Premature IUGR baby - slow weight gain - breast/bottle dilemma

Bobo23 · 2009-02-16T15:02:29+00:00

Apologies for cross posting from Premature baby forum... Our LO has been back from hospital a week and is exclusively breast fed. He weighed 1250 at birth at 34 weeks (severe IUGR) and is now 40 weeks and is 1860g. The health visitor has just been round and he's only gained 90g since being back from hospital (6 days). She says we should be putting him on formula after his feeds if he hasn't gained more weight by wednesday. She thought it might be partly to do with him not latching on properly and getting the richer part of the feed so she had a look at his positioning and gave me some tips. I'm really upset as I was hoping he would be exclusively breastfed and I'm also really upset cos he's so small and I feel so useless. Anyone have any experiences to share? Feeling really down.

tiktok · 16/02/2009 15:25

Bobo - what tips did she share with you? Have they made a difference? How often is he feeding? Are you using at least two breasts every feed?
What about at night?

Teeny little ones like your ds may well need to feed very often indeed, taking small amounts each time. They also need to feed very effectively as they haven't got the spare capacity/energy to mess about - I'm sure you know all this.

Have you got him skin to skin with you most of the time so you can respond to feeding cues quickly? What about expressing?

You have done brilliantly to cope with the early birth and his small size - can totally understand your wish not to want to use formula now.

Original poster

Bobo23 · 16/02/2009 15:52

Up until yesterday he was feeding every 3 hours.. past few days he's been fussing and not latching on so well.

She suggested

checking he was directly on the nipple as she noticed he was a bit lopsided
swapping breasts half way through to keep him awake and interested
feeding him all the time!

I haven't got him skin to skin - is that a good idea?

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tiktok · 16/02/2009 16:16

Thanks for the extra info, Bobo.

Yes - skin to skin is a very effective way of

ensuring you can respond quickly to his feeding cues
stimulating feeding behaviours in the baby
stimulating milk production in you

Swapping breasts as HV has suggested is sometimes called 'switch nursing' and it can be effective - you can switch back again and again. Also see breast compression (google it) to keep a sleepy baby interested.

tiktok · 16/02/2009 16:17

Also three hourly feeding is probably not enough - most newborns feed more often than this.

Jot81 · 16/02/2009 18:13

Hi Bobo,
My baby was also premature - born at 28 weeks & weighing 1lb 12oz (820g) and i went through exactly the same as you. She has only been home 2 weeks but the first week was hell because she just wasn't latching on properly or would 'snack' because she just didn't have the energy to feed properly. In the end i decided to express & put it in a bottle and give it to her. It works out about the same about of time, if not less. Its easier for her, i'm less stressed and therefore producing more milk. My HV made a really good point - small babies do find it harder to latch and suck properly and the bottle is so much easier. Premmies have already gone through so much, you don't need to put more pressure on yourself or baba. I'm now feeding her every 3/4 hours during the day and get up at about 3/4 in the night and then 6/7 in the morning.
Have you throught about expressing? x

bronzeShower · 16/02/2009 18:16

I had problems getting them to let me take my prem dd home as I was breastfeeding and she wasn't putting on weight at a rate they like.
I expressed a little for each feed and gave it to her through a syringe as a) she got tired so easily and b) like celery she seemed to be using up more energy feeding than she got from it.
I found that by using ebm in a syringe I wasn't giving her formula plus she wasn't getting any nipple confuuion.

bronzeShower · 16/02/2009 18:17

ps it also meant I could sneak her vits etc into her

Original poster

Bobo23 · 16/02/2009 18:46

Thanks lovely ladies - I spoke to a breastfeeding counsellor chum and also to the Bliss (premature baby) helpline and the both suggested giving LO expressed milk in a bottle as an alternative to topping up with formula..

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Original poster

Bobo23 · 16/02/2009 19:11

also I'm trying the compression techniques - seem to be helping him keep feeding when he's falling asleep on the breast...

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Original poster

Bobo23 · 17/02/2009 10:43

As regards feeding LO all the time - should I just try putting him on the breast whenever he stirs or squawks?

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neenztwinz · 17/02/2009 11:26

Yes definitely put him to the breast whenever he looks vaguely interested!

One of my twins was only 4lb 8oz at birth and really struggled to feed at first - she would only manage about 3mins at a time. She was so tiny - like a little plucked chicken! So I can only imagine what feeding your LO must be like as he is even smaller.

It really helped my DD if I put the other twin on first for a couple of minutes to get the letdown going and then put her on.

