This isn’t going to be my normal ‘Jaxson update’ post, so for those of you patiently waiting to read funny stories and see adorable pictures then I apologize.
1 week ago Jaxson had his NG tube removed after 6 weeks of being ‘tube fed’, due to the VERY disgusting formula he had to be on post open heart surgery. We assumed that being the little porker Jaxson is, he would have absolutely NO issues with going back to the bottle. Now we didn’t run into major issues per say, but we did have a couple of VERY frustrating days. Of course I turned to my trusty friend Google for some tips and help, however I didn’t find much helpful advise. So here is my post on what worked for us during the transition back to the bottle. Hopefully this will be of some help to another frustrated set of parents!
DAY 1: Optimism turned sour
Jaxson is still feeding every 3 hours, minus one feed during the night. He was originally slated to take 105mL Similac Advanced (what he was on prior to surgery) at 20kcal/0z. Every single bottle given on day 1 was a total disaster! Refusal to latch, gagging, choking, latch for 2 swallows, swallow wrong leading to more gagging, pushing nipple out of mouth or just gumming it. After an hour and a half of trying we would manage to get 80mL in him. Felt like we were force feeding, but were unsure how much he HAD to get with the meds he is on. Tried switching from the Avent bottle (what he was on prior with no issues) to a Nuk (Seeing as he would suck a Nuk soother we thought we would give it a shot). No real improvement from one style to the next so we decided to press on with the Avent since we have over a hundred bucks invested with the product. Also switched him from a slow flow (1 hole) nipple to a faster flow (2 holes). Which did help a lot, as he did not have to suck as hard when he would finally latch.
Day 2: Ditto
Day 3: Improvement
We had a chest x-ray this morning to make sure the chylothorax had not returned, and it indeed has not! Went upstairs to the peds clinic to see the doctor for the x-ray results. We voiced our issues to the clinic nurse. She arranged for an occupational therapist to come see us to talk about options. The nutritionist also offered great help with letting us know how much he NEEDS vs extra that he doesn’t need. She also thought that trying to get 105mL in by bottle every 3 hours was maybe a bit too ambitious right off the bat. She then changed him to 80mL every 3 hours at 24kcal/oz. The occupational therapist offered the best help of all! Seeing as he would latch (even if not for long) she didn’t think that there was a physical issue with why he wasn’t taking the bottle, he just needed to re-learn the tools it took to eat. So we were sent home with the instructions to only try to feed for 30 min as long as he seemed happy. The constant trying and forcing would frustrate Jaxson and if it continued it could create negative feeling towards the bottle and cause him to regress. GREAT ADVISE!! We also always had the option of putting the NG back to supplement his feeds if need be, which did ease the push to feed.
Went home and applied the new feeding tools. Took tons of breaks during feeds. He would latch for 3-5 swallows at a time before gagging. We would sit up, burp and play every time this happened. Then back to it for another few swallows. Bottles took about an hour, and we got 90% done every feed. Once he lost interest the feed was over. We were satisfied with the amount he got and would revisit the bottle in another 2 hours.
Day 4-5: cutting time
Same as day 4 with improvement. Bottles taking 35-45min. More swallows per latch with less gagging and coughing in between.
Day 6: WE DID IT!!
Latching and swallowing for half the bottle. Little to no gagging. 15 MINUTE BOTTLE!!!! Also remembered how to sleep eat or dream feed. Eating while fast asleep, which makes his midnight feed much quicker and easer then trying to wake him up to squeeze 20mL into him before falling back into a coma. Jaxson would not wake up enough to ‘sleep eat’ for his 6am bottle. We made the executive decision to skip his 6am bottle and add that volume to his other bottles throughout the day. Now he has a 9 hour ‘no feed’ zone which he is sound asleep for the entire time (NO HATING!).
How We Did It:
- Decrease the volume per feed
- Increase nipple flow
- Try changing nipple brands/shape (didn’t work for us but it was worth a shot)
- Don’t force it – you will end up frustrating baby and creating a negative experience
- Limit tries to 30 min as long as baby is content
- Tons of breaks
- Have baby sit semi fowlers (half sitting) or on side so food isn’t being forced to run down their throat causing gagging
- Stay calm, positive and relaxed. Your baby will pick up on your energy and feed off of it (no pun intended :P)
- Let baby get hungry – Why bother if they aren’t feeling the need to eat. Take their lead and let them run the show
Hope this offers some help to the parent who just Googled ‘bottle feed post NG tube’. GOOD LUCK!!!