# mixing formula and breast - premie



## cassn1 (Mar 16, 2005)

Hi

Sorry to bother you but need some help and am really confused. 

I have a 4 week old dd born at 34 weeks. She has been exclusively on EBM but i am now struggling to express enough (DH does one feed and possibly another during the day) and bf. Am i ok to make one bottle a day or night aptamil 1? I know you can combine with bf but as she was a premie am not sure. I want what is best for dd but it would be great if I could do both so know that she is having enough. The last bottle of expressed EBM wasn't enough and i had to bf too which kind of defeated the object. 

She had dropped off her centile (vomiting after each feed - still doing on the feeds where not having gaviscon - reflux) but is working her way up slowly i think. SHe had put on a little more on friday but then hadn;t had a bm for two days so could have caused that. 

Any advice is much appreciated. 

Many thanks

Nic x


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## verity c (Oct 23, 2006)

Hi hun,

sorry was trying to get back to you today but spent most of the day feeding theo again   he has very bad reflux and vomits ALOT!!! sometimes a whole feed so i can sympathise with the worry...

I mix fed theo right from the beggining as i could not express enough to keep up with his needs so i sometimes did feeds that were 1/2 ebm and 1/2 formula or just formula sometimes... has mollie ever had formula?? i have always used aptamil for theo and he was born at 36 weeks and has always agreed with him.....

there is no reason you cannot use some formula hun but try to keep up the bf if you want to keep doing it too.... are you drinking plenty of water and eating plenty of nutritious foods?? there is a bf board on here where ladies can help if you like?? i personally wouldnt feel bad for using a little formula and lots of ladies do...

it doesnt make a difference she was a premmie hun....

as for the vomiting... how many feeds and how much gaviscon does she have does she bring her whole feed back?? do you keep her upright after feeds?? does she have any other symptoms of reflux?? back arching? screaming while feeding?? i have a wedge that theo sleeps on which is brilliant and he always look very comfortable.. does she have any other medications or have any been mentioned??

what weight is she now and what centile is she on

let me know and hth regarding the mix feeding     for you hun

luv v xxxx


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## cassn1 (Mar 16, 2005)

Hi Verity

Oh you are a super star! I have been worrying about this so thank you so much for coming back to me 

I don't seem to have quite so much milk and boobs are getting very sore but want to keep it up as long as poss. If i can use the occasional formula would be great as last night was trying to express after a feed and they were like deflated balloons!!

Re: the poss reflux, that's what the dr has sort of suggested hence gaviscon (although wasn't really very clear). She doesn't arch her bac or scream at feeding. It's just if she doesn't have the gaviscon it seems she can bring up pretty much all the feed sometimes. We sit her upright for about 30 mins post feed and burp her well.  Sometimes the vomiting is quite ferocious, other times not quite so bad but the minute we recline her it pour out her nose and mouth. The gaviscon does seem to help but was told not to give at every feed, perhaps x3 per day.

She had gained weight on friday but then hadn't pooed for two days so could have contributed to that they thought. She is now pooing quite a bit and sick when not on gaviscon so hoping she is gaining enough still.  

She is on trimethoprim still pending her scan on tues of her urinary tract/kidneys and the outcome of that, just in case the sepsis/ klebsiella did any damage. Am sure she's ok.

Her weight friday was 2.58kg (she was 2.33kg at birth just over 4 weeks ago)

She feeds t roughly 5am, 8.30am, 11.30/12, 3.30, 5.30/6, 8.30, 11.30, 2.30/3 - very roughly. The last couple of feeds she has had without gaviscon she has not really settled comfortably. Lots of writhing and groaning though she is asleep. In fact she does that quite a lot. 

The GP thought on tuesday that she might have a heart murmur but i know they are common and nothing to worry about and they are going to follow it up. 

Think i might get one of those wedges. Are they the sleep positioner things? 

Anyway, i will try maybe one formula feed a day just to see. I didn't know you could physically mix them in the bottle. 

