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Sunday, May 6, 2007

Feeding Frenzy

Thursday was a bittersweet day for us around here. It was the day that I defrosted the final bottle of frozen breastmilk.

When the babies were born, Sharon started pumping like crazy because it was one of the few things she could do for the girls that was real, even if they weren't able to drink her milk yet. And, over the tumultuous next three weeks, as the girls first did well for 23 weekers and then embarked on the downward swing of the awful rollercoaster that is NICU life and did so much worse, Sharon kept pumping. Neither Hallie nor Olivia could have more than TPN (total parenteral nutrition) because they had open PDAs and it would be unsafe to feed them just yet. And so the pumping went on and, every day, we'd come into the ICN with bottles and bottles of milk for the freezer in East Nursery. After we lost Olivia on day 18, it was emotionally difficult for Sharon to keep pumping, but she kept on keepin' on because Hallie needed her milk. And so, even through our worry and our sorrow, knowing that Hallie had pulled through her PDA surgery just fine and would soon be "eating" was enough to keep the Medela humming in our household. On her third week birthday, Hallie started to be fed, and she completed her 10 day feeding cycle in 10 days (this is where you increase the amount gavaged through a tube into the babies stomach incrimentally and make sure that digestion is working and that the baby is tolerating things well). At first they only syringed a couple of cc's of milk at a time; then we moved up to a whopping third of an ounce every two or three hours. This was not sufficient to wear down the incredible stash that just kept growing and growing as Sharon kept pumping and pumping.

On one day in July, it looked like this:

Eble milk filled up several shelves of a deep freezer and we were asked to take some home with us to make room for all the milk being produced by all the other micropreemie moms in the unit (remarkably, 3 sets of 23 weekers, several 24 weekers including multiple multiples, and lots and lots of 25 and 26 weekers were in the ICN all at the same time this summer).

That's when we went out and got a second fridge for the basement and started freezing some of Sharon's milk at home.

We were all very hopeful that the stash would diminish quickly once Hallie started to bottle feed. But no such luck. Hallie turned out to have reflux even back then (though she wasn't placed on meds for it until after she came home). After a while, she started to push away the bottle of Sharon's milk, which was very hard for all of us to take emotionally. It's clear to me now that it must have been totally painful for her to eat, and I wish that we would have pushed for her to get on prilosec back then. Well, hindsight is great, and I know that the neonatologists and PAs were worried about the side effects of zantac and prilosec and that, given that Hallie never vomited back then, her reflux did not seem 'that bad.'

Anyway, Hallie was put on enfamil AR, which she tolerated though didn't love, and began to embark on her oh-so-fun bad eating habits. She might suck a bit and take part of a bottle sometimes, but most of the time did not bottle feed completely. This, plus her oxygen requirements, probably led to her being hospitalized a week or two longer than she might have been otherwise.

When we brought home Hallie, we also brought home 200 or so bottles of milk. We weren't sure what the hell we were going to do with them, but they ended up in our basement freezer because we could not bear to throw things out.

At about the same time, Hallie's feeding issues got worse and we lost a lot of sleep around here trying to get her to take any food and keep it in her system. The vomiting started, and so did a serious bout of bottle aversion. After numerous visits to the pediatrician, the GI specialist and many, many sleepless nights, we finally came up with a system that sort of worked. We started to mix ready to feed AR with some powdered AR, with some breastmilk (to thin out the powder and make it a good drinking consistency) and some corn syrup. And so began the gradual decline of our stash of breastmilk. Hallie never did become a great eater, but she ate enough of her super-charged formula to keep growing and growing and we just seemed to all the docs to be another set of munchhausen moms complaining about the bad eating habits of a kid who had no trouble staying on her growth chart.

And this brings us to this past weekend. With the breast milk gone, the formula had to change. On top of this, as Hallie has gotten bigger (she is currently somewhere between 15 lbs. 3 ounces and 15 lbs. 8 ounces---we don't have a precise weight from this past week but she was the former last Monday), her calorie needs have mounted and she has gotten physically stronger and more capable of pushing away the bottle and causing her mommies real physical damage (I say this staring at a Hallie-induced black and blue mark on my thigh; Sharon has a lovely gash on her face where an over eager soon-to-be-toddler 'stroked' her mommy). Anyway, it was time for a switch. But what to do?

The first thing I tried was vanilla and sugar. Bleh. It must not have been sweet enough for our kiddo.

Next, came the fruity cocktail trials.

Coconut cream and coconut milk added to the bottle worked really well the first time around. I had dreams of Hallie kicking back and drinking this:

Alas, what works once does not always work twice.

