Wednesday, May 23, 2012

Ending sleep feeding: what works and what does not

By Sonja P Monday, August 02, 2010

     After being away for over a year from Health Central, I thought I need to come back and update the status of my sleep feeder baby. Avin is no longer a baby and he is no longer a sleep feeder; he is now a 2 year old toddler who had graduated to eating table foods; rice, veggies, fruits, crackers, toast, yogurt etc. We had stopped his Prevacid (Lansoprazole) briefly, but had to start it again after he began vomiting. He had barely begun to eat solids (boiled rice cereal with water) and the doctor/therapists did not want him to get terrified due to the vomiting. Prevacid does not actually stop vomiting but the discomfort goes away and my son began eating his liquidy-rice-cereal with pureed solids (carrots, squash, peas, lentils, chicken and rice, turkey and rice, chicken and vegetables, turkey and vegetables etc). Sweet potatoes, potatoes, puddings, Oatmeal, Macaroni and cheese never really agreed with him and we did not force it on him either. So here is what I learned from other reflux moms, therapist, doctors and my own experience: Tip 1:How to begin solids for a sleep-feeder? Allow the child to guide you and respect her/his dislikes for some solids. Respect when they indicate that they are full and always pause if/when they gag. Do very small quantities (1 to 2 oz) in the beginning and gradually (in 2 to 4 months they will eat almost a small bowl full of solids 3 or 4 times a day). If the child is gassy, refluxes more than usual, or has break-outs do not feed those solids again; later you may choose to have an allergy test done. Feed the child his solids in a walker (not bouncer) so that her/his torso is not slouched or slumped. If there is gagging give some liquid wash (plain water to drink), a sip of plain water helps them swallow their food. Sometimes raising their arms over their heads helps them straighten their upper body and the food goes down effortlessly. This is normal for a baby who has slight underdeveloped or slow esophageal motility which doctors/therapists believe is a cause of regurgitation and/or reflux. The condition is not permanent and within a few months your baby will sit in high chair/normal chair and eat.

     Avin's sleep feeding with formula/milk had continued well into his 2nd year. We had asked our insurance company for approving extensive, at-home feeding therapy when he was 14 months old and they denied. We went to a local therapist and paid out of pocket but after first few visits, I realized that the therapist did not have anything new to offer. Besides, she never really "fed" him there, just gave us tips. Things were hard and I would be perpetually tired, 24/7 I thought about my baby's problems and worried. To add to my worries people around me told me that his texture issues, inability to swallow could be linked to more serious conditions, metabolic disorders, structural abnormalities and even neurological defects. Although, in my heart I knew that my little boy was neurologically healthy and had no structural problems-such excessive information is always unsettling and can distract you from your goal: finding the right solution to your child's feeding problem. I cut off almost all my social contacts but stayed in touch with few other moms whom I had met on health central. However, I also got help and went to a therapist. Speaking helped and fortunately my therapist had a child with similar issues. She convinced me to follow my instincts and keep fighting to get help for the baby. Tip 2: How to deal with frustrations of sleep feeding? My friends (other sleep-feeder moms) and I  learned two things- 1. Take a break: Ask parents/relatives/friends for help. If someone can give you some company and perhaps do the cooking and basic chores for you at home, you can continue to remain sane during sleep-feeding, doctor's visits, therapist visits, and during solids transition. 2. Speak with a therapist for yourself and get help. It is normal to feel low and depressed. It is perfectly normal to be mad at the father of the child who might have a busy working schedule but don't lose it and never force feed your child because you are frustrated. Just get help-it's ok.

8/ 3/10 12:53pm

Dear Sonja,


Thankyou for this helpful update. Good to know that Avin is back to being a normal kid. Wish we could enjoy them more as babies! My daughter was diagnosed with GERd at 11 weeks and put on 1.3 ml Zantac. At 4 months, her Ped GI changed it to 7.5mg prevacid 2x a day and 1.2 ml zantac mid-day. So, she is now taking medications three times a day!.She has been on Neocate/Elecare for 10 days but no improvement. She also has diarrhea, mucuosy stool and 2 out of 9 guiac stool test cards were positive for blood today. She also lost couple of ounces this week. Her ped is now running some very basic blood testsafter drawing 9 ml of blood.

