How long is too long between feeds for BF 4month old?

We have had a strange day today with big mood swings in DS3. He fed every 2-3 hours last night as normal. Fed about 6am then 9:00am. After some fussing, fell asleep in a sling until about 10 or 10:30. We left the house for an appointment just after 11. He became upset in the car, I thought, due to hunger, but he wouldnt feed whilst at the appointment 12-1. He had a few sucks then broke off crying.

He slept about 30min and I thought he'd want to feed when he woke, but more breast refusal and fussing. I was at Mum's and ended up expressing from both breasts. He then had another short sleep in car from Mum's to Paediatrician appointment. He finally fed in the waiting room at 3:30pm. He was then chatty and bright.

Another sleep in the car from there to home. Got home about 5:30. Offered boob at 5:30, 6 and 6:30 but he wasnt interested. He's been asleep on DH since 6:30 with a couple of quick wakings before going back to sleep. I've expressed again.

that's 2 x 6hr breaks between feeds. That doesnt seem right to me, if only for thirst.

is this ok?

Not sure of length between feed but do you think he could be too tired to feed?

Does he have a temperature? Any signs of cold or flu?

Sometimes they won't feed if they have a sore throat. It sounds like he is fussing because something isn't right. Could be teeth, sore throat, upset tummy... Anything.

Periods of breast refusal is part of the rhythm of breastfeeding. Keep offering. I think 6 hours is a long break but as long as he is still feeding frequently overnight look at the total feeds in 24 hours and see how that looks.

DS1 started sleeping 10-12 hours a night from 3 months, and there were no dream feeds etc in the middle.

DS2 didn't sleep for more than 90 minutes at a time until he was about 9 months old, and would generally want a feed every 5 - 185 minutes ...

As will all the things, every baby is different. If they're hungry, they will wake and let you know xx

Thanks. He is very tired. I think it's a combination of overstimulation and reflux. The reflux is getting worse. I suspect he may have had a big developmental leap too, just from the extremes of giggling to screaming.

he's now been feeding on and off for an hour. His temperature is 37.2.

What are you doing for the reflux? I can't sing the praises of Losec enough for very refluxy babies. DD2 was a different child once it started working.

Hiya
Changes in feeding patterns are very common at around this age - there's a developmental leap and who knows what going on there. Babies will often (and sometimes quite abruptly) start feeding very quickly during the day (1-2 mins maybe) and perhaps picking up more feeds overnight as they're more distracted during the day. If mum tries to offer more feeds or keep her baby feeding longer, baby will often refuse. It's not 'refusal' as such, it's just a change in patterns, however, though understandably it can really throw you.

Watch him. Is he ok? output the same? etc, etc? that's how you will know whether all is ok, not by the clock or other measures :)

After another night of feeding every 2.5 hours, he's not feeding again :(

the paed told us to increase the Losec dose from 5mg to 7.5mg, which we did last night. His last feed was 3:30am. He woke at 5:45 and went to feed but wouldn't due to acid. He had a chat and giggle then fell asleep on DH at 7am. He slept to 8:20 so I thought he'd be hungry. He has Sandifers Syndrome, which is arching of back and stiffening limbs from acid reflux. He's been doing that, so I gave him baby Gaviscon. I've tried different positions, but he won't feed. I'm now expressing and we'll try a bottle.

he's bright and alert when the reflux isn't distressing him. I don't think he's ill. Temp is 36.6. Nappies full of wee.

He's 19 weeks old tomorrow and I realise there's another developmental leap about now. He discovered his toes yesterday.

At four months dd was going 4 hourly between feeds. She had been having one overnight feed at around 3am, but dropped it around 4.5 months. I have read on a few occasions that apparently at 6 weeks babies no longer physically need an overnight feed. Sounds like he's doing ok though. DD would also get very cranky at times and id check my wonderweeks app and sure enough there would be a big black cloud on her week :lol:

I can understand him moving feeds out to 4 hours, but 6 seems a bit much this early.

we tried the bottle. He half heartedly sucked at it then pushed it away. He had about 10ml, then proceeded to throw it up, which he thought was funny. I figure he's not hungry...? he's 9.8kg, so he's not exactly fading away.

if he wants to stretch out feeds, it would be more convenient if it was overnight.

At 10kg, our doctor out DD2 onto 10mg. Like your DS3, DD2 was a big baby, and we found she really needed to increase her dosage the heavier she got. How are you administering it? Do you use the tabs? DD was on Losec until after her first birthday, and after lots of trial and error, we found the most effective way to dose her was to place the tab in a shot glass, cover it with 5 or so ml of warm water, wait until it was fully dissolved and then give it a gentle stir, and suck it up into a Nurofen syringe.

Could he be becoming more alert and distracted by the world? I'd try feeding somewhere dark and quiet. But it sounds like he is making up for it at night so getting enough especially if all other signs are good.

