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four weeks premature, low birth weight, still struggling .... help please

(35 Posts)
deleting Mon 03-Aug-09 17:03:58

dc3 (ds2) born at 36+3 and small for dates (1.88kg). He had problems latching on, staying awake for feeds and was on formula for the first couple of days while still in hospital because I hadn't got an expresser. Then I got an expresser and we started on ebm. He put his birth weight back on in about 5 days, but since then has been really slow (didn't put on anything for two weeks at one point) and it's only in the last week that he has put on a respectable amount (9 ounces!). It seems to have spurred him on though and this week he has been feeding A LOT, which is exhausting, but encouraging. However, at 7 weeks is still only 2.41 kg and is right off that chart. Have been sent to paediatrics a few times and have even stayed in hospital overnight while they prodded, poked and took blood etc and watched how he fed. They can't find anything physically wrong with him, but are concerned that he's still really small (so am I). Question is, do I keep going with the exclusive bfing. Not doing top ups now because I just don't seem to have a time when he's not feeding to express! and just feel that if he's on me most of the time, there's not much point. Anyway, this is turning into a ramble, but would you introduce a bottle of formula in the hope of giving him a boost and try to get back on the chart. I'm just worried that he will fall so far behind he'll never catch up (with whom I'm not sure, but don't want him to be 'stunted' because I've been stubborn about exclusively breastfeeding). What would you do? Is Tiktok around or anyone with some experience of small babies?

crokky Mon 03-Aug-09 17:07:55

I don't really know much so ignore if necessary, but I though tiny babies could be prescribed a formula that has more energy than formula that you could get in the supermarket? In your position, yes, I probably would give a bottle of the super calorific formula.

chibi Mon 03-Aug-09 17:20:01

is he being measured as a 3 week old 9ie from term) or from birth?

my ds was born 35+6 and has his weight measured from term date, ie as a 4 weeker not a 9 week old - this means he is on the 25th centile as opposed to off the chart.i would check this first tbh

also, my ds is gaining 6 oz a week, a respectable amount, but it only just keeps him on the 25th centile - he would have to gain phenomenal amounts to move up a centile.
your ds faces the same issue!

how are the nappies? what does your hv think?have you had anyone observe a feed(ie a bf counsellor)

formula may well be needed but i think you have some things to check out first - it doesn't seem cut and dried to me.

chibi Mon 03-Aug-09 17:23:59

also well done for bf...if it is challenging for the average mum, it is even more so for mothers of prem babies. you have done an amazing thing for him, he couldn't have had a better start to life smile

deleting Mon 03-Aug-09 17:24:09

thanks for quick reply crokky. haven't heard of this stuff? will have words with hv tomorrow at weigh in.

AbricotsSecs Mon 03-Aug-09 17:31:09

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AbricotsSecs Mon 03-Aug-09 17:32:19

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tiktok Mon 03-Aug-09 17:33:22

deleting - small and prem babies not my forte, sorry, but there is deffo an argument that giving babies who are struggling like this a boost is worth it...first choice for the boost is your ebm, second choice is donor milk, then comes formula. The fact he has put on a good bunch of weight this last week means (I would have thought) that he could be turning a corner, and is on the way to approaching the chart....what do the HCPs say? It is good he is feeding a lot. It is far better than him falling asleep, which I bet was an issue before.

On what you say, I don't see the urgency of making a decision now this minute or even in the next few days. If he is healthy, and you can cope with the extra feeding and celebrate it, then the boost he would get from formula might be at the expense of he would glug back the formula and then not bf quite so much.

These are issues to discuss, anyway. Obv, some babies in this position do actually need formula in the absence of ebm or donor need to think about whether the wonderfully frequent feeding he's doing now is the boost you have been wanting

(BTW, to your scbu not having an expresser for you. Have they not heard of hand expressing? Hand expressing is the means of choice in the first couple of days, anyway. To tell a mum her only option was formula because of lack of a pump is a disgrace, IMO).

