Prem baby with IUGR - bf or bottle?

[stillfrazzled]

DS2 was born 35+3 weighing 3lbs 5ozs due to IUGR. He spent 3 weeks in SCBU, but with quite a bit of work and support from the staff was discharged EBF and has never had formula.

They were very keen on bf in the unit, at least in the early stages, and I really really wanted to bf.

We're now home and he's gaining between 5-8ozs a week (usually nearer 6) which is OK and follows the line below the 0.4th centile but isn't catching him up at all.

I am getting obsessively worried that I've stunted him for life and he'll never catch up, and that my milk isn't good enough and he'd gain faster and grow bigger on a prem formula. I spend weigh in day at the clinic either nervous or depressed.

Don't know what to do. Really wanted to bf, love the idea of it and the health benefits, but long term would DS2 be better served with something a bit more fortified?

Please stick with bf especially if the decision is based on trying to do the best for him. He needs your milk even more as a prem. All those good antibodies that you make a soon as you come into contact with anything. In your own environment. Formula milk is an imitation of breast milk it is not better. It is just easier to get more of it into him. Maybe you could try expressing again for a little while to up your supplies and give him the ebm as a top up. If his weight gain is fine then don't panic

There's no milk "more fortified" than your breastmilk. A cow can't possibly compete with a real human when it comes to feeding human babies! Try phoning the NCT breastfeeding line for a bit of moral support and suggestions to keep your milk supply up - but I'm sure and certain that the very best thing for him is your milk :)

still I can provide some reassurance. DS was IUGR weighing 3lb 14oz at 37 weeks. I want to say a MASSIVE congrats on managing to BF as with those circumstances it is really difficult and we didn't manage it. The weight gain you are describing sounds very similar to what he did on FF so there would seem to be very little difference in weight gain.

About half a pound a week is great and the 'average' for babies. But remember where he is starting from - to put on half a pound might be 10% of his body weight which is an amazing achievement when you think about it.

DS caught up over about 18 months and is perfectly normal now so it will take a little time. I found it went in spurts as well and I'm sure he'll tell you if he's hungry!

Breastfeeding all the way. SO much better for prem babies.

Stick with it. DD wasn't premie and only spent 3 days in SCBU but we had real feeding and weight issues at first but once she got past 4 weeks old, she's been gaining and gaining. She's climbing centiles more and more now - HV says she's into catch-up!

As long as he's not dropping centiles further, do not worry.

Goodness, you are doing absoluitely the best^ thing possible for your baby.
Why are you having doubts?
Is someone suggesting otherwise?

I think my confidence is low because he's so tiny, everyone remarks on it, and 12 weeks in I suppose i'm desperate to see some reassurance so i'm questioning my choices. Thought of worrying about him for years is really getting to me. Thanks for the support, though.

His weight gain sounds really, really good to me! Ds3 was 8 weeks prem and gained at a similar rate. You are doing really well!

Hi, my DD was born at 34 weeks and had a really tough start. I went through the exact same thing as you are. I stuck with BF as I felt it gave my DD the best possible start. My DD is now 13 weeks and is over 13lbs and absolutey thriving. Obviously it is your decision but I honestly believe that "breast is best". Good luck x

When I was struggling with (not) breastfeeding, there was a bit of research that hit the headlines. It was a randomised trial that was done in the 80s (before ethics were tightened up apparently) - they took a number of prem babies and gave them breastmilk in a bottle, or formula in a bottle for one month. Years later when followed up, the ones who had been fed breastmilk had better heart health than those who'd had the formula.

HTH

(I've never forgotten it because for some reason the reporting of it was so badly twisted in the press, and I got dh (a scientist) to get me the original paper.)

DD1 was IUGR. I got REALLY fed up of people telling me how tiny she was - I'm not sure if you're experiencing this too but it's very irritating and it makes you doubt yourself.

Like your DS, DD1 followed the 0.4th line for around four months. I was impatient for her to start climbing through the centiles and it felt like I'd waited forever for her to be and look like a 'normal' baby. I know that sounds horrid but I just wanted people to stop making comments!

Suddenly, one day, it came to me: I was using the weight chart as a set of targets (must get DD to the 50th! Must!). I reminded myself to 'look at the baby, not the scales' and saw my happy, alert, stubborn, well-hydrated DD who was meeting her milestones. I forced myself to stop weighing every week and moved to once a month. I reminded myself that someone, somewhere always has to be on the extreme end of a spectrum and that there is no evidence babies at this end do any worse than babies anywhere else on the graph, so long as they aren't plunging down centiles.

By 6 months she was touching the 9th centile and by 12 months, if I remember correctly, she was somewhere between the 25th and 50th? All this to say that it takes time and can be massively frustrating but it did happen. And, after she reached a year, I stopped weighing her at all. It felt like such utter freedom.

I developed a few mantras (!) to mutter to myself everytime someone suggested "giving her a nice bottle to fatten her up".

• My milk is perfect for my baby
• A fatter baby does not mean a healthier baby
• (As above) Look at the baby not the scales
• My baby is getting enough milk. She is happy, growing and thriving.

I'm so, so glad I persevered. DD1 (now 2.5 years) still guzzles breastmilk at any opportunity and it's provided such a lovely, enduring connection between us.

Good luck - keep hanging on in there. You couldn't be doing anything better for your DS.

