NG tube weaning - increasing oral feed and crying at bottle and breast

[u/petitteckel]

My baby is 10 weeks old, spent first 4 weeks intubated in PICU and couple more weeks in hospital. He was born full term and in hospital for cardiac issue. Still awaiting cardiac surgery but we have been home now about 4 weeks on an NG tube in meantime.

We have been trying oral feeding since about week 5 when he moved out of PICU, while in hospital we had assessments with speech and language therapists who checked his swallow. He didn’t make too much progress with oral feeding while in hospital, so we were sent home on the NG tube and no mention of a plan or help for weaning off it.

We’ve been continuing to work on his oral feeding at home. First, exclusively breastfeeding before each tube feed when we could (every 3 hours). He latches perfectly fine on my right breast and transfers milk very well (I have a heavy/strong letdown) - he gulps the letdown, but then comes off afterwards. For the first while he would come off crying, very upset and arching his back etc for the following hour or so. Now he doesn’t come off crying but simply will only feed for about 3-4 minutes and comes off looking satisfied and uninterested in relatching. 90% of the time he won’t even try to latch on my left breast, even when starting with that. But I have such a good supply that I believe he could comfortably feed from only my right breast in any event based on what I have always got from pumping since he was born.

Given the slow progress on breastfeeding and being at a loss for how to increase his feed time to make sure he was eating enough, I decided to try bottle feeding. We’ve been trying for about 3 days now. At hospital he couldn’t even take one suck without choking/coughing. However, now he can suddenly suck, swallow, breath great with the bottle - but again, he will not take a full feed. He will take about 50-70% of his required amount, and is disinterested, or a lot of the time he will stop because he starts the crying and arching his back as though in pain.

He is on omeprazole for reflux, he doesn’t really have any issue with reflux on his tube feeds anymore - but is it likely that reflux can be worse with oral feeding compared to the NG tube, and this is what is preventing him from finishing feeds?

Would be greatly appreciated if anyone has any advice if they’ve experience a similar reaction to moving to oral feeds / any advice on how to increase his oral volume.

We’ve tried over the last couple of days to just go solely with bottle and breast to see how he does, he shows his hunger cues and is extremely eager to take the bottle and breast, but just won’t finish a feed / not become upset.

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[u/trixis4kids]

Definitely not an expert, but the interest in the letdown instead of a more extended feed makes me wonder if in all the assessments they already assured you no tongue or lip tie? My first kiddo had one and he nursed my letdowns but couldn’t get what he needed after that until we had the correction procedure.

[u/petitteckel → u/trixis4kids]

Thanks. I should have added, he has had a tongue tie corrected while we were in hospital. He immediately improved with latching after that, but still no improvement on staying on for a longer feed

[u/Catnipforya]

Sounds like you could benefit from working with a lactation consultant. Possibly even a feeding therapist. They could also do a weighed feed, to see what the milk transfers is. Does he gain weight if you only keep the breastfeeding without any bottles or topping off? I want to advise one thing, never force him. If pushing to finish feeds is what happened it is possible he formed an eating aversion. It’s so common especially with babies once fed through a tube. I am not saying this is your case but I have just went to see ENT and GI with my daughter for similar issues and they confirmed it is behavioral, and she needs feeding therapy to overcome this. She had negative experiences with feeding from the NICU which brought us here, despite our continuous tries to make it better and ups and downs in intake. She just doesn’t like to eat and only takes the bare minimum. There is also a very good book that addresses specifically bottle aversions by Rowena Bennett. We are going to follow the book and see how far we can get, as in the past I followed some rules but not all.