 

8/ 3/10 11:13pm

Dear Ritu,

The most frustrating part is the diagnosis and convincing doctors that something is wrong with our children. I have a feeling that you are about to find solution to your babies problems. Once the doctors can figure it out (what it is that she is allergic to), things will get better. You are moving in the right direction, just hang in there. All the best wishes for you and your little girl. Do keep us posted and feel free to contact any of us.

Regards,

Sonja

8/22/10 2:05pm

Hi Sonja, Jan, Bao, tweety,

 

I have a feeling that my 6 month old baby does not know how to feed while awake since she has been sleep feeding since 2 and 1/2 month. Is it safe to spoon feed milk or there is a danger of the aversion being transferred to spoon? Should I keep the spoon exclusively for solids? I also want to try feeding her milk while awake. She has completely rejected the bottle. What should I do? Did you try to spoon feed milk to your baby? If so, what happened? Any tips would be helpful. Looking forward to share your experience.

Jan Gambino, Health Guide
8/ 4/10 2:26pm

Hello Sonja,

Congratulations on getting your little guy to awake feeding! You all worked so hard and I am glad that he is eating so many foods and thriving!

Thank you also for sharing your knowledge about sleep feeding with everyone here at HealthCentral. We all learn from each other. That is why it is important to post your stories, updates and tips for everyone.

Best wishes, Jan

8/ 4/10 4:37pm

Thank you Jan.

8/ 7/10 12:32pm

Hi Sonja,
Blood work has been normal so far.After 2 weeks of neocate/elecare her diarhea has subsided. But, her feeding is going down.I really can't blame the taste of neocate as she is on little bit of breast milk and she is fighting that bottle too! She was drinking far better with Zantac and regular cow's milk till 4 months of age. I sometimes wonder if it is the fact that now as she is getting older (5 months now)she can excercise more control. Or things started going downhill with prevacid. UGhhhh! It is all so confusing :-( My ped is stil saying that she is not allergic to cow's milk as occult blood could be due to anal fissure and mucus is sometimes normal in kids.

8/ 7/10 2:35pm

Hi Ritu,

 

Do you think that you might benefit by going back to the GI? They might run better tests, btw, if there is fresh blood from minor fissures you would notice the difference. If you do not see any blood when you clean her, it is worth running a blood allergy test and find out if she is negative to all common ingredients. Good luck.

 

Sonja.

8/ 7/10 8:54pm

Thanks much Sonja! I will be seeing my 3rd GI on Monday.Will keep you posted how it goes. There is no visible blood however.

Anonymous
bao
8/18/10 6:31pm

Sonja and I became good friends during the time we struggled to sleep feed our babies. She had asked me to share my story in hope that it might help others who are having the same issue. Here is my story.


If I'm given a chance to go back in time to correct my mistakes, I would breastfeed, breastfeed, breastfeed. I would not even bother with the pump. I would be more patient and believe in myself that in time, I would produce enough milk for him. As long as he's gaining weight, it doesn't matter if I have to feed him 15 times a day and he's crying because maybe I dont have enough milk for him. I would do the very best thing for him, the same thing that women have done since beginning of time, breastfeed their babies.


Frankie is 26 months now, he was sleep feeding since he's 2 months. He was diagnosed with GERD when he was 5 months. When he was 6 months, we decided to give him the NG tube hoping that he would gain weight and be strong to have a better appetite. It was a mistake to think so because he quit eating by mouth shortly after the NG tube was installed. He did not eat even after we remove the NG tube. . He was under different kinds of reflux medication but none of them seemed to help. It was a point of no return, we had the G tube installed when he was 9 months. Afterwards, he began to eat solids again and eventually learned how to drink fluid with a cup with straw. A year and a half passed by and we are unable to wean him off the Gtube. Again, if I'm given a chance to go back in time, I would skip the NG tube. It made his oral aversion worse and he was so miserable wearing them all the time (worse when we have to reinstall them because he has pulled them out). However, if you have no choice but to have the Gtube put in your child in order for him to survive, don't feel so bad. The Gtube has helped Frankie to grow into a happy, strong and healthy boy. We no longer have to worry about our child being malnourished. We believe he will be tube free one of these days (if not, he can pump his own food by the time he's able to if he refuses to eat by mouth). For us, the months or years ahead is busy but sane.


