Low Birthweight Baby and Weight Gain

[BB01]

DD was low birthweight (4lb 9). We've been exclusively breastfeeding but her weight gain has dipped for the second time (not second time in a row) to just under bottom centile. Hospital are concerned and wanted me to top her up after feeds with expressed milk or formula. NCT and La Leche previously warned this should be last resort due to supply issues etc and also cos I just felt it wasn't something I wanted to do unless really necessary (and hospital doctor didn't seem convinced it was previously). They have now suggested trialling her on Calogen, a high calorie supplement, and also advised waking her up again at night every four hours max. They say the Calogen might also help suspected reflux. I kind of feel like whatever I do someone is sat there saying 'don't do that. Do this!'. I'd much rather exclusively bf if poss but would never do this if doctor and dietician said outright that DD really needs top ups. I hate expressing with a passion and as she's a velcro baby and quite unsettled sometimes (she's 12 weeks but was early) I find it hard enough add it is to get out the house but feel I need to every day for my sanity. Really would rather avoid having to express as well as breastfeeding her and then doing top ups. On other hand am worried about formula being a slippery slope and kind of felt I wanted to commit to just breastfeeding for the time being. Feel like hospital think I'm being silly and they said they can't see any reason NCT and La Leche disagreed with their advice. Meanwhile NCT and La Leche seem to think hospital is too risk adverse, obsessed with the weight chart and underestimate the benefits of ebf. Would really really appreciate any advice or even just a hand to hold!

[crikeybadger]

How many centiles has she dipped?
How do you feel dd is in herself ( if you weren't looking at her weight chart)?
Can you squeeze in any more feeds or do some switch nursing to up the milk intake?
Interesting that the hospital don 't acknowledge the impact of formula on supply....would make me question the extent of their breastfeeding knowledge perhaps.

[BB01]

Thanks Crikey. She has dipped from being right on that line of the bottom centile originally to just below. At one point she was just above it. She looks really healthy - even the doctor says - and seems to have plenty of wet nappies. I tried block feeding at La Leche 's suggestion which seemed to help her weight increase but I now feel my supply has dipped (but have never felt it's not enough for her). I am trying to increase frequency of feeds even though hospital said it may not be good idea as she met get too much at one time (but not sure why top ups are ok then?!)

[Igloofornow]

All three of mine have dropped one or two centiles, we just kept going as long as they were well and not actually losing. All three are now on the 50th centile and have stayed there from age 1.

[crikeybadger]

Block feeding would reduce supply...do you mean switch feeding?
I wonder why the hospital would say that? Perhaps they had a good reason, but I can 't think what it would be.

[hettienne]

Sounds like you could fit some more feeds in? At least every couple of hours in the day, 4 hours at night and lots of switch feeding.

[BB01]

Thanks everyone. I'll definitely try to do more frequent feeds. Block feeding was suggested to make sure she got the fattier milk (and I previously appeared to have a massive supply any certainly still seems plentiful now). Maybe I should try switch feeding but worried in case she doesn't get to the fattier milk!

[hettienne]

If you feed frequently from both breasts then she will get the fattier milk. The milk gets fattier as the breast is emptier - full breasts have more water in them.

[BonaDea]

I have to say I agree with LLL and the advice above. Just keep on feeding your baby as often as you can. Wake her for feeds and strip, change or jiggle her to wake her if she's sleepy.

My DS was not low weight but lost 12% in hosp which they were v concerned about and my milk took ages to come in. I was scared into giving a couple of top ups of formula and then later into feeding, expressing and topping up with ebm by cup as I didn't want to bottle feed. The whole thing was so time consuming and stressful.

Sensible community mw and also lactation consultant said just keep feeding and it was so right. I was less exhausted and stressed, no faffing with expressing and sterilising. I got more sleep and DS got more milk.

I agree the hosp are very conservative re weight and feeding and completely hypocritical when it comes to supporting bf'ing (or not). Good luck.

[crikeybadger]

Block feeding is often suggested for women who have oversupply and the end result would be to reduce milk supply-not sure it should be suggested for a baby that is trying to gain weight (imo).

The whole hind milk thing causes lots of confusion - The analytical Armadillo does a good explanation ( sorry can't link).

[minipie]

It sounds like she is tracking her centile line pretty much, so she's not dropping centiles or actually losing weight? Personally I wouldn't bottle top up if she is alert and happy, has plenty of wet and dirty nappies and is tracking her own line. How early was she? if pre 37 weeks is she being tracked on the prem chart?

maybe ask if there are any HVs with experience of prem or small babies, they might be a bit less obsessed with bulking your dd up at the expense of BFing. my HV had also had a tiny prem baby herself and never suggested supplementing as long as my dd showed continuous weight gain and tracked her centile.

[BB01]

Thanks all. She was two weeks early minipie but had growth restriction in the womb and an infection so was initially tube fed. It's the hospital who are more worried rather than hv. She has to have regular check ups as part of her discharge

[BB01]

Thanks Bonadea. Good to hear a success story. I feel as you felt re expressing. I honestly feel like it's either bf or formula for me and that I made a choice to do breastfeeding as it's better for baby but have now been doubting that due to the weight thing.

