Trying to persevere with BF with premmie not gaining weight quickly

[Saritabean]

Looking for some reassurance/advice...!

My DD was born at 29+4 due to Pre-eclampsia. We have been really lucky in many ways as she has not had significant health problems apart from her bowel being v slow to get going due to her immaturity and as a result poor weight gain. She is EBF only taking a small amount of EBM in a bottle with her vits/iron etc (gulps it with no probs!) once a day.

She is 16 weeks actual, 5.5 weeks corrected and is well below the 0.4th centile. She was 2lb 5oz at birth (betw 2nd / 9th) and weighs 5lb today (yey!), but it is v slow going and she's not following even her curve (1-1.5oz per week).

We had tried giving her some nutriprem 2 wks ago, but she refused it or threw it back!!! Gave that up after 4 days. Milk supply was great, she was BF really really well, but last few days seems to have lost the plot... Not going for long, pulling off, windy/retching. I posted this in prem section last wk, and wrote 'BF well' but since then things seem to have deteriorated :(

In the last 2 -3 weeks she is pooing a lot less- once (or 4 in a row!) every 2-3 days and it is browny/yellow and quite liquid (it was yellow mushy milk poo on the unit once she was on full NG feeds before she could BF). when she hasn't pooed for a while she is v windy/unsettled and possets lots and has the occasional large vomit if been crying lots.... Large wet nappies still...

We saw consultant y'day who has suggested trying reflux meds, so we'll give that a go, and I'm going to go to BF clinic tomorrow. Suddenly feel though that persevering BF may not be the right thing, especially as it suddenly seems to have become a battle with her :( I can't quite understand why it suddenly seems to have gone wrong when was doing so well... Can it really just be down to me being more worried about her weight?!

Sorry for the long winded post. Any advice/reassurance most welcome!!

Really sorry Sarita, I've got to dash out on the school run now. Hopefully this will bump for you and I'll try to pop back later when I've got more time.

Thanks jiltedjohnsjudy.

Unfortunately had a really bad 24hrs with my DD.... Very very unsettled, definitely taking less feed, my milk decreased dramatically for first time in 15 weeks and seriously considering quitting BF :(

Just can't believe how quickly things have deteriorated in last 48hrs...

Only positive thing is that now she will at least take a bit of formula... Managed 20mls just now, then a token BF, then I tried to express... Only 20mls in total came out, although my boobs still feel like they have more, just not letting down...

I'm pretty much at my wits end, and for the first time am not enjoying my DD as I should be :(

Right, had some time to read both of your posts now that the DC are both in bed.

Poor you, you've had a really rocky start haven't you and you've done wonderfully well to reach this far, just look at everything you've achieved so far.

A few things stand out from your original post. Firstly that you are unable to express much. Please take it from me that how much you are expressing is absolutely no indication of how much you are producing. Your DD will be far more efficient at getting the milk out than you will ever be. Also, by this age your supply will be better matched to your babies needs.

When I had DC1 I would have whooped with joy if I had ever managed to express 20ml, but he grew and I just had to accept (after a few weeks of really trying and worrying) that actually he was ok and was getting enough even though I could hardly ever express a drop.

Another thing that you mention is the fussing. It could well be reflux, or silent reflux as the Paed has said. Have you read this on fussing on Kellymom? Fussing at the breast isn't necessarily an indcation of low supply either.

The pooing less frequently isn't an indication of low supply in itself either. Babies digestive systems mature as they get older and it is normal for a bf baby to poo less at this age. Some poo with every feed and some will go for 2 weeks without a poo, my DDs record at this age is 12 days!

Some other things that may be affecting her behaviour at the moment are the a growth spurt, the 4 month sleep regression and coming up to the next development leap.

Did you make it to the bfing clinic today? Do they have a Breastfeeding Counsellor and did you manage to talk to her? What have they said about how you are feeling and how DD is doing?

Just one last thing, I think you sound quite down and I think that it may do you some good to speak to another BFC before tonight as things can often seem worse in the dark hours. Have you got a BFC locally you could call or maybe you could call one of the helplines like the National Bfing Helpline on 0300 100 0212, LLL on 0845 120 2918 or ABM on 08444 122 949.

Keep posting and let me know how you are getting on

Just thought I'd bump again for you to see if you can get any more responses .

Thanks so much jiltedjohnsjulie, you're absolutely right it's made me feel pretty low these last 24 hrs, as she's really not feeding much now and even trying a bottle of EBM or formula, she's only taking max 30mls at a time and often vomiting back 10mls at least....

BF clinic is tomorrow morning. My DH is going to help out with bottles of EBM/formula overnight so I can express a bit and we'll see how it goes when I'm less tired!

