My 4 mos old refuses to eat

My three+ month old is refusing the bottle and refusing to eat from the breast. She now is solely on the bottle we are doing a mixture of breast milk with formula. She hates the bottle and will cry/fuss as it nears her. It takes us about an hour to get 3-4oz in her. Although occasionally she will eat 3 oz in 15min. And she has eaten 4+oz in her sleep when we slip the bottle in her mouth. Any ideas? She is barely gaining weight and is hovering around the 5th percentile. We have seen two top GI doctors who don't have any ideas and our pediatrician is stumped as well. We have tried every type of bottle/nipple and formula. Help please...has anyone else faced this situation and if yes, is there a solution or when do they start eating/grow out of this phase.

[grannienannie]

Have you tried an iron supplement drops....my daughter refused to eat at that age and that would make her hungry....

[tiredbuthappy]

I went through the same thing with my first. It was terrible. It took literally over an hour to get just a few ounces in to her, and then it was time for the next feed! Interestingly, mine also was able to eat in her sleep. Here is what we found:
~DD had trouble coordinating her s.uck-swallow-breathe pattern. It was actually a lactation consultant who realized this. The pediatrician, who is wonderful, had no clue. Because the LC was watching and evaluating feeds, she was able to see and determine this. Because of her problems, we never successfully breastfed. The LC observed bottle feeds for me, because she was having so much trouble.
~We think she also might have had a weak s.uck.
~Her problems actually got WORSE as she got older. It peaked between 2 and 3 months. My LC said it was getting worse because she was getting older, more aware, and more frustrated. This explained why the sleep feeds were a bit better.
~We had improvement around 4 months, when we finally found the bottle nipple for her. We tried almost everything on the market. Unfortunately, what worked for her happened to be discontinued a few years ago, and we had to search the internet to find them. What worked was the old-style *narrow* Nuk orthodontic nipple, size small, medium flow. They had discontinued size small, medium flow; although they have a small/slow; and medium/medium flows still available. My baby needed the size small because she had a small mouth. Here's why this specific nipple worked when all others failed miserably:
~the nuk has a very firm base. Because she couldn't coordinate her suc.k-swallow-breathe pattern, she had to release the nipple frequently to catch her breath. It was easy to relatch on to the firm, narrow nipple base.
~The nuk's hole is on top of the nipple. With other nipples, when she paused to breathe, the milk continued to flow in to her mouth which made her choke or it harder for her to catch her breathe. With the nuk, milk didn't shoot to the back of her throat when she paused to breathe.
~she needed the medium flow because of her weak s.uck. The slow flow frustrated her.

If you haven't tried the older nuks (not the wider new ones), i suggest you give it a try. You can also see an LC about observing a feeding session. Also, instead of a gastro, you may want to get a referral to a feeding specialist. We had a referral to one, but luckily found that magic nipple before going. The difference was night and day.

[AnnieBrooke]

All of tired's advice is excellent.  Do, do, do see a lactation specialist.  Your hospital can recommend one.  They really know their stuff in this area, compared to the doctors.