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Taste Test - Elizabeth Unexplained
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greyautumnrain
greyautumnrain
Taste Test
I’m writing this during lunch at work for posting when I get home.

This morning I played a trick on Margaret, meaning that sometime today she will get her very first ever taste of rat poisonformula. Warren and I discussed the plan last night and I saw no reason not to put it into practice right away. The plan was to top up any bottle that had less than three full ounces of breast milk in it with formula. This isn’t a lot of formula, but it’s certainly more than zero.

At Margaret’s six-month checkup the doctor heaped praise on me for exclusively breastfeeding for so long. It made me a little uncomfortable, actually. I was doing it because it was easy for me as well as being best for her. I also didn’t feel so comfortable being praised essentially for my body doing the right thing, especially in light of the fact that my body can’t manage conception without major intervention, so I’m acutely aware that there is a luck factor involved. I also knew that we’d have to start the transition to formula at some point.

Up to now the drill has been that I nurse on demand whenever I was home. I also always nurse her right before I leave the house at around 9am, so she get’s delivered to Warren as fed and happy as I can manage. I pump twice at work, once between 11:30 and noon, and once between 4 and 4:30. The first pumping typically yields between three and four ounces between both sides. There just isn’t a lot of recharge time before that first pump, but I have to pump when the room is available. I combine the product of this pump into one bottle, which we’ll call bottle A. The afternoon pump yields 2.5 ounces each side; each will be its own bottle, which we’ll call bottle B and bottle C. Then I’d come home and nurse. Overnight Margaret will nurse several times, but without waking all the way up. She complains loudly with her eyes closed until you put her on the breast. She’ll then nurse until she’s fast asleep again. I’ll hold her, rock her, and put her back in her crib. On the first wakeup I’ll also go downstairs to pump from the other breast (i.e., not the one she just nursed from). This is bottle D which ranges from 2 to 3.5 ounces depending on how long she slept. The reason I pump in the middle of the night instead of first thing in the morning is that after the first waking her she sleeps less soundly and semi-wakes to nurse much more frequently; if I waited until morning there wouldn’t be anything left. (I pretty much have to nurse her when she wakes, or she will keep Warren up.) So, we have four bottles a day containing between 10 and 12 ounces of milk, all procured through out custom just-in-time delivery system.

Back in December, Margaret would frequently leave some milk un-drunk during the day, sometimes an entire bottle’s worth. The past couple of weeks she hasn’t left a drop. She’s also been noticeably hungrier when I get home and has been nursing more frequently. If I were home full-time no doubt my supply would increase to meet demand, and she seems happy on the days when I am home all day, but I’m not getting an increase on the amount I pump. I can’t pump more often than I do at work and I am dubious extra pumping would do anything anyway. We have started her on solids, but they mostly seem to end up on her rather than in her. We need to transition her to formula by March anyway, so now that supply is starting to become an issue it seems like a good time to start. Yesterday’s pump was also not a good one; bottle A was only 3 ounces and bottle D was only charitably 2 ounces. Margaret had been very hungry when I’d come home last night, and leaving her today with only 10 ounces of milk when there was a handy alternative wasn’t something I wanted to do. It’s only two ounces of formula total, spread out over bottles B, C and D, but it’s a big step for us.

Obviously we’ll have to see how this goes. I’m hoping that she drinks the formula-enhanced bottles without fuss and isn’t famished by the time I get home. My tentative plan is to see how it goes for a week and then if all is well to start skipping the night-time pumping session and instead stop combining the morning pump into one bottle. If I do that, then I’d have two bottles that are half and half, and two bottles that are mostly breast milk. More importantly, I’d get rid of my most hated pumping session. Not only is pumping in the wee hours of the morning a drag, but I’ve noticed that on weekends when I get lazy and skip it (instead of pumping and freezing, which I used to do more regularly on the weekends), Margaret tends to sleep better. On weeknights Margaret is often up every half hour after the second waking, clearly unhappy. On weekends when I am lazy she seems to get more at the second waking and will often sleep through until 7.