Thank you for you help- all of which makes sense - its just hard to stay confident when she's not putting on weight and seemingly more and more unsettled! I'm sure we'll work through it somehow! I'll keep you posted x

You do sound like you've had a tough few months :( You've done amazingly to express for your DD while she was unable to feed directly and then teach her to feed from the boob once she was able - well done to you :)

I really hope your daughter takes some milk for you overnight, whether that be from a direct breastfeed or EBM or formula. As JJJ said, by this point, your boobs will have regulated their supply to match your DD needs, so it might get harder to express, but have faith that if you keep removing the milk (by feeding or expressing), your boobs will make more :) It might be that the reflux meds will help with the wind and unsettledness and direct feeding will get easier again.

Good luck for tonight, and I'll try to check back in either in the morning or overnight if I can keep my eyes open while feeding babies myself :)

Yey- just had a slightly better feed (both sides from me), feel bit more relaxed and she's less fussy.... Gonna try and get a little bit of shut-eye now if she'll stay settled!

Thanks so much for supportive posts x

Whoops.... Gorgeous DD and me both slept through til now... 5 hrs between feeds... :( I had set my alarm, but cos I was so tired, didn't wake until she was crying too...

She has nice wet nappy though, and latching on brill and nice and hungry to start with so pretty good so far...

Switched sides 4 times, still seems like maybe wants more, but when gies back on, started to pull off retching again...

Only felt 1 let down though too so worried now that maybe she was frustrated by not getting enough?

Not 'milk drunk' but just seems shattered now. Can't wait to go to feeding clinic for someone with experience to witness what's going on!!!

Great that she took both sides and great that you got some sleep and she has had a really wet nappy .

If you are worried about such a long break without feeds you can always make up for it by trying to feed her at least every 2 hours today.

Let us know how you get on this morning and at the clinic .

Oh and the letdown thingy. Some women never feel letdown. After 3 months I can count on one hand how many times I felt letdown, so don't let that worry you either.

Bumping for you again

Thanks again!

BF clinic v useful, latch good, supply good, but DD unfortunately feeding less and less for some reason... Gets in 25-30mls, then stops and won't have any more.... Bottle or breast. Only gaining 9g average per day since discharge. Still weeing, but sometimes now more concentrated. Reflux meds not really helped yet 24hrs in... :(

Going to switch to bottle only for 24hrs to see how much she's getting, continue expressing and see where we get to.

Fingers crossed something clicks in next day , or we're gonna have to go to hospital with her :(

Thanks for all your help x

Sarita glad you found the clinic useful. What did they say about her weight gain?

Still think it would be useful to ring one of the helplines. There a are couple of BFC on here usually but haven't seen them for a couple of days. The helplines should be able to talk to you about the concentrated wee, the spitting up and the weight gain. They should also be able to tell you how much milk to give her. I think I read on here recently that a bf baby usually takes an average of 1oz per hour, so if you are expressing she would probably have 2oz every 2 hours. Does that sound about right?

Hi jjj,
She'd not put on any weight in 2 days since last weighed... (maybe 5g, so now 2300g=5lb 1oz). We calculated at clinic that she needed to take 43ml (1.5oz) 3hrly as a minimum, so the 25-30 she's taking is not great!

Gave in this feed cos she took 10mls of formula, then flat out refused anymore, but just had a token BF... Probably about 20mls maybe (guessed from the quality of sucks and time spent- I have occasionally weighed her before and after a feed on the kitchen scales and can now roughly estimate how much she may have had!!!) and now seems fairly settled.

Reflux meds don't seem to have made much difference yet, and starting to wonder if there's another reason for DD only taking small volumes, hence the slow wt gain.

Just taking it feed by feed for next day or do, cos it all seems to change so quickly!

I'm glad you had some good feeds and a bit of rest.

I think JJJ is right with the quantities - about 1oz (30mls) per hour is normal (though I think the range is about 19oz to 35oz in 24 hours, so there is some variation).

If you're going to bottle feed. (whatever type of milk) for the day, could you put DD to the breast for a while before the bottle to keep stimulating your milk? She might take some and will almost certainly enjoy the cuddle, then you can top up with the bottle (EBM or formula) so you know that she's had at least the amount from the bottle plus whatever she took directly? If expressing and direct feeding and top ups wears you down in an endless cycle then rethink before you go mad, but it might be a short term option?

Let us know how you get on - we're rooting for you :)

Oh, we cross posted!

Just thinking about the fact your DD seems to be taking small amounts despite a seemingly good latch, has anyone checked your Dd for tongue tie? Are your nipples in a decent state after feeds?

I had pre eclampsia, and though my DS was born at 37 weeks, he hadn't grown much for the last few weeks of the pregnancy and was 5 lb 6, dropped to 5 lb 2 in the first week.

