four weeks premature, low birth weight, still struggling .... help please

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dc3 (ds2) born at 36+3 and small for dates (1.88kg). He had problems latching on, staying awake for feeds and was on formula for the first couple of days while still in hospital because I hadn't got an expresser. Then I got an expresser and we started on ebm. He put his birth weight back on in about 5 days, but since then has been really slow (didn't put on anything for two weeks at one point) and it's only in the last week that he has put on a respectable amount (9 ounces!). It seems to have spurred him on though and this week he has been feeding A LOT, which is exhausting, but encouraging. However, at 7 weeks is still only 2.41 kg and is right off that chart. Have been sent to paediatrics a few times and have even stayed in hospital overnight while they prodded, poked and took blood etc and watched how he fed. They can't find anything physically wrong with him, but are concerned that he's still really small (so am I). Question is, do I keep going with the exclusive bfing. Not doing top ups now because I just don't seem to have a time when he's not feeding to express! and just feel that if he's on me most of the time, there's not much point. Anyway, this is turning into a ramble, but would you introduce a bottle of formula in the hope of giving him a boