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Daycare Center and Family Home Forum>Weaning too early
Pestle 12:48 PM 04-24-2017
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.
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Pestle 12:58 PM 04-24-2017
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.
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Leigh 01:58 PM 04-24-2017
Originally Posted by 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.
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.
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Cat Herder 02:43 PM 04-24-2017
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.

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.
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hwichlaz 07:40 AM 04-26-2017
Are you misunderstanding the instructions?

I'd have read that as 1 ounce of formula to 3 ounces of breastmilk.
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Pestle 07:49 AM 04-26-2017
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.
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childcaremom 08:01 AM 04-26-2017
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?
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childcaremom 08:02 AM 04-26-2017
Originally Posted by 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.
I would get them to show you how she eats.
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jenboo 08:06 AM 04-26-2017
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.
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hwichlaz 08:39 AM 04-26-2017
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
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Cat Herder 10:12 AM 04-26-2017
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...ormula_8883.bc
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happymom 11:00 AM 04-26-2017
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.
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Pestle 12:12 PM 04-26-2017
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.
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happymom 12:54 PM 04-26-2017
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.
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Pestle 12:56 PM 04-26-2017
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!
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Cat Herder 01:30 PM 04-26-2017
Originally Posted by 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.
I think you are already ahead of this game.

Go with your gut.
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happymom 02:07 PM 04-26-2017
Sounds like a tough situation and you are doing your best! Hope something works! She doesn't sound ready for solids =(
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hwichlaz 03:09 PM 04-26-2017
Originally Posted by Cat Herder:
I think you are already ahead of this game.

Go with your gut.
once it's come into contact with her mouth it needs to be consumed within an hour, even BM.

I'd probably mix like asked, then put into two ounce bottles, or even one ounce bottles to reduce waste.

formula can be reheated if it hasn't been in contract with teh baby's mouth.
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hwichlaz 03:13 PM 04-26-2017
I'm also betting, that she'll refuse straight formula so they are trying to get her used to the taste to make the switch.

I don't see why a doctor is needed since this is one of the standard ways of feeding a baby. It's infant milk, FDA approved infant milk. They aren't trying to switch to cow's milk too early or similar. I'd insist on a Dr. for that.
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happymom 03:34 PM 04-26-2017
Originally Posted by hwichlaz:
I don't see why a doctor is needed since this is one of the standard ways of feeding a baby. It's infant milk, FDA approved infant milk. They aren't trying to switch to cow's milk too early or similar. I'd insist on a Dr. for that.
If they are mixing powdered formula directly with breastmilk (not water as instructed), it is not being used as intended and can be dangerous and should require a doctors note.

Combining properly would not need a doctors note as you stated.
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hwichlaz 03:36 PM 04-26-2017
Originally Posted by happymom:
If they are mixing powdered formula directly with breastmilk (not water as instructed), it is not being used as intended and can be dangerous and should require a doctors note.

Combining properly would not need a doctors note as you stated.
OP says that they are mixing properly constituted formula with mother's milk
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Pestle 09:32 AM 04-27-2017
Yeah, the note was a little hard to decipher but the mom confirmed it's reconstituted.

I'm dividing the breast milk today--just adding formula to 2 oz. milk at a time.

She's here every other week, so I'll try feeding her oatmeal again in two weeks and see if the tongue thrust reflex is still going on. She actually keeps her tongue protruding slightly all the time.
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happymom 12:04 PM 04-27-2017
Originally Posted by Pestle:
Yeah, the note was a little hard to decipher but the mom confirmed it's reconstituted.

I'm dividing the breast milk today--just adding formula to 2 oz. milk at a time.

She's here every other week, so I'll try feeding her oatmeal again in two weeks and see if the tongue thrust reflex is still going on. She actually keeps her tongue protruding slightly all the time.
That sounds like a good plan. Has the family looking into BLW? My son never would eat jarred food or oatmeal, but did really well with solid food once we started feeding him regular foods (I agree with waiting at least 2 weeks to try again though).
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