Should I accept I need to give up?

[KidsCooking]

Hi, ladies, it's me again. I have the 29 weeker who is now 6 weeks corrected. She's a happy little thing and has started smiling this week!

But, she is struggling to gain weight. She is falling further away from the 0.4th centile (dramatically so except the ruddy HV keeps plotting it wrong). She is under the dietician and paediatrician who we are seeing next week.

I'm expressing and giving via a bottle (she will breastfeed-thanks for the help a couple of weeks ago- but last week after pending a week breastfeeding, she didn't gain weight). She is also supplementing it with a very high calorie formula and is currently having roughly half and half.
She is having 90 mls every 3 hours and for her weight of 5lbs 13, this is a massive amount of milk!

I'm worried about her. It's causing lots of stress. Do I need to go to the appointment next week with the frame of mind that I need to stop ebm? She obviously I failing to thrive on it . I bf my dd1 to 6 months and I had planned to do the same for dd2. I totally understand the pros of doing it. One of the biggest reasons for me was the possible protection against type 1 diabetes, which i have suffered with for over 20 years. Will she have the protection now? Or does it have to be until 6 months?

Very down about her weight. It's like a cloud over everything to do with her. We get 'mobbed' everywhere we go as she is just so tiny. She appears to be meeting her corrected milestones, but she had an war infection last week and the GP seemed very surprised that she had one at such a young age. Is thi down to her size?!

Argh. I'm waffling. WWYD?

[KidsCooking]

Crap. Just realised I didn't name change back . It's NoFork.

[KidsCooking]

• ear infection. Bloody phone.

[HormonalHousewife]

Aah sorry dont know anything about ears.

My DD was tiny and so I know what its like to be surrounded by 'fat' babies when you have this little bundle of scrawny arms and legs !

I perservered 'cos I wanted too, and now she is a perfectly normal although slender 16 year old

Just take it one day at a time.

[oscarwilde]

Hello there
Sorry but I don't follow some of your post. Is your DD 6 weeks old [born at 29 weeks] ? Or 29 weeks old and only 5lbs? [in which case I'd say yes, give up the ebm]
You say you are supplementing so your DD is not EBM. Is that your ultimate goal?

I think you are telling us that your DD is 6 weeks old but v premature and only weighs 5lbs. You are expressing all of her feeds as she failed to thrive in the week that she BF [and had top ups by bottle presumably]

So - assuming that's correct. Firstly it sounds like you are doing a cracking job - expressing that frequently and for that quantity is soooo timeconsuming and such hard work with all that washing and sterilizing.
Secondly, between the BM and the formula she is getting her 90mls every 3 hrs [had to do this also with a 37+1 baby born at 6lbs6oz] as per doctors orders. She will put on the weight, it will just take time.

I don't see how switching to formula is going to change matters other than the calorie content? It might be worth investigating expressing techniques to ensure that you are getting the hindmilk? I know I had a lot more milk with DD2 than post EMCS DD1. If you can express what's required easily, you may not be draining your boobs. It might be better to express less frequently and for larger amounts? There are plenty of people on here who say that hindmilk as a concept is a load of guff though so I don't know what to believe so it's just a theory [unhelpful]

I hope some of that made sense #sleepdeprived.

[KidsCooking]

Thanks for replies.

oscar she was born at 29 weeks. She's 16.5 weeks now-that's 6 weeks corrected. And yes, only 5lbs still. She was 2lbs 2 at birth.
She's is on the high calorie formula under drs orders. She's not gaining weight and they're worried hence te prescribed formula. She has been on it a month now and has put on less than 1lb.

She's feeding 50:50 ebm and formula every feed (except just ebm for overnight feed) and has 90mls each time.

It's seeing the growth chart that's got me concerned again. It practically looks like its levelling off.

Surely having 100% formula will have more calorie hence hopefully more weight gain? Is that not how it works .

I suppose what I want is to know what is better for her. Is it gaining weight quicker but losing the BM or continuing to be seriously underweight but get some BM? My instinct was always the latter, but I'm not so sure in her case anymore .

[5madthings]

I think you need some specialist advice.

