My boys were born on March 9, 2010 at 34 weeks. All were pretty decent weights (Trevor = 4.10 lbs, Peyton = 4.6 lbs, Maxwell = 4.15 lbs). Trevor only spent 4 days in the NICU and then came home. Whereas the identical, Peyton and Maxwell, was in the NICU for 21 days due to feeding issues, O2 desaturation, and bradycardia.

The boys were brought in for their 3 months visit on June 4th and the doctor is happy with their growth and weight gain. However, I'm little concerned about our smallest boy Peyton since it seems like he's gaining/growing much slower than his brothers. At this last visit, the weights were -- Trevor: 11.7 lbs, Peyton 10.4 lbs, Max 11.1 lbs. I fear the older the boys get, the bigger the difference in weight.

Currently I'm having a really difficult time feeding Peyton and Max. I use the Dr. Brown bottle with size 1 nipple. Every time when I feed them, it seems like their struggling to drink the formula and after drinking about 1-2 oz they start falling asleep...or they would throw one of their little fits. I've tried many different distraction techniques from singing, making funny noises, reciting nursery rhymes, changing diapers, opening the light. I've even tried to switching to size 2 nipple but it's too fast for them and they start gagging or they would throw one of their fits. With the size 1 nipple I've tried loosening the cap until it's almost falling off...and with the size 2 I tried tightening it as much as possible to slow down the flow...and nothing is working. I've also tried the wide neck bottles, but it seems like they are struggling even harder with the nipple. I've also recently went out and bought the Playtex bottle to try it out and they drink well at first but then they stop drinking and they seem to have difficulty burping and have alot of discomfort afterwards (I may give it another try again).

So as of now, these 2 will drink anywhere from 2 oz on a bad feed to 4 oz on a good feed. The average daily intake could be anywhere from 21-25 oz. They drink every 3-4 hours during the day and at night it's a hit or miss 5 hour...sometimes 4...3...or 2.

Anyone has any suggestion or advice...sorry for the long post.

Last but not the least are they drinking enough?? I looked up on the website and they say I should multiply their current weight with 2.5 oz. If I did that, then Peyton should be drinking ~26 oz and Max should be drinking ~28 oz. Which means they currently aren't drinking enough.

I do not have identicals, all 3 are fraternal, but there always has been one smaller than the other. At first it was my son who was the smallest and the girls were growing wonderfully and then my one of the girls' weight gain started slowing down and actually dropped off. They are 9 months old and my son and my "big" girl are almost the same weight, but the one that had failure to thrive, even though she has been gaining for a while now, is 2 lbs smaller. Getting to the point, its ok if they are not exactly the same size. Peyton may just be a smaller kid OR the other 2 have taken growth spurts and Petyon has not got to that spurt yet. They will grow at different rates their whole life.

None of mine were big eaters and still really aren't. I think 21-25oz a day is fantastic. Some babies need 40oz+ a day, but some don't. Mine were the ones that never needed that much. The 2.5oz for each lb stuff NEVER has worked with my kids and still does not.

What I would be most concerned about through everything that you have said is the "fits" they are having when they are eating. Have they been checked for reflux? Reflux can cause a lot of discomfort and can make them not want to eat because it causes them pain. That is exactly what my daughter did (the one with failure to thrive) and she eventually stopped eating COMPLETELY and has a feeding tube in her stomach now (g-tube.)

Shely~ Mom to 1+GGB
http://thehansontriplets.blogspot.com/
http://www.marchforbabies.org/team/TeamLilyGrace

I was thinking reflux, too. My two with reflux have always gained at a decent rate, but my littlest at birth by a half pound never had eating issues and she was the heaviest by a pound at their 6 month appt.

Anyway, there are some non-medicine things you can do like keep them upright (or at least inclined) for 20-30 minutes after eating and raising one end of their mattress so they aren't sleeping flat. There are also several prescriptions that you can try. They each work in a different way, so you may have to try more than one before you find which one works for each child.

