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Why Does My Baby Not Cry To Show That She Is Hungry?
Question: Hello Doctor, I am first time mother in the UK and I had contacted you before regarding my baby girl.
Brief details - my daughter was born after IVF at 38 weeks by c-section. Birth weight was 2.960kg. Initially she struggled to latch on breast so after many consultations I started expressing breastmilk by pump and used to give her by bottles. First two months were fine.
After two months of age my baby struggled to take feed easily. She would arch back, reject bottle, cry or go to sleep during feed time. Due to this I could not express breast milk properly and now at 4 months my supply is almost nil. My baby is on formula milk since last three weeks.
After two months of age my baby struggled to feed properly and also weight gain was lower then expected. I had been to three doctors but they said some babies do that. As long as there is a weight gain all is fine. I went to two private doctors and both said it could be silent reflux and both advised to give Renitidine.
My baby is on Renitidine since last one month. She is now rejecting less and crying less. But I think she does not take enough formula milk. She was taking about 650ml at two month's age and at four months age now she is still taking 650ml. And this 650ml is also a kind of struggle to achieve as during the day she would take 40ml or 60ml at a time and sometime take 100ml. Night also she take 80ml or sometimes 120ml. Point is she is not demanding for food. I have to be on her feeding case all the time. My worry is that she will get dehydrated or will go in some problem if I do not offer her enough time.
Birth weight: 2.960kg
Weight at two months: 4.100kg
Weight at four months: 5.00kg
1> My concern is that why she is not asking for food herself? Why is she not crying in hunger? I am sure that if I do not offer her food every 2-3 hours she will not ask for 5-6 hours. If I wait for her to ask then she will not finish even 500ml in a day. What should I do and why this happens?
2> After Renitidine she is crying less and not arching back. But it has not made difference in her amount she could take. Do you think she has reflux? Or can it be some another problem?
3> Do you suggest any tests to be done? We had blood tests done at three months age. Renal profile, Full blood count, calcium and parathyroid hormone came back normal range. Are we missing something?
4> According to growth chart in UK, her weigh gain is lower then expected. But no once seems concerned as my baby is still gaining weight. Do you think her weight gain is acceptable or should I be concerned?
5> She urinates about 7-9 times in a day and poo about once a day. Yesterday her poo was little solid and also she looked in pain. I did tummy massage and today poo came normal soft and looks happy. Do you think she should be taking more milk to avoid dehydration or constipation?
6> Do you recommend we start using Gripe water or other colic relief medicine to make her tummy comfortable? As of now we are not giving her anything.
7> One doctor had advised that we can start solid food from 4 months of age to improve reflux symptoms. Do you think it is right advise?
8> Can we give my baby boiled water in between feeds to avoid dehydration or constipation?
9> If she gets constipated, what would you suggest?
10> One has suggested to give her milk protein free formula. He said sometimes baby is allergic to milk protein. Do you think this will help or is it necessary at this stage?
Apologies for long query but I am worried.
Awaiting your reply.
Thanks.
Brief details - my daughter was born after IVF at 38 weeks by c-section. Birth weight was 2.960kg. Initially she struggled to latch on breast so after many consultations I started expressing breastmilk by pump and used to give her by bottles. First two months were fine.
After two months of age my baby struggled to take feed easily. She would arch back, reject bottle, cry or go to sleep during feed time. Due to this I could not express breast milk properly and now at 4 months my supply is almost nil. My baby is on formula milk since last three weeks.
After two months of age my baby struggled to feed properly and also weight gain was lower then expected. I had been to three doctors but they said some babies do that. As long as there is a weight gain all is fine. I went to two private doctors and both said it could be silent reflux and both advised to give Renitidine.
My baby is on Renitidine since last one month. She is now rejecting less and crying less. But I think she does not take enough formula milk. She was taking about 650ml at two month's age and at four months age now she is still taking 650ml. And this 650ml is also a kind of struggle to achieve as during the day she would take 40ml or 60ml at a time and sometime take 100ml. Night also she take 80ml or sometimes 120ml. Point is she is not demanding for food. I have to be on her feeding case all the time. My worry is that she will get dehydrated or will go in some problem if I do not offer her enough time.
Birth weight: 2.960kg
Weight at two months: 4.100kg
Weight at four months: 5.00kg
1> My concern is that why she is not asking for food herself? Why is she not crying in hunger? I am sure that if I do not offer her food every 2-3 hours she will not ask for 5-6 hours. If I wait for her to ask then she will not finish even 500ml in a day. What should I do and why this happens?
2> After Renitidine she is crying less and not arching back. But it has not made difference in her amount she could take. Do you think she has reflux? Or can it be some another problem?
