IUGR / SGA baby 5 months - hardly feeding and been advised to wean - can this be right?

[TaraFlapalata]

Hello,

I'm posting as I'm getting contradictory advice from different health professionals and I'm now totally confused as to what's best.

A bit of background: due to pre-eclampsia my baby was IUGR and despite being delivered by CS at full term was only 4lb14oz.

I was assured he would catch up but he's never been a great feeder. He's been exclusively breastfed since birth, except for his first few days in the NICU where they tube fed him SMA formula.

He is now 5 months old and still skimming the bottom of the centile charts at 12lb12oz.

Some are telling us to wean now, others saying wait until 6 months.

I have no idea what's best - my understanding was that there are more calories in breast milk so isn't he more likely to grow better and catch up if he stays on my milk? However he is interested in ohter peoples food and is reaching out for what I'm eating etc, he can put toys etc in his mouth and his head control is fine so he can 'sit' up if I'm holding his waist (is this what they mean by sitting with support?).

He isn't a great feeder unfortunately so I've always had concerns about the amount of breastmilk he's getting anyway. I know people always seem to say wean if they don't seem to be satisfied with breast milk alone but he's never fed much anyway and of late getting him to feed at all has been an absolute nightmare. Maybe having baby rice in his tummy is better than the minute amount of breast milk he's currently getting. But then surely a little breastmilk is more nutritious than a little baby rice or whatever. I just don't know what's best to do!

My husband thinks we should wean as breastfeeding has been a totalnightmare for the past two months especially. I don't know what happened to the three and four month growth spurts in our case - baby just isn't interested in feeding much at all.

If anyone has any experience of breast feeding and weaning a low birthweight baby and has any advice I'd really appreciate it. I just want to do what's best for my little boy. Thank you

You are right, breastmilk is way more calorific than baby rice and veg (baby rice is virtually wallpaper paste anyway). If there are concerns about weight (although sitting on a low centile is not a concern in itself - someone has to be smaller than average for there to be an average if you see what I mean) then I would be making doubly sure that the latch is spot on rather than introducing solid food.

Also a vote for you are right regarding the calories of breastmilk.

When I had DC1 I was put under alot of pressure, mainly by my Mum, to start weaning early. The advice then was 4 months. I just stood my ground and very calmly and politely pointed out that I couldn't see how the baby would get more calories from a bit of apple puree, which is mainly water, to a bf. She soon backed off.

Being not interested in feeding is a different issue though.

This might be of some help as it contains advice for "a baby who is a fussy nurser (but does not completely refuse the breast".

Think it might also be a good idea to talk over your concerns with a Bfing Counsellor. Here are the details of the NCT Helpline.

My first was also IUGR 4lb 10oz at term!
He was a complete nightmare to breastfeed but I did persevere. I never had advice to wean early I def bf for 6 months. I think that they are more tricky to feed just because they are small. He is 6 now and eats loads and is just a fraction under the 50th centile! It's a long old haul but they do get there!

Thank you for your replies Jemjabella, Ineedsomesleep annd bridgetfidget, apologies for not returning to this for so long.

I'm going to stick to weaning at 6 months and persevere with the bf - his last weigh in, he hadn't gained at all. The HV said I should give him formula now just to get weight on him, which I have triedon numerous occasions , but he just will not take that either.

His latch is good according to the HV, and I've followed the advice on the kellymom website religiously but still he just doesn't seem bothered. Little half hearted feeds is all he'll do.

bridgetfidget it is wonderful to hear your experience, it's great your DS is doing so well. I would love to ask you about so many things! How was his weight gain during the first 6 months? DS was OK up untill 3 months when it started to tail off and it is now non existent.. Did your DS start putting more weight on after he was weaned? Did you continue to bf past 6 months?

Tara - I too had an IUGR baby - she was 4 lbs 9 oz at full term (officially - she was 37+3). However, my story is different as she/I couldn't get breastfeeding sorted so bottle fed mostly (mixed with ebf for 7 weeks).

She too is now almost 6 and does not look any different to her peers (she's still thin but then that's because she takes after DH !). I have a second dd, who is 18 months - she was a normal 7lbs 1oz at birth but by 6/12 months they were about the same weight.

Hi Tara,just looking back at the red book!! By about 6-7 months he was 13.12 his climb was a steady up for the first year finishing just under the 9th having started well below the 0.4th!! I don't think weaning made a huge difference to begin with. I am on my 3rd child now and they have all been quite small but seem to get going later. I remember with the first having to see a paediatrician at the hospital because he was so small! He was never concerned and said to me that a slow gradual weight gain oft seen in breastfed babies was preferable to bigger quicker weight gain. It sounds like you are doing just fine ...as long as he is healthy ,alert etc I would carry on how you feel is best.TBH I never felt that ds latch was great but we just found our own way and it worked for us!!!
Hope this all helps.

By the way I breastfed for 14months. Obviously feeds much less as food intake bigger. By the end I was just doing a morning and bed time feed.

Tara- there's no more calories in formula, so I'm not sure why your HV is suggesting that.

