Force-feeding 35 weeker with formula? Is this the only way?

[Picante]

Forgive me as I know nothing of premature babies. My friend has just had a little girl at 35 weeks. She was fine, breathing etc and has latched on. She's been topped up with formula - forcing it down her when she's asleep. My friend's been told she can't latch her on between these 4 hourly bf/ff.

If this is necessary then fine, and I know my friend is hopefully going to express for the first time today so she'll have expressed bm as well. But is the formula necessary?

I have no experience of premmies but that sounds wrong.

Even with a term baby 4 hours is too long to wait between feeds, I used to feed every 2 hours unless they were sleeping at that stage, essential to kick off supply.

If she is giving formula it will tell her body that she doesn't need as much milk and will reduce her supply.

I think especially with a premmie loads of skin to skin contact and BFing lots is the way to go.

Someone more experienced will be along soon

i think it depends really, ive had 3 36 weekers so here is my exp

ds1. born 5lb9 breast feed after birth, went home supper sleepy and having to pump offf and spoon feed. went down to 4lbs, readmitted formula fed, sick. under phototherapy light for 2 days, gradually bf begins baby fine.

ds2 born 6lb2 breast fed at birth advised to top up with formula-i refused sent home all fine.

ds3 born 5lb13 breast fed at birth advised to top up with formula,i refused and becaue he was very sleepy was squeezing milk into his mouth continually until his blood sugars dipped so low he was formula fed, he was then admitted to scbu as his tummy wasnt working, after 2 days of failed to only mildly sucessful tube feeds of formula i picked him up to breast feed and instantly he improved and was sent home the next day.

i think with early babies the risk of blood sygar levels dropping is quite high, that and jaundice and so the like to frmula feed as a sleepy baby wont breastfeed. i was always against it but if the staff feel it is needed then i spose they are best placed to decide.

picante - I don't think this is fairly described as 'force feeding'. Sometimes, prem babies don;t have the energy to take in the calories they need in order to grow, so they are tube fed, often when asleep.

I think you may have the timings wrong - it would be unusual for a prem baby to feed no more often than 4 hrly.

If the baby needs to be topped up after the breast, then ideally it should be with the mum's own expressed milk.

Maybe the mum can ask her carers about 'kangaroo care'
www.kangaroomothercare.com/

i don't know anything about it either but it sounds a bit off.

will they let her give ebm in a bottle picante? why is she on four hourly feeds?

sometimes an early baby just needs a little help getting going and yes i expressed milk to cup feed my lot but the amount was too small, so formula was them next best thing-ateotd anything to help a tiny baby is a good thing-certainly having formula feeds didnt impede my breastfeeding.

Ds was born at 35 weeks - the first few days he wasn't very well, and so was solely tube fed every 3 hours, and could only be handled then. I expressed from the start, and as his blood sugar was low he had to be topped up with formula to make the amount he needed up until my milk came in and he solely got breastmilk down the tube. He was too tired, jaundiced etc etc to give him a bottle.

Once he had stabilised I was able to put him directly to the breast every 6 hours, then 3 alongside his tube feed, then bf on demand.

I hand expressed every 3 hours from the start, then once my milk came in used the pump every 3 round the clock. Really important that her breasts get as much stimulation as possible

I agree with Tiktok. Sadly, formula is not the next best thing. After mum's own expressed milk the next best thing is donor milk, but it's often not available .

Hmm. I will have another chat to her. It's her second baby and she successfully bf her first, so she's keen to succeed this time.

And it's definitely 4 hours.

Well....she needs to know why it's four hours. She also needs to know why the baby is not being cared for skin to skin (like the kangaroo care model), why she is not being urged and helped to express, so the baby gets ebm and not formula.

Hi - my DS was born at 33 weeks, luckily in a hospital where he could be fed donated breast milk (via a feeding tube) as I was initially too poorly to express milk.

I suspect had he been born in a hospital without a milk bank that formula would have been the only option until my milk came in.

Bliss is the prem baby charity and has lots of brilliant leaflets available to order or download and a fantastic one on breast feeding a prem baby have a look at www.bliss.org.uk/publications.asp?section=578§ionTitle=Download+or+order+Bliss+publications"

Unfortunately I think the formula will be necessary until your friend has enough bm to feed her little one. She may find that hand expression initially is a lot easier to harvest the colostrum into a syringe, then a good hospital grade pump for expressing their after.

Hope your frend and her little girl are both ok, it's a really stressful and worrying time.

Also meant to say that Bliss have an excellent leaflet on kangaroo care as well.

How are the formula top-ups going in? By tube or by bottle?

FWIW, my experience with my 33-weeker was that they did tend to limit cares and feeding to 3-4 hourly to give her long periods of uninterupted sleep as she would have had if she'd still been in the womb. It also helps the SCBU staff monitor weight gain if feeds happen at set times.

But yes, your friend should definitely try to express, and the unit should be set up for that. EBM is much better, and they should have a fridge and freezer for her to store it in.

From what I remember when my baby was in SCBU his feeding schedule was initially every 4 hours, then went to every three hours, (or might have been the other way round) then feeding on demand before he came home. The nurses calculate, based on weight of the baby, how much the baby should be taking in a 24 hour period, then calculate how much should be given at either 3 or 4 hourly periods.

when you mean force- feeding i presume you mean putting the feed down and naso gastric tube ?

Scbus don't ime like babies to have to put a lot of effort in to feeding, they like them to use their energy for maintaining their body tempreture and growing.

Formula is going in by bottle but she's asleep. Sorry 'force-feeding' was probably a little harsh. Have spoken to her and they are phasing out the formula as soon as possible. Thanks for all your help.

I don't understand how you can 'force feed' a sleeping baby with a bottle?

4 hourly feeds for a 35 weeker does sound odd though (have some experience with premature babies). Are you sure it's not 2 hourly feeds but alternate breast feeds and tube feeds? That would make sense if baby is small for age/sleepy/struggling with blood sugars/temperature control/jaundice. Is the baby on the ward or neonatal unit?

Anyway, hope all is well for your friend now