Like Sonja said, try not to force your little one to eat. You may get him to eat a lot by force, but it doesn't last. It's a battle you will never win. Rather, encourage your child to eat but respect him when he has decided that he is done with it. Also, seek support from friends and family (beware that there are merry weather friends). I think most importantly, believe in yourself. Remind yourself that you are the best thing this baby has and you are the person who loves him/her most (and the baby probably feels the same).


Please take care of yourself so you can care for your baby. You've probably found out already that you're not alone. Most of us who stumbled across this website probably have the same feeling. You will be in my thoughts and prayers.


Bao

 

1/31/11 12:52pm

Bao-

 

Thank you for sharing your story. I have some questions for you about the feeding tube and your son. I'm a little confused about the feeding tubes because I know there are different kinds.. I have an appt. with dr.next week where she will go over everything in more detail

 

 My son is a sleep eater and is continuing  losing weight. We are seriously considering a feeding tube but I am very cautious because of all the negative stuff I have read. I am scared that like your son, Asher will have hard time learning to eat after the tube is removd. My doctor mentioned that she would like to try  out  the NG tube for a week or two and only have him tube fed at night; I would cont. feeding him by bottle during the day.  What has your experience been with the tube? Did you exclusively tube feed  for a period of time or were you able to feed with the bottle as well? Did your son have the G tube or NG tube?  How long did you plan to use the tube when you first discussed it with your doctors? Does he just have an aversion or are there other issues that are keeping him from eating on his own...I'm sorry to ask you a million questions but It's so stressful trying to figure out what to do.

 

Thank you SO much for your story and your help. It has been such a help to know that there are others that who understand my struggle.

Jan Gambino, Health Guide
2/ 1/11 6:16am

Hello Jenn,

 

I will try to contact Bao for you. I want to make sure she can respond and give input too.

 

The NG tube is a temporary way to bypass the mouth and get nourishment to the stomach. An NG tube is often used during surgery, injury, etc. The tube does cause some mild discomfort (going in/out, swallowing). NG tubes can cause feeding trauma/aversion for some babies. On the other hand, an NG tube gives parents and doctors valuable information too. For example: the NG tube is used and the baby is still having spit up, vomiting, pain and poor weight gain or, the NG tube is used and the baby gains weight and there is no discomfort. This information may help to determine the next step in treatment. I have heard of babies with reflux and other digestive disorders using an NG tube for short term (days and weeks) as a way to rest and regroup. The caregivers and baby can reduce their stress from feeding and the feeding aversion often is reduced or goes away. It gives everyone a fresh start. This may be true for some sleep feeding babies but we just don't have the data and experience with a large group of babies to determine the best treatment. Like all of reflux treatment, there is no one size fits all method of choice. I so wish there was....

 

If a baby responds positively to the NG tube or has a long term need for the tube: again this might be surgery, other medical condition, prematurity, severe reflux or severe feeding aversion (and many more reasons), then a gastostomy tube may be inserted. This tube is surgically inserted through the abdominal wall into the stomach. There is no discomfort from the tube and oral feeding will not be impacted. Tube feeding and oral feeding can proceed. A g tube may be needed for months or longer. My daughter had a feeding tube for gerd combined with another medical condition and feeding aversion. She needed the tube for the majority of her intake during the first year and I was able to slowly wean her down as her oral intake increased.

 

Whether a ng tube or g tube is used, feeding therapy is essential. Babies and children do become dependent on the tube feedings and may have mild to severe feeding aversion. I wonder if the struggles are equally big if a feeding aversion continues with a tube vs without a tube. I found that the tube lessened my stress about feeding and allowed my daughter to approach food at her own rate and comfort level. I didn't worry about calories, fluids and nutrients so our meals were a lot more pleasant. Again, I think every baby and child has a different set of circumstances. You and the doctor are in the best position to make a decision that is right for your little one.

 

Please let us know about your appt with the doctor.

