Bottle & Pacifier "Strike?"

These last few weeks have been challenging with a newborn and toddler.  As a result, this blog and many other things in my life has been neglected.  My day to day life now consists of nursing every 2-3 hours, changing diapers, cleaning spit up (and occasional pooplosions) cooking, grocery shopping and entertaining a very active toddler.  My time spent on the Internet has been limited to whatever I can do on my cellphone while I nurse.  Typing one handed is frustrating and time consuming.  Despite all of this, I am finding a way to peck this post out of desperation.  I am presently functioning on no more than 3 consecutive hours of sleep since the baby was born 42 days ago.  To say that I am delirious is a gross understatement.  Please excuse any typos or grammatical errors since many things do not presently make sense.

My lovely baby has decided to go on a pacifier and bottle "strike."  He had taken a pacifier and bottle before.  Unfortunately, over the last week, he is refusing to take either one and only wants me to nurse him.  He is absolutely refusing to even latch onto a pacifier or bottle.  We have been trying nightly without any success.  A lot of milk has been wasted in our futile attempts.  To make matters worse, my husband has been working two weeks straight without a day off so I have been his primary caregiver.  I have turned to my favorite breastfeeding website, kellymom.com, for answers and despite trying many of their suggestions, the baby is still refusing to take a bottle.  We have a wedding to attend on Sunday but I am finding it less likely that I'd be able to go if this baby will not take a bottle.  I would also like to start getting more than 3 hours of sleep.  I can't do this if my husband cannot do a feeding with a bottle.  My supply is well established (which brought its own set of problems that I can write another post about) so supply being compromised is not a concern. I have plenty of expressed breastmilk ready to give to him and we do not have to use formula.  We have tried the following thus far:

1. Feeding the baby when their cues indicate hunger, rather than on a schedule.
2. Held in an upright position; it is especially important to avoid letting the baby drink from a bottle when lying down. Such a position is associated with bottle caries and an increased frequency of ear infections. Note also that babies should be held often at times when they are not being fed, to avoid the baby being trained to eat in order to be held.
3. Gently, allowing the infant to draw nipple into mouth rather than pushing the nipple into the infant’s mouth, so that baby controls when the feed begins. Stroke baby’s lips from top to bottom with the nipple to illicit a rooting response of a wide open mouth, and then allow the baby to “accept” the nipple rather than poking it in
4. Use a silicone rather than a rubber nipple to avoid an unpleasant odor or taste.
5. Warm the nipple under running water before offering the bottle to the baby.
6. Make sure the milk is not too warm and not too cold. If when holding the bottle in your palm, it feels warm to the touch, it is most likely too warm. If it feels cool to the touch, it is most likely not warm enough. If you can feel no difference in the temperature of the bottle and your palm, the milk is probably at the right temperature.
7. Most babies will accept expressed breastmilk more readily than formula.
8. Offer the bottle while holding the baby with his back to your chest so that he is facing outward, rather than trying to cradle him.
9. Move with the baby - rock, sway, bounce, walk, walk in circles, etc. as you offer the bottle.
10. Place the baby in a swing, bouncy seat, infant/car seat, etc. and offer the bottle. Try to distract the baby with something else as you offer the bottle.
11. Place an article of mother's clothing up near the baby while offering the bottle, or wrap the bottle with an article of mother's clothing.
12. Lightly tickle the baby's lower lip with the nipple and allow him to pull it in his mouth rather than trying to force the nipple in.
13. Offer the bottle when the baby is already sleepy or just waking up (but not fully awake) or once the baby is already asleep. Many babies will instinctively suckle at these times.
14. Try to use a bottle with a newborn or slow flow nipple no matter how old your baby is so that he always has to work hard with the bottle just as he does with the breast.
15. Having my husband feed the baby without me in the vicinity of the bottle.

We have tried Tommee Tippee bottles and Medela bottles.  Our older baby used the Tommee Tippee, Medela and Dr. Brown's bottles without any problems.  He also used a pacifier until he was four months old and we discontinued using the pacifier.  This baby is six weeks old and I do not know if the six week "growth spurt" is the cause of our troubles.  Does anyone else have any suggestions or ideas??  I love my baby but mommy needs to get some sleep!  

Cereal in the Bottle?

I starting hearing about parents putting cereal in their baby's bottle so they can sleep longer through the night.  I don't plan on giving the baby a bottle of anything for a few more weeks to make sure breastfeeding is firmly established.  However, since I am up every 2 hours to nurse, I decided to do a little research to determine if this has been proven to work.

The American Academy of Pediatrics does NOT recommend giving cereal in the bottle until a baby's digestive tract is ready to process solid foods at around 4-6 months of age.  At that time, they should get the cereal from a spoon and not from a bottle.

Prematurely adding cereal to the bottle can cause the baby to aspirate (inhale into their lungs) the cereal and it can also activate any allergies a baby may have.  I have also written a blog post about breastfeeding and foods to avoid which touches on the American Academy of Pediatrics position of no solids before the age of 4 months.  If you're breastfeeding, it should be done exclusively (without solids or formula) for at least 3 months to protect against wheezing early in life.  If you are using formula, then there is evidence that extensively hydrolyzed formula without cereal is best for the prevention of atopic disease (allergic disease).   Adding cereal to the bottle may cause a baby to "overfeed."  "Putting cereal in the bottle is considered by some to be a form of force-feeding that can cause babies to “overdose” on calories."

I don't believe with a lot of things Dr. Sears has to say but he does break it down in an easy to understand manner why you should not feed your baby solids before 4 months.  Aside from the issues mentioned above, he gives an excellent description of the tongue-thrust reflex.  "In the first four months the tongue thrust reflex protects the infant against choking. When any unusual substance is placed on the tongue, it automatically protrudes outward rather than back. Between four and six months this reflex gradually diminishes, giving the glob of cereal a fighting chance of making it from the tongue to the tummy."  My mom fed me solids when I was 2 months old.  She took pictures and at the time said that is what the doctor told her.  You can clearly see that my tongue-thrust reflex was in action at that age.

This is another great post from a pediatrician who advises against cereal in the bottle because of the issues with overfeeding that this may cause.  "A major study looking for the causes of obesity found that short-circuiting young children’s self-regulation of how much they eat is a major cause of later obesity."   "Cereal in the bottle does just that.  Babies that are fed this way may appear to be unaffected – but those few weeks of added convenience may result in a lifetime of struggles with weight. This common practice may have contributed to our being the most obese generation in history.  And it doesn’t even work. Scientists at the Cleveland Clinic studied the effect of cereal on sleep and found that adding the cereal did nothing at all to speed up the age of sleeping through the night. That first uninterrupted 6-hour stretch of sleep came no earlier in those who took cereal early."

After reading more about the issue, I think putting cereal in the bottle is one thing I will not be doing to my baby in the hopes of making him sleep longer during the night.