Thank you so so much again, you've no idea how much it means to have the advice and support 

Hope your little one is ok. Sounds really rough on both of you   Is he on gaviscon?  

Nic x


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## verity c (Oct 23, 2006)

Hi nic,

it is no problem hun    sounds as though you and mollie are having a rough time of it so far.

she actually sounds very much like my little man Theo did at her age.... now he is just bigger and worse but take heart as this is very unusal and reflux babies usually grow out of it by 1!! Theo has been on gaviscon but is not anymore but is on omeprazole (an antacid) and erythromycin (helps the tummy empty) and has maxed out on all doses!!! waiting for surgeon to review him now...

As for mollie... i would be inclined to say she can have gaviscon with up to 6 feeds a day so try her with more. As long as she is having no more than 6 doses in 24hr then she will be fine... if you are giving a bottle you can mix it into the bottle.... 1/2 of the double sachet to 115ml (or4oz) of milk..,. is easier than syringing it in.... if you are seeing the doctor i would mention that when she is sick it can come down her nose etc... she may need some form of antacid like ranitadine to help hun, but they may not feel it is necessary but always worth mentioning.

this is the wedge i have....

http://www.babyreflux.co.uk/products/Baby-Lift-Safely-Cot-Wedge.html

it is fabulous and i have jst ordered another for nutrsery as their cots are flat so he is unable to lay on them.... i would recommend them as they keep their head at a tilt so reducing the reflux for mollie..

i actually prefered mixing ebm and formula as i could never express enough for my little man for a full feed... some people will probably scowl at me but i believe happy mummy and happy baby and vice versa so do what works for you and mollie...

which bottles are you using?? we have the dr browns for t and they are fabulous, reduce his wind and i have tried many but always gone back to them as theo feeds lovely from them.. he still hurls the lot back sometimes tho!!!

right have waffled enough but let me know the above and you know where i am if you need anything!!!

luv v xxxx

/links


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## cassn1 (Mar 16, 2005)

Hi V

Thanks again. You really are fab 

Well DH gave Mollie half a carton of aptamil first and she gobbled it up. She normally has about 80ml expressed milk but had 100ml of this and probably would have had more! She was quite sick after - DH said it wasn't much but my step daughter told me she was sick about 3 times and it;'s all in SD's hair and down her top so I think it was a bit more than DH let on. He knows i worry hence he probably made little of it   Anyway, i guess it's to be expected because it's so different so ebm. 

I wonder if i haven't been feedimg mollie enough (certainly not with the expressed it would seem). My boobs are quite sore and am feeling a bit run down today, sort of tight chest, sore throat, headache...fun fun fun! Would be easier not to bf under the circumstances but i am determined to keep it up. Maybe mixing the two means mollie will put on more weight. 

I agree with you though, they are our babies and we know them best and what's best for happy mummy and baby is the right thing. 

Am using the Avent bottles which seem ok though i have heard the Dr Browns are great. It's just my mum and DH bought the Avent ones, as advised by Boots/Mothercare so don't want to waste their money. I do have Dr browns teats as was told by SCBU nurse that they fit with Avent bottles. Wonder if this will help at all. 

Am going to order one of those wedges for sure! Thanks for the link. At the mo have some disposable changing mats propping up her mattress!! 

I have to say i think you and your colleagues are true angels and i was so inspired by the medical team i had in hospital. It made me wish i had done something more 'useful' and fulfilling. I am toying with the idea of training to be an HCA but can't seem to see how you go about it! Can't do it for ages obviously and when girls old enough am stumped with no childcare but i think it would have been great to do it  (I have a degree, had a pretty 'good'  job with a large retail firm years ago and more recently taught at the local secondary school but you guys help people and i know how much i appreciated the staff, especially the HCA's and nurses who were always so smiley and kind  )

Anyway, now who's waffling (and you weren't by the way!)

Will go and feed mollie in a mo. She seems so unsettled in her sleep poor love. 

Will keep you posted.

