Things have been getting better and better in terms of Hallie's intake and Hallie's general lack of refund since Saturday. Her mood has even gotten better (and this is a kid who seemed happy even while she was retching and gagging and vomiting multiple times a day. This is saying something).
What changed? We're not sure, but this is what we are doing and it seems (for now) to be working and hopefully it's not some sort of fluke.
1. Food change. Instead of either Nutren, Jr with Fiber or Pediasure with Fiber, we now have her on a super charged goat milk formula. Sharon felt that part of the constipation issue might have been related to the Simply Thick, and without the Simply Thick, we'd be sunk in terms of her eating orally because we strongly believe (we have a bit of data, and we'll leave it at that) that she is still aspirating on thin liquids. We needed a lot of Simply Thick to thicken the pediasure or nutren, jr. and we felt that even unthickened, she had begun to slow down on stooling on the super rich 30 calorie formulas. Given that she did well on the mix of breast milk with Enfamil AR powder and Karo Syrup that we used to have her on, I did a bit of research on other milks and found a lot of data that suggested that the proteins in Goat Milk are the ones most similar to human breast milk and that they tend to be easier for people in general to process. Given our desperate situation, it seemed worth a try. We started mixing Goat Milk and the Enfamil AR powder (we are also adding in vitamins to compensate for the lower B-s and especially Folic Acid in Goat Milk, relative to the complete nutrition formulas) with a bit of Karo syrup and less in the way of Simply Thick. Hallie loves the taste of it and, in contrast to the other formulas, is also taking more of this during meals (from a straw cup) than she ever did the Pediasure or the Nutren Jr. We estimate it at 27 kcal/ounce and that she is now taking (for the first time in a long time) more than 20 ounces of this a day, on top of her purees (appx 4 ounces per meal, with a goal of an average of at least 100 calories per meal, three times a day).
2. Meds might have kicked in. We are splitting 30 mg prilosec into two doses, mixed with applesauce (morning and night). We are keeping up with the Reglan (1 ml 4 times a day).
3. Hallie is on a firm schedule that spaces her meals, bottles, and naps more effectively. She is napping upwards of 3 hours per day (two naps) and sleeping from 10pm to 7am (roughly). She seems to thrive on this schedule and we are aiming for complete consistency to enhance her happiness and our own. Her last bottle is around 12am and it is still a sleep-feed but we are hoping that we might, over time, increase her consumption during the day and be able to discontinue this. In any event, it sure as heck beats the 3am bottle of yore.
Stooling is now regular, more of the consistency that one has while on breast milk (instead of pebbles, which is what we had been getting some of last week, and sometimes hard formed cakes). She is no longer retching and her gassiness has subsided. She seems happier.
So we are pretty happy. The only vomiting we have seen has been mechanically (mommy) induced: we had one bottle that was too thin (hence our data about aspiration), and one meal that came too quickly on the heels of a bottle (hence our very precise scheduling). Otherwise, no retching, two small wet burps and a whole lot less laundry. And she sounds clear as a bell and has no congestion whatsoever.
Did I mention that we are happy?
Very belated Hallowe'en pics to follow later on tonight...