 

Best wishes,

Jan

 

 

8/22/10 4:50am

Sonja - I really appreciate how much of time and effort you're taking in helping parents who are going through situations similar to what we've been through. And thank you so much for being such a great friend and providing help and support when I was going through very difficult time.

 

--

 

My son Sid who is right now 22 months old was sleep fed during his first year but now he is an absolutely normal kid who eats all kinds of food through mouth. Sid was diagnosed with reflux at about 3 weeks old. He would arch his back  and  would refuse feeding after just 5 min of breastfeeding. He was almost at the verge of loosing weight. He was on Zantac for 1.5-2 months. Initially it seemed to help but not for very long.  I stopped breast feeding during this time as it was hard to measure the amount of milk he was drinking and started pumping milk and giving it to him in a bottle. During this time we were so stressed with his feedings that we tried to force feed him but that just made things worse and he developed aversion to bottle. Even on the sight of seeing a bottle he would start crying. This was when we figured out that he was taking milk better while sleeping rather than awake. So we continued with the sleep feeds. We swtiched from Zantac to prevacid at around 3 months but there was still not much change in his feedings. We just continued with prevacid though we were not very sure if it was really helping him.

 

Sometimes the sleepfeeds were smooth and sometimes not. The things which helped with the sleep feeds are rocking chair, fan for white noise, closed room. I had a fixed schedule to feed my son milk every 3-4 hours. Before I put him to sleep, I would offer him the bottle, sometimes he would just refuse but sometimes he would take 0.5-1 oz. Of course with time he started tkain more while awake(after 8 months). When he refuses, I would just try a second time and if he refuses again I just leave it and dont force him. I would gently rock him to sleep and then sleep feed him. There have been lots of ups and downs with feedings,days of elation when he meets the daily milestones of milk intake and days of real depression when he would hardly drink. Things got better as sidhu grew older and also as we introduced solids. While introudcing solids we worked with an occupational therapst who was of great help. She gave lot of tips like allowing sidhu to play with food on the high chair and not forcing food at any time. I wouldnt say sidhu started eating big quantities of solids at once but it was a gradual process. My mother-in-law was there for 5 months to help me. I would work on  sleep feeds exclusively whereas she would work on giving him solids. He put on weight well that way. As he grew he started drinking more milk awake and I could slowly reduce the sleep feeds.

 

I've seen 2 Ped GI's. I was not happy with the first one because she seemed very pessimistic and was talking about NG tube on day one. The second Ped GI who happens to be a top GI in WA state, said he didnt find any thing wrong with my son and didnt even think he had reflux :)  Anyway he jsut referred us to a nutritionist and wanted us to work with nutritionist to help sid gain weight. He said we could continue with medication if we feel it was helping. Sid was on prevacid till amost 11 months and then we slowly weaned him off. Till date he hasnt been on medication again but he still does have episodes of throwing up sometimes when he is on full stomach.

 

My son is not very high on the growth charts. infact he fell off the chart at one point and is now just above the border line. But we are not worried about the charts anymore as long he is a happy boy and active. He is a very naughty kid, very active, happy boy, loves to eat candy,choclates,cookies,gummies etc. He also loves non-veg food, fruits but not a very big fan of healthy veggies :)

8/22/10 2:07pm

 

Hi Sonja, Jan, Bao, tweety,

 

I have a feeling that my 6 month old baby does not know how to feed while awake since she has been sleep feeding since 2 and 1/2 month. Is it safe to spoon feed milk or there is a danger of the aversion being transferred to spoon? Should I keep the spoon exclusively for solids? I also want to try feeding her milk while awake. She has completely rejected the bottle. What should I do? Did you try to spoon feed milk to your baby? If so, what happened? Any tips would be helpful. Looking forward to share your experience.

 

8/22/10 3:25pm

Hello Mari,

 

I tried feeding my son milk with spoon but he did not like it so I never tried it again. I dont find any harm trying to feed milk with spoon but be very careful and dont force if your child doesnt like taking milk with spoon. You dont want to mess with the spoon coz thats only alternative for her to take solids. If hse is wiling to take milk with spoon then I feel it shoudl be good.

