Help! 4week prem boy too sleepy to BF

[charliestirling]

Hi all,

I'm Charlie?s dad - our first little boy who arrived 6 days ago, 4wks 2 days early, weighing 6lbs 2oz. He's doing well - although remains in SCBU as he was jaundiced a little and of course, 4 weeks+ premature. His main problem is feeding and I am struggling to offer practical advice to the missus re breast feeding - which we are committed to... Help!!! Apologies for the terrible grammar and syntax ? sleep deprivation has really destroyed any of my authoring capabilities...

My wife is still in hospital with Charlie and he is struggling to latch on. He was on photo therapy for a few days (came off today) - which made him very sleepy. This was exacerbated by his 'full' feeding to keep his fluids up (through a nasal tube) This full feed - nearly always 100% expressed breast milk ? also seemed to keep him sleepy.

The problem is that whilst he occasionally latches on for 15-20 mins once a day, the rest of the time he simply gets too sleepy once close to his mum. We've tried cradle and rugby ball positions and all manner of tricks to stimulate him into a waking state - but he simply nods off. We are convinced that the pillow he is supported on - plus the warmth of his mum - is sending him to sleep. He is following a regimented 4 hr feeding schedule as recommended by the nursing staff.

I am going to pick up a Brest Friend pillow - which seems firmer - that I hope will help. However, if there's anybody out there who went through similar trials and has any tips or advice, please post! It would also be good to hear of any success stories whereby perseverance, perhaps coupled with changes / adaptations of technique, resulted in the right outcomes for both mum and baby. Sorry to ask so much, but as a Dad its remarkably frustrating and I really want to offer some support or advice. As I can?t offer any real practical help, I'm hoping that my posting will help find an answer. Thanks in advance for any assistance ? it will hopefully result in getting Charlie in tip top shape and home with us very soon.

Thanks,

Charlies Dad!!

Hi Charlie, I'm by no means a bf expert (was actually pretty crap at it myself) but my ds was very prem & too sleepy to feed.

Firstly I would discuss with the nurses a change to his feeding regime, (assuming that he has been gaining weight) don't stick to the 4 hr regime, allow him to wake and demand a feed, start him off on the breast and then when he gets tired & he will get tired easier as he is prem (even tho a good weight) top up with the tube. Remember his little body is still maturing and recovering from the jaundice which also makes him sleepier.
My ds never got the hag of BF but he was 3 months early V poorly and lot sof other preoblems BUT there were MANY bfing mums in SCBU.
It may take a little longer to establish but if it is what you want then stick with it, don't get frustrated and be hard on yourselves you just ahve to be patient and wait until he is ready & strong enough.

Once you get the demand feeding you may well find he has the strength to feed fro short period but more frequently.

And of course CONGRATULATIONS!

Congratulations Charlie's dad (and mum) on your new arrival.

I confess I know nothing about prem babies but Charlie's behaviour sounds fairly normal (in comparison to a newborn).
I found with my DD's that when they are very small (up to about 3 months) feeding is more about 'grazing' than a 'regimented schedule'. What I mean is baby goes on the breast, feeds well for about 5-10 minutes, then cuddles in closes to mummy, snoozes for about 10-20 minutes, then turns head to breast (assuming they bothered to turn away from the breast before snoozing) and feeds for another few minutes.
I suspect Charlie hasn't read the parentig manuals and doesn't realise he's on 4 hour feeds. I'd try to b a little more lexible with him (unless you're planning to feed every 4 hours when you return home).

I've not experienced feeding with a nasal tube and it's impact on breast feeding. I'm sure other posters will share their experiences.
HTH

Newborn full term!

Jaundice itself without being premmie will make them sleepy.
If he is doing a 15 to 20 min feed a couple of times a day he is doing really well.
Its really usefull to have him at the breast when he is getting his NG feed to associate being in a feeding position with his tummy filling..
My DS just seemed to wake up about 38 weeks and started to look like he really got it!
Even with a full term healthy baby breast feeding is a 6-8 week learning process for both Mum and Baby, hang in there it will all click soon.
Many Congratulations!

Congratulations Charliesdad

I am certainly not an expert on b'feeding, but I have just come home with my ds, who although only a week early was in scbu for the first week with lung problems. He was unable to feed, because of his breathing, so was tube fed, he also had jaundice.

When I started trying to b'feed he would not latch on at all, he just didn't seem to 'get' the idea of suckling. One of the nurses suggested trying a nipple shield, to give him something more pronounced to suckle. Ds sucked straight away, although we had to remove the nipple shield, so that I could work on getting the latch right. He would also fall asleep within 5 mins, although sometimes would suckle in his sleep. I tried to keep him on the breast for about 10 minutes, then change him, and the nurses suggested washing his hands and face with cool water, and then try the other breast.

