When to Transition from Neocate to Alimentum

[Anonymous]

Hi Everyone.

Been reading this forum religiously since my son was born but this is my first posting. LOVE this website. Anyway- here is our story.

My son John has been formula fed since birth. Was given regular Similac in the hospital, but when he started screaming all day and night day 3 my mother (who’s 5 kids all needed to be on Nutramigen) told me to try making the switch. He was a perfect baby on Nutramigen for about 2 weeks. No fussiness, gas, or constipation issues. Gulped it down no problem. THEN all of a sudden he started screaming in pain only when passing a bowel movement. Rest of the day he was completely happy. That’s when I noticed he started to have blood in his stool. At 3 weeks old pediatrician recommended we start Neocate and see the Pediatric GI. For the next 7 weeks he was miserable on the Neocate, went down to 12-15oz a day- but the blood in the stool stopped after the switch.

Pediatric GI we saw was not the best as far as I was concerned- very young and didn’t seem to have much info to answer my questions. She did no tests to confirm a MSPI just told me it looked like that was the problem since he didn’t tolerate the Nutramigen. I always had trouble accepting the assumption that he didnt tolerate the Nutramigen because of the blood alone- as he was overall so much happier on the Nutramigen and ate so much more.

Last two weeks he has been the best baby in the world- sleeping thru the night and content all day long. FINALLY. But he is still- at just a few days shy of 3 months- consuming less than 20oz a day. Most days less than 16oz. Because he is totally comfortable I’m assuming this is bc he simply hates the taste, as he has no symptoms of pain or reflux.

At his 2 month check up with his regular pediatrician (about 2 weeks ago) he weighed 10lb 8oz- only 30th percentile for weight. Pediatrician then suggested trying a transition to Alimentum or Nutramigen as soon as he hits the 3 month mark…according to him his digestive system should have matured enough to handle a hydrolysed formula. Now I know from my months of reading this site that NO ONE tries to transition off Neocate this early, and I’m just not sure what to do. I realize worst case scenario I try it and its too early- then I deal with a few bad days of fussiness and once he’s back to Neocate he will be fine….but he has been SUCH an angel that I just don’t know if I can handle even a temporary step backward!

I just really wish I could get him off this Neocate. Between the taste he hates (flavoring it didnt help much), his low weight, the cost, and the miserable and constipated baby it gave me for so many weeks I’m a serious Neocate hater…. despite the fact that he is so wonderfully pleseant and comfortable now.

If you were me what would you do?

And- if you would give it a try- how gradually would you do the transition?

Thanks so much!
Jackie

[hellbennt]

to be honest, I don’t think taste is an issue at this young of an age? it IS, for sure, when they get to be older, even 6 months, etc…

read here:

https://www.infantreflux.org/forum/forum_posts.asp?TID=6013

another thing to consider: is it ‘only’ mspi? could he be in pain and therefore not want to eat bcse he’s associating the bottle w/ pain?

If this is the case, then it’s time for meds…

maybe try carafate first? see if this helps? if it does, then you know it’s pain?

Caarafate:

https://www.infantreflux.org/forum/forum_posts.asp?TID=13485&KW=search+feeding+aversion+forum

the easiest thing to do in the meantime would be to try mylanta cherry supreme before a feed (they don’t make it anymore but the cvs brand equivalent is the same…)– just look for one that does not list aluminum in the ingredients. you can give 1ml up to 5 times a day- it’s safe, even for newborns. if you see loose stools back off.

please post your review of your ped GI here, and, perhaps you can find another one here:

Looking for GI: https://www.infantreflux.org/forum/forum_posts.asp?TID=660

there are recommendations for ped GIs in your area…

another option is to give him probiotics and see if those help?

probiotics, brands used:

https://www.infantreflux.org/forum/forum_posts.asp?TID=8970&PN=1

[Anonymous]

I agree with Laura that babies this little shouldn’t have trouble with the taste of Neocate because babies under 4 months old don’t have fully develop taste buds.

