder]

I would be required to have a medical statement to mix formula into breast milk. I would also be required to have a statement to add cereal to a bottle of formula.

Cereal and commercial infant foods are not needed during the first year.

Cereal fills an infant up with empty calories that limit the intake of the nutrition the breastmilk or formula offers.

I would not agree to any of that. :hug:

Parent information:

Solid foods are started between the ages of 4 and 7 months, when the infant is ready. The infant should be able to sit without assistance and turn its head from side to side to show fullness. Be sure that the infant can accept food from the spoon without the tongue pushing the food out of the mouth. Avoid starting solid foods too early. Starting solid foods too early means the infant does not get the calcium, protein, and iron that are important for growth. Solid foods can be a choking hazard. Solid foods should be introduced to an infant gradually. Iron-fortified rice cereal is typically the first food given to a baby because it rarely causes an allergic reaction and it is easy to digest. It is also a good source of iron and B vitamins. Do not add solid foods or cereal to the infant’s bottle. This can cause choking in young infants.

[hwichlaz]

Are you misunderstanding the instructions?

I'd have read that as 1 ounce of formula to 3 ounces of breastmilk.

[Pestle]

Yes, that's what she meant. It's due to a reduced milk supply. Her mother says she eats at home with no problem, but I'm confused; it's definitely a tongue thrust reflex.

[childcaremom]

My dd (who was a prem) had formula mixed into breast milk in an attempt to boost her caloric intake. I don't remember the ratio but it was set specifically to her weight, etc.

I would def. double check with them. Maybe even ask for a doctor's note?

[childcaremom]

Yes, that's what she meant. It's due to a reduced milk supply. Her mother says she eats at home with no problem, but I'm confused; it's definitely a tongue thrust reflex.

I would get them to show you how she eats.

[jenboo]

Mixing the powder with the breastmilk is done to boost calorie intake. I'm a firm believer in not feeding solids before 6 months. I tell all parents that i won't feed solids here until 6 months.

Food before 1 isn't needed nutritionally, but it is very important for children to be exposed to the textures and taste.

[hwichlaz]

Pumping is hard for a lot of women. Combo feeding is often necessary. I bet they originally started solids early because of a supply problem, and when that didn't work out so well for little one they had to combo feed. <3

[Cat Herder]

Another parent resource:

"Some mothers mix powdered formula with their breast milk in order to increase the calories their baby gets during a feeding. Please do not do this! Not only does it change the composition of the breast milk, but the micronutrients in the formula will become so much more concentrated that it can be very hard on your baby's immature kidneys. Always follow the exact directions on the can of powdered or concentrated formula, and never mix formula with anything but distilled water." - lactation consultant

https://www.babycenter.com/404_can-i-mix-breast-milk-and-formula_8883.bc

[happymom]

I don't know if this helps, or if this is something you allow as a daycare provider...

I was a pumping mom and started struggling with supply around that age. I would pump at work and take the milk home and divide it into 3 bottles, then I would mix 4oz of formula in a separate container to the directions/with water and THEN add it to the breastmilk and send to daycare.

This gave bigger bottles, still more than half breastmilk. In the end I only used ONE CAN of formula and it helped me get through the first year without going insane.

[Pestle]

Yes, the formula is being reconstituted and then combined with the breast milk instead of dumped right into the breast milk. You're right, hwichlaz; they're trying to deal with low supply, but they don't have a doctor's input on it.

Breast milk can be reheated a couple of times but formula can only be reheated once, right? Since this little one does such tiny feedings, I'm not pleased about mixing the two. The breast milk is too precious to throw out.

[happymom]

Things I would try:

-a sippy cup like this link instead of a bottle

-SMALL bottles so you don't have to worry about more than an ounce of waste. You can always add more if she needs it. Would she drink cold milk? This would eliminate any downtime (of warming milk) if she needed more.

[Pestle]

She is extremely finicky (here and at home) about milk temp. You have to hit exactly the sweet spot or she'll refuse.

I'll try something with a different spout and see it helps!