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

Lou, thanks for clarifying re doc. I am a little surprised at the paed's comment re weaning - the 5 to seven months quoted is UK best practice so you might want to query this, or might consider asking her to clarify what her criteria for "being ready" are. You can download a copy of the BLISS guidelines from their website to show her if you feel that would help. (I would stress, I am not saying here that weaning is the answer, just that it is one of the options that you could consider).

I do think that it is so unusual for paeds to see any baby still bf at six months, let alone a 28 weeker, that their practical knowledge base is pretty limited. Telling you that three bottles a day will not affect your milk supply betrays a basic lack of knowledge about the physiology of breastfeeding, for example.

I also understand how you feel about expressing, I too had a bellyful of it. Your approach to feeding, now that the other issues re latch are resolved sounds sensible.

Don't know about the crying during a feed, however one of the things about very premature babies is that they spend more time as a newbornm just because they are here iyswim. It was a big shock to me when dd suddenly started being more alert, more demanding at around three months corrected. In your ds's case, maybe it's teething, maybe it's just he is more aware of his surroundings as he grows and develops.

Most of all, you are doing so well after all you have been through and all you have to contend with. Sending you hugs and weight gain vibes xx

his weight yesterday was 9.6 so 6oz in 8 days - is that good ?
the hv wasn't impressed but she never bloody well is!!

The problem with the charts that they currently use is that they are based on a very small sample of formula fed babies so these types of problems come up sooo often! The world health organisation are releasing the new ones in March which are based on a very large sample of exclusively breastfed infants worldwide - not much help to you now I know but in the meantime you might be reassured by these charts:

www.kellymom.com/babyconcerns/growth/growthcharts.html

They helped me because my DS was also considered a 'slow gainer' but he fit in great with those charts.
I would speak to a breastfeeding expert. Contact La Leche League - they will be able to give you qualified advice. I can tell you that giving any bottles will reduce your milk supply becuase the baby is filling up on formula rather than you and therefore not feeding as often to maintain your supply. The frequent feeding is how they stimulate your milk to change - usually when they are coming up to an important developmental stage. Just go with it becuase it does pass quickly. You are doing a great job - just keep feeding him on demand and your body will take care of the rest. DO get a second opinion from a qualified breastfeeding professional. Unfortunately, a lot of health professionals just don;t have the specialist knowledge of breastfeeding that they need and often their recommendations do more harm than good. Take care. xo

Lou 6oz in 8 days is fantastic! Well done!

DS2 was born at 30+5 (3lbs) and has also just turned 6 months and is exclusively breastfed. TBH I'm not sure how much he weighs as I can't get to the HV clinic but he keeps growing out of his clothes and is happy so I'm assuming he's OK! (Will take him to be weighed at our SCBU meetup and talk to the neonatal nurse there though).

I think that feeding as much as you possibly can is probably the key. I'm lucky and seem to have a good supply but I still have days where DS2 seems permanently attached to my boob, he seems to always be hungry even when he's spent the last hour feeding (DS1 was the same though and he was born at term).

Re crying during feeding - sometimes DS2 does this and sitting him up for a good burp usually sorts him out!

I'm in agreement with some of the PPs that unfortunately most some paediatricians seem woefully ill-informed about breastfeeding which is a disgrace really .

Hope everything continues to go OK!

He sounds fine to me. Had to read through to find out what age he is. My dd was a 27 weeker and I was put under loads of pressure to bottle feed (I did top up later on but under my terms)
As long as their weight is increasing then they are doign fine.
Remember an ounce on a small baby is a larger proportion of their body weight than an ounce onto a born 9lber would be.

Re the crying when feeding. Could he have silent reflx? A lot of prems do

btw from my experience paeds can be quite single minded about these things and arent always right. I know I'm not the only one whos discovered this with prems

Lou, I would say 6oz in 8 days is not bad at all. I looked at DD's growth charts and her weight gain worked out at 4-8 oz a week. She did slow down a lot around the 5-6 month mark but by then I wasn't having her weighed very often, in fact the HV encouraged me to have her weighed every 2-3 weeks.

Take care

lou, that weight gain sounds fine

bubbley - sorry to correct you, but the charts in use in the UK are based on data from several data sets amounting to thousands of babies, and their feeding is not differentiated. There is a lot in the mumsnet archives on this, because I and others correct this myth a lot. Many of the babies will have been formula fed, it's true, but the issue is not the charts but the way they are interpreted by poorly trained HCPs. For the first six months or so, standard charts differ hardly at all from the forthcoming newer charts.

The standard charts and also the forthcoming newer charts are prob not the right charts for a baby born at 27 weeks, whose growth is likely to be different for some time.

Tik, I'm really interested in the charts. I had this discussion with DS' Paediatrician who says that the charts are hypothetical; that there aren't a magic 100 children....

Are these charts similar to actuary tables?

Tiktok - I've read quite a few of your previous posts so I'm sure you know what you're talking about! The information I have about the charts was given at a breastfeeding conference I attended recently and we were told the old charts were outdated - not only because the samples used were so small and confined to a narrow geographical area but also because the guidelines at the time meant that many of the babies were weaned early and/or were having formula from very early on. These new charts would overcome this because they used a worldwide geographic, had stricter criteria for the feeding habits of the babies that were used and were based on the current weaning guidelines. From what I saw of the charts, there was a new way of measuring premature babies as well. Does this tie in with your info or do I need to go back and reread all my notes??!

bubbley - either you have misremembered or the conference got it wrong, sorry!

I suspect you have misremembered, and you are talking about the so=called 'breastfed from birth' charts which were intro'd in the UK a little while ago and which have not (thankfully) caught on. These were indeed based on a small no. of babies in (I think) Cambridge. UK 1990 is the name of the standard chart in use in the UK and you can google this term and find out all about them - there is a very good PDF looking at the history of the 1990 data and you'll see that literally thousands of infants were involved, from different data sets.

I haven't looked at the new charts recently but I don;t recall anything about pre-term babies in this, and dont see how they could include them. The babies used to collect the data were all full term.

I don't think the conference got it wrong so it must be my pregnancy brain hormones getting things confused! I'll go and check my notes! I know it wasn't anything to do with the breastfed from birth charts - it was WHO charts they were discussing. Off to do my reading again!

Ok, I've checked and it was the integration of the new WHO charts that was discussed at the conference. (I'm not going mad! ) The RCPCH recognised that the UK 1990 charts don't describe the growth of exclusively breastfed infants, particularly in relation to weight, because those charts included infants that were mixed fed and formula fed as well as breastfed and therefore don;t adequately reflect the fluctuations of BF infants in the first few weeks.
The new charts are based on infants that are exclusively breastfed for AT LEAST 4 months and complimentary foods were not introduced until 6 months - so are more accurate in relation to the current feeding guidelines. The new charts mean that breastfed infants are far less likely to be classified as underweight as opposed to the UK1990 charts. They are going to continue using the current charts for preterm infants though - it had just been mentioned that the current system can be misleading because preterm infants grow so differently and that there were plans for new charts...
Sorry if I misled anyone with my earlier posts and I realise that in relation to the OP which was to do with a preterm infant the new charts aren't going to be relevant!

Glad you checked on this, bubbley

The new charts will only mean that breastfed infants will be less likely to be wrongly classified as underweight when they are beyond the newborn stage only - breastfed babies tend to grow very slightly more quickly than ff babies in the first months and then their weight gain typically slows down from about 4-5 months, and this is seen on the chart (when you compare WHO with UK 1990) from about six months, and noticeably at 9 - 12 mths. The new charts will I hope prevent healthy (older) babies being diagnosed as underweight.

It's excellent that the new charts will be coming in soon, and that HCPs will be trained in how to use them properly.

