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?

If you are normally feeding him at the 'anxious looking' stage and he only gets to the yelling on the odd occasion if you are unable to feed him then and there. Does he get lots of skin to skin time (e.g. in the evenings when the other DCs are in bed) and free access to your breasts?

If I'm being honest, when DD3 was very under weight, I would try and feed her at least once every hour (i.e. a feed sometime between 10-11, a feed between 11-12, a feed between 12-1, etc through out the day and we co-slept at night) and usually with breast compressions if she was just 'nibbly'. I was going on the basis that an empty breast makes milk faster and fattier than a 'full' breast so the more often I fed in a day the better though I know it's difficult juggling baby's needs with older children's needs (well at least I found it so at times).

I do think though that you need some proper, professional support from someone who has a clue (not your HV at her own admission) and who can help give you your confidence back.

Yes, only get to yelling when completely unavoidable. Last two feeds of day are always skin to skin. Will try feeding more often, but yes, think clued up professional support would make me feel a lot more confident.

still I don't have experience of IUGR, but in one of your earlier posts you said you were convinced he shouldn't be 0.4 centile because his brother was 25th and tall family. my ds1 was 98-99.6th centile (also 99.6th for height) and tall family. my next two have been between 9th and 25th centile, and for ages I was convinced it was my milk. it took until I realised they hit milestones earlier than ds1 for me to relax.

if ds1 had been my third, I might have worried that I was overfeeding and making him too big. notice that the centile differences are the mirror image of yours (99.6th to below 25th vs 75th to 0.4th). so all I can say is that no two babies within a family have to be similar sizes. I hope you can build your confidence, it sounds like you're a wonderfully caring mother.

sorry, typo, his brother was 75th

It really sounds like you are doing all you can and you are doing it with all the love and care only a devoted mother can give. Hang in there a few more days to see some one in real life - you can make any decisions then

Obviously if there is a problem with latching on then having someone observe feeding in RL will be really helpful but sometimes it might only take a teeny tiny tweak to change how much milk a baby can access. Not saying there is anything to change but short of you posting a you-tube video of you feeding so MN can critque......

ds1 was born at 33 wks with IUGR weighing 3 and a half pounds and tube fed with breast milk while we were in hospital. Was 4 lb 12oz on discharge after a month. I used a pump and froze it. He had bm by bottle for 6 months

Hospital were giving him extra vitamins and liquid iron and we had a prescription to continue with both for his first year - I put it in his bottle.

He was slightly smaller than his peers until he left primary school. (2nd shortest in the year) He followed the 2nd percentile all the way through till we stopped going to be weighed. Now 17.5 he towers above me. Still slender but unaffected by his prematurity and IUGR

I would ask the midwife or health visitor for some vits/iron

Hi frazzled I have no idea why the adjustment on chart tends to happen around 16wks but it was also the case with ds1 and DD (who were born on 9th centile and 50th respectively, now at 5 and almost 3 probably 30th and 75th so no correlation between them either . The GP said the same thing too.

Re hi cal foods, ideas try avocado and bananas (refused by my ds2 but good if you succeed). Ds2 adores plain Greek yoghurt and also we found he likes a chopped up poached egg with a teaspoon of butter melted in, also mash with butter/ cheese/cream, sometimes I mix flaked baked salmon in with the mash and he likes that too.

it sounds to me like you are doing fine too, please try not to worry, you will get there.

OK, another update: Saw HV again on Friday, and DS2 had put on just under 10ozs in exactly a week .

Only thing I'd really done differently is force myself to wake up properly and pick him up properly during night feed. He's been waking up an extra time or two during the night, as well.

Chuffed as nuts - this puts him close to the 0.4th line, and means he's trebled his birth weight at not quite five months. Trying not to get excited, but is this a good sign?

Fantastic news stillfrazzed! Most babies only double their birth weight by 6m and treble it at 1y. Does that make you feel any better?

It does a bit, although three times hardly anything is still not much .

Trying not to get all excited and start thinking that we've Turned the Corner and now catching up will happen, and all that sort of thing...

Miles better than my DD3 - if she'd have doubled her birth weight at 12m she would be 11.7kg. At 18m she was 9.8kg.....oops

Tripled - christ I did not have a 5.85kg newborn!!!

I just found this in my Watched items and re-read it. It brought back so much of the emotion and stress and fear (and gratitude to all the lovely people who helped me).

Anyway, for those worrying about their skinny prem babies now and in the future, an update:

DS2 had his three-year check last week. He is still very small for his age but has reached the ninth centile for height. And, erm, the 75th for weight. So possibly I may have worried a leetle too much on that score...

He is stubborn (currently resisting potty training with a Death First attitude), cheeky, articulate, unpredictable, naughty, affectionate, rambunctious - and generally an absolutely typical three-year-old, albeit crammed in to a rather smaller package.

If you're going through this now - better days are coming. Honestly.