Our DS with the worst reflux also had bad gas. We had a terrible time burping him for a long time. We had to burp him midway through his bottle and used Mylicon at nearly every feeding. The reflux med he's on didn't help the gas problem, he just had to outgrow it. But, he did outgrow it by about 6 months or so when his core muscles were strong enough to start getting the burps out without as much help from us.

Mom to GBG born 7/28/09 at 30w6d: 3#10oz, 3#12oz, 3#2oz

I don't think it's reflux, since sometimes they throw a fit less than a minute of putting the nipple in their mouth. I notice that they are trying to suck on the nipple, but then get frustrated b/c the formula is not coming out fast enough for them...then they don't want to drink anymore. This evening, after their bath, I tried to feed Max with the size 1 nipple and then he started to cry and throw fits. Then I tried to switch to size 2 nipple and he got even more pissed off b/c the flow was too fast...so I immediately switched back to size 1 nipple again. The whole entire time he was throwing fits, however, towards the end he calmed down and drank a little over 3 oz.

My other boy Trevor, I know for sure has reflux and is currently on Similac Alimentum and also gets .33ml of Pepcid everyday. But, I'll double check with the doctor and see whether she thinks Peyton and Max have reflux as well.

I'm going to try in the morning to make the hole in the size 1 nipple a little larger. I spoke to friend and he said I could boil the nipple and then pull on it a little and that may stretch it out a bit. I hope it works.

BTW, I'm relieved to hear that 21-25 oz is not too little for my boys.

OK, now your description sounds like what ours were doing when they were ready for a faster flow nipple.

We've been using the Dr. Brown's bottles for several months and for a while we used an Evenflo nipple instead of the Dr. Brown's nipple because the flow was in between the Dr. Brown's level 2 and 3. I'd do that instead of messing with the other nipple.

Also, you might try the level 2 for more than just a few minutes before deciding if it's really working. It'll take a few feedings for your son to get used to it. You could always pace him so he doesn't choke. If you haven't had to do that before (we had to in the NICU when they first started on bottles), you hold the bottle just tipped enough so the nipple is full of milk and tip the bottle down after every couple swallows to give him a chance to catch his breath and swallow if he needs to.

Mom to GBG born 7/28/09 at 30w6d: 3#10oz, 3#12oz, 3#2oz

I did try the Level 2 flow nipple for a little over 2 days...and now Peyton won't even drink. Once I put the bib on him and bring the nipple close to his mouth he starts crying and turns his head away. So now I'm using Level 1 flow again, but this time I took a needle from my cross stiching kit and widen the nipple hole just a little bit (I did this by taking the needle and burning it with the fire until it glowed red and then pushed it through the hole in the nipple). So the flow is now just a bit faster, but not too fast.

In any case, I'm still struggling with feeding him. It seems like now he has an adversion to drinking, but I know he's hungry b/c he starts crying and sucks on his fingers.

I've scheduled an appt on Monday with the doctor and will ask whether he needs to see a feeding specialist.

That sucks and I'm really sorry you're dealing with this. Did you get any answers from the pedi?

One DD was very, very difficult to feed for weeks and still is sometimes. We tried everything: different bottles, different nipple shapes, different flow rates, etc. She's picky about temperature, you have to let her suck her thumb for a while and then when SHE'S ready she'll take the bottle - it was a nightmare. Even though her symptoms were nothing like the classic symptoms our son had for reflux, we got her on a prescription for it and she's much better now. She still has her moments, but they're once or twice a week instead of having only one or two feedings per day that WEREN'T difficult. All that to say, it may still be reflux.

Besides the medicine, the thing that made the most difference was taste. After all those months of fortifying my breast milk with high-calorie formula, she didn't like the taste of straight breast milk. Now we give her half/half and she eats much better.

I hope you got some answers and/or ideas from your doctor. Not being able to get DD to eat has been by far the most stressful thing we've had to deal with.