Next, staying in the fruity drink genre, we added some sorbet (passion fruit and mango) to the bottles and got so-so results. It was a bit messy to mix and I am not sure all the powder got dissolved, and I am not sure that Hallie liked it. Let's face it: it is hard to tell what a kiddo likes when most of the time you have to 'sleep feed' her. (For those of you without preemies without feeding problems, this involves putting your child to sleep and then introducing the bottle. For whatever perverse reason, the child does often start sucking. Hallie almost never has a decent suck while awake, but when asleep often does. I attribute some of this to the fact that she was intubated for so long and that she never associated eating with feeling full---the bottle is an evil invention designed to put her to sleep, not comfort her and certainly not provide her with the energy she needs to be her active little self).

I digress. After the sorbet trials, we changed things up again. Since our issue was getting the consistency of the bottle smooth enough to take while adding extra calories, we thought it might be nice to try adding nectars to her bottle. So I went out and got some organic pear nectar. The baby loves pear juice (she will drink this, just not her bottle!) so I figured that this was a good flavor choice. Little did I know that this was a poor idea. The first time we tried it, Hallie vomited all over herself and her crib. The second time she vomited all over Sharon. The third time we just marginally spared the cute little party dress she was wearing for her two (yes, two) preemie birthday parties yesterday. This seemed too coincidental and we decided that the new bottles had a lot to do with the bout of barfing. When I got home and checked the bottles in the fridge that I had made up yesterday morning, they seemed to have clumps and curdles suggestive of spoiled milk. I was poisoning our child. Great.

So we tossed out all that food and are now back to the drawing board. We're trying to coconut milk and a little AR powder added to the Ready-to-Feed stuff again. Hallie did fine for the 13 ounces we crammed into her between 8pm and 1am yesterday (she was hungry and sleepy---up until that point she had eaten 4 or 5 ounces of formula, 3/4 of a baby food jar---which was amazing in its own right, 2 ounces of juice, and 3 chunks of pineapple that she sucked the hell out of. Pineapple is her favorite food and she would gladly suck on it all day and we'd be happy to serve her vast quantities of it were it not for the obvious choking hazard that it currently poses to our little girl).

So all was well in Hallie feeding land, or at least back to the quasi normal state that feeding Hallie amounts to. Or so we thought. But then came the 3am bottle, and once more, Hallie barfed. I woke up this morning to find Hallie next to Sharon on the futon in our office and, just like yesterday, Hallie's crib sheet (thank god for the miracle sheets that prevent seepage) covered in vomit. Great.

It is possible that we tried to get too much into the kid at one time and that her system could not tolerate it. It is also possible that her reflux meds require adjustment. And it is possible that her tummy is irritated from the assaults of the past few days.

We hope that this was it on the vomitting (we are running low on miracle sheets for the crib). If not, I guess it's back to the doctor's office for us. Of course, our pediatrician is on vacation this week and we go on vacation (we hope!) next week. And we don't have a GI visit scheduled until mid June. So please keep your fingers crossed for us.

Anyway, on other happier notes, Hallie is really getting ready to crawl. She's been flipping over in her crib and getting up on all fours and rocking:

And she has been rolling around like crazy and has figured out how to sometimes make it from a crawling position to a sitting position. This is all very cool and, feeding issues aside, she is a joy to be around. I leave you with one last cute image taken earlier this week:


Kim said...

Please give my best to Sharon. I know how devastating it is to defrost the last milksicle :( And I would think that these sad feelings would be compounded by having a baby with an oral aversion who is doing well with a breastmilk mixture.

I hope that you guys can find something that works for Hallie. It's so frustrating to have to do trial and error and, in the meantime, have your kid be unhappy (or barfing). I'll be thinking of you all and praying that things work themselves out soon!

p.s. Have you tried one of those mesh feeder thingies for fresh fruit--not worries about choking hazards with those contraptions!

Sarah said...

Kim beat me to it, but I have a link. ;^)

Try this thing:

S never really liked it (except now, as a really random toy - she took it to daycare filled with rice today - I don't know why) but it sounds like it would be perfect for Hallie.

Jamie and Jill said...

I still remember how devastated I was when I defrosted the last of my breast milk. Looks like little Miss Hallie got A LOT of it though!

OMG........definitely get the mesh feeders! John loves them......and remember, he doesn't take anything by mouth. I put all kinds of fruits and veggies in their and he just chomps away.

Kirsten Wood said...

Just thought you'd like to know that Hallie is beating George in the mobility stakes. _He_ cannot scooch backwards into sitting, and he can't commando crawl yet either.