I found it very hard in SCBU to establish b'feeding, because, by necessity they work to a very regimented schedule (eg the 4 hourly feeds). However, through expressing and regularly putting ds to the breast we did manage to start demand feeding.

Ds lost a lot of weight (don't be disheartened if this happens to Charlie), but eventually we were allowed home, and he is now 4 weeks old, exclusively b'fed and has regained his birth weight.

One of the things I found very hard about being in SCBU is that they were not in any way set up to support the parents - so although I had a room, there were no tea making facilities, no food supplied, I had had a c-section and couldn't walk as far as the canteen, so relied on dh to bring food in for me. I don't know if your wife is in a similar situation, but bringing in some really good food and lots of nice stuff to drink will be fantastic for her, and tell her to get as much rest as she can whilst she has the support of SCBU nurses.

I really hope things go well for you and your family. Good luck with the feeding, and with getting home and enjoying your family.

My dc3 was full term so not sure if this is relevant. However he was very sleepy and I couldn't get him to feed at birth and the first day of his life. It turned out he had an infection and had to have a course of AB. So he ended up being tube fed for 3 days till he was better. I was still able to BF him and he is still bf at 14 months,

4 hours is a really really long time between feeds. Can she keep him close in kangaroo care? i.e. get a sling take her shirt/bra off and strip baby to nappy and wear him close as much as possible.

I think small and often would work better for a sleepy baby as far as feeds go?

Hi

My DS was 11 weeks early he's now 21 weeks and exclusively bf.

To get from one to the other I would recommend:

1. kangaroo care - at least an hour a time
2. expressing at least 3 hourly in the day, 6-8 hours overnight
3. that your wife tries to eat and sleep as much as possible.
4. that your son nuzzles when he wants but he will be tired and having him try to bf all the time will wear him out - I never tried more than every other feed (we were on 3 hourly then). Small and often was a disaster with ds. He didn't have the strength. He needed some "free" food down the tube to get his strength up to feed initially once then twice then three times a day etc...
5. he may not demand to be fed (prems often don't) so you do need to be careful with demand feeding - if he doesn't demand to be fed every 3-4 hours he will need the NGT. He needs the food to get stronger, and unless he's stronger he won't bf - it won't interfere with bf if that's what you want to do
6. The rugby ball hold is easier for prems especailly if you wife can hold the weight of her breast with one hand and the baby with the other - it can be a bit tricky to explain but talk to the nurses in SCBU they should be willing to show you
7. If she really wants to BF don't feel you have to rush to get charlie home, many many scbu mums I know let scbu give the babies bottles as they normally will only let a baby home if it can feed a certain amount without the tube. My DS is fine with bottles of EBM but we waited 2 weeks of bf before we let the staff feed him with a bottle. If they want to feed without the tube they should be willing to do so by cup.
8. once you get home then its much much easier ~(but still tricky especiaaly as he will by then demand feed really often.
9. keep looking after your wife

We were in a similar situation. First he was tube fed ebm, then I expressed and cup fed as well - so I offered the breast, but he still got the bm from a cup. As he grew stronger, the breast took over. I then fed for more than 2 years. It's still early days, so please don't lose heart. It took me 5 days to establish the breastfeeding with a lot of support from the SCBU staff. hth

Thought I'd add my experience. My daughter was born nine weeks early and was in hospital for five weeks. She was initially solely tube fed with me doing about half an hour of kangaroo care each day and expressing loads, I think about eight times a day. When she was stronger we tried her on the breast. This was an uphill struggle and we ended up putting her on bottles of ebm. We used tommee tippee closer to nature bottles. She got her milk through a mix of bottle and tube. I kept trying her at the breast and one day she suddey got it and we have been successfully breast feeding for about six weeks now. As soon as she 'clicked' how to take from the breast we didn't look back.

So I guess what I'm saying isthat you shouldn't be scared to ifferbottles so long as your wife keeps up the expressing. Totally your choice but my opinion was that so long as she was getting breast milk it didn't matter how she got it and I just wanted her home as soon as possible.

Hope that's of some help.

Hi Charlie's Dad,
Many congratulations on already being a great dad, getting on line and doing all you can to help your lady and wee boy. I am mum to a 8 week old(corrected) bf baby boy born at 30 weeks plus 5 (born 2lb 6oz and now 8 4 at real age 15 weeks. He and I supported by Daddy got through the ups and downs of exclusively bf an intensive care baby but it is possible just exhausting, frustrating, boring(dare I say it...10 weeks of 3hrly expressing to a picture?!!!).