Hope this helps a bit!

deleting Mon 03-Aug-09 17:40:25

hi chibi, thanks for reply. he has been on the pre-term chart, but was small for his dates so was on 2nd centile, then dropped down when he lost a bit in 1st few days and it's not that he's been losing weight but that he has gained so slowly, he's being left behind and fell further iyswim. had a lactation expert come over and she gave me a few tips which did work. his latch seems to be good etc. he gets lots of wet nappies, but only poos once every five days and then does two in the space of a few hours and there's loads of it and it's quite thick, but soft. Don't know what that means.

deleting Mon 03-Aug-09 17:52:06

thanks hoochie, recently heard of compression and that does seem to get his attention and helps.

tiktok. am really hoping we've turned a corner. thing is he is healthy and looks fine. more alert nowadays etc which is the main thing, but if there's a chance to boost without compromising the bfing .... although as chibi says he would have to put on a silly amount to get back now. we weren't in scbu as he was healthy enough to stay on ward, but yes it would have been nice to have borrowed a machine from them.

deleting Mon 03-Aug-09 18:07:17

tiktok - yes, he was very sleepy before and I would have to wake him to feed. HVs seem concerned and suggested the 20 ml ebm top ups after every feed, but most of the time it's a struggle to get him to take it, so was just doing it if he had not taken a good feed or was a bit sleepy. Didn't want to forcefeed him, so they could tick some boxes. will wait to see what he's put on this week, but if he has put on a decent amount is there anything more formula could do. how much more calorific is it?

tiktok Mon 03-Aug-09 18:11:12

Formula is about the same calorie-wise as breastmilk.

There are speciality 'energy dense' formulas which are given to babies who need them - they have more calories in them.

Is there someone you can talk to in real life who can go through the pros and cons with you?

letsaveabrew Mon 03-Aug-09 18:12:05

hi, my ds was 35+2
5lb 6 a good ish weight but had jaundice.we were in hosp for 10 days. He started on formula and gradually moved to ebm. he lost weight twice, the second time as the bf wore him out.He had a poo once a week as he was using all the milk and had little waste. If his abdomen is soft and he's not in pain he is ok. Keep going with bf - you will get there. We only topped up with formula when he had a growth spurt and my boobs were slow to catch up!
Good luck

AbricotsSecs Mon 03-Aug-09 18:13:12

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tiktok Mon 03-Aug-09 18:15:50

deleting - you're using both breasts at least once each at every feed, aren't you, except when the baby really, really shows you he is 'done'?

letsaveabrew Mon 03-Aug-09 18:16:07

and he fed for 1hr 30 every 3 hours and i had to change his nappy in the middle to keep him awake

AbricotsSecs Mon 03-Aug-09 18:16:37

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JammyQueenOfTheSewers Mon 03-Aug-09 18:16:55

Just to say my DD was born at 35 weeks, ans was very sleepy too. I had to wake her every 3 hours to feed. Thankfully she was a very good weight (7lb, 98 centile!) but she lost enough and then had slow recovery to worry the MWs I had a pump on loan from the MWs and as well as BF I would express in the morning and give her EBM (by syringe) after feeds. But she got better at feeding with time and perseverence and ended up very healthy, and BF until 13.5 months (with occasional formula). So it can be done and I wanted to say it sounds like you are doing a great job!

redtabby Mon 03-Aug-09 18:28:39

My DS was 1.9kg and he was also very sleepy to begin with, I woke him up religiously for feeds every three hours for first month, even if he took two hours for a feed (which he sometimes did) a so there was only an hour before the next one started! We kept a chart and alarm system going, and I am afraid that yes, we did supplement with formula in the first few weeks. This is what they did in the hospital and we carried on at home, first just adding a little extra fromula to the end of each feed, then later just giving him some extra formula at night, as my milk increased. He began to grow well on that and I gradually stopped the formula, he is now exclusively breast fed.

In some ways I later felt annoyed about the hospital having given him formula as a matter of course (having now done a lot more reading about bf, especially in books such as "The Food of Love", a wonderful book), but on the other hand he is doing very well now and I have managed to get to the stage of exclusive breast feeding, so am very happy about that.