Honestly, you may not like my suggestion, if you’re concerned about his weight you could talk to the doctor about concentrating the formula to a higher calorie per ounce than the standard dilution. Obviously this means you would be using more of the formula and I know you said it’s expensive. Have you been able to receive any insurance coverage or looked into possibly getting help through WIC or Medicaid? There is some helpful info here: http://www.neocate.com/reimbursement/

As far as what would I do, I’m not sure? I don’t think I would transition so early especially since the bloody stools have cleared up. My son is almost one and I’m still worried about transitioning him and trialing dairy/soy. That is really a decision you’ll have to make with your family and doctor and do what you feel is best, YKWIM?

Good luck!

[Anonymous]

If it can’t be the taste that’s his issue I just can’t see why he won’t eat more. He is very obviously not in pain at all. And it was such a short period of time that he spent in pain associated with feedings that I have a hard time assuming it could be a food aversion. He doesn’t fuss while he’s eating as if he doesn’t want to eat– he just always acts like he’s had enough to eat when he’s only had 3 oz…sometimes only 2. During the day he wants to eat every 2 to 3 hours…ends up having 6-8 bottles in a 24 hour period.

He was actually on Zantac for quite a while- showed signs of silent reflux after we switched to Neocate. I didn’t really notice any change once we started the Zantac… slowly stopped giving it to him.

After he was off the Zantac the wet painful hiccups, wheezing, uncomfortable squirming during/after a feed went away on its own.

I did also put him on a probiotic and that’s actually when he really started to improve. Almost immediately he was no longer gassy or fussy and started sleeping thru the night.

I keep coming back to the idea that the blood in his stool that started 10 days into our initial Nutramigen trial could have been a residual effect of the straight Similac he had in the hospital and that I jumped the gun starting the Neocate- as I didn’t continue on the Nutramigen for a few more days to see if the blood would stop.

It’s just so scary in the beginning being a FTM every little cry or scream I was desperate to try everything to make him feel better…now that I’m more comfortable and confident in being a Mom I just wonder if an over reation got me to this place and on this formula…And maybe all he ever needed was a little probiotic supplement.

[hellbennt]

well you could try slowly transitioning back to nutrimigen- I would do it slowly, once ounce of nutrimigen mixed w/ neocate for a few days, then 2 oz of nutrimigen, etc? until you’re back to nutrimigen entirely. then, once on nutrimigen give it two weeks and see how it goes?

[Anonymous]

I agree with Laura, you could always try switching back and see what happens especially if that’s what your doctor is suggesting? You have to do what you feel is best for you and your LO, YKWIM?

I have my older two boys on a probiotic, I wonder why I haven’t put the baby on one yet? I’ve got to do that!

Good luck and let us know what happens.

[Anonymous]

Wow. Shocked at how quickly it was clear he was not ready to come off the Neocate. Only put 1 oz of Nutramigen for every 3 oz of Neocate in only his first 3 bottles of the day. After the first mixed bottle he started having diarrhea right away…which alarmed me but thought might be par for the course with a new introduction to his digestive system. Following day he started to seem crankier than usual and I started to notice a diaper rash forming. Also started hiccuping more frequently like he used to. After an hour long session of him crying inconsolably that evening from what seemed like cramping and gas pains I threw the rest of the Nutramigen in the trash. He has been back to Neocate only for 36 hours now and he is already pretty much back to his happy self…although his BMs are still working the Nutramigen out. Glad I tried… fast to see it wasn’t time… fast to get him back to normal. And now I know for sure he is a MSPI baby. I’m officially happy to be on team neocate!

jwarren952011-08-02 14:51:45

[Anonymous]

Wow! Well at least you tried and now you know, right? I’m glad he’s starting to feel better again 🙂 Hopefully once he gets older he’ll outgrow his MSPI.

[Anonymous]

Ok- so many confounding factors here.