If I’d first added the formula a month ago I would have felt sad. I’m glad events have transpired as they have. Now her first tiny bit of formula is kind of welcome to me. She’s already had some food other than breast milk, and she clearly would be happier with a bit extra to eat while I’m gone these days. Now I feel like formula can be an ally in dealing with the least pleasant part of my day, the dreaded midnight pump. I’m also pretty happy with the formula that Warren bought. It’s label almost says, ‘You are an evil person for buying our product instead of nursing your poor baby until she is four years old. Shame on you. But if you persist in your evil ways, here’s the next best thing.’ Honestly, I was scrambling to measure it this morning because they don’t include a measuring scoop for fear that a plastic scoop would leech plastic into my baby’s food. While I’m may be eager to cut out a pumping session or even two I am still not looking forward to giving up the actual nursing. That part will be harder. On the other hand, I need her to be at least mostly off the breast when we see the RE on March 4th, and completely weaned before the start of my next cycle after that. So, we take it one step at a time. Doing it gradually, one feeding at a time will be easiest on both of us, especially if pumping sessions are the first to go. I’m trying not to look so far ahead that I start making mad plans to cut down to a single pump a day before I see how she reacts to today’s test.

Added upon getting home: She drank every drop and was hungry when I got home.
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Comments
enugent From: enugent Date: January 8th, 2009 01:07 am (UTC) (Link)
Sounds like a good plan! I know that this process is bittersweet for you. Six months is a pretty standard time for a growth spurt, so that may be why she's looking for more right now. It's a good opportunity to get her used to the formula while she's really hungry and willing to drink it.

My understanding is that many formulas are less calorie-dense than breastmilk, so you may want to consider upping those bottles to 3.5 ounces, especially if she's drinking everything and still hungry.

May I ask which formula you picked? Howard is steadily eating through my freezer stash, so I'm probably going to have to supplement before the end of his first year. Since I expect that you researched it thoroughly, maybe I can freeload off your findings. :)
greyautumnrain From: greyautumnrain Date: January 8th, 2009 01:59 am (UTC) (Link)
Warren did the research, so you can pester him. It's Baby's Only Organic. It's labeled 'toddler formula' because these folks think you shouldn't be giving formula to babies less than a year old.
psychohist From: psychohist Date: January 8th, 2009 05:19 am (UTC) (Link)
This isn't a final decision yet.

You've seen my post on the paleolithic diet. I had started working on a post on infant formula, but it was private until I had a chance to fill out what's currently essentially an outline. I still haven't had the time, but I've switched it to friends locked so you can read it:

http://psychohist.livejournal.com/23807.html

It's not unlikely that the solvent extracted algae and mold sourced DHA and ARA used in DHA/ARA baby formulas - including organic DHA/ARA formulas - is fine; however, I'd feel safer with the water extracted forms from egg yolks that are available. Unfortunately, I haven't found any formulas using the latter; they seem to be available only as a supplement:

http://www.naturesonedirect.com/dhaarafaacsu.html

The obvious solution is to get non-DHA/ARA formulas and use the supplement. I also wanted to use a dairy based formula since it seemed likely to be less unlike human milk than the soy based or hypoallergenic stuff. It turns out, however, that Foodmaster doesn't actually stock any non-DHA/ARA formulas. Plus, they didn't have any dairy based powder formula, and the liquid DHA/ARA fortified formulas they stock come only in quart sizes after dilution, which would involve a lot of waste since we'd be using only a few ounces before it expired.

At Whole Foods, the Baby's Only toddler formula was the only non-DHA/ARA formula they had. Since I remember the spec sheet showing it as maybe half way between other formulas and breast milk, I figured it would be safe to use small amounts, pending possibly checking with the pediatrician before a complete changeover. I'd been planning to get some of the egg yolk based DHA/ARA supplement on line, as I didn't find it at Whole Foods, but Elizabeth went ahead and started using it - probably a good idea, as Margaret has been wanting a lot more food after finding out her growth curve wasn't matching the charts, or perhaps after her post-Thanksgiving ear infection.

