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I would probably try to see someone to rule out any issues, but that’s coming from a mama whose boys have had feeding issues and have worked with a speech language pathologist extensively!

This may or may not be relevant but DS was born 5 weeks early, though very small (4lbs12oz) and was an extremely slow eater for quite a while. It got better about 2-3 months old though so that doesn’t quite match...but like someone else said, he was diagnosed with a motor speech disorder around 2.5 years old and we had to do the exercises and whatnot to strengthen his mouth and jaw. We did pediatric occupational therapy for that when he was that age, and also a craniosacral therapist when he was like 4 months old for difficulty feeding. Maybe it is connected somehow for you...

So, I will caveat this with the fact that this is just my personal experience and it's probably worth checking with your doc just in case, but my daughter was exactly like this as an infant and pretty much until she was a toddler. She was a premie as well (though 4 lb 6 oz, at 36 weeks), and had reflux and spit up nonstop until she was almost a year old, so I was obsessed with her eating, and of course, she would do 2-4 oz max per feed, and cap out at 16ish oz per day total. I drove myself completely insane over this, but the advice I got and that I want to pass on, once you rule out any medical issues, is that babies and kids will eat as much as they need, they can't go hungry (assuming medical issues are not interfering). If he's gaining weight, is a normal weight, happy, sleeping well, all the things, then he's probably fine. It seems weird and mind boggling, but it's definitely not out of the question. My daughter was way below the growth curve until about 2 years old, but she always gained weight regularly, was always happy, and we even weaned off reflux meds by 5 months, and she's about to turn 5, is happy, healthy, strong, normal size, and eats like a vacuum. Definitely worth ruling out medical issues, but I think your logic/gut is right on this one. Good luck!

If he eats well/faster when drowsy then I’d just feed him then. What’s the point of doing EASy if it’s not, right?

Have you tried doing small feedings but spaced closer together?

Just some ideas, I have no personal experience so idk if it will help.

If he's gaining and pooping/peeing well, I wouldn't be too worried. The recommendations are just average, and my understanding is that there is a wide range - with breastmilk I've seen 20-30 oz/day, just depending on the baby, and I think formula may be even wider since there is a wide range in how it is metabolized.

My LO is the opposite, in that he weighs a little less than your LO despite a due date that I think was a couple of months earlier, and he takes in *a lot*. We estimate he gets around 28 oz of breastmilk a day and often a formula top off on top of that. He's actually moved up the growth curve some in the past couple of months and apparently just has a fast metabolism at this point. So just to say, there's a pretty big range of normal.

As for being slow and gagging, I would probably just experiment with the bottle, if you've already ruled out other stuff like tongue tie.

@SweetiePie: My son had a tongue tie, not the typical one that they check for (thrust out) but a lateral issue. It was finally correctly diagnosed by a feeding therapist. If you're in the tri-state area, we saw Lori Overland.

@SweetiePie: I think this sounds frustrating, especially for you because I know you are such a big proponent of schedules and separating sleep/eating! I would not wait more than 4 hours, that sounds like a recipe for disaster with the smaller bottles and small appetite. I mean maybe try it st night but not as a rule. I would play with the bottle type and nipple type like you/pp said. And finally I would just follow his cues and do small frequent feedings. If he has reflux, that’s a great way to manage it, so maybe he just is self regulating to prevent his tummy from getting too full. As he grows it will probably change!

Sorry I have a lot of thoughts I keep adding! Be careful pushing the bottle when he seems done because if his tendency is to get gaggy,, that could make everything worse if he starts to fight it!

@SweetiePie: Ok, got it. I know it's super frustrating! It does sound like we are in similar boats in some respects. DD has always been a slow eater too. When I was nursing they told me it was normal that it took an hour and she'd eventually get faster, when we switched to bottles she got a bit faster but I'd say 30 minutes to finish 4.5 oz is normal for her, except in the middle of night. I am dreading when I have to offer her more than 4.5 oz because I'm sure it will take an hour. But same as your baby--she quickly guzzles the 4.5 oz in the middle of the night and passes out! She's also on a similar sleep schedule with usually one wakeup between 1 and 3, though her bedtime is all over the place (which I asked for your help with!) The easy MOTN feed makes me think nothing is seriously wrong with her but it is very perplexing.

I literally just fed her and she drank almost 3 oz quickly (15 mins?) and then just refused to have more. I kept offering and she freaked out (arching back, crying) but then was happy to play. I feel like it might be her reflux which, although better, is still there. I think like another poster said sometimes she just feels full/refluxy and doesn't want more. That said, she doesn't do this every bottle (1-2 out of usually 6 per day) so if yours is doing it every time except MOTN, I get that it is more annoying/worrisome. But I do wonder with your baby and mine maybe they just don't need/want to eat the way it's recommended to. If they are happy (she is the smiliest baby ever) and gaining weight on their curve then maybe all is okay? Honestly, I don't know and am sort of just trying to make myself feel better, and as you said, more zen.

@SweetiePie: She knows her stuff. She can be tough to get an appointment with because she mostly teaches, but if there is any feeding therapist worth seeing, it's her. A lot of SLPs that do feeding therapy in the area were trained by her.

Yeppppp, right there, too. LO was 5lbs 8oz at birth (IUGR born at 37+4), still in the 3rd-4th percentile at 12lbs 8oz (5.5 months). She's on omeprazole 3x day for her reflux. The speech path who did her barium swallow study said that it's really common for reflux babies to associate eating with pain even after it's controlled and become reluctant. We've had times where it takes 45 mins to eat 4 oz or weeks at a time where she's barely averaging 20oz/day. And then with no changes, just like that, she's eating 24-26 oz. Through it all, her overnight feeds were reliable, though. During the day she'll start and stop over and over and look around and push it out of her mouth. Even now it takes 20 minutes for 4 oz. We've tried 5oz and she can do it but it throws her off and then she has lots of 1-2oz bottles and weird stretches and it's stressful to keep track of so we're sitting around 4oz every 3 hours with longer stretches overnight. If everything else is good and he's gaining, even slowly, I'd probably ride it out. If ties have been eliminated -- see a pediatric dentist/preferred provider. Pediatricians are admittedly not trained well in that. If it doesn't improve check into speech path/feeding therapy. Good luck! I never thought something so fundamental and basic would be so incredibly hard.