Back story I left out before- we had been traveling the week prior to our Nutramigen trial and I mistakenly left his probiotic behind for the last leg of our trip…didn’t seem as tho he was regressing after a week of no probiotic so I figured he might not need it anymore and stopped giving it.

ANYWAY, we had him off the Nutramigen and he started to act like himself again…not that he got much Nutramigen to begin with…and his BMs had turned back to what was typical for Neocate after a few days- assuming then that the Nutramigen poops had cycled through him… and his system was Nutramigen free.

Maybe a day later he started to fuss more and more, hiccups continued more frequently like they used to be months ago, and he has been SUPER clingy…on top of him drooling like a maniac all of a sudden and constantly trying to suck on his whole fist. Wants to sleep all day and night and cluster feed.

From my readings online this sounds awefully similar to what he would be acting like during his 12 week growth spurt or “wonder week”….and also like maybe teething? Not to mention maybe the frequent Nutramigen pooping flushed the remaining probiotics out of his system and maybe that’s the cause of his increased irritability? One thing I ever gave him that immediately showed a positive change was the probiotic.

Got him back on his probiotic today… will see how this effects his mood and report back!

[hellbennt]

does sound like teething?

[Anonymous]

He is back to being a very happy baby MOST of the time. His reflux symptoms are gone- as they have been for some time- but he is starting to get difficult to feed. Sometimes he sucks down 4oz of Neocate no problem…other times he will eat an 1oz and then refuse to eat more…but act as if he his still hungry. I then have to wait a bit then “trick” him with his pacifier by pulling it out and switching it for the bottle as soon as I can. If I offer him a little water in a bottle he sucks it down happily always. He will be 4 months in 6 days….and we started the Neocate at 3 weeks…so I know it sounds insane to think it might be the taste but I just can’t imagine it being anything else!

We had him under control reflux/mspi so quickly and he was happily eating for so long after that that I can’t imagine this being a food or bottle aversion all of a sudden. No gas pain like straining, no BM issues, no wet hiccups, no spit up or wet painful burps…apparently not teething because its been two weeks and his gums look no different…he is just sometimes so pissed to eat the Neocate!

Any suggestions for flavoring just to see if it makes a difference? Any other suggestion? If only I could get him on a good feeding regiment we could finally be problem free!

[hellbennt]

have you tried mylanta before a feed?

get the cvs brand equivalent of mylanta cherry supreme (no aluminum & safe even for newborns) and give before feeding- you can give up to a tsp a day- if you see loose stools then back off…humour me/yourselves & see if it helps…

[Anonymous]

Will try anything- will go out and see if I can find that later…how much should I give?

[hellbennt]

you can give up to a tsp a day- if you see loose stools then back off…

a tsp is 2.5mls, so give/divide up however you want…

[Anonymous]

Update on our progress…tried Mylanta, didn’t notice an improvement. Was convinced for a while that spacing out his feeds was helping to improve his intake. At his 4 month check up his weight was down to the 20th percentile. Pediatrician told me to feed him more- yeah, right- like that isn’t what I’m already trying to do all day everyday.

Got myself worked up again over what to do to get him to eat more so I made an appointment with the Ped GI office. Explained despite an increase in normal (not reflux sounding) hiccups, all of his reflux symptoms have disappeared- only issue I have is getting him to finish his bottles. Always acts as if he is just “full” after eating only 2 or 3 ozs.

She suggested we try Prevacid and see if we notice an improvement. Well almost right away he was ever so slightly eating more. Up from 21oz a day to 24oz on average. As I know it takes 2 weeks for this medicine to work I assume this may have been coincidence. BUT he turned into an absolutely MISERABLE baby. Every night he woke up more frequently- by night 10 he was up every 45 minutes and after that I threw my hands up and stopped giving it to him. At first it was gas pains waking him up but soon it just seemed as though the prevacid was making him restless and jittery during the day. I just couldn’t take it anymore.

Two days off the Prevacid he is back to his happy self but also eating slightly less again. I am at a loss. Might a different PPI cause less of a reaction and be the solution?

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