[BB01]

Feeling a bit . Just went to LLL meeting and the leader encouraged me to try ebm top ups even if just one a day so think I'll give this a go. However she really worried me by suggesting there could be a medical reason behind all this. Hadn't been too worried before as doctor just seemed to think it was just one of those things but something to keep an eye on and to try to tackle with different feeding approaches. Now worried in case there's an underlying reason. But at the same time she has only just dipped down under the bottom centile and has mostly put enough weight on according to the chart - sometimes more than enough.

[lotsofcheese]

If your baby has IUGR, it can be very difficult to catch up growth-wise, on BM alone. Or so I was told by a paediatric Dietitan, in relation to my DS who was also IUGR.

In the end we went onto Infatrini, a high calorie prescription milk - he's now nearly on 25th centile but it has been a long battle. IUGR babies are often poor feeders too.

Another friend whose baby had IUGR kept EBF until weaning, then did high calorie weaning (double cream, cheese, oil etc added to everything). Her DD began to catch up at this point.

It's hard when you have a small baby, you always feel under so much pressure.

[BB01]

It sounds like you're doing really well, lotsofcheese. Did you also start doing top ups of expressed milk? I definitely do feel a massive pressure and although I strongly believe in breastfeeding and am so determined to continue, some days I almost wish I didn't feel like that and just formula fed so at least I knew how much she was getting. Did your baby just gain weight slowly or did she go up and down in terms of a line of growth?

[lotsofcheese]

BB, my situation was slightly different in that DS was a 29 weeker, plus had severe reflux & required oxygen for lung disease. So he was a complex case. He never managed to BF, which I was extremely sad about, so I expressed for him, until I was advised that he needed more calories. I was heartbroken about not being able to BF, but once I realised that High calorie formula was better for him, it was an easy decision. He was off the bottom of the centile chart & has gained weight slowly over a number of years.

So a completely different scenario to you. However, it seems illogical to be topping up with EBM or Formula - they both have the same calories, after all. Calogen has more calories, so there is some logic to that.

Have you seen a paediatric dietitian to discuss options? It might be that earlier weaning, mixed feeding etc might be options? It's good to be aware of what might work.

Good luck.

[BB01]

Thanks for this lotsofcheese. It sounds like you found what worked best for your baby and you can't say fairer than that.

We've just started seeing a dietician who seems fairly helpful and knowledgeable and happy to look at different options.

Here's hoping the Calogen makes a difference

[Poppet45]

Hey BB have you heard of a supplemental nursing system? Its a wee container of milk (you pick formula or ebm) with a tube you poke into babys mouth during breast feeds and it delivers top ups more passively while baby nurses. Dd was 13 weeks early, 800g at her lightest and 4lbs on discharge. We used one as she struggled to breathe while taking a bottle of top up prem formula. Fiddly as anything but I was darned if she was going to get nipple confusion after 9 weeks of expressing in scbu. We used our stockpile of expressed milk to skim off the cream and syringe that in too. She was born on the 50th centile fell to the 0.4th but at 2 is again back on the 50th despite two hospital readmissions lip tie tongue tie and being intolerant to dairy so we've both been dairy free for 18 months. Theres growing evidence that making low birthweight babies pile on the pounds asap predisposes them to obesity as adults. On that basis my paed let us drop top ups after 6 weeks. But she fed two hourly by day and four hourly at night til 6 months plus! Thankfully its just two feeds a day now but I am actually trying to work out how to wean her off the boob!

[BB01]

Thanks Poppet. That system sounds v interesting. I'll take a look. That's interesting about the obesity too. They aren't putting that much pressure on yet thankfully. Very well done for getting your little one to make such great progress!

[NoForkNKnife]

Hi Bb, I'm in a similar situation, although more extreme like lotsofcheese (who has helped me before).
My dd is a 29 weeker also with IUGR (980g birth weight). She has been way below the 0.4th percentile for corrected age since the beginning. She is now 6 months and 3.9kg.
She was labelled as FTT despite always following her curve and they have done all sorts of metabolic tests and are now doing genetic testing . I still atm feel it's her reflux (absolute hell) and IUGR that are responsible for the slow weight gain. She wont gain if she wont eat!
Like lotsof, I was advised to give up expressing and bf last month. I was told the calories are more important and that I'd done my best. In a way I was relieved someone had said it. She is onninfatrini and duocal (aswell as rantidine). She has never lost or not gained. Steady amount-100g a week.
Weaned a few weeks ago (have you been told that weaning a preemie is against their actual age not corrected?). She lives it. She will eat 120calories or more in one meal (took a few weeks) whereas her usual amount if milk is 60mls (60 cals of infatrini). So far, not a massive difference to her weight gain!