Anyway, maybe that's more information than you want to know. If you just want a recommendation, I'd recommend:

1. Download the nutritional charts for Baby's Only Organic Dairy formula linked to on this page:

http://www.naturesonedirect.com/ordafo.html

2. Show the charts to your pediatrician and get his or her okay to use them before 12 months

3. Use that formula together with the supplement linked to above.
enugent From: enugent Date: January 8th, 2009 06:05 am (UTC) (Link)
Thanks for the reply! It sounds like your reasons for picking this formula may not apply to me - I'm not as worried about the DHA/ARA issue, since I'm not looking for a whole-diet solution - I expect that he will still be getting the bulk of his nutrition from breastmilk throughout his first year. He probably won't need more than a couple of ounces of formula a day even after my frozen stash runs out, so I think he'll get enough of that from me. The mold/algae vs. eggs doesn't concern me, either, especially in those quantities - I haven't cut blue cheese out of my diet, either. (And none of us are on a paleolithic diet. I understand the reasoning, but I'm not willing to take the time to prepare the food. I have a hard enough time fixing non-chicken-nugget meals that my whole family will eat now.) I was hoping you might know something about whether there is any difference between what you want in a breastmilk supplement and what you want in a breastmilk replacement, but of course you're looking for a replacement, at least in the longer term.

I haven't asked his pediatrician her opinion on formula choices yet - I forgot to do it at his six month appointment. I'm taking him in on Friday for an ear check, though, so I can ask her about it then. I just hope he'll be as compliant as Margaret about actually drinking it and keeping it down. The few times we gave Dorothy formula, she vomited copiously. (Incidentally, a few people on amazon complained that the Baby's Only supplement caused diarrhea in their kids, so you may want to keep an eye out for that. The benefit of a certain type of DHA/ARA probably doesn't outweigh the costs of chronic dehydration.)

When my milk supply was faltering in Dorothy's twelfth month, we started mixing whole cow's milk (not formula) with my milk without telling daycare what we were doing, since they weren't allowed to feed cow's milk to a baby under one year without a doctor's note. (She was actually perfectly happy to drink only what I was sending in with her, but they were complaining that it wasn't enough and they wanted a doctor's note saying that it was OK for her to only have that much milk during the day - she was still nursing a fair amount at night). We figured that she was very close to one year and we would just sidestep the whole issue. If she lost any IQ points, she must have had them to spare, because she did very well on the IQ test she had recently (part of qualifying for a private school for gifted kids where we'd like to send her for kindergarten).
psychohist From: psychohist Date: January 8th, 2009 06:56 am (UTC) (Link)
Yeah, if it is just for supplementation, the DHA/ARA is not a big deal - he should get enough from your breast milk. You might almost prefer a non-DHA/ARA formula, or cow's milk, as you tried with Dorothy. I seem to remember that simmering of cow's milk offers some kind of benefit - there was a reason why condensed milk was preferred to normal milk for formula back in the old days.

Interesting about the diarrhea. One of the main complaints about the solvent extracted DHA/ARA formulas is vomiting, diarrhea, and dehydration in some cases. More info here:

http://usfoodpolicy.blogspot.com/2008/01/how-safe-and-effective-are-dha-and-ara.html

I had assumed it wasn't the DHA/ARA itself, since they are present in human milk without causing issues, but perhaps there's some kind of bad interaction with something else in formula. The PDF available at the above link has a throwaway sentence suggesting that iron catalyzed oxidation of DHA or ARA might be an issue - formula is required to have much higher levels of iron than is present in breast milk.

How is Howard doing on solids? At one point I was kind of hoping that Margaret could go directly from breast milk to solids, but while she likes tasting some solid foods - especially meat - I don't think she's getting any significant amount of calories from it yet.

How much does a private kindergarten cost?
enugent From: enugent Date: January 8th, 2009 03:34 pm (UTC) (Link)
Howard loves solids. We may be able to use those to avoid having to supplement at all, but I need to check in with his doctor on that, too. But he will happily eat a whole jar plus a bunch of instant baby oatmeal, two or three times a day (she has approved his eating up to twice that much, but I want to check and make sure that that's OK even if his breastmilk intake declines). He also loves the whole milk baby yogurt. About the only thing he doesn't like is green beans (which is funny because that was Dorothy's absolute favorite food as a baby). He's still pretty suspicious of any texture - we can't even mash a banana smooth enough for him to accept - but he's happy to eat lots of the jarred purees.

We're looking at this kindergarten, which is $15k/year, plus before and after care and something for the summer. It ends up being basically comparable to what we're paying now for daycare.
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