High calorie formulas

I am wondering how long babies who are discharged on high calorie formulas (enfacare, neosure, etc) stay on those? Has anyone who was discharged on a HCF, switched and if so, why did you switch and what did you switch to?

My LO was born at 27 weeks and came home on Christmas eve. He gets half breast milk and half enfacare in every bottle. Recently he was diagnosed with reflux. He has been on prevacid for about 2 weeks now, and while he has stopped vomiting, he is still fussy when eating and sometimes still refuses to eat. I had been thinking that he might have an allergy, especially since he has been very congested and also has a red ring around his anus (which I have read can be a sign of an allergy). My pedi hasn't really taken my concerns about a possible milk allergy seriously, so I'm considering taking matters into my own hands and trying him on a soy formula. I'm just not sure since I definitely think he needs the higher calories, but i'm also thinking that a high calorie formula isn't doing much good if he is refusing to eat it!

Any comments/suggestions/ideas???

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This sounds exactly like what happened with us (31 weeker son) - except minus the breastmilk. The congestion in our case was caused by the refluxed milk - it's not really congestion, it's like 'milk boogers' (that's what we called them anyway - when you suck out his nose does it look like little milk-globs?).

We ruled everything out, so on the bright side there was nothing really wrong with him, and on the not-so-bright side, he's 8 months old and STILL fights his bottle (but loves to eat off the spoon). He does do better with bottles mixed with oatmeal though.

I chose to stick with the milk-based formulas, since it wasn't allergies. He might end up having liked Soy better, but I don't like that soy formulas have a lot of corn syrup in them. (Just my preference as a mom - would rather have lactose as the carb than corn syrup.) We tried every single milk-based formula out there, and we took him off the high-cal around his actual due-date and he's been fine. Right now we are using the Similac Advance Early Shield.

Here's what I would do:

1) Insist that your pediatrician refer you to a GOOD pediatric GI (gastroenterologist). That is, if you have an HMO. If you don't have an HMO, you should be able to find one yourself.

2) Have the GI do allergy tests and a more intense reflux test to see if there's any damage to the esophagus or if he's aspirating any of his milk (sucking some of it into his lungs, which can be very uncomfortable - not to mention bad for the lungs).

3) If there's no allergy, try switching formulas to another milk-based, non-high cal one. That helped a lot with my son - not sure if maybe all the extra vits and minerals were harder to digest or something? He LOVED the Enfamil A.R. there for a while (but warning - it made him really constipated so we had to start adding prune juice a few times a day).

4) Talk to the GI about goat's milk as an alternative to adding formula to your breast milk. I know a couple mothers on this board have had great success with goat's milk and reflux issues (katek is one of them that I can remember).

And as for myself, I chose to only keep my son on the Prevacid for a month max because I didn't want him to become too reliant on medication. His reflux was not THAT severe - it wasn't affecting his weight or anything. That month got him over the 'pain & discomfort' hump, but he still spits up after every meal (although it seems to be getting better over the past week). At that point I just dealt with it as a laundry problem - as long as he isn't in pain and screaming after burps and having very acidic spit up, I don't want to medicate him.

Good luck, I know how frustrating it is when your baby fights meals!!

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I second everything dustarella said. My son receives BM supplemented with Pregestimil, which is hypo-allergenic. We discovered in Dec that he has a cows milk allergy and he is finally getting tested next week (and he's 14 mo old!). I went dairy free in Jan. I want to stop pumping, so we're getting him tested to find out exactly what he's allergic to so we can make a decision on a more toddler appropriate formula.

I just want to point out that switching your son to soy may not answer your questions. Many babies with cows milk allergies also have soy allergies. I agree with finding a good GI and getting allergy tested. Good luck!

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There are several reasons to use high calorie formulas. It can be for weight gain. It can be for nutritional issues. And, the much ignored reason, for brain development! The dietician at the NICU where my boys were had good research on this and recommends preemies stay on Enfacare until nine months adjusted. My boys were switched to regular formula at only 4-5 months olf (2-3 months adjusted) because they were do big. However, they are very short (compared to weight and head circumference) and I was told by a dietician that they may have needed to be on high calorie formula longer. But what sticks out in my mind is that the extra nutrients (remember, it's not just higher calories, but also extra nutrients) are needed for brain development. My thought is to go to a GI if you feel you need to, but don't switch formulas before being told to by a dr.

