Pedialyte Trial - Day 1 (Thursday 12/4/08)

Day 1 of our trial went really well!

Weight 7.090 kg (15 lbs, 10 oz)
Oral Intake 12 oz.

To recap, basically up to this point we worked on fattening her up to keep her healthy and get her through surgery and the healing process (Phase 1 of Peetie Unplugged).

Then we spaced her feeds out during the day and didn't push her limit on volume quite as much. Her daily intake went down from 32 ounces per day to 28-30 ounces per day. This allowed her to tolerate her feeds better and space them out so she could begin to feel hungry in between them. This got her to start taking the bottle again in minimal amounts. (Phase 2 of Peetie Unplugged). She was 100% NG fed a little over 2 weeks ago.

We are now nearing the end of Phase 2, which is working to encourage oral feeding by bringing back her hunger mechanism. We are getting a bit more aggressive now and are doing a Pedialyte trial. We'll do this trial for a few days and then reevaluate our plan with the help of Sofie's Dietitian, Dana.

The Pedialyte trial is simply bottle feeding her milk (same thing she's been getting) during the day based on her hunger cues. We don't give any NG supplementation during the day. Based on her current weight, she requires 23 ounces of fluid to stay hydrated, so at night we give her the remainder of the 23 ounces that she hasn't taken during the day in the form of Pedialyte through the NG on the feeding pump at a continuous rate of 60cc/hr. This way she stays adequately hydrated with regard to fluid and electrolytes, but the Pedialyte won't fill her up and zap her hunger like a night feeding of milk would.

We can do this for a while from a nutritional standpoint without causing any harm. She is going to lose weight though. From what I've read the average weight loss is around 9%, up to 15%. We are prepared for the fact that during this process she may lose a pound or more. That's why we worked to fatten her up before we started, so that she can still lose that weight and not fall below the growth curve that she's been on all along.

I truly believe in the hunger mechanism and it's extinction in tube fed infants. There is a lot that goes into this theory and it's not widely accepted, but it makes perfect sense to me and there's really no reason not to try it at this point.

Today was Day 1 of the Pedialyte Trial, and I told myself that if she took 6 ounces total from the bottle for the day I would be okay with that. She took 12 ounces! I feel like that was excellent for the first day, given the fact that today wasn't a whole lot different for her yet. The hunger mechanism takes quite a while to return (a couple of weeks or more). So tonight she's getting 11 ounces of Pedialyte through the NG on her feeding pump.

Tomorrow may be a bit more rocky for her, since tonight will be her first night without a continuous milk feeding in almost 2 months (with the exception of the days surrounding her surgery). Until she recognizes that she is hungry and that she needs to eat to satisfy that hunger, I don't think she'll understand it when she gets hungry. She'll probably just get really irritable until she figures out what to do about it. We just need to support her and comfort her and offer her food in a nonstressful way until it clicks for her, but I do think it will happen.

Feeding her based on hunger cues is really difficult when even she doesn't realize she's hungry. I don't know what her hunger cues are! Basically I have a bottle at hand all the time and when she seems fussy or insistant on something or is sucking more aggressively on her binkie, I offer her the bottle. Today it worked pretty well, and she took 2-3 1/2 ounces each feeding. She took 5 feedings, anywhere from 1 1/2 hours to 5 hours apart.

I don't think she'll ever eat on a regular schedule or the daily volume that the clinic says she should be taking. She will tell us what her needs are. But to me, a healthy, happy baby that eats orally with no feeding issues, is much better than a baby that is tube fed for years only to be a few points higher on the growth curve. You have to look at the big picture and all the physical and psychological things that go along with this feeding issue.

I look back to June when she came home from the NICU and was 100% orally fed. Just a couple of weeks ago she was 100% NG fed. We made her that way!!! And we can get her back to oral feeding.