Mom to GBG born 7/28/09 at 30w6d: 3#10oz, 3#12oz, 3#2oz

Thanks everyone for your input. So I just wanted to give an update on the boys. I did bring them back to the doctor a few weeks ago and asked if she thought it was reflux and she said that it might be the case. So now they are on Similac Alimentum formula and Pepcid, and occasionally I wold give then a 1/2 teaspoon of Mylanta if they refuse the bottle. The boys are doing much better now, but are still fussy eaters.

Also I've switched over to the level 2 flow nipple for Dr. Brown since the Alimentum formula is a lot thicker. So the flow now is perfect.

However, the last few days Peyton and Maxwell have been eating worse, so this past Friday the doctor increased their Pepcid dose. Today is their first day with the increased dose of Pepcid and they haven't been eating too well (they've been crying and refusing the bottle). I can't wait until the reflux issues goes away.

You need to give every new medicine dose at least a week to see if it works. However, Pepcid isn't one of the stronger reflux medicines. If the increased dosage doesn't work, ask for Prevacid. It seems to be the standard reflux drug when the others aren't working well enough. Although 2 of my kids did great on Zantac, Prevacid was the miracle drug for my 3rd baby.

Good luck. Reflux is so frustrating for you and uncomfortable for the babies.

Lori

http://yesidohavemyhandsfull.blogspot.com/

One thing you might look at is what formula they are on. We had to switch formulas a couple of times around that age due to feeding issues. They were on Neosure when they came home and we started having a lot of issues with it so we switched to Enfamil Gentle Ease. That was great for awhile and then they all of a sudden stopped eating it. Bottle time was horrible. So we switched to Enfamil AR (our had mild reflux and spitting up issues). It was a little thicker so it worked great with the #2 nipples (also Dr Brown's). They have been on that ever since and gaining tons. At almost 5 months they are: Caitlin 20lbs,
Haley almost 19lbs, Criton is about 17.5 lbs. As you see there is a good difference in weight between my biggest and smallest but I think sometimes they just have periods where it will be that way. As long as you can get the proper amount of formula for growth, you should be fine.
As far as how much formula... my pediatrician has always been happy if they stay between 20-40 ounces a day. They go more by age range then by weight.
I hope this helps a little.

www.thetripletlife.com

http://www.zazzle.com/the_triplet_life

If you continue having problems you may want to get a swallow study done on your boys. All 3 of mine ended up on thickened liquids due to them aspirating the thin liquids into their lungs. They don't always necessarily cough but it makes drinking VERY uncomfortable. This would make sense since you say sometimes they throw fits after only a few drinks and are becoming averse to the bottle. We had LOTS of feeding issues including reflux and aspiration so I understand your frustrations....

Megan

Proud mama to Will, Quinn and Jack (8/2/08, 29w2d)

My boys have been on Similac Alimentum for over a month and I noticed that the formula is definitely a lot thicker then the regular formula. With the Alimentum formula I am able to use the Dr. Brown level 2 flow nipple.

Wow, those are great weights. At the 4 month visit my boys only weighed -- Trevor 13 lbs 8 oz, Peyton 11 lbs 14.5 oz, and Maxwell 12 lbs 15 oz. I think my heaviest one will only be close to your lightest one in weight at the 5 month visit. I'll ask the doctor about the Enfamil Gentle Ease and Enfamil AR.

With the boys reflux there is hardly ever any spit-up. So I believe they have silent refluxes, b/c I do see them scrunch up their faces and make a slight gagging face during feeding.

Just recently we switched Peyton over to Prevacid, he takes 1.6 ml 2x a day. Maxwell is still on Pepcid, but his dose has increased from taking .35 ml 1x a day to .35 ml 2x a day. In addition, I've beeng giving them 10 ml prune juice. The feedings has been somewhat still difficult but not as bad as before. I spoke to the pediatrician and she recommended that I should take Peyton to see a Ped Gastro...so I have an appt scheduled towards the end of Sept (that's the earliest appt they have). If everything checks out ok, then the pediatrician will refer me to a feeding group.

I'm really hoping by around 6 months this reflux issue will go away.