• Why not give baby led weaning a try from 6 months? I did this with DS and he has piled on the weight (after being off the chart from a severe weight frop at 3 months). I gave him loads of avocado, cashew nut butter and butter enriched food and he's now looking small but chubby.

My baby was suspected IUGR, in the end was born by c-section at 42 weeks at 6lb3oz. (only suspected when I had a scan at 42 weeks and baby measured 34 wks - but actually she was pretty much ok when came out).

I'm still breastfeeding her now (18 mos) but she really took off with solid food around 12-14 mos so we are just on morning, naptime and evening feeds. She's still a skinny thing, but I haven't weighed her since 12 mos now. In my experience weighing them can just make you worry. How often are you weighing? If its too often they often wont seem like they've put on much at all.

I did BLW - it took ages for DD to really eat much, but it was the best way for us. She kept sucking up the nutricious BM when she really needed it. Now she likes food but the comfort of milk too.

DD was also tricky to BF when younger. Rarely wanted much in the day. Does your baby feed in the night? I found that was when DD would take on the most milk. Also my DD was just interested in all around her in the day, and not interested in milk when she could be exploring!

Bear in mind, baby rice will stick in his tummy and take longer to digest, and make cut his appetite for milk even more!

I think crikeybabger has good advice - foods like avo, butter (I just give my DD the butter dish - she loves sticking her hands in!!) and BLW is a good starting point

I don't really have anything to add, but mine was born at 41 weeks at 6lb 12oz and at 6 months weighed 12lb 12oz. So sounds like yours has gained more than mine and we've had no worries, someone's gotta be at the bottom.

The only reason I can see for introducing solids making a difference is if your IUGR baby is struggling to get enough breastmilk due to difficulties in suckling. That happened to us: dd was hypotonic and not good at feeding, so she actually got more from the breast once she had started solids, because she became that little bit stronger. Again, the only way giving formula would be an improvement is if it makes it physically easier to shovel milk into him iyswim (so it's not actually the formula but the bottle that does it). With two hypotonic babies, I had to do all sorts of juggling to actually get the stuff down them. But most people are not going to be in that situation.

Thank you, everyone, you've got so much good advice and I feel very reassured.

wheelybug it's great to hear your baby has caught up and also that your second baby was a normal weight

bridgetfidget , wow, thank you for taking the time to have a look through your red book for me! We seemed to be following the centile line, but are now dipping down again. Although I have had him weighed every couple of weeks and I'm starting to think that might be too much...

It sounds like the hospital staff at your hospital were reassuring. I wish we could turn back the clock as I'd never let them take him to NICU 'as a precaution', it just set the ball rolling for a barrage of tests and medications which I am convinced were unneccessary.

The slow weight gain being prefarable advice seems sound, I will just ignore our HV when she insists I persevere with the formula - in fact, I am not going to take him to baby clinic this week!

crikeybadger I'd love to do BLW and those foods sound like a great idea, I'll look into which other finger foods are the most calorific.

Islandisla thank you for your post, I'm weighing every fortnight apaft from recently when I've had him weighed three weeks in a row since we've seen his weight dip - it's true, the weighing is worrying and I hate the crushing feeling when I see the counter settle almost exactly where it did the last time. Whatever he weighs it doesn't actally change what we do day to day, all it does is make me lie awake for a time in the early hours. I might even plan a visit to my family next week so I physically can't get him weighed even if temptation strikes.

He does also feed every few hours in the night, he is extremely bright and alert and interested in absolutely everything during the day. Feeding utterly frustrates him (and then I worry about the damage this is doing to his bond with me... but that is for another thread!).

That is a good point too about baby rice, I will tell my husband as he is pushing for us to go that route.

climberchick thank you, it is true! I think I just feel like his natural size is somewhere around the 50th since that's where he was measuring most of my pregnancy until he totally dropped off the scale at the end.

I am going to continue to bf and start BLW at 26 weeks with lots of the stuff suggested.

I think I kind of feel like my body let him down during pregnancy and I was so determined to bf for as long as possible but with it going so wrong and his weight gain being so poor I feel like I've let him down with this too somehow. I have to admit to having a big old cry about it just now after (stupidly) having read the 'bf smugness' thread, since he won't even take formula. Seeing your replies and advice and experience on here though has given me a new confidence boost and belief in myself and DS that we'll find our own way and we'll get there! Thank you

cory, i cross posted with you due to writing a massive essay. That must be incredibly hard to feed a hypotonic baby. That's a good point abou the only improvement with using formula, unfortunately (or maybe fortunately actually) it is much harder to get that into him and we always end a failed formula feed wiith a breast feed. When his heart is in it there's real strength in his suckling so I think he's ok with that luckily.

Glad that you're feeling happier now Tara and I think you're right to stay away from the weigh ins for a while as it just adds extra stress.

Have a look at the blw thread over in the weaning section - you'll get loads of help and advice there. Other things to try once you start are vegetables in a cheese sauce, porridge with extra double cream, in fact add double cream to anything you can to get extra calories in him.

Good luck with it all and don't be too down about it all. You're right- you'll get there and he sounds like a happy baby. [smile