Q&A: Is sleep feeding my baby normal?

I need to start by breaking down the problem of bottle refusal into possible causes.

The first is medical. If she has significant reflux, she may be in discomfort during or after feeding from the acid 'burn', which is similar to what you would feel with heartburn. You would need to rely on your primary doctor or specialist to change her medicines or feeding techniques for better reflux control in this case.

Another factor may be behavioral. If she's learned to associate drinking with pain, she'll avoid the first to escape the latter. Though most four-month-olds drink between 28 and 32 ounces a day and may be ready to add solids to that, the more important question is whether your daughter is gaining enough weight on what she is getting. The problem is much bigger if she isn't.

If she is gaining well, you have more lee-way in terms of re-training her to eat when not asleep. Remember, she is basically on your side--infants don't like hunger and don't intentionally starve themselves. If she is hungry enough and not in pain, she should help you with the feeding process. Stopping the "asleep feeds" may trigger her hunger and make her interested in the day option. Offer her the liquid when she is hungriest, and any solids later.

So, to address your three questions specifically:

1. No, this behavior isn't the 'norm' and she may not grow out of it until she is medically and behaviorally ready to.

2. Once she starts rice cereal (if she hasn't already), mixing the dry cereal with formula will add more to her diet.

3. I wouldn't recommend pouring powder onto her solids, as the formula needs to be mixed with the correct proportion of water.

The priorities in your approach should be: make sure her reflux is fully controlled and that she is gaining adequate weight, then retrain her to drink. If you need help with the re-training, ask for a referral to a feeding or "Failure to Thrive' clinic, where you will find specialists to work with you.

Good luck,