Grow, baby, grow

4-3-3-5
Start with 4 ounces of very warm water.  Add 3 scoops of formula. Mix well.  Add 3 scoops of thickener.  Mix well.  Add 5 mL apple juice (to combat constipation that comes from the thickener).  Let sit for 5-10 minutes until thick.  Mix well again.  Feed to the baby, with her sitting almost upright, and stopping every few minutes for baby to rest, burp, and get mad.  Cross your fingers that she drinks it all.  Repeat every 3-4 hours.

For about the last 2 weeks, Hannah hasn't been eating as much as before.  She used to drain a 5 oz bottle and then cry that it was empty. But recently, she hasn't had as much of an appetite.  She will only take a full bottle first thing in the morning, after going 10-12 hours overnight.  All the other times she doesn't want to take more than 2 or 3 ounces, and sometimes even less.  If she had better, more established hunger cues, I would trust that she knows how much her body needs.  She had a continuous feed on the NG tube for so long that she hardly ever tells us when she is hungry.  She never learned to self-regulate how much food she gets.

So naturally, I have been hyper-attentive to the volume, and ultimately how many calories she gets each day, and then how her weight charts each week.  She had a bumpy start, after all, and lost weight, failed to thrive, and has been playing catch-up ever since.  Back in January, she dropped into the 5th percentile for a while, down from the 90th percentile at birth  She's in the 38th percentile now, which is amazing progress!

Her decreased appetite also coincided with when she started aspirating (on nectar thickness, no less), and also when I quit pumping and ran out of breast milk.  For a few weeks, she had been getting half breast milk and half formula while I used up my freezer stash, in the hopes that transitioning to 100% formula wouldn't be that noticeable in terms of taste and ease of digestion.  I'm not sure why exactly switching to all-formula would lead to her starting to aspirate, or have less of an appetite. Maybe the aspirating caused the decreased appetite.  Maybe the taste of formula caused the decreased appetite.  Maybe the different consistency of formula caused her to aspirate, even with the thickener.  My mom even suggested that it might be too thick, since formula is thicker than milk, making her tired faster.  (She aspirates when she is "tired," or rather, the swallowing mechanism has been working for a few minutes and those muscles get "tired").  Maybe these factors are unrelated and the timing is a coincidence.  Either way, it is a reason to feel guilt over my decision to quit pumping, in case that is the cause.

MORE MATH
Hannah needs 80 calories per kg of weight right now in order to grow, which is 544 calories per day.  And at 26 calories per ounce, that means 21 ounces or 630 mL.  For the last 2 weeks, she has had a calorie deficit every single day, and not just by a little.  Being the math nerd that I am, I calculated that she is only getting 72-84 % of her needed calories.  Normally, if a baby had a calorie deficit for a day or two, she would make up for it in subsequent days, but as we've already established, Hannah isn't normal. 

I went in for a weight check last week and sure enough, she had only gained 2 ounces in a week and a half.  The doctor's opinion was that Hannah's lower appetite relates to the change in taste of formula versus breast milk, and suggested we try a different formula that supposedly has more flavor (Doh!  I just bought 5 cans of the other kind!).   Another change I made is that I switched from adding 5 mL prune juice twice a day to 5 mL apple juice 5 times a day, hoping to help improve the flavor.  I was also able to accept about 100 ounces of donated breast milk yesterday, and have been mixing it in so that Hannah has half and half again, and I can already tell that it's making a difference to her.  Again, clue the MOM GUILT over quitting pumping.  It might not be too late...Do I start pumping every 3 hours again like when I had a newborn, to see if I can get my milk back?  Obviously, Hannah prefers it.

Just 2 weeks shy of being 6 months old, Hannah is old enough to start solid foods.  This is on my list of things to do this week, but I'm a little hesitant to introduce something new for her to learn how to swallow.  It might turn out to be a good source of calories if she consistently refuses to drink her whole bottle.

With all the crap we've been through, I've noticed that I have a tendency to be negative and pessimistic about our whole situation. But really, things are 1000% better than they were a few months ago.  We have been through a lot and have come a long way!  I need to find the "wins" and celebrate them better.  Here they are: Hannah is taking food by mouth.  Hannah is growing.  Hannah is healthy.  Hannah is sleeping all night.  And Hannah is happy!  This week she finally laughed and I was able to catch it on video.  That was my favorite Mother's Day present!