How many feeds is he having during 24 hours? Is he making up for it over night? I'd expect him to be having between 8 and 12 feeds in 24 hours. Many mums find 4mths is a shocking phase for breast refusal and apparent low supply - baby gets fussy at the breast for some reason and many mums think it is because they don't have enough milk. I know you're not worried about that but I just wanted to mention that 4 months is generally known as a bit of a tough patch.

So. Sounds like he's got good output, so how many feeds in 24 hours?

And poor little mite with the reflux. Sounds awful :(

PN - we do the same. He now recognises the Nurofen syringe and opens up for it. Weirdo ;)

i'll count feeds again for a few days. We are definitely having a challenging time. The old way of comforting him when he cracks it of holding him tight seems to make things worse. I've just put him down on the bed and am holding his foot. He's calmed down but is having Sandifers episodes which he finds distressing.

If I count feeds from 3:30, then he had a feed at 3:30am, 11am (about 2min), 12:40pm (5min) followed by throwing up, crying and Sandifers. I'll start counting nappies too.

We're also overstimulating him too. We dont mean to, but it's hard to understand his limit when he's chatting and giggling. I was hoping we could have a nap but it doesnt look likely.

There are people who reckon babies should go all night from x age, but the evidence is pretty clear that most babies still have at least one night feed at 12 months (yes, even bottle fed babies).

The reverse cycling is likely just a temporary thing. Some babies will go all night and feed all day, so clearly it *is* possible to get enough milk this way. Just watch him for those signs of adequate intake.

It's always hard when they go through these developmental leaps and changes; things will settle again once you guys find your new 'thing' that works.

Also just on this...

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At four months dd was going 4 hourly between feeds. She had been having one overnight feed at around 3am, but dropped it around 4.5 months. I have read on a few occasions that apparently at 6 weeks babies no longer physically need an overnight feed. Sounds like he's doing ok though. DD would also get very cranky at times and id check my wonderweeks app and sure enough there would be a big black cloud on her week :lol:

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Every baby is different... Some mums talk about babies who sleep through the night at 2, 4, 6 weeks of age. But the majority of babies need night feeds. Physically NEED night feeds. BM is designed to be quickly and easily digested and as a result most babies need frequent feeds, day and night. You need to make sure baby is still having the 8-12 feeds a day as well, and that's tough to squeeze into 12 hours, if they sleep 12 hours at night.

It absolutely sounds like a symptom of the reflux. My daughter was at her peak in terms of how bad her reflux was at 4 months of age. We have only just managed to wean off meds successfully with her recently and she is 4 years of age.
Breast refusal with reflux happens because they develop pain association. I did not have much support with my daughter and ended up having to stop breastfeeding at 6.5 months due to the severe breast refusal that was just getting worse and worse till I was not in a good place mentally as I was so anxious about making sure she would feed ok, not be dehydrated etc. I got mastitis countless times and she started losing weight, stopped growing in length etc. Up until this point she was a frequent feeder (comfort feeder) and was a big baby who put on a lot of weight. Most reflux babies are at either end of the spectrum, they either are small or are big because they are feeding so often to try and soothe, but then they later (sounds like your son) work out what is hurting them.
I suggest that you get onto the doctor about managing the reflux better, as I was devastated to give up breastfeeding, but in the end really did not have any choice as it had gone on too long.

The Reflux Infant Support Association is a great organisation and offers lots of support. there are forums, a private facebook page for members to post and ask for advice etc, a library and lots more. I didnt join until both my refluxers were much older as I kept thinking they would grow out of it (which most do, but mine didn't) and wish I had joined much earlier for support and guidance. I am now a volunteer for them as an email contact among other things.

I don't want you to have to stop breastfeeding, as it was really quite soul destroying to me as a person at the time and I actually needed counselling to come to the decision to stop and be ok with it. If the reflux is sorted out soon, you should be able to continue your breastfeeding relationship. I just wish someone (including the docs at the time) helped me and supported me when I was having so much trouble with a baby who didn't want to feed.

Thanks for that Razzberry. I absolutely do not want to stop breastfeeding. I'm hoping this feeding strangeness is a developmental thing and not a pain association thing. He did get 8 feeds in 24 hours yesterday. I'm going to continue logging input and output for a few days to see how things go.

the doctor recommended starting him on solids - rice cereal mixed with breast milk half an hour after a feed, to help keep the milk down. I'm reluctant to start him on solids this early. He can't sit up by himself and he's only just started showing an interest in us eating. However, I don't want him to start refusing boob because of pain....

i'll contact the reflux association. I've had a couple of people suggest Losec can make things worse by reducing acid production, therefore crating an over production of acid, making the reflux worse.

there's nothing like contradictory information whilst dealing with a baby screaming in pain to do one's head in :wall:

Alot of doctors recommend starting solids early, and for some bubs this does help, However, the mums that I work with in the reflux association were also told that and for alot of us it makes things worse, especially when they are so young and not ready. Many reflux bubs whole gastro system is very sensitive and are more prone to constipation and rice cereal can just makes things worse as if the pressure below can just make the reflux worse at the top end.