3> Do you suggest any tests to be done? We had blood tests done at three months age. Renal profile, Full blood count, calcium and parathyroid hormone came back normal range. Are we missing something?
4> According to growth chart in UK, her weigh gain is lower then expected. But no once seems concerned as my baby is still gaining weight. Do you think her weight gain is acceptable or should I be concerned?
5> She urinates about 7-9 times in a day and poo about once a day. Yesterday her poo was little solid and also she looked in pain. I did tummy massage and today poo came normal soft and looks happy. Do you think she should be taking more milk to avoid dehydration or constipation?
6> Do you recommend we start using Gripe water or other colic relief medicine to make her tummy comfortable? As of now we are not giving her anything.
7> One doctor had advised that we can start solid food from 4 months of age to improve reflux symptoms. Do you think it is right advise?
8> Can we give my baby boiled water in between feeds to avoid dehydration or constipation?
9> If she gets constipated, what would you suggest?
10> One has suggested to give her milk protein free formula. He said sometimes baby is allergic to milk protein. Do you think this will help or is it necessary at this stage?
Apologies for long query but I am worried.
Awaiting your reply.
Thanks.
Brief Answer:
Does not seem to be a cause for concern. Proper burping is important.
Detailed Answer:
Hi,
I have gone carefully through your query and understand your concerns. Your doctor has also been reasonable in assuming the diagnosis of reflux and it is good to know that the feeding has improved after that. You should burp the baby for at least 15-20 mins after each feed. All you need to do is to hold the baby head end elevated for this duration. Proper burping will ensure the escape of ingested air and the milk will not regurgitate back from the stomach to the food pipe, thus providing relief.
Weight gain is proper and there is not the slightest reason to be alarmed. Now coming to your queries.
1. No issues at all. No need to worry. No specific intervention needed.
2. She can only take as much as her stomach can accommodate, not beyond. And you need to give time for the stomach to empty. So, the amount is not supposed to increase and neither is she supposed to feel hungry any faster.
3. No tests needed. I do not suppose you are missing something.
4. The weight gain is proper and you have no reason to worry.
5. Passing urine more than 6 times in 24 hours indicates that feeding is adequate. For a baby of this age, it is normal to pass stool several times a day or even after each feed. Alternatively the child may pass stool once in 10 days and that is normal too. Unless the stool is hard and pellet like, you need not grow concerned.
6. Proper burping will ensure that any colic medicine or gripe water is not needed. However, in case of unexplained and uncontrolled cry, feel free to give it.
7. If not on breast milk, early weaning to semisolids can be done. I would focus on burping rather than shift to semisolids.
8. I would not recommend that. In fact, that will fill up the tummy and will hamper the actual nutrition the child gets. As I mentioned, passing urine more than 6 times in 24 hours indicates that there is no dehydration.
9. As I mentioned, that unless stool is hard and pellet like, its not constipation even if the child passes stool once in 10 days.
10. I would not suggest that. Had it been so, the indications would have been different. Not going into that.
Feel free to write back.
Regards
Does not seem to be a cause for concern. Proper burping is important.
Detailed Answer:
Hi,
I have gone carefully through your query and understand your concerns. Your doctor has also been reasonable in assuming the diagnosis of reflux and it is good to know that the feeding has improved after that. You should burp the baby for at least 15-20 mins after each feed. All you need to do is to hold the baby head end elevated for this duration. Proper burping will ensure the escape of ingested air and the milk will not regurgitate back from the stomach to the food pipe, thus providing relief.
Weight gain is proper and there is not the slightest reason to be alarmed. Now coming to your queries.
1. No issues at all. No need to worry. No specific intervention needed.
2. She can only take as much as her stomach can accommodate, not beyond. And you need to give time for the stomach to empty. So, the amount is not supposed to increase and neither is she supposed to feel hungry any faster.
3. No tests needed. I do not suppose you are missing something.
4. The weight gain is proper and you have no reason to worry.
5. Passing urine more than 6 times in 24 hours indicates that feeding is adequate. For a baby of this age, it is normal to pass stool several times a day or even after each feed. Alternatively the child may pass stool once in 10 days and that is normal too. Unless the stool is hard and pellet like, you need not grow concerned.
6. Proper burping will ensure that any colic medicine or gripe water is not needed. However, in case of unexplained and uncontrolled cry, feel free to give it.
7. If not on breast milk, early weaning to semisolids can be done. I would focus on burping rather than shift to semisolids.
8. I would not recommend that. In fact, that will fill up the tummy and will hamper the actual nutrition the child gets. As I mentioned, passing urine more than 6 times in 24 hours indicates that there is no dehydration.