 

Another thing u can do is try introducing sippy cup, she might start taking milk with sippy cup. But it might take long time for her to get used to the sippy cup, so just be very patient with her. Allow her to play with the cup first and then u can try milk. From my experience what I've learnt is that we have to be very patient while dealing with fussy feeders. It takes long time to feed milk with spoon so I personally feel sippy cup might be a better alternative.

 

Good luck Mari, praying that your child will soon be out of this sleep feeding habit. I'm very sure she would.

 

 

 

8/22/10 5:57pm

Thanks for the prompt reply tweety!! :-) It is so depressing these days. She is 100% sleep feeding, not doing well on solids. I don't how and when this will end....I also read that babies who sleep feed after 6 months continue to do so in the second year. I am ready to do that also, but getting her to sleep is the most frustrating part. It's her wish whether she will go to sleep or not.

8/22/10 7:33pm

your welcome Mari :) Sorry to hear all that your going through. Its not easy I know. But hang in there. Even Sid was sleep feeding almost 100% at one point but then things gradually changed. So dont be discouraged. Sid didnt do super great with solids as well,initially he would take like 3-4oz a day, but that also changed when he was around 8-9 months old. When I was sleep feeding my kid, I always used to wonder when it would end and did end. I dont think most kids who sleep feed during the first year will continue to do so even the second year. Most parents I spoke to said thier kids who were sleep fed during the 1st year quit sleep feeding anytime between 9 -13 months. 

 

I know its very hard trying to get your child to sleep. I used to feel bad when I deprive my child of sleep. I would never allow him to nap more than 1/2 hr, If I did he will not go to sleep for his next feed. 

1/29/11 8:13pm

Thank you for giving me hope!

1/29/11 8:34am

My son is 7 months old and exclusively sleep feeds. We've tried giving him solids and he won't take those either. It's becoming harder and harder to feed him his bottle, and many times he spits up most of what he is eating. I feel like ALL I do is feed him and constantly worrying about how many ounces he is getting or (is not!) getting. He's in the 2nd percentile and I feel like he will continue to lose weight since he is sleeping less/sucking reflex is diminishing. We've just started seeing a OT and she is working with the solids but told me to cont. to sleep feed him for another 6 months.

I've never felt so stressed...my husband works all the time and my family lives in another state. I really don't want him to be put on a feeding tube, but I feel like he is heading in that direction.

Jan Gambino, Health Guide
1/29/11 3:30pm

Hello Jenn,

 

Sleep feeding is very stressful because you are the source of nourishment and the reflux treatment too. It seems that sleep feeding helps babies who are in pain from reflux and other digestive problems eat. It sounds like your little one is having a harder time growing with the sleep feeding. If he only ate when he was awake, he might refuse to eat altogether. That would certainly necessitate a feeding tube.

 

I hope you and the doctor have explored different diets, medications and tests to figure out why he is exhibiting these symptoms and to find a way to decrease the discomfort and fear of eating. My question is: why is he sleep feeding? Is he in pain? Did he have a traumatic event that caused him to fear eating such as choking, reflux pain, ng tube or intubation/surgery? I would be happy to review the steps if you would like.

 

Feeding therapy can be slow going. It can be really important but frustrating in that there may not be dramatic changes. Parents have told me that the number of sleep feedings may decrease from 6 months to one year as cup drinking and spoon feeding increase. So, you may be sleep feeding for some feedings for the next 6 months but I would hope that your little one would be able to make progress with the other feeding methods. I know of some sleep feeders who eventually opened their eyes and drank a bottle while awake. I know this seems impossible right now but it does happen.

 

I am so sorry that you do not have family nearby to help you. It is a huge job and maybe the hardest thing you will ever do. I hope you can connect with the other parents of sleep feeders here at HealthCentral and get some support and ideas for coping.

 

Take care, Jan

1/29/11 8:07pm

Thank you so much  for getting back to me Jan! He is currently on omeprazole 2ml and famotidine .5 ml twice a day. He has had an upper GI and endoscopy. The endoscopy showed no changes in the lining or esoph.

We are currently giving him enfamel AR mixed with enfamel premium. We've "tried" to give him other hypoallergenic formulas, etc. but he he refuses those even more than he does the other formulas. We've also tried numerous types of bottles and nipples.  I gave up trying to give him the other formulas when he wouldn't even drink an ounce after 8 hours.