I bf my eldest. dd2 was even a better latcher at one point! But I just had to let the idea go. I found it easier being told by the consultant to do this.
I am certain not saying you will need to give up bf. Every case is different, and my dd was a lot more prem. But im in the same position growth curve wise and I know how awful the appts are.
Good luck and fingers crossed for a big gain for you this week. I always find a bad gain one week means a good one the next.

[BB01]

Thanks so much NoFork. Gosh sounds like you've been through a lot. Well done for breastfeeding as long as you did.

Your post has really made me feel like someone understands as one of the worst bits of this is that most people in RL just don't know what it's like having the extra pressure of a low birthweight baby. I had to explain again and again to DH's family, who are pretty anti - formula, why she was given formula for the first couple of days in intensive care. Also finding the same with some breastfeeding counsellors who seem to ignore the fact she was low birthweight when they give advice. I know what you mean about it being a relief of someone suggests formula. At the same time knowing that I'd have to put up with constant questioning from family and friends about switching make me feel so crap. I can see that in some situations the negatives are outweighed by the positives but I just can't work out if that yet applies to us or not! Sorry if I missed this but did your LO's weight actually improve once you switched? Did you find that before you switched you received completely contradictory advice from health care professionals and bf advisors??

You're right - the appointments are awful. I just didn't expect this as they were happy with her weight gain for the first month and a half.

Really hope things improve for you and your LO with the weaning. Think that's the next issue I'll be having dilemmas about as they have suggested early weaning.

Thanks again x

[NoForkNKnife]

Finding weaning interesting! I did blw with dd1 and I'm struggling a bit with the purees. First week this week of introducing some proper veg.

Her weight has improved slightly. It's only been 4 weeks and I think she's averaging about 150g per week now (from roughly 100g). Tbh, the reflux has been worse than ever this last 4 weeks and I have really struggled to get her to feed some days. She has reacted to the reflux by refusing to eat. Many many tears (hers and mine) and it makes it so much worse when you know that weight is so important. Least with the solids I can get calories in more easily.

That's awful that you feel unsupported. I can't imagine having comments like that from supposed well meaning family. Gosh, the way I've felt some days, a comment like that would have tipped me over the edge. My DH was more disappointed than I expected. I still have the freezer full of ebm, but it will soon have to be thrown.

It sounds like you're 3 months behind me. The last 3 months in some ways have been harder than the first. BUT-you will now start getting something back from her. Smiles, giggles and all the other milestones. She rolled last week and it felt so good to be doing and seeing normal baby developments! I've met so many parents and preemies recently and all have said that we will look back on this in a year or 2s time and struggle to remember. Have a look on the bliss forum I found lots of support on there.

[NoForkNKnife]

Oh, and I didn't really see any bf advisors after I left hospital. Thankfully, she latched really well, but because of her weight, I was expressing and bottle feeding to ensure she was getting 'enough'. The expressing was hard work though. The hv does even now, give me advice I know is not really really applicable to preemies. She nearly had a fit whenni said I was going to wean (advise from dietician and paed) as she was too small. I choose to smile and nod and do what I want .

[BB01]

Hi NoFork. Smiling and nodding is something I seem to be doing a lot of!

We've found latching ok generally but I've been going to them for advice on stuff like switching sides, and have had SO much contradictory advice!

Were you advised not to do blw weaning this time? That's a shame but guessed that may be the case. Great to hear the weight gain has been a bit better though. That's a shame about the reflux too. I thought reflux usually improved when weaning started. Hope it gets better soon. It sounds like weaning is a whole new set of challenges but as you say at least you can get more calories in. It sounds like you're coping really well, especially as you have another daughter to look after! Much kudos to you.

Yes, the comments on the formula really hacked me off. It is as though breastfeeding is more important to some people than the overall health of the baby. They made out that I should have fought against it (while still in total shock /half delirious /in major pain after a traumatic birth!). On the other hand they were so helpful when I was struggling to express and do the first breastfeeds etc so it's swings and roundabouts.

You're right - already getting lots of smiles and it makes it all so worthwhile. I'll take a look at Bliss - thank you.

Oh yes! Like your example of looking on the bright side. We're constantly getting comments on how advanced she seems for her age with smiling and thumb sucking etc!! And she is always centre of attention still at all the baby groups and classes . Enjoy the extra attention while it lasts, I reckon

[Poppet45]

Dd had terrible silent reflux too... Think going blue and limp everytime the acid burned. For us the only med that worked was a massive dose of omeprazole (3-5mgs per kg of her body weight) which were now slowly weaning her off at two. Forks could you ask about omeprazole and a trial of hypoallergenic formula now Dd is past 6 months? Her oral aversion suggests her reflux is not under control. And uncontrolled reflux is hell Many prems develop reflux due to weak sphincters and also because of intolerances to food due to early gut damage and milk is a biggie but until 6 months theres no prem hypoallergenuc formula to try. We too found weaning made reflux much worse for a while... A long while. So no blw for us second time round as she choked on even the thinnest puree and couldnt handle finger foods safely til 1.