9. As I mentioned, that unless stool is hard and pellet like, its not constipation even if the child passes stool once in 10 days.
10. I would not suggest that. Had it been so, the indications would have been different. Not going into that.
Feel free to write back.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you doctor for your reply.
1> I forgot to mention one detail. She takes feed relatively easy when she is in sleep. While sleeping or half sleeping she takes about 110-120ml if given at after 3-4 hours of last feed. But when she is awake and I try to feed her even after 4 hours she takes 30-60ml and starts rejecting and crying. For this reason I have to make her sleep at feeding time so she can take more feed.
Why she is doing this? There must be some reason behind it.
2> We try to burp her everytime. We hold her on shoulder for 10-15 minutes and tap her back gently or rub her back. When she is awake she burps. But as I said we feed her many time in her sleep, and after feed in her sleep she stays in sleep and does not burp. We dont want to wake her up otherwise she will not feed properly.
Can we try something else?
We are using special bottles which reduces the amount of air baby takes during the feed so it is not always she burps while awake but most time she does if she is awake. In sleep she does not.
3> She does not look constipated at the moment. But in case she does then what remedies do you suggest we should try?
Regards.
1> I forgot to mention one detail. She takes feed relatively easy when she is in sleep. While sleeping or half sleeping she takes about 110-120ml if given at after 3-4 hours of last feed. But when she is awake and I try to feed her even after 4 hours she takes 30-60ml and starts rejecting and crying. For this reason I have to make her sleep at feeding time so she can take more feed.
Why she is doing this? There must be some reason behind it.
2> We try to burp her everytime. We hold her on shoulder for 10-15 minutes and tap her back gently or rub her back. When she is awake she burps. But as I said we feed her many time in her sleep, and after feed in her sleep she stays in sleep and does not burp. We dont want to wake her up otherwise she will not feed properly.
Can we try something else?
We are using special bottles which reduces the amount of air baby takes during the feed so it is not always she burps while awake but most time she does if she is awake. In sleep she does not.
3> She does not look constipated at the moment. But in case she does then what remedies do you suggest we should try?
Regards.
Brief Answer:
Questions answered
Detailed Answer:
Thanks for writing back.
1. When she receives the feeds during sleep she cannot actively indicate you to stop even if the stomach is getting over distended. This is in fact the primary cause for the reflux. While awake he naturally protests.
2. Whether you hear the burp is not something to consider. Burping would be needed even if you feed during her sleep. You need not try anything else.
3. In case she constipates you need to increase the fluid intake. Medicines unlikely to be required.
Regards
Questions answered
Detailed Answer:
Thanks for writing back.
1. When she receives the feeds during sleep she cannot actively indicate you to stop even if the stomach is getting over distended. This is in fact the primary cause for the reflux. While awake he naturally protests.
2. Whether you hear the burp is not something to consider. Burping would be needed even if you feed during her sleep. You need not try anything else.
3. In case she constipates you need to increase the fluid intake. Medicines unlikely to be required.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you doctor for your reply.
Last two days she has rejected all feeds while awake. Sh has taken some in sleep but not as much as she had taken few days back.
Are there any tests to determine why she feeds only in her sleep? I mean can we ask doctors here to carry out blood tests or any other tests to rule out any problems she may have?
Is she really suffering from reflux/silent reflux? Are there any tests to make sure she is indeed has reflux and medicines (renitidine) we are giving is right for her?
We just want to make sure that my baby has not underlying problem and we are not wrongly assuming that she has reflux or fussy eater.
Please suggest.
Regards.
Last two days she has rejected all feeds while awake. Sh has taken some in sleep but not as much as she had taken few days back.
Are there any tests to determine why she feeds only in her sleep? I mean can we ask doctors here to carry out blood tests or any other tests to rule out any problems she may have?
Is she really suffering from reflux/silent reflux? Are there any tests to make sure she is indeed has reflux and medicines (renitidine) we are giving is right for her?
We just want to make sure that my baby has not underlying problem and we are not wrongly assuming that she has reflux or fussy eater.
Please suggest.
Regards.
Brief Answer:
Nothing alarming
Detailed Answer:
Thanks for writing back.
She feeds passively during her sleep as she is relaxed during that time. Nothing alarming about this. No tests applicable. She is possibly overfeeding during this passive feeding and that is likely to cause silent reflux.
Ranitidine is correct medicine but more importantly, you need to reduce the total amount of feed you are giving while she is sleeping.
Regards
Nothing alarming
Detailed Answer:
Thanks for writing back.
