Addressing Infant Feeding Challenges: Tips for Parents on Milk Intake

The issue of drinking milk?

Hello Dr.
Zhang,
My son is currently 4 months old.
He has been fed a combination of breast milk and formula (Nestlé hydrolyzed formula) from a bottle.
However, since he was 2 months old, his milk intake has decreased.
Initially, he could consume 90-120 ml, but now he only takes 30-60 ml at a time, and it seems to be getting less.
We took him to see a doctor, who prescribed gastrointestinal medication, and his intake improved to 90 ml when on the medication.
However, when he is off the medication, his intake decreases again.
Now, he refuses to drink from the bottle altogether, regardless of whether it contains breast milk or formula.
Is this a nursing strike? I am quite worried about this situation, and I would like to ask:
1.
My son refuses the bottle but is willing to breastfeed directly.
I am happy to feed him, but my milk supply is very low (I pump and only get 30-50 ml every 4 hours), and he tends to fall asleep after just a few minutes of feeding.
Throughout the day, he consumes very little, and his diapers are not very wet.
The doctor mentioned that he needs at least 600 ml of milk, which I cannot provide.
What should I do in this situation?
2.
If I am feeding him expressed breast milk, how often should I feed him? (Considering a target of 90 ml per feeding) I have heard that breast milk is easier to digest, so should the intervals be shorter than with formula?
3.
My sterilizer does not have a drying function.
If there is water left in the sterilized bottles, can I store expressed breast milk in them in the refrigerator?
4.
My son loves to sleep.
How often should I wake him up to feed him, or should I let him wake up on his own? He can sleep for up to 4 hours.
5.
My son is taking gastrointestinal medication, and his milk intake improves with it.
I asked the doctor if he has gas, and the doctor said it’s okay.
When mixing breast milk and formula, for example, if he has 30 ml of breast milk followed by 60 ml of formula, is it better to have all breast milk or all formula in one feeding for his digestive health?
6.
What does "small frequent meals" mean in terms of quantity and frequency? Previously, I was feeding him 60 ml every 2 hours, but I heard that Nestlé formula is hard to digest.
Is feeding him too frequently causing gastrointestinal discomfort?
7.
I have a nasal discomfort, and the doctor prescribed "Fugen Cream" for me to apply.
Does this have any implications for breastfeeding?
I apologize for the trouble, and thank you for your help.

Xiao Yu, 30~39 year old female. Ask Date: 2006/03/01

Dr. Zhang Wenwang reply Pediatrics

Breastfeeding directly stimulates an increase in milk supply, and breast milk is easily digestible and absorbable.
On average, babies may feel hungry every two hours.
There is no particular formula that is superior; as long as the baby is feeding and gaining weight consistently, and is active and alert, it is sufficient.
It is not always necessary to rely on medications to increase appetite.

Reply Date: 2006/03/01

More Info

Hello! Thank you for reaching out with your concerns about your 4-month-old son’s feeding challenges. It’s completely normal for parents to feel anxious when their little ones are not eating as expected. Let’s address your questions one by one.

1. Milk Intake Concerns: It sounds like your son may be experiencing a phase commonly referred to as "nursing strike" or possibly an aversion to the bottle. This can happen for various reasons, including teething discomfort or simply a preference for breastfeeding. Since he is still willing to nurse directly, try to focus on breastfeeding as much as possible. If he is only taking 30-50 ml every 4 hours, it’s essential to monitor his weight gain and hydration. If he is producing fewer wet diapers (less than 6-8 a day), it may indicate he is not getting enough milk. You might consider consulting a lactation consultant for personalized support.

2. Feeding Frequency: Breast milk is indeed easier to digest than formula, so it’s generally recommended to feed more frequently. If he is taking around 90 ml per feeding, aim for every 2-3 hours. However, every baby is different, and you should follow his cues. If he seems hungry sooner, respond to that.

3. Storing Expressed Milk: If your sterilizer does not have a drying function, it’s crucial to ensure that the bottles are as dry as possible before storing milk. If there is residual water, it’s best to let the bottles air dry completely before using them to store expressed breast milk. You can store expressed milk in the refrigerator for up to 4 days.

4. Waking for Feeds: If your son sleeps for 4 hours, it’s generally okay to let him sleep unless he is underweight or has specific medical concerns. If he is gaining weight appropriately, you can let him wake up on his own. However, if he consistently sleeps longer than 4 hours during the day and is not feeding well, you might want to gently wake him to ensure he is getting enough nutrition.

5. Mixing Breast Milk and Formula: It’s fine to mix breast milk and formula, but it’s often recommended to keep them separate during a single feeding. This is because breast milk and formula digest differently, and mixing them can lead to digestive discomfort. If he takes 30 ml of breast milk, you can follow up with formula, but monitor how he reacts to this combination.

6. Feeding Amounts and Frequency: "Frequent small feeds" typically means offering smaller amounts (30-60 ml) every 2-3 hours. If he seems to have difficulty digesting formula, consider spacing out the feeds a bit more to give his stomach time to process the milk. If he is showing signs of discomfort, it may be worth discussing with your pediatrician.

7. Medication and Breastfeeding: Regarding the cream you mentioned, it’s essential to consult your doctor about any potential effects on breastfeeding. Most topical medications have minimal systemic absorption, but it’s always best to double-check.

In summary, focus on breastfeeding as much as possible, monitor his hydration and weight, and consult with a lactation consultant if needed. If you have ongoing concerns about his feeding patterns or weight gain, don’t hesitate to reach out to your pediatrician for further evaluation. Remember, every baby is unique, and it’s essential to find a feeding routine that works for both you and your son. Best of luck, and take care!

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