He is a happy baby when he is not eating and he's hitting all of his milestones. He doesn't arch his back and he doesnt ever cry AFTER feedings...just during. The doctor said she thinks it is reflux but I just want to make sure I'm not missing something else....

 

What do you think I should do, what would you do if it were your child...I'm so at a loss. What other steps should I take?  Should I take him to another GI? I live in Richmond, Va if you have any recommendations.

 

The only trauma I can think of is that at birth he had a severe case of jaundice which caused us to feed him around the clock practically....even as a newborn he wouldn't eat but we assumed it was bc he was so lathargic due to the jaundice. I also tried breastfeeding and he wouldn't eat enough for the biliruben to pass. Thank you SOOOOOO much for your help!

1/29/11 9:45pm

Hi Jenn, I am so sorry to hear about the sleep feeding troubles with your little boy. Many parents (including myself) have fed their babies successfully in sleep until about 18 months or so. Of course eventually our kids started taking some solids and some "liquid wash" with the solids such as water. The fact that your little guy is at 2 percentile, you need a good GI who is experienced in this matter and you need him/her soon.

 

Here is what I would suggest based on the experience of few other moms and my own experience

  • 1. By trial find out how much Prilosec/Prevacid is needed. Personally we had to go from 7 mg prevacid to 22.5 mg to start seeing a difference in his feeding patterns. However, each child is different and responds differently so you need a pediatrician/GI doctor who is willing to try different doses and test on the side. These things have to go in parallel.
  • 2. I had read that Famotidine (pepsid) is not a drug of choice for small babies as it has some bad side effects. Zantac is used more commonly. Again this makes me wonder whether you are working with a doctor who is more "hand-on" with latest research/findings. It's ok to change doctors in the best interest of your child-sometimes the effect is dramatic.
  • 3. The omeprazole (prilosec) has to be given on empty stomach in the morning and not with feedings. The feeding should be given 30 to 40 mins after the prilosec. There are bubble-gum type flavors that babies like.
  • 4. Recent research suggests testing for allergies and if your baby is + for allergies you may have to switch to a hypoallergenic formula and/or use Zyrtec type med if needed. Parents who did see a difference have claimed that it was not just 1 med but a combination of meds that finally works.
  • 5. Therapy is needed and takes a long time but you can also play the role of your child's therapist. I worked with many good and bad therapists and learned a lot from them. I have some posts on sleep feeding here and see if you find them helpful.

 

Please feel free to send me e-mail if you want to discuss anything in more detail-send me an e-mail by clicking on my name and give me your number, I can call you too. I have formed a very close group with some sleep feeding moms on Health central here and we always support each other with information/advice.

 

Lots of love to your little one and hope things get better soon.

xoxox Sonja

Jan Gambino, Health Guide
1/30/11 11:39am

Hello Jenn,

 

It is important to give the acid reducer (pepsid) and the proton pump inhibitor (prevacid) at different times of day. I am not sure if you are doing that already.

 

Your son might not be ready for solids. Since he has had some difficulties with bottle feeding, he may be very wary of a spoon and new flavors and textures. I would go very slowly with this. My reflux babies were very slow with solids and I think they thought I was giving them yucky medicine! Also, check your Emotions at the Kitchen Door...I talk about this a lot in my book. If you are stressed about feeding and eating and your face looks stressed, your baby will know and respond accordingly. This is very hard as we know how important it is for our babies to eat and grow. As much as we push and force, they will resist and refuse to eat.

 

Since you are in VA, have you been in touch with Suzanne Evan Morris at New Visions? Her website is www.new-vis.com.

 

Please keep in touch. I see Sonja has replied too. She is a wealth of info on sleep feeding.

 

Take care, Jan

 

 

1/30/11 2:13pm

Thanks Jan for that important tip. btw, are there good GI's in that area? Also, where does Dr. Chatur practice (does she still practice)?

 

Thanks for the answers--since you are local, I am sure you can help Jenn.

 

Sonja

By Sonja P— Last Modified: 10/26/11, First Published: 08/02/10