Losec suppresses acid production and does a good job of it, It doesnt make the acid worse and a gradual wean off losec when the time comes helps with what they call "rebound acid". I absolutely hated the idea of my young babies on losec but the consequences of not being on were far worse. My son was on it by 2 weeks as I saw the change it had made in my daughter. It is alot more effective then zantac in most babies. I have had lots of people say to me, "oh my baby had reflux too and so I put them on an anti-reflux formula or used thickener and they were all good". This just tells me that all it did was stop the spew - a true reflux baby is in agony and no amount of thickener will make the acid or the pain go away. Having a reflux baby is hard work. I really feel for you xxx

Have been reading along and not posting, but wanted to offer hugs....Bub is on Losec for silent reflux here too, so I get how hard it is to see them in pain. The Losec made a big difference here, but we've noticed another huge improvement since I eliminated dairy and soy a couple of weeks ago. Bub was wanting to comfort feed all the time, but would then pull off in pain every few seconds - heartbreaking for me, not to mention painful too! Stopping Breastfeeding is not an option here either - plus the LC/dietician's advice and all the reading I've done suggests it's less likely to cause issues than formula, especially with the CMPI. He's now feeding very well most of the time and not so often either. He was also catnapping during the day and falling asleep within two or three minutes at each feed, but this has improved a bit - we often get one longer than 40 minute nap during the day, and one or two 30 min naps, as opposed to only 5-15 minute cat naps. We still get a few of those too though.

It's still very early days here as Bub is only 7 ½ weeks old, so it's interesting to hear about others journeys. Please look after yourself in all this too, and get whatever support you can. My MCHN has been great at helping me access some practical support.

I've also given up dairy, which the paediatrician doesn't agree with. I had a coffee yesterday and am regretting that. I hadn't thought of soy though I generally avoid it. I'm also gluten free and boy, do we all pay for it if I cheat.

It's good to know Losec is effective though things do seem worse in the last couple of weeks. Interesting about the rice cereal possibly making these worse.

A friend had to go off all cruciferous and bulbous veggies, as they are what upset her LO's tummy. I think that's to do with gas build up... ?

L&B, Joy Anderson is an LC/dietician who specialises in babies with allergies/intolerances and is a good person to talk to if you need some professional advice.
It's really hard to track reactions to things because they're delayed and only occur after sufficient buildup of the offending substance to beyond tolerance levels. (Well, you probably already know all this :))

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A friend had to go off all cruciferous and bulbous veggies, as they are what upset her LO's tummy. I think that's to do with gas build up... ?

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I've done this too.

thanks MadB - I'll look her up

Hugs for an unsettled baby. Sometimes the hardest thing is looking for answers. Sometimes you have to energy to look for solutions and other times I've found it yes easier to submit to this being a 'stage', rough period. Only you know what you have in you :)

Joy Anderson is who I'm seeing. :) I can highly recommend her; she had great insight into what could be happening with Bub and is helping me with a dairy challenge this week (feeling a little nervous that Bub is probably going to get worse again because of me, even if it's only for a little bit). Definitely email her as she can help with both the feeding and the reflux/diet.

I thought I didn't eat much soy either, but when I started label reading, it's in a heck of a lot of stuff that I had no idea about. You'd probably be avoiding a lot of it by avoiding gluten though.

Hugs

How are things lionsandbears?

He's decided to feed every 2 hours through the night, then wake up to chat and play with Mummy at 5:30am. Mummy is not impressed with waking up so early.

we had 1 four our block between feeds yesterday, but otherwise back to 2-3 hours. The 5-6 hour block overnight still eludes us.

the reflux is still there. I was on omeprezole whilst pregnant and it stopped the pain of heartburn. I assumed it would work just as well for bub but it hasnt. I'm still researching the pros & cons of starting him on solids. We're also using Infacol for wind build up.

That's tough. You must be tired. The frequent feeding seems normal to my babies but very hard when you think they are in pain. I took DD3 to a naturopath that tests them for intolerances using a hair sample. Dd3s intolerances are complex/random and I would never have figured them out on my own. After not sleeping for 2years the new diet started working straight away and major difference within a month.... Something else to google maybe??

He may need his losec dose adjusted. Babies grow very quickly at this age and it is constantly a catch up to keep their meds at a dose suitable for their weight. Some babies also require a combination of reflux meds and some require a higher dose than others.

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He may need his losec dose adjusted. Babies grow very quickly at this age and it is constantly a catch up to keep their meds at a dose suitable for their weight. Some babies also require a combination of reflux meds and some require a higher dose than others.

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I agree with this. For his weight, 7.5mg seems low.