milk volume, one meal a day

Hi there,

My LO has started solids early on the advice from the paediatrician and paediatric dietician. Weight gain has not followed a normal curve, we've had reflux and a milk protein allergy. I'm following the advice from the professionals (I know some of you might do things differently but I'm happy with the advice) which is to feed on meal a day prior to his bottle (it's EBM as I"m an EE). I"m giving my DS maybe about 2.5 tablespoons of a mixture of veg, rice cereal and mixed with about 60mls of EBM. I then follow his meal with a bottle. He generally only takes about 60mls of this bottle, sometimes less. He normally takes on average about 110-130mls of EBM 7 times a day. I've noticed that his bottle intakes for the 3 bottles during the middle of the day and afternoon are about 3/4 of what they used to be. I'm just worried that he might not be getting enough calories to prevent from falling further behind with his weight gain because his feed volumes have reduced.

How has one meal a day affected your bubs milk volume? I know the equations are different for EBM and FF, but if you are FF how much would your bub have a day with one meal?

The other factor is that my bub is 4.5 months - we started early on the advice of the professionals.

when DD was on one meal a day she would have 3 bottles at 200ml and one at 250ml, but that only lasted a few weeks and then changed....

i think we ended up with 3 bottles at 150 and then a 200ml one at night...

oh and we are FF

Dear Lisa,
Allergies are a special area, and it can be very difficult to get correct information. It is very stressful for mothers! (I know because I have been there and done that personally, as well as in my experience with mothers I work with.)
At this age your baby still needs 700-800mls of breastmilk per day - which seems to be what your little one is having. Generally babies who take this much milk will grow and thrive. Food is *in addition* to breastmilk. What you are observing is exactly the reason why it is usually not recommended to give solids at this age. Research shows that low cal solids (rice and vegies and the other first foods babies take are usually low in calories) displaces milk from the diet. Generally they need more breastmilk rather than more food. Babies who suffer from allergies often do gain weight more slowly than their counterparts. They use more calories just to keep their bodies intact, their immune system is under constant asault. It's not really possible or helpful to compare what the formula tin says to what your baby needs.
Many mothers find that the key to getting more milk in is trying smaller, more frequent feeds. It is important in situations like this to watch the baby, not the *numbers* - they will grow differently to other babies and their will be multiple factors involved. It is really, really important in these situations that breatmilk feeding is preserved. Breastmilk supports your baby's immune system and reduces inections. Feel free to ask more questions. You are doing a really great job in very difficult circumstances

Crumpt - thanks for letting me know the amounts your bub has and how it has reduced.

Barb - the paediatric dietician told me today that I am feeding too often, that I should be trying to give larger amounts 5 times a day, so I began to think I'm pestering with the bottle too often in the middle of the day (the fussy feeding nurse we saw when he was 9 weeks old told me I was pestering too much then because of his low volumes...so i know i can be a pest...lol)

There seem to be a lot of *shoulds* flying around. Why precisely *should* he be having five bigger bottles? Scarily too many health professionals get their education on infant feeding from the side of a formula can. Your baby is NOT formula feeding. You are the mother, and you know your baby best. It is really *NOT* normal for a baby that age to be feeding only 5 times a day. Normally a baby this age would have 8 or more feeds in 24hours. Imagine, too, if you had an icky, sensitive tummy, would smaller, lighter meals suit better, or huge meals? Many health professionals believe mothers *won't want to feed this often* (but other members of the family would feed this often. Keep asking "why" they are suggesting these things and don't be afraid to ask for a second opinion.

Thanks Barb. I don't have a problem feeding him more often but I know I have a pestering potential as I get anxious about weight and feed volumes. I will try and listen more carefully to my son and be guided by him during the day about how many feeds he wants.

One more query - if my milk is making his stomach sensitive is BM still best for him, is it giving him something worthwhile or is this a case where I should look into the allergy formula? Moving to formula hasn't sat easy with me (particularly the soy and allergy ones, please don't be offended if you are FF users. I respect your decision and totally understand why you make the FF decision because EE isn't for everyone) which is why I find myself EE and restricting my diet by cutting milk out.

Hi Lisa Barb has given great advice. My DD is intolerant to dairy and I have found by eliminating it from my diet has helped considerably not sure whether you have done this all ready but if you haven't this may help. Just want to say you are doing a great job EE!