It was really difficult in the beginning and I sympathise with you. Keep at it and remember that even if he has started with some formula, you can get back to exclusive bf if you are determined.

CookieMonster2 Mon 03-Aug-09 18:30:29

My first was born below the 0.4th centile and really struggled to put on weight, despite all the help I had with breastfeeding. We used a prescription formuala milk called Nutraprem (I think) that was much more calorific than normal formula milk. This was used to topup breastfeeding, and did not interfere with breastfeeding at all, she was breastfed until she was a year.

I am replying to your post because I totally understand what you say about your dc having stunted growth because your were stubborn about breastfeeding. I really wanted to exclusively breastfeed but just had to get over that and accept that the baby has to come first and I had still done a lot better than most people by continuing to breastfeed to a year (sorry if that shounds a bit harsh) Now several years on how she was fed in the first few years is of no bother to me but the fact that she had the help with growth is.

Mixed feeding can work well if done well and the Mother really wants to continue breastfeeding. I was lucky that I got the help I needed with it and would be happy to give you more info about this if you want. I know a lot of HCP don't discuss mixed feeding as an option.

deleting Mon 03-Aug-09 19:43:54

sorry, had to go off for a bit to get kids to bed. thanks so much for all replies, it's encouraging to hear from people further down the line. so difficult to know what to do for the best. desperate to bf and feel he needs it even more because he's so tiny. had lost all confidence and was reeling from all the different opinions. will see what he's put on tomorrow and if it's not good will consider the nutraprem (thanks cookiemonster). tiktok - doing 2 boobs, also doing switch feeding to keep him interested and compression. he must wonder what the hell is going on!
ta again for all your replies and encouragement. has anyone seen that 'tales of the unexpected' where they feed the baby royal jelly? might be worth a try?!

JammyQueenOfTheSewers Mon 03-Aug-09 19:52:38

Oooh yes, I remember that one deleting - buzzzzzzzzzzzzzzzz!

I agree that mixed feeding can work if the mother really wants to BF. It certainly got us through some difficult times - she had half a bottle of formula a day for a few months. We were lucky that she had no confusion between niple and teat. I am still angry though that when she was just 12 hours old, the hospital persuaded me to give formula on the premise that she needed extra fluid and it might avoid her needing surgery. Of course, despite my high hopes of BF I agreed to it, if it would avoid the need for surgery, but within about 10 mins or less it became clear that she wasn't going to avoid it, formula or no formula Thankfully she only had 2 days in SCBU and they had me expressing and taking it into her with a syringe so they weren't all bad, but still...

deleting Mon 03-Aug-09 20:17:17

when did you all give the formula feed. was it straight after a bf, because most of the time we struggled to get the ebm down as he was full or fast asleep and in between feeds might compromise supply? i was annoyed with hospital as well jammy. there was no discussion, the formula was just brought over and I was in no state to argue.

CookieMonster2 Mon 03-Aug-09 20:20:38

My first post was done in a bit of a hurry. The other thing I wanted to add is that if he still hasn't started putting on weight at a reasonable rate by the time you start to wean I would ask to see a specialist health visitor to discuss feeding. The information people are given about weaning now tends to focus on making sure you don't end up with an overweight child, which is fair enough, but in some cases different help and information is needed. We did this and it was a great help, if only to reassure us that we were doing the right thing.

Hope it all gets sorted soon.

JammyQueenOfTheSewers Mon 03-Aug-09 20:26:48

DD had a bit of formula after the bedtime feed. I found that once she got her latch sorted (so after the fist few weeks) she fed massively all afternoon and then seemed unsatisfied with the bedtime feed (~7pm). I know that supply is meant to meet demand, and yes, the body IS wonderful in how it adapts, but it just wasn't working for us, even after a few weeks of that. So I'd BF her, then DH would give her a small amount of formula which would get her settled nicely and give us a couple of hours together, which was incredibly important to us. And DH got to feed her which he liked. After a few months we found she would settle without the formula so we stopped that and she was then exclusively BF for a while, and continued BF until she was a year, and then had a few more weeks morning and night BF only and then she dropped those feeds herself.

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