What you have been through sounds very stressful and to me it sounds like you have done really well to get this far with breastfeeding (I found it hard enough to get started sat at home with a healthy baby). The hard bit is over now as your supply will have settled down, it would be a shame to give up the convenience bfing gives you. The health benefits (for both of you) last as long as you continue to bf. Formula is not poison but it is simply not as good in so many ways as breastmilk.

There is a difference between a baby who is small and one who is not thriving - look at his skin, his eyes, his level of alertness and interest in his surroundings. And someone has to be the smallest, thats how it works. It must be bloody infuriating listening to people make the same comment but a lot of people just don't know what to say about a baby!

As others have said maybe you need to try and relax about his weight (easier said than done I appreciate) and concentrate on marvelling at this baby.

Hi, I would continue with the breastfeeding and not go down the formula route. DD1 was IUGR but full-term and 4 1/2 lbs. She followed the 0.4th centile for much of the beginning of her life and I breastfed. Now she is nearly 9 years old and a perfectly healthy beanpole of a girl. Don't worry, your baby will catch up!

Definitely keep on breastfeeding. Breastmilk is also sterile which formula isn't. It has antibodies and antibacterial properties that formula can't replicate.

As regards to the comments people make, I know it's disheartening but do try to ignore them. I get the opposite comments. That she has fat cheeks, how she has never been late for dinner, ha, ha! The only milk she's had has been my milk. Hate the comments too.

You're doing an incredible job.

Hi, thanks so much to you all. Just updating - have spent a week trying to look at the baby, not the scales and all that, and it was working until today when he'd only gained 9ozs in two weeks.

And the prem baby next door had gained 18ozs in a week on the bottle.

I am trying, but I could cry right now. Like Frozen said, I just want to feel like he's going to be normal sized. I think I'm carrying some illogical but v strong guilt that he failed to grow inside me, and now he's failing to grow enough on what he's getting from me.

stillfrazzled, my dd was born at 32 weeks. She didn't have a sucking reflex so I expressed and fed it through tube. Five weeks of this and she hardly put on weight. I was advised to put her on formula because the breastmilk simply wasn't providing the fat she needed. I did, and she gained enough weight and was able to go home. Both she and I never felt better. Don't feel guilty - just do what you think is right.

Not had a prem baby but I feel I can comment on the charts. I ff dd1 after bad support from all around me she was very small and still is quite small.

dd2 I ebf the midwife upset me one day as she suggester she wasn't gaining enough weight, she left me not knowing what to do for the best. She seamed perfect to me. I looked at her red book the looked at her sisters book the lines were the same. When the mw came back the next day I showed her I told her I was going to keep bf as I said thats how my babies grow.

Not every child can be the tallest. The lines on the charts mean if you lined up 100 children the 50th would be on the 50th line. When you look at it it is just a number it takes no account of how short your mil is. The things to ask about your baby are

Is she hydrated
Is she content after a feed
And as frozen said your milk is perfect for your baby

being on the 0.4 centile line IS normal sized. for your baby. they don't often climb the centiles, they are supposed to follow their line. some even drop a line and all is fine.

6oz a week is awesome. keep it up .

you could easily flip the whole thing and say the bottle fed baby who gains mammoth amounts is not doing what they are supposed to. 18oz in one week?? good grief! i'm sure they are fine and that is just the way it is. equally, your baby is probably a little beauty

He is, thank you :-). But 0.4 doesn't feel like his natural centile - he's only on it because I was apparently shite at supplying him with blood. His big brother is 75th cent, and he comes from a family of v tall people.

Hi
I also had a prem baby and the SCBU experience,and just wanted to say you are doing really really well.
If you want to switch over to FF, or try mixed feeding, that is ok. There is no need to put pressure on yourself if it is making you stressed or unhappy.

That said, as movingsoon said, if your baby is on the 0.4th centile then you would expect that line to be followed - ie your baby is doing fine on your milk in terms of growth.

I had guilt feelings too, I found face to face support helpful - breastfeeding support people from the hospital, and the NCT and la leche BF info lines, perhaps that might help you too. I think it is a common feeling when you have had a traumatic experience.

But just to reiterate the weight gain along the 0.4th centile sounds fine, in that that is what you would expect.

ok so all he needs is more of your milk, if that - he may well gain momentum of his own accord. offer him two, three, four sides - as much as he will take, and often. and relax and enjoy your baby

Sorry cross posted, didn't see your last post.
If that is the case, then probably he will catch up at some point with some big growth spurts, I am guessing, but it is probably too early for that to be happening.
Could you ring the SCBU secretaries and ask if you could speak to someone for some reassurance as they would have seen cases like this all the time and would be able to tell from experience that babies who are small but from large families do in fact usually catch up?

Also agree with peanutdream, they take what they need, and feeding as she suggests is good advice.

My baby was IUGR and in first 4 weeks of BF dropped from just below the 25th centile to below the 9th. I introduced one bottle of formula a day at that point and over the next four weeks she went up to almost the 50th centile - it does not have to be all or nothing - you can still mostly BF but add in a top up. If you are worried about this affecting your supply then just express to keep it up. If you have BF exclusively for 12 weeks your boy has already had the vast majority of the benefits of BF.

You have done absolutely brillantly to keep it going this long and I totally understand how you feel - feeling that you are not nourishing your child properly is horrible. once my LO started to move up the centiles I relaxed and started to enjoy her instead of worrying constantly.

Very best of luck with it all.