my 6month old premature baby weighs 9 lb , advised to give 3 bottles a day top up??

[lou222]

my little boy was born at 27 weeks and weighed 2lb 8
i have struggled and struggled to breastfeed, expressed for 4 months had bleeding cracked nipples, poor latch etc, been through hell and we cracked it at about 5 months!! !!!... but i've been to the childrens clinic today and was told to give 3 x 120 ml bottles on top of breastfeeding as he is very slow gaining and under that line in his book (he's been under since he came home but is still going up)
He already has one bottle at night with his medication and that hasnt affected my supply as i don't cut out a breastfeed - but will 3 affect my supply? does anyone think there is another solution.
would hotfoot down to breasfeeding club but they aren't there for the next 2 weeks.
hope someone can advise

Its very hard to advise but everything I've ever been told is that Breastfeeding is the best and only thing your baby needs. He is gaining weight, which is great, albeit slowly and after all your hard work, which my heart goes out to you (I also had painful weeks starting up with my two DD). I would carry on as normal and get some proper BF advise in the new year.

Hope all goes well!

How does he look?

Is he chubby, bright, alert, pink skinned and happy? Does he do plenty of wees and poos? Or is he thin, lethargic, pale and whiney?

If he is rounded and happy and wees and poos plenty then there is nothing wrong with him, he's just a prem baby who is still playing catch-up. If he is gaining weight, even if it is slow, then there shouldn't be any need for top-ups.

And yes, that much formula would affect your supply as it would impact on the amount he nurses.

As long as he looks happy and healthy I'd carry on with virtual-exclusive bf until you can get to Baby Cafe.

put a call out for SGK, she has fab ideas and experience.

Who advised you? A paediatrician I assume?
While I totally agree that you've given your DS the very best by BF him, I also think that professional advice shouldnt really be dismissed as I fear may happen on this thread.

This is a special and unique situation- your baby was born extremely premature and therefore advice given to you regarding weight gain etc is different to that of a healthy term baby.

How you will give 3 bottle feeds without effecting supply im not sure? Would your son be topped up after a BF?

You need professional advice on how to go about this as it would be a shame for your BF to suffer because of the top ups.

At what rate is he gaining? If he is gaining steadily I woudl be suprised if he suddenly gained more by adding bottles, I would think it is more likely that he will just substitute the bottles for a breastfeed. If I was to advise a mum I would say to offer the breast more often to increase your supply. Offer both breasts each feed. I'm no expert just my instinct on this sorry. How about calling ABM laleche or NCT helplines they are very experienced and have 24 hour helplines.

My advice would be, don't do anything you don't want to. If your DS is fine in all other respects and is gaining - albeit slowly - then there isn't a major worry.

My DD was born 9 weeks early weighing a titchy 2lb 1oz (due to IUGR) I expressed for 9 weeks until she was strong enough to breastfeed.

I worried for months about her size and the amount she put on each week. As time has gone by I have learnt not to worry so much.

In our culture big babies are perceived as being healthy babies when this isn't necessarily the case. My DD has just turned one and is still breastfed and although she is still small at 13lb 12oz she is perfect in everyway.

At 6 months (actual) she was 9lb 8oz so not much more than your DS and I never gave any formula top ups.

There is nothing wrong with doing if you feel you need to and WANT to BUT more calories in breast milk and you will be weaning soon too etc Can you not BF more? Spend the weekend in bed with him and feed, feed, feed!

I do feel for you . I know how stressful it is and how worrying but my DD is perfectly fine and advanced for her age and I am sure that is down to me breastfeeding her

thank you so much for your replies

yes it was a paediatrician.

he is not chubby but is alert, pink skinned and happy.

he wees and poos aplenty.

yes he's gaining slowly but surely.

daytimes he feeds well and is content but it seems from 5 ish onwards he needs alot more .
after a 45 min bfeed he still gulps his bottle down. i'm worried he's not getting enough from me but my instinct tells me to try and bfeed him alot more rather than give him 2 extra bottles but i also don't want an undernourished baby.

thanks rascal - our posts crossed.
so glad you've gone through similar (well not glad but you know what i mean!)
did you ever feel she was hungry?
i wasn't really worried about his weight till today even though i put up with weeks of pressure from the health visitor who was always happy to point out how below that line he was and kept pushing formula
it was only when i went to bfeeding cafe that they reassured me his weight was fine
he's just slow gaining!
i'm sure they'd say the same but as i can't go for a couple of weeks was hoping to get reassurance on here.
the paediatrician assured me it wouldnt affect my supply but i can see that it probably would
or has the one bottle already affected my supply?
god it's so hard to know what to do

You could compromise and give him say 2 bottles a day a time when you know he would take them after a BF. That way your milk supply may not be affected as much. And you're giving extra formula as per Dr advice.
Then when you return to the clinic and have him weighed you can see how much effect the extra bottle has had on his weight gain. And then take it from there.

Ive just thought...what about breastmilk fortifier? Its powder that comes in a sachet to add to breastmilk...it makes the breastmilk more calorific. But that would mean expressing some milk and giving in a bottle instead of the formula.

lou, I think it would be worth calling the clinic and asking for clarification on this. No one on a talkboard can see the whole picture, but we can suggest questions to ask :0

If the clinic is worried about your baby's growth, and there is no actual crisis or concerns about metabolism or development, then all we are talking about is 'calories in' - yes?

You might want to check that with the clinic when you call them.

So, if that's the case, you have the calories - in the milk in your breasts Like you say, you can offer him more breastfeeds, and always two, three or more breasts at each session. You can read about breast compression (check archives here or google it).

Three x 120 mls will definitely affect your supply - no doubt about it. As is said here, the risk would be you give more formula and yet have less breastmilk as a result...bit daft

Hope you can find support at the clinic for continuing (almost) excl bf.

hi tik tok
yes she said i needed to give him 3 bottles cos he needed more calories but developmentally he was fine

My DD went through a similar pattern Lou222. She would feed like crazy at night from about 5pm and still wake 3-4 times in the night. So yes she seemed hungry. This has settled and she wakes far last most of the ime!

The mechanics of BF'ing - supply and demand - mean that as soon as you introduce any bottles your supply will be affected. The more you breastfeed the more you produce

At 6 mths your DS is probably going through a growth spurt - this can be height and development related not just weight gain! ( I remember being distraught at the amount DD had fed over a week and then only put on 2oz! but looking back her brain was developing and she was learning new things)

HV and paediatricians are usualy NOT Breastfeeding experts. I often felt I had to battle to continue exclusively breastfeeding but I would go through that battle 10 times over again if it meant I could continue breastfeeding again.

Breastfeeding is giving your DS the best start in life. HV and paeds should be congratulating you particulary as your DS was so prem. It's a real achievement and you should be proud of yourself and your DS for getting this far.

He is NOT failing to thrive. he is putting on weight. Don't worry about him not being chubby DD isn't at all but she is perfectly in proportion and more than capable of holding her own with her (much bigger) peers!

DD is still not on a centile line (has always been below the 0.4th) but she follows her own line and that is the main thing.

Do you not have a breastfeeding counsellor at your local hospital or a breastfeeding group you could go to for support? I was lucky in that I found a fab breastfeeding counsellor who was so supportive and without her I may have given up.

As I said before Breastmilk has more calories than formula so to swap is nonsensical.

hi rascal thanks again for your reply
yes have a fab breasfeeding cafe but they meet thursdays so arent there xmas day or n y day!

was speaking to my friend who is a doctor and she explained nutriprem 2 has tons of extra things in , omegas, fats etc aswell as just calories

having looked at his red book he is further away from the 0.4 bottom line than he has ever been

think i will struggle through till i can get to the cafe - maybe give him 2 bottles a day.

if i am still bfeeding the same no of times and just giving a bottle after the feed will that still affect my supply?

"daytimes he feeds well and is content but it seems from 5 ish onwards he needs alot more .
after a 45 min bfeed he still gulps his bottle down. i'm worried he's not getting enough from me but my instinct tells me to try and bfeed him alot more rather than give him 2 extra bottles but i also don't want an undernourished baby. "

Most bf babies do this, it's called cluster feeding, and is perfectly normal, and not a sign that you don't have enough milk etc. If you want to stimulate an increase in your supply then swap him from one boob to the other several times. Feed him, when he stops actively nursing swap sides, and the same again.

Hang in there, slow weight gain is not a huge problem as long as he's gaining and not losing and is developing well.

(Is he 6 months adjusted age or 12 weeks adjusted age?)

"was speaking to my friend who is a doctor and she explained nutriprem 2 has tons of extra things in , omegas, fats etc aswell as just calories "

yes but it is still just a nutritionally inferior poor aproximation of breastmilk, lacking in antibodies and trace elements etc.