Hope Theo ok, it's such a worry isn't it   

Nic x


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## verity c (Oct 23, 2006)

Hi hun, me again!!!  

glad mollie liked the formula and sorry you are feeling run down hun     it is so hard whe they are so little...

i just wanted to say that i know you mainly bf mollie and this is fab but the amounts that she is drinking out of the bottle ie.. 80ml and 100ml seems quite alot   i think it is probably useful for you to know that mollie should be having a total of 387 ml in 24hours which is based on her taking 150ml for every kg of her wt.. i know you dont know what she is taking when you bf which i think in some ways is best but if you divided 387ml into 8 feeds this would be 49 ml per feed... so have you thought about maybe cutting the amount down a little... this may help with her vomiting too hun. You may have already tried this but i have to suggest it.. so maybe just bf her normal feeds then give 50ml, say as her expressed/ formula feeds and see how you go...

i hope you dont think i am picking but this is just a suggestion  

glad you like the wedge and as i say theo loves it and looks so comfy at night...


i understand where you are coming from on the bottles but the dr browns bottles have a special vent system inside which helps reduce the amount of air glugged in therefore reducing the wind, so just using the teats wouldnt help. But what about just buying one?? they are abut 5 pound per bottle so alittle expensive but i would buy them all again if i hadnt got them... tbh i would snog dr brown given the chance!!

just dont tell my hubby......

on the mixing formula and ebm i would be tempted to try it as i found theo tolerated this much better when little... remember their tummies are still very small and imature so find it difficult to deal with new things.

maybe do 25ml ebm and 25ml of formula

i do hope this helps and get back to me!

luv v xxxxx


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## cassn1 (Mar 16, 2005)

hi v

am expressing hence all lower case!

as ever thanks for the advice. gosh didn't6 realise we were giving too much especially as she always seems to want more! so 3oz too much?worried she wont settle on only 50ml. wonder why not putting on much weight then. we will try 50ml tonight then on the bottle eed. maybe not gettin enough from bf?

will buy dr brown bottle tomorrow - my hubby might need to worry too if it's that good! 

funny my hv's have never asked how much i feed mollie. will try what you suggest then see weight gain tues. hope she settles after the smaller feed!

thanks again hun - and no i dont think you are picking at all. i need all the advice i can get so thanks. 

nic xx


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## verity c (Oct 23, 2006)

Maybe she is not settling because she is too full, if you see what I mean?? 

I know it will seem like such a small amount but just put 2 ounces which is 60 ml and see how you go!! Does Mollie have a dummy Maybe you could use this if she does after a feed as it will help her settle.... Theos dummy was and still is a god send!!! 

See how it goes Hun and let me know!! Remember as she gets bigger she will increase her feed volume!! Do you have a breast feeding counsellor in you area?? It maybe worth getting in vontact with one and she may come visit you and advise on bf or your hv!! 

Keep in touch 

Luv v xxxxx


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## verity c (Oct 23, 2006)

hi nic,

hows it going hun?? any success??

luv v xxx


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## cassn1 (Mar 16, 2005)

Hey verity

Hi, thanks for thinking of me! Mollie had put on 6oz at last visit so we are getting something right. Have been decreasing the bottles though as you said and so far no major complaints! Occasionally DH slips her a little extra though. 

She is still being quite sick but saw GP today and she seemed to think it's because she's premie and valve may not be formed or closed completely yet and she'll grow out of it. I guess as long as she continues to put on weight, shoud be ok. 

Been a bit worried tonight as she has been really sleepy all day. Went from 9.30am til 3pm without a feed and i had to wake her for that one at 3pm, which was half hearted and then she sicked it up. This evening she woke for a feed and wanted loads but she is really pale. Did perk up a little after feed but then has gone pale again and sleepy. Am sure she's ok, maybe it's the heat or something although she is very cool. Guess we'll just keep an eye on her. 

Anyway, we are doing ok I think and thanks again for your advice and support. 

How's Theo doing? 

Nicx


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