He had reflux and was EBF and he bumbled along under the 0.2nd centile until I weaned him at 6 months.

He's on 75th cent for both weight and height now - I think some babies are just slow starters. If you can, I'd keep going with as much bf as you can. It can be hard to resist 'knowing' how much the baby has had, but you can't go far wrong if you just feed feed feed.

Thanks HappyAsASandBoy, no tongue tie and nipples fine after feeding. Unfortunately DD refuses a bottle after breast, but will do it a bit the other way round. Since 19.45 she's had 10mls of formula in bottle (refused anymore) and has had 4 short BF (5mins each side used twice), seems settled now, no retching/crying etc.... Every feed is just completely different!!!

I did wonder if she may have thrush which is causing the retching/'chewing the cud' and not wanting to feed for long, but although she has a v slight milk coating, it's not typical of thrush and my nipples are fine.

Hi BombasticAghast- great to hear good news stories of longer term outcomes! Unfortunately DD now well below 0.4th centile, and just a flat line really with very little increase :(

Until last week, I was pretty laid back that it was just my DD taking her time and that she'd suddenly take off, but 6 weeks post discharge with only 12oz weight gain, I'm finding it hard to know what's the best way to help her gain some weight. The plan today of bottles only (some EBM some formula) and me expressing to keep up my milk, has already gone to pot this evening because she point blank refused more from the bottle, and despite keeping trying would only settle with a BF! As her weight is so important, I don't have the luxury to persist trying with the bottle, and if she'll take the breast, then I want to give it to her!!! It's a catch 22... Not gaining enough with breast alone, but refusing to take enough to make a difference from a bottle...! With the amount of EBM I have stocked up whilst she was on the NNU, I even have the luxury of being able to syringe off the fatty hind milk from some bottles to add to another bottle to make it a bit more high calorie... Still not made a difference! Also tried expressing off fore milk first, then feeding, but just made my supply increase, so then she was still getting same proportion!

Fingers crossed for a feeding frenzy night!!!

DH just spent 45 mins trying to give DD a bottle, unfortunately despite being v hungry/rooting etc, would only take 10mls again. He's woken me up to BF her, and she's had a little... Possibly up to 15mls, but no more than that, refusing more, one coughing/retching episode, no vomit.

She's slightly sleepy, seems comfy, had a wet nappy prior to feed... It just doesn't make sense. She's obviously having just enough to keep her hydrated, but not much more, and despite all the skin to skin, encouragement, just cuddling, burping etc, there's no getting her to have more...

So... BF at 12.30, 2.30, 5.30 and now 10mls formula (then refused rest!) and Bf rest at 9am.

Wees better overnight- lots of heavy pale wee.

Plan of bottles really not working out...! But at least she's taking enough to keep her hydrated.

new plan offer her bottle first and if doesn't take much, then breast... Fingers crossed again!

Sorry Sarita, I haven't been around much. How is the new plan working and how are you feeling? .

Hi Sarita, I'm another mum of a prem little girl who is just turned 1 corrected, she was born at 31 weeks with severe IUGR weiging 2 lbs and I just wanted to say I know how hard it is and how stressful it. I am not much of a BF expert but I was desperate to BF her and despite slow weight gain, we're just about still going so wanted to offer you a good news story. I have only just about got over my weight issues and I was so so anxious about weight gain in those early days.

I don't really have any words of wisdom, but variously have found the LLL, kellymom and the NNU nurses all useful sources of info when problems have arisen.

Really really hope your LO has started taking on some more milk - one other idea, could you call your unit, will they offer you post-discharge advice?

ps I would also second that vols of expressed milk in no way correspond to milk taken by LO x

Thanks JJJ and MMM

Unfortunately little periwinkle here refusing most bottles, but seems to be BF well again, occasional refusals and some coughing/retching still, but wet nappies every time so must be getting enough volume, just hope it's enough high calorie fatty hind milk, as my supply seems to have increased again!

In general I'm feeling so much better about it... I know she is getting enough volume due to wet nappies, I just wonder if it's taking quite a while for my supply to adjust to her demand after 10wks of expressing, and once it does then things will improve...?!

The NNU nurses still come out and weigh her/ support/advise, and they will get advice from consultant tomorrow if weight not increased or dropped.

We'll see how the weigh in goes tomorrow...! Thank you for your kind words and reassurance... Definitely helps in the wee hours! :)

Think the hind/foremilk thing is a bit of a myth Sarita so don't get too hung up about it. If she is feeding and coming off by herself then she should have had enough of that side and you can offer the other. If she still wants more you can offer the first side again and just offering alternate sides until she is satisfied.