If you are concerned that he is not getting enough calories then bf him more, if you are worried about your supply then bf him more, and perhaps try a galactogogue like milk thistle or fenugreek to get your supply boosted. WHilst formula is often suggested as a "cure" to a bf/weight problem, it is rarely the only possible, or best one.

thank you greenmonkies
he is 13 weeks corrected 6 months actual
i have had domperidone previously may get some more
but yes i have done all my dashing about now so will stay home for next few days and just feed and feed and feed the gorgeous boy
thank you again
it is reassuring to hear your words of wisdom

ok i have fed and fed some breastfeeds lasting 2 hours
last night i fed from 3.30 am - 5.30 am he was still hungry so i got up and gave him a bottle was then content and went to sleep.
my question is if i don't reduce any breastfeeds
so for example still feed 10 times per day and then gave 2 or 3 bottles on top how does that decrease my supply if i am not reducing the number of feeds i give him
i really want to get this right but it seems that 30 mins after a feed he wants more and sometimes (not always) is only satisfied if i give him a bottle
i have ordered some more domperidone from the doctors to see if that will help satisfy him

It's really hard to get the full picture without talking to you in person. Could you call the national bf helpline on 0844 20 909 20? They'll be open now . If you don't get an answer first time do try again or try calling from a mobile (as that will put you through to someone different -the technology is complicated!).

There is research evidence that shows that a bf baby supplemented with anything (formula/solid) will automatically reduce their bm intake. They may take the same number of feeds, but less at each feed -you wouldn't be able to tell.

It may be hard to get your head round, but when they're feeding on and off all the time for several hours and your breasts feel soft, then this is when a baby takes the most calorific fatty milk. This is exactly the time to avoid giving a top-up, as that then fills baby up and they stop taking the fatty milk and stop stimulating your supply. The highest fat, lowest volume milk flows most slowly from the breast and a baby has to work the hardest to access it. At these times breast compressions can be really helpful to keep babies feeding actively.

It may also be that over the 6 months your LO has grown longer and may not be in an as effective position for feeding as they were. This is where getting a bf expert to observe a feed can be helpful.

Weight is only a symptom, not a problem in itself, IYSWIM. te question should be is there any problem leading to slower wiehgt gain and if so what is that problem and what can be done about it?

The first question of course is, is the current rate of weight gain actually a problem? Babies who start small or lose weight often don't regain it. This is actually normal. I really think you could do with talking it all through with a bf expert.

HTH & Happy Christmas

rem weigh chart he looks in scale on that one.

Could you carry on as you are during the day and start giving him a bottle at say 10pm. Get your OH to give the bottle while you express milk. Once you have got into the habit of expressing you can give a bottle of EBM at that time instead. I know it sounds silly but sometimes a baby will take more from a bottle becauseit is easier and if they are sleepy etc.. That way you will know how much he is getting and it is still BM so more calories and you can BF normally for every other feed.

Hi Lou

I'm no bf expert but my ds2 was born at 28wks so understand the additional pressures that come with it.
The thing that has worked well with my friends baby was to suppliment each breast feed with a few ounces from the bottle.
Half an hour breast feeding followed by the bottle.
This has allowed the mum to maintain breast feeding but the baby who tires so very easily has been able to get those extra calories from the bottle.

Hi Lou, sorry not to have answered earlier. I am SO glad that things seem to have clicked for you after all your struggles. Not surprised that your HV has been pushing bottles, in my experience most of them understand very little about prem baby weight gain. DD was unusual for a 27 weeker in that she never dropped off the normal growth charts (for her adjusted age) but even she crawled along the 9th centile until around 6 months and never gained the 30g per day that some paeds and HVs are very fixed on.

I would be tempted to discuss other options with the paed - eg referral to a dietician who is better qualified than a paed to say whether his weight gain pattern is within normal range for a baby of his prematurity and history. There is also the possibility of starting solids - current best practice(from BLISS ) is to start solids at 5 to seven months actual age, not corrected- their weaning leaflet is accessible via the link. So if your lo is already six months old you could consider introducing solids rather than extra bottles.

I'm reluctant to simply say trust your instincts given how complex prem babies needs can be. But it remains to be seen whether your lo would in fact take in more calories were he to be given top-ups in place of more breastfeeds.

Lou, one more question - was the paed you saw a hospital paed involved in neonatal care, or a community paed.

thanks for all your replies

matnan for some reason i can't open those charts.

thatsnotmy
on my own so no-one to feed while i express and to be honest i expressed for nearly 5 months (aswell as bfeeding) so really could not go back to that

lizzytee the paed was one who did the visits on the neonatal unit. i mentioned weaning to her and she said he was nowhere near ready

grendle thanks for that have been trying compressions now

i have the domperidone and am trying to give just one 120ml bottle a day
but have given 2 more often than not
i am feeding him alot more and for longer than i was so i'm hoping that may make a difference
previously i had been thinking well i've just fed you so you can't possibly be hungry but now i am just feeding and feeding
i'm going to go to the breasfeeding cafe but that won't be until 8th jan i'll try and get him weighed before that but his nappies are very wet and he is content most of the time
sometimes he is crying while i am feeding him - not really done that before and there is milk there i've checked.
would he cry during a feed if he was teething?