(But it's misleading to suggest that the UK 1990 charts are based on small samples - they are not. )

anyway back to me !! ha ha
i did give in the other day and decided to give him a bottle in the afternoon (mainly cos i had friends coming round and needed to cook and not constantly feed)
well he was just sick and sick and sick with it so that just confirmed that i am doing the right thing and am only going to give him his one bottle at night.
I'm going to the bfeeding cafe tomorrow so will hopefully get more reassurance there
thanks again for your replies

Hope you don't mind me jumping into this conversation late on but just wanted to add my own experience in case it helps at all (if not, please feel free to ignore!). My DD2 was born at 33 weeks (well 2 hours into the 33rd week!) back in April and is now 8.5 months. I BF until a week before six months although I got a lot of pressure from GP/HV (but luckily not paed) to supplement with formula before this as she was also slow to gain. She weighed 3lb 4oz at birth so bigger than your little one, and at six months actual (19 weeks corrected) was around 11lb (I think at 13 weeks corrected she was around 9lb but can't be exact as her book is in her room and she's currently fast asleep). The topping up with formula was something I caved to and tried for all of a week before I realised what I suspected all along - she was getting plenty from me and formula was not the answer. She barely took half an ounce after the feeds I tried supplementing and it greatly aggravated her silent reflux. So, I dropped it. I went back to work at 6.5 months so stopped feeding a few weeks before then and she is on easy digest formula now. Her weight gain has been slower since being FF and at 8.5months actual now weighs only about 12lb. So about 1lb gain in 2.5 months and has dropped from the 9th to 2nd centile for adjusted age (not yet on chart for actual age). This has been a really long winded way of me saying that the assumption that FF will give better weight gain than BF is not always true. So, if your instincts tell you that you should stick to mainly BF, I would give some credence to that (so long as your little one appears healthy and alert etc).

Good luck with whatever you decide.

Fiona

Just on the growth charts:

The new WHO charts came out ages ago, what's coming out in March is the UK version of the WHO data. The WHO cahrts are here.

This page provides info on UK chart developments.

Hi lou, glad to hear from you xx

thanks thomsonf, grendle and lizzytee
i really wish i'd never caved in and given him that one bottle especially as I am now aware of the virgin gut benefits but anyway it's done now and he does seem to want it and guzzle it down and it was a relief when my nipples were sore and bleeding.
i have been given lots of info from the bfeeding cafe and will go back to the paed and tell her just why i won't be putting him on 3 bottles - see what she has to say about that!!
when i look at the bfeeding charts for boys he is on the bottom line all babies can't be on the middle line can they as they are averages so someone has to be on the bottom and someone at the top
my boy is just a slow gaining, happy, content and healthy little boy

Hi Lou, good to hear from you and really don't beat yourself up about what's done. You have fed and nurtured a tiny and vulnerable baby in the face of multiple challenges and by the sounds of it have drawn your own conclusions. May he continue to grow and develop in his own sweet time.

Hi there. Just joined mumsnet to post here as this is a topic I am a little obsessed with. DS was born at 29 weeks and just turned a year (actual) on Jan 8, and is still about 90% exclusively bf. I too was bullied about giving bottles of formula as my lo was and is also slow to gain. At present he is 17lbs (which I know isn't bad at all, but my paed thinks differently!)
In my desperate search for a more specific growth chart that took into account the slower and all-together different rate at which prems grow, I came across the IDHP charts. My son wasn't even on the CDC charts (which my doctor uses), and was below the 3% line on the WHO charts for adjusted age. However, on the IDHP chart, he is just slightly below the 50% line. I'll try to pose you the link... hope it works and I hope you find some confidence in seeing how other prems grow.
look here
go to page 293 to find the charts for VLBW babies.
Good for you for sticking it out and doing what you know is best for your son!!

thanks courto sorry for taking ages to reply life is soo busy at the mo.
for some reason i can rarely open links but if you tell me the website i will go and find it.
he weighs nearly 10lb now and is coming up to 7 months old so i don't think he's doing too bad. i'm seeing the paed on the 23rd feb so i want to go armed with lots of info and will print off a more accurate chart and show her that.