It would be a faff and not sure if it would work but could you maybe express a little and then put the baby on? Then the pump is doing the hard work of getting the milk going IYSWIM.

neenztwinz · 17/02/2009 11:31

BTW, my DD only put on 8oz in the first four weeks and the HV was trying to get me to top up with formula but I was adament my body would be able to make it work, and it did. Just keep offering him the breast - and well done!

bronze · 17/02/2009 12:32

the other thing I had to do was set my alarm during the night for every couple of hours and wake her up to feed her.
Highly irritating as she was the first og my lot to sleep properly

neenztwinz · 17/02/2009 13:01

Wish I'd had that problem!!

Original poster

Bobo23 · 17/02/2009 13:16

Right... he's snoozing in the sling, feeding every couple of hours, doing the magic compression thing... lets hope this helps!

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TinkerBellesMumandFiFi2 · 17/02/2009 13:46

Hi Bobo, my daughter was IUGR at 35 weeks and sounds like they're a similar age, although mine is/was bigger. She is also my second premature baby and I was always told that this age and size babies should be gaining 1 to 2oz a week. HVs are more used to bigger/term babies and worry about the gain. Speak to the hospital and ask them what they expect from your son's weight gain.

I've moved in with my parents partly to get away from my old HV who panicked over Tink's weight and I ended up mix feeding, she started doing it with Fifi, but I still have the community NN team coming out and they're much more used to the weight gain of small babies.

Original poster

Bobo23 · 18/02/2009 11:25

Huzzah! HV has just been round and he's gained 80g in two days so no need for top ups. I think the compression and switching has made all the difference!

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bubbleymummy · 18/02/2009 11:36

That's great news Bobo - well done!

neenztwinz · 18/02/2009 13:50

Good for you - well done! Keep up the good work.

Rascal1979 · 22/02/2009 11:07

Hi Bobo

I did post this on your prem baby thread....hope all is okay x

As Trixiethepixie said I managed to exclusively breastfeed babyrascal who was born at 30 + 6 with severe IUGR - weighing a titchy 2lb 1oz, until she was 7.5mths and at just over 14mths she is still breastfed twice a day (before bed and around 4am) - with the odd sneaky feed in the day if we are having acuddle and showing no sign of stopping any time soon.

It makes me so angry when I hear the crap some HV come out with. In my experience many simply don't know the first thing about breastfeeding or premature babies so couple the two together and they go bananas!

DD was slow to gain weight (although over the year she has put on a respectable 3.5oz per week if you average her weight gain out). Some weeks were better than others. At 14mths she weighs 15lb 10oz so still extremely small BUT perfect developmentally and as bright as a button. All of which I attribute solely to 'Boobie' (well that and my fab parenting skills

I have been where you are and it's soooo difficult but hang on in there it is so worth it. In the UK there are far too many people - esp HV's who are preoccupied with weight gain.

There are loads of thread on here if you search under my name where I received lots of fab advice from fellow mumsnetters

Keep up the good work you are doing AMAZING!

Where abouts in the country are you? - just out of interest as I have set up a prem baby support group in my local area.

Rascal1979 · 22/02/2009 11:07

Hi Bobo

I did post this on your prem baby thread....hope all is okay x

As Trixiethepixie said I managed to exclusively breastfeed babyrascal who was born at 30 + 6 with severe IUGR - weighing a titchy 2lb 1oz, until she was 7.5mths and at just over 14mths she is still breastfed twice a day (before bed and around 4am) - with the odd sneaky feed in the day if we are having acuddle and showing no sign of stopping any time soon.

It makes me so angry when I hear the crap some HV come out with. In my experience many simply don't know the first thing about breastfeeding or premature babies so couple the two together and they go bananas!

DD was slow to gain weight (although over the year she has put on a respectable 3.5oz per week if you average her weight gain out). Some weeks were better than others. At 14mths she weighs 15lb 10oz so still extremely small BUT perfect developmentally and as bright as a button. All of which I attribute solely to 'Boobie' (well that and my fab parenting skills

I have been where you are and it's soooo difficult but hang on in there it is so worth it. In the UK there are far too many people - esp HV's who are preoccupied with weight gain.

There are loads of thread on here if you search under my name where I received lots of fab advice from fellow mumsnetters

Keep up the good work you are doing AMAZING!

Where abouts in the country are you? - just out of interest as I have set up a prem baby support group in my local area.

Original poster

Bobo23 · 25/02/2009 17:51

Rah! 280 grammes gained in the past week! Our LO is now 2.2 KG.... So pleased!

Meanwhile I'm shrinking visibly by the day!

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