Addressing Formula Feeding Challenges in Infants: Tips for Parents - Pediatrics

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Formula milk issues?


Hello Dr.
Hsiao, my baby is currently on formula milk.
At birth, the weight was 3.9 kg, at one month it was 4.5 kg, and at two months it is 5.4 kg.
The growth curve has been consistently declining.
I started taking care of my baby myself when they were about 15 days old, but feeding has always been challenging.
My baby never seems to drink the expected amount of milk.
Today (currently 2 months and 15 days), the weight has not increased and remains at 5.4 kg.
According to the calculation (5.4 kg * 150 ml), the expected intake should be 810 ml, but the actual intake ranges from 600 to 700 ml, with only one instance of reaching 760 and 810 ml.
Due to insufficient milk intake, I have switched formula from S26 to Enfamil Hydrolyzed, then to Enfamil A+ Complete Care, and back to Enfamil Hydrolyzed.
When I first switched to Enfamil Hydrolyzed (around 1.5 months old), my baby did drink up to 800 ml, but it has since dropped back to the 600-700 ml range.
I am very worried about the inability to increase milk intake and wonder if there are any methods to encourage my baby to drink more.
Could it be that my baby is getting bored with the taste? Since hydrolyzed formula is less palatable, should I try switching to a different brand (my baby does not have allergies and can tolerate regular formula)? However, I am concerned that frequently changing formulas might not be good for my baby.
Should I increase the feeding frequency (currently about 6 times a day) or prepare larger bottles (currently preparing 135 or 150 ml), possibly up to 180 ml? I am truly at a loss and would appreciate your guidance.
Thank you, Dr.
Hsiao.

Qing Ting, 30~39 year old female. Ask Date: 2021/06/07

Dr. Xiao Kaiwen reply Pediatrics


The weight is 5.4 kilograms, and the milk intake should be at least 600 to 700 cc per day, which should not lead to dehydration (as long as there are more than 6 urinations per day that are not concentrated or dark).
If weight gain is insufficient, it is advisable to feed smaller amounts more frequently, increase the number of feedings, and even include night feedings (feeding while the baby is asleep).
There should be no need to frequently change the formula brand.

Reply Date: 2021/06/07

More Info


When it comes to addressing formula feeding challenges in infants, it's essential to understand that each baby is unique, and their feeding patterns can vary significantly. Based on your description, your baby has been consistently gaining weight but is currently experiencing a plateau, which can be concerning for any parent. Here are some insights and tips to help you navigate this situation.

1. Understanding Growth Patterns:
Infants typically experience rapid growth in the first few months of life, but growth rates can vary. It's common for babies to have periods where their weight gain slows down or plateaus, especially after the initial growth spurt. The key is to monitor your baby's overall growth trajectory rather than focusing solely on daily or weekly weight changes. If your baby is following a growth curve, even if it's on the lower end, it may still be within the normal range.

2. Feeding Amounts:
You mentioned that your baby is consuming between 600-700 ml of formula daily, which is within the recommended range for a baby of that age. The general guideline is that infants should consume about 150-200 ml of formula per kilogram of body weight per day. For your baby weighing around 5.4 kg, this translates to approximately 810-1080 ml per day. If your baby is consistently consuming around 600-700 ml, it may be beneficial to gradually increase the amount per feeding or the number of feedings throughout the day.

3. Feeding Frequency:
Currently, you are feeding your baby about six times a day. If your baby is not drinking enough at each feeding, consider increasing the frequency of feedings. Instead of focusing solely on the volume per feeding, you might find that smaller, more frequent feedings can encourage your baby to consume more overall.
4. Formula Selection:
You mentioned switching between different formulas, including hydrolyzed options. While it’s important to find a formula that your baby tolerates well, frequent changes can sometimes lead to feeding aversions. If your baby does not have allergies or intolerances, you might consider sticking with one formula for a longer period to allow your baby to adjust. If you suspect that the taste of the hydrolyzed formula is less appealing, you could try a standard formula that your baby has tolerated in the past.

5. Feeding Techniques:
Ensure that you are using appropriate feeding techniques. Hold your baby in a comfortable position, and try to create a calm feeding environment. Sometimes, distractions or discomfort can lead to decreased intake. Additionally, consider using a slow-flow nipple if you are bottle-feeding, as this can help your baby pace their feeding better.

6. Monitoring Hydration:
Keep an eye on your baby's hydration status. Adequate wet diapers (at least 6-8 per day) and normal urine color (light yellow) are good indicators that your baby is getting enough fluids. If you notice fewer wet diapers or darker urine, it may indicate that your baby is not getting enough formula.

7. Consult a Pediatrician:
If you continue to have concerns about your baby's feeding and growth, it’s crucial to consult with your pediatrician. They can assess your baby's growth patterns, feeding habits, and overall health to provide tailored advice. They may also suggest a referral to a pediatric nutritionist if necessary.

In summary, while it’s understandable to feel anxious about your baby’s feeding and growth, focusing on gradual adjustments, maintaining a consistent feeding routine, and consulting with healthcare professionals can help you navigate this challenging phase. Remember, every baby is different, and with patience and support, you will find the right approach for your little one.

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