Premature baby and weight gain

[Penguindreams]

Can someone please give me some reassurance or ideas?!

My son was born in Dec at 26+2 (at 2lb 2). He came out of hospital at 37+3 weighing 3lb 14. He's had BM exclusively all the way through. I EBF until last week when I started work again and my lovely nanny has given him EBM between 8 and 6 Mon-Thurs and I've fed him the rest of the time whenever he wants, which tends to be about every 2 hours in the day and every 3 hours overnight. He's not a voracious eater - he feeds for about 10-15mins max before making it plain he's had enough, but things seemed to be going ok.

He had a slow start to gaining weight when we got home (too used to the NGT!) but was doing brilliantly and putting on about 6-8oz a week, and was on the 0.4th centile, which apparently is rare for such an early baby .

I just took him in to be weighed now, and he has put on 1lb in 3 weeks and now, at 9+6 weeks adjusted age (5 1/2 months actual) he weighs 8lb 8 and is just off the bottom of the chart.

My rational brain tells me that this is not the end of the world! He is happy, hitting developmental milestones for his adjusted age, lots of wet nappies (usually one dirty nappy a day, and I mean really dirty ). But I'm having a panic because he's not following his centile now and his weight gain isn't going at the same rate. And to get back to the 0.4th centile would require him to put on about 400g in a week (for example), which I really can't see happening.

I wondered if it might be partly due to the upheaval last week with me going back to work, but to be honest that doesn't appear to have bothered him as much as it does me , and if anything I suspect he takes more from a bottle.

Please tell me I'm being ridiculous! I know my son is healthy and happy. Or else tell me how to get more milk in him given that he feeds so frequently in any event!

Many thanks if you've made it this far...

My triplets were still the size of a 2 year old when they started school. They were born at 33+2 weighing 3lb1/2oz, 2lb4oz and 3lb1oz. The littlest only weighed around 13lbs at 8 months old. She was always off the bottom of the chart. Is he signed off from SCBU yet? If not, have a chat with the neonatal nurse - they'll be better than an HV at reassuring you. Btw, the time will come when he'll be wanting solids as well as his milk and his weight gain will speed up slightly.

Lastly, the two boys are pretty much the same as their peers heightwise, and DD is only a little small.

Yes, he was discharged weeks ago. I think he's due to be starting on solids in the next few weeks since they said actual age of 6 months rather than corrected. He is clearly not ready by conventional standards but I'll have a word with the Outreach team to check.
Thanks for replying.

I wouldn't worry about it, his weight gain sounds great!

My ds was also 2lb2oz at birth, 27.5 and 4lb4 at discharge at 36 weeks. He lost weight initially that we were discharged as we were ebf but he soon picked up but has always gained very slowely. He was 9lb when we started weaning at 24 weeks and still below the 0.4th. He was just up the the second by his first birthdayand 16lb4oz. I breastfed him till 19 months, and he's 2.5 now and 28lb the 50th percentile and entirely normal both mentally and physically. He no longer looks prem.

Weight gain can be used as a stick to beat you with.. Everyone has an opinion on how much your baby should weight and you will always second guess yourself, especially when ebf! It's a rare thing to ebf such a tiddler( well done!) so no-one really knows how their weight gain works. My team recommended high calorie milk and some of the most disgusting yogherts and general shit food to make George put weight on, I refused and I'm glad I did now.

It sounds like you are doing absolutly brilliantly

Nutriprem milk. Vomitous stuff. Took me an age to persuade the Paediatrician to let DD come off it.

Yes, and there was another one they gave me too. Grim!

Your son sounds perfect OP, and what a fab weight for 26 weeks!

My babies were born about half the size of yours and weighed 10lbs at 6 months but they were on nutriprem 2.

Thank you all. I just had a panic when I saw that dot below the bottom centile line for the first time! If he'd always been off the chart I doubt I'd be fussed, but combined with the guilt about leaving him with the nanny, I was beating myself up that I was clearly starving him into the bargain!

Hi, I have a similar story to Worszel . My dd1 was born at 27+5 weiging 1.08 kg(2lb2oz) and came home weighing 1.96kg (4lb 4oz) at 35+5. She was born on the 50th centile and was on the 9th when she came home....but no-one at the time told me that it's actually quite rare for extremely prem babies (ie under 28 weeks) to be on any of the normal chart lines at all. I can't remember what she weighed at 5-6 months but it was still around the 9th centile. She was EBF until around 6 months when I started weaning her with tiny, not very nutritionally dense amounts of baby rice and watery slop lovely pureed veg and fruit. She didn't get any regular milk feeds other than BM until a year actual, and over the first two years gradually climbed the centiles - although I'm not sure about the rate as she wasn't weighed at all often after about 5 months on the guidance of (I now realise) a very sensible health visitor.

So....in your situation...it is worth remembering that the growth trajectory of full term, breastfed babies is initially steeper, but that the curve then flattens. The belief used to be that prem babies should be 'fed up' and the aim was to get them to the 50th centile.....but there are indications that this creates longer term health risks eg a higher risk of diabetes. There is also no real evidence base supporting weaning at actual rather than corrected age. Much of this is a product of the fact that both survival rates and outcomes for prem babies have improved so much over the last 20-30 years...so our children are, to a degree, guiding practice for the next generation of babies.

Moving to what is certain.....which is that breastfeeding (or feeding expressed milk) has a very real impact for prem babies....so yes, you are right to be proud, big time. I can understand you having a wobble: going back to work after what you have just lived through, with a precious baby who is still very tiny and young is huge . Moving from the very abnormal surroundings of NICU to 'normal' life is a big deal too. Having a baby who looks different and incredibly special, similarly so. And weight is just one of the things that brings this home.

If you'd like to share experiences with other parents of prems, I recommend the Bliss messageboard - not surprisingly, weight gain is a recurrent theme.

HTH