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I forgot to mention this: keep in mind that there are many potential issues with reflux. One many people don't think about is that a child could aspirate the reflux which could cause pneumonia.

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Sorry, but I disagree (and so do my doctors) that a preemie absolutely needs high cal formula through 9 months. I found that when I switched to lower cal, not only was my son eating better, he was eating MORE volume. I did some math and figured out he was getting the same amount of calories (if not a little more) and nutrients as he was on the high-cal that made him uncomfortable (for whatever reason).

Ultimately YOU are the mom. If you are uncomfortable about feeding him what you are feeding him, no matter what, some of that stress is going to transfer to the baby and it may make it worse, which may lead to longer term feeding problems. So try figure out what would make you and your baby happier, together with an understanding doctor, and go for it! As long as your baby is getting the love and nutrition he needs, that's what's important!

(Not only that, but if you notice most of those studies have been instigated by the formula manufacturers. Sure, they may be 'independent' - ie: not done by the manufacturers themselves - but that doesn't necessarily mean that they aren't biased.)

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Wow! Im sitting here reading your story and it sounds like my story! My daughter came home on enfacare. she has severe reflux so they put her on prevacid, with no help. so at 4 months they changed her to nutramigen, thinking there was a milk allergy. still no help, they added reglan.....and long story short, she is now 11 months, and had a ng tube placed 3 weeks ago due to relux.

Back to your little one, he may have silent reflux that is why he still fusses with feeding. You should talk to the peds. and stay on top of them, i ended up switching peds b/c i felt like my daughter wasnt getting proper care. and the next peds sent her to a new Peds GI doc, and 5 days later we were addmitted to the hospital!!


Good luck, ihope your story doesnt turn out like ours!

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My doctor took our kids off Enfacare (high-calorie) at 6 months and went on regular Enfamil Lipil (yellow can). He said he continues for low weight preemies that aren't gaining well, but for our tanks, he said they would have probably have better results and eat more if they were on the regular stuff. My pediatrician was also on staff at our NICU, so he was very familiar with preemie issues, and said that brain development would not be effected by high-calorie vs. regular lipil - as long as they were eating enough. We were very comfortable switching at 6 months actual, and the reflux improved.
P.S. soy did nothing for our reflux issue, as it often doesn't . Removing acidic fruits helped greatly. Each babe is SO DIFFERENT, it can be totally hit or miss. Good luck.

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I'm sure you Ped has seen the effects of allergies many times before. Before you start changing his diet maybe you can change to a different reflux med, like Zantac or for worst cases -Reglan. The "congestion" can be formula gurgling in the back of his throat. And the red bum can be normal baby butt. Ian gets a red crack, we just slather on Dr Smiths cream and it's gone. If you're truly concerned, request to be reffered to a pulmonologist or Gastroenterologist , they specialize in reflux.

To answer your question. We went from Similac Neosure, to Similac Sensitive (Ian gets gassy on Advanced, lol) After he caught up to his birth age weight, height and milestones around 5-6 months.

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When we were discharged the Neonatologist at the NICU said the latest studies have shown that using Neosure or something similar for a whole year as opposed to the previously recommended 9 months actually improves head circumference. I don't know what my regular pedi thinks but I know my girls are having trouble (gas, trouble pooping, reflux) which may be due to the formula. Who knows what to do. Just go with your gut and keep asking questions. We are all just feeling our way through this preemie business.

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we did bm/enfacare until zoe was 9 months actual, 7 months adjusted. when she switched to the similac advanced her weight gain slowed to the point i was ready to put her back on the enfacre just for my own piece of mind. my pedi says weight gain slows at this time because babies become mobile and burn more calories. at 12 months actual, 10 adjusted she is now slimming down quite a bit. btw, she was also a happy spitter that she has mostly outgrown.

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