She feeds passively during her sleep as she is relaxed during that time. Nothing alarming about this. No tests applicable. She is possibly overfeeding during this passive feeding and that is likely to cause silent reflux.
Ranitidine is correct medicine but more importantly, you need to reduce the total amount of feed you are giving while she is sleeping.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks for reply.
I think we are going round and round on this feeding issue.
She feeds ok during sleep but according to you it may contribute towards over feeding and silent reflux. And while she is awake she does not take enough or sometimes not at all and refuse the bottle. This is dilemma for us.
We had tried to feed her while awake for 1-2 days but she took only 450ml instead of her average 650ml on those two days. We were worried about her less feeding and dehydration, weight loss etc so we started feeding her again in her sleep.
To finalise the matter, I need your opinion before closing this query:
1> What our feeding plan should be? I mean if she does not demand then how many hours should we wait before we offer next feed?
2> While awake if she takes only 50ml, then next feed should be after how many hours? (normally we wait 3-4 hours for next feed if she has take 100ml or more)
3> What if we do not feed her while sleep to avoid reflux and then what if she refuses to take while awake? I mean what if she does not want to feed for 6-7 hours?
4> Normally she takes about 100ml around 10pm at night and then sleeps well. We feed her around 2.30am in night in sleep and she takes about 70-80ml then we wait till morning. Do we still continue this?
5> What her feed volume should be at this age and weight (4 months + 2 weeks, 5.100kg)?
Any other suggestions on feeding plan will be welcomes.
Thanks.
I think we are going round and round on this feeding issue.
She feeds ok during sleep but according to you it may contribute towards over feeding and silent reflux. And while she is awake she does not take enough or sometimes not at all and refuse the bottle. This is dilemma for us.
We had tried to feed her while awake for 1-2 days but she took only 450ml instead of her average 650ml on those two days. We were worried about her less feeding and dehydration, weight loss etc so we started feeding her again in her sleep.
To finalise the matter, I need your opinion before closing this query:
1> What our feeding plan should be? I mean if she does not demand then how many hours should we wait before we offer next feed?
2> While awake if she takes only 50ml, then next feed should be after how many hours? (normally we wait 3-4 hours for next feed if she has take 100ml or more)
3> What if we do not feed her while sleep to avoid reflux and then what if she refuses to take while awake? I mean what if she does not want to feed for 6-7 hours?
4> Normally she takes about 100ml around 10pm at night and then sleeps well. We feed her around 2.30am in night in sleep and she takes about 70-80ml then we wait till morning. Do we still continue this?
5> What her feed volume should be at this age and weight (4 months + 2 weeks, 5.100kg)?
Any other suggestions on feeding plan will be welcomes.
Thanks.
Brief Answer:
Small feeds at small intervals can help in preventing reflux
Detailed Answer:
I understand your anxiety. This is about the perception of 'adequate' feeding amount. The adequacy would be measured by the amount of urine output. If the baby passes urine more than 6 times in 24 hours, consider the feeding amount adequate. Now coming to your queries.
1. Continue with the existing feeding plan. Just make sure to reduce the amount of milk given in a single feed. You may halve the amount and give at half the interval. You have to experiment and see what works. You need not increase the feeds during waking hours.
2. No change needed during waking hours. If you can, you may try giving smaller feeds at smaller intervals, but thats optional.
3. Even if she does not wish to take feeds for 6-7 hours, do not forcefeed. Just make sure that she does not receive any small top-ups (of breast milk or anything else) during this period. I am certain that she would gradually demand.
4. As in point 1
5. 150 ml milk per kg body weight per day. Divide the total (750 ml) into 8 feeds, and give 3-hourly overall.
Regards
Small feeds at small intervals can help in preventing reflux
Detailed Answer:
I understand your anxiety. This is about the perception of 'adequate' feeding amount. The adequacy would be measured by the amount of urine output. If the baby passes urine more than 6 times in 24 hours, consider the feeding amount adequate. Now coming to your queries.
1. Continue with the existing feeding plan. Just make sure to reduce the amount of milk given in a single feed. You may halve the amount and give at half the interval. You have to experiment and see what works. You need not increase the feeds during waking hours.
2. No change needed during waking hours. If you can, you may try giving smaller feeds at smaller intervals, but thats optional.
3. Even if she does not wish to take feeds for 6-7 hours, do not forcefeed. Just make sure that she does not receive any small top-ups (of breast milk or anything else) during this period. I am certain that she would gradually demand.
4. As in point 1
5. 150 ml milk per kg body weight per day. Divide the total (750 ml) into 8 feeds, and give 3-hourly overall.
Regards
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Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
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