Has her weight gain gone up with the formula.

She was 2lb 2oz at 29wks,is that small for a bay of that gestation? It sounds it to me? But I a, no expert. Is she being tracked on the correct bit for prem babies? I know there is a diff bit? My friends baby was like this, prem at 28wks, very small and was for ages, he and a few problems, but bfed until four years! And is now am very healthy six year old.

He had the high calorie formula as well.

Have they ruled out other cause for slow weight gain?

What does the paed think? It could jsit be that she will be small/ a slow gainer re weight.

She will be more susceptible to infections as she is prem and small and having an older sibling to share germs with, I dont see an ear infection as unusual, some babies are more prone to the than others.

[Thesebootsweremadeforwalking]

I'm sorry if I've overlooked this in the posts above, but do you think it might be worth talking about the BF/ EBM issues over with your local trust's lactation consultant? IME they can often give a different perspective on BF issues than you might necessarily hear from other HCPs, which might be helpful just now?

[KidsCooking]

Thanks, 5.

Yes, she is under a dietician and a paed. I have an appt next week so will obviously discuss it with her.

She was on the 2% at birth but this dropped massively to way below the 0.4th%.

Her weight has gone up since she's been on the even higher calorie formula (they swapped it a month ago) but it hasn't increased in rate iyswim. Last week no gain. This week only 90g.

Last appt the dietician made it clear she felt I should continue, but also made it clear that her weight was worrying. I'm just wondering if I should be more proactive and say I want to give up because it's not working? I mean, would they even be allowed to advise to give up?

The other thing is that she loves to cluster feed (on breast) between her bottle feeds, in the evening. It's the only thing to comfort her and she takes quite a bit. If I switched to exclusively giving the formula at feeds and then still breast fed like this inbetween, would my supply allow it? Would it dry up?

I appreciate it's hard to advise on such a special case. I'm just kind of hoping someone will turn round and say 'you absolutely must keep going because...' or 'you need to switch because...'.

The ear infection/cold is her first ever infection. We've been very lucky. And the reasons WHY she's not putting on weight are obviously really concerning. It's another conversation for next week but I'm quite worried of the answer.

[tiktok]

OP, can understand your concern.

Breastmilk and (ordinary) formula are roughly same in calorie terms. Maybe your baby needs feeding more frequently? Mostly, babies on very high calorie formula are not on this alone - is that what you were contemplating?

I agree you need to see a specialist who also understands about breastfeeding. My understanding about the protection against diabetes is that it is exclusivity of breastfeeding that is thought to be the essential, and that the 6 mths thing has to be exclusive...but the research in this is not clear cut and in any case there are strong arguments for ensuring any breastfeeding for as long as poss.

[KidsCooking]

boots I don't think it's a problem with my milk or her latch etc. Besides, I'm feeding her via a bottle now. Her weight gain was worse when I introduced more breast feeds.

[KidsCooking]

Thanks tiktok,
But her formula is much much higher than BM. It's 100 cals per 100mls. Even the previous formula they prescribed before was 75 cals. The formula isn't for any other reason other than weight gain. I have 6000 mls of ebm in the freezer!

Are you saying that by her having both milks she has lost any benefits of the BM anyway?

[KidsCooking]

Just retread your post tik and realise you meant protection against diabetes. Is this the case with all the other benefits.

.

[UnderwaterBasketWeaving]

I am way out of my depth here, so please feel free to entirely disregard my twopenneth.

Ignoring the calorie issue, surely there are so many additional benefits to having breast milk (immune factors, etc) that to continue some breast milk, however little, is surely a benefit and a bonus?

If she loves to cluster feed, and it soothes her, then why not continue? (Apart from the intensity on yourself, of course, which is a valid point). And breast feeding overnight always seemed the far easier option to me rather than faffing with bottles.

As I understand it, babies can become frustrated with the difference in flow between breast and bottle. But if this isn't an issue, then why not continue to mix feed.

But, as I said, I'm out of my depth here! Don't mean to upset anyone.

[tiktok]

OP, no, it's not the same with other benefits. There are benefits in any breastfeeding, it's just some specific ones seem to be linked to exclusive.