Dear Lisa,
I didn't say your milk is making his stomach sensitive. It sounds like your little one has a range of food intolerances and allergies. His tummy probably is sensitive - many babies like this do better on smaller more frequent feeds of breastmilk. Breastmilk is VITAL for babies like this. Elemental formulas are an absolutely last ditch option for when breastfeeding can't be sustained. I can't tell you how often I have seen mothers of sensitive babies coerced into stopping breastfeeding, only to see them on the treadmill of one formula after another. Breastfeeding protects your baby from the worst effects of allergies. Breastmilk has anti-inflammatory properties and so protects from allergies. it also prevents infection. Generally symptoms are much worse once a baby stops breastfeeding.
I wonder, what are your baby's weightgains like? He seems to be getting adequate amounts of milk. You know the weight charts are charts for normal babies - if they are on the chart they are in the normal range. If you are cutting out dairy, you have to also become a label reader and cut out all forms of cow milk and possibly soy (a large proportion of those allergic to dairy are also allergic to soy) You need to cut out whey and casein as well

Thanks Barb. I don't want to stop BM feeding if it is in my son's interest. My son's weight a couple of weeks ago was just under the 50th percentile. It consistently drops in relation to the curve. It was holding better on the last weigh in which was positive. I had cut out all dairy but the dietician has asked me to reintroduce some now to test given I had been off it for around 6 weeks. He seems to tolerate 1-2 serves of dairy but not more than this. She has told me that there can be a dose type response to dairy. If I take more I get more fussy behaviour at the bottle. This is how he has been labelled as having a milk protein issue, or a likely issue. He seems to cope okay with my soy intake - no fuss at the bottle (fussy behaviour and low volumes were the original issues).

Em - thanks, as mentioned yes i have been on an elimination process and now trying to reintroduce under the dietician supervision to check if diary is indeed an issue and how much of an issue it is. Thanks for the support.

it is really common and normal for babies to swap percentiles after the birth. In utero a baby's weight reflects the mothers nutrition and effectiveness of the placenta. After birth they move towards their genetic potential and are affected by factors in the environment (ie their diet etc) The fact that he has dropped compared to his original percentile doesn't mean he is *underweight* (anymore than if he increased his weight in comparison to that original percentile would mean he was *overweight*) In the first 3 mnths it would be normal for babies to put on 150 g per week, and then over 3 mnths you would expect weight gains in the order of 70-100g per week.
Often family history can give you a really good starting point. Are their people in either side of your families who have intolerances or allergies? Eczema? Asthma? Coeliacs? Are you and your partner big people/small/average?

Yes I'm coeliac and his dad is lactose intolerant, there are also family members on my side with lactose intolerance. I also get eczema but that is from dry skin. We are both fairly small builds. I'm waiting on the result of his buccal swab to see if he carries the genetic mutation for coeliac disease. I'm on the GF diet so he should be right even if he carries that mutation.

Over the last couple of days DS has drank between 650-680mls a day. This doesn't include the 60mls I put in his rice/veggie mix - I'm not sure if I'm supposed to count that towards his milk consumption. I've gone back to offering the bottle every 3-4 hours to try and help keep up his volumes so this works out to be about 7 a day.

You count the amount of milk in his food in his total milk intake - that's fine, milk is milk. 7 per day is great, I think you are doing the right thing. He needs milk at this age. He sounds like he is *your child*. Has your paed dietician given you information for introducing solids with a family history of coeliacs? Have you had a look on the ABA website at Joy Anderson's fabulous paper on lactose intolerance? (go to the "breastfeeding information tab at the top of the home page - the artical is under "speical situations"

Thanks again Barb. I'm relieved to know that the milk in his food counts towards the total volume. I've had a look at the ABA website at the article on lactose intolerance which was an interesting read. The paed dietician has been giving advice on introducing gluten. We are doing that close to 6 months using weet bix and whilst I am still BM feeding. She has asked me to do it a tad prior to 6 months because I'm EE and she wants to get it in whilst I"m definitely still BM feeding. Coeliac disease is one of her speciality areas.

Hi, Are you planning to stop expressing for her? If you are OK to keep going I would, especially in your case. EE can be tough going, but it makes such a positive and valuable contribution to your little one's health - in babies like this it is hugely important. She is right - it's vital that solids be introduced while a mother is still breastfeeding, but I am wondering if she is assuming you will stop or if that came from you?

Lisa, have a read of this thread too:
https://www.bellybelly.com.au/forums...p-barb-134303/
because it is quite a similar situation.

Barb - the 6 month thing came from me as I told the dietician that I was setting myself small goals for EE, but as 6 months is approaching I think I can go for a bit longer.

Kmn - thanks I will have a read.