Be real patient, babies born prem, easily get tired and my wee guy only managed a bf for 2-5 mins sometimes every other day but even a daily kangeroo cuddle to the boobie worked for both of us, although sometimes I let him be to avoid over handling/stimulation in the very early days...soooo hard. they only get the suck reflex at 33-34 weeks so give a bit of time to build his strength. our unit offered LO a non nutrative sucking device (aka dummy!) to help with this. He still uses it occasionally to help with bad reflux but only now and then.

Hilda the Builders suggestions are great and many of them worked for me.

we did expressing and tube...1ml an hour to start with to eventually 2 months later getting to go home weighing 4lbs 2oz. We left once the wee fella could sustain 48hrs of feeding without tube regardless of bottle or boob so we stuck with boob, however a bottle was used to give medication mixed with tiny bit of ebm and no nipple confusion occured apart from some sucking 'laziness' once we introduced a couple of ebm full bottle feeds to let me sleep a little! so we just switched to a tommy tippee teat with a slow release teat to give his 'sook' a work out! I hear Dr Browns are good too but not tried them yet.

But your wife's biggest secret weapon is you, lots of cuddles, praise and love.

If the scbu journey is a long one you will be often at a loss to know what to do, my other half was, particularly on the awful day (that is not able to be prepared for but must just be survived) if or when she goes home ahead of baby...hopefully you'll be able to take them both home together but if not just go home, probably cry, have a sleep, eat and then take her straight back to the unit if possible that day.
but I wish you good luck and strength. well done daddy and way to go, bfeeding scbu mums unite cos its really tough going...we rock and so do you!!!!

oh forgot to mention...my lovely man did some research when we had this problem...(aside from baby energy and suck muscle strength) boobie milk comes in two parts, fore milk and hind milk. the foremilk is the thin thirst quencher milk, like us drinking a glass of water with dinner but it also contains higher level of oxytocin which acts a calming drug for the baby, in a full term, full size baby this is useful for feeding but with a wee prem, they just get going then pass out on this 'sleepy' hormone, sometimes I expressed a little before feeding to get the let down going to save him the hard work and to take off some of the foremilk so he got to the hind milk quicker and avoided the full on oxy-rush!! The expressed stuff I just stored and it was mixed and used along with any other I expressed after he'd had a wee go. hope this helps. Also there is a brilliant book on bf in special care... Breastfeeding Special Care Babies by Sandra Lang. All the best!

Hi and congrats! Not got time to read whole thread but just wanted to say you should contact the nct for advice - they can put you in touch with a bf counsellor who will be able to give you loads of excellent advice.

Good luck!

My dd was a 27 weeker.
I found she was very sleepy and wouldnt feed well.
I found it easier to try her on the breast before her ngt feed.
I did struggle though and they weren't going to let me take her home (or I could against advice) as she wasn't putting on weight fast enough
have to admit I syringed in some ebm when I was rooming in so I could guarantee she was getting a feed just so I could take her home

We pressured and pressured them though and eventually they gave in as long as the hv came and saw me everyday

When we got home everything changed. I was more relaxed and dd started to feed on demand. It made all the difference and from that point on she went from strength to strength

What does your wifes gut say?

I do think little and often is the way for these tiny babies, they tire so easily and have such small stomachs.
I guess I'm just grateful that she was my 3rd so I was confident enough to say we know best.

Meant to say congratulations

First off, congratulations, Charlie's dad.

My baby was 6 weeks early and 3lb 4oz. It took two weeks before she could tolerate my milk. Like your Charlie and many other preemies, sleepiness was a challenge. The main thing I found was to be patient, hard I know!

We didn't really change techniques, but built her up slowly, putting her to the breast only once or twice a day at first, with tube feeds every two hours. But my baby was smaller and earlier than yours.

Perhaps you could ask the nurses why they recommend four hourly. That's not to imply that they're wrong, all babies are different, but that way you can better understand what the thinking and expectations are. Also, UCL apparently doesn't do four hourly, they do three, so there are different approaches.

I can understand your frustration but honesty, the most important thing is what you're already doing, supporting your wife. I couldn't have done it without my SO.

My early bird is now 10 weeks old and breastfeeding is going really well. I'm sure you guys will make it. Good luck!

ds1 was 7 weeks prem (3lbs 7 oz) and latching on just knackered him so he had a nasal - gastric tube for ebm.

Congrats to both of you.