Ordinary formula is about the same calories as breastmilk - obv this is not the case with the VHC.

Please do understand it is always 'worth' bf in health terms, with or without formula! It is absolutely not the case that formula somehow 'wipes out' benefits!

[lotsofcheese]

OP, I remember your previous thread & I'm sorry that your DD is still struggling with weight gain & you are stressed about it.

I also had a small 29 weeker & ended up on high calorie formula too due to inadequate weight gains on EBM. I was advised that weight gain was the most important parameter to consider.

I suspect you will be guided in that direction at your appointment.

Perhaps it's worth discussing with your diabetes consultant the evidence for BF & preventing T1? Sometimes evidence can be limited & patchy. And at least you'll be fully informed of the benefit. I always used to wonder just how good EBM that had been frozen/heated/chilled was in comparison to EBF - am sure many active compounds were destroyed in the process.

If you have spare EBM, there are donor banks - I didn't know about it at the time & mine went in the bin . 3 months of hard work - it was depressing.

I'm not sure how helpful that is to you, but I just wanted to wish you good luck & hope things improve for you.

[KidsCooking]

Thank you so much lots of. I'm worried sick .


I totally get that BM has lots of benefits-not just a source of food/calories. But, do the benefits outweigh the negatives of no gaining weight?

lotsof I'm at the diabetes clinic tomorrow, so thank you, I'll bring it up.
So did you switch to formula completely? My dd suffers with spitting it up-much more than the BM on its own. But I suppose there are ways around that too.

Her bowels were really immature. She wasn't pooing more than once a week, but this has corrected itself over the last 2 weeks. I was hoping this would mean her intestine had got better at absorbing nutrients but I guess it hasn't. I'm so worried there is something more sinister although nothing has come up so far. She has passed every additional test from brain scans (no bleeds) to a scan on her spine (perfect). Her routine spot blood tests showed no underlying conditions such as cystic fibrosis which I know can be a reason for poor weight gain.
lotsof I remember you saying that once you weaned your LO gained weight quicker. Was that the first time the weight rate increased, or did changing to the formula help first?

Sorry. Lots of questions.

[KidsCooking]

Also, can't donate the milk as I'm on insulin. I've already thrown sonmuch down the sink when we were discharged as we couldn't fit it in the freezer.

[lotsofcheese]

That's a shame about not being able to donate your EBM. It's heartbreaking to bin it, especially when it could help other premature babies. And it's very hard to let go of BF, especially when you have invested so much in it (expressing) & when you believe in it's benefits. I cried over it, a lot.

DS's weight gains improved as soon as he went fully to high-calorie milk & he stopped the mixture of EBM & high-calorie milk.

For us, weaning didn't make much of a difference weight-wise. It was a struggle to get him to follow his centile line (the 0.4th) as he also had severe reflux. His reflux was better in EBM, I think it's kinder to their guts than formula.

I think it's a good idea to ask the paed team/dietitian next week about the priority over weight gain versus benefits of EBM - am sure they'll answer it for you.

My DS is now 4.5 & between 9th/25th centile. Weight gain has been a battle & hard work, he is still on high calorie milk. I hate to think where he'd be without it.

[KidsCooking]

Thanks again, lotsof.
I'm not sure what they'll say next week as last time I brought it up, I was encouraged to keep pumping. I'm just so sick of the negligible weight gains. The thing is, her head circ is bang on the 2% and doesn't seem to drop like her weight percentile. If this keeps up she's going to start to look a little strange and top heavy .
She much prefers the BM over the formula too. She's started bringing milk up since the switch to the high cal stuff too. I wonder if they'll prescribe stuff for that too .

You've been really helpful. Thank you so much

[notwoo]

By no means an expert but I have read that breastfeeding can be quite tiring for premature babies and I wonder if by cluster feeding she is actually burning off calories she would otherwise be putting towards gaining weight? tiktok - is there any sense in that?

I do feel for you. I had a small, very slow gaining, hard to feed baby (not premature but everyone always asked if she was so i get what you mean about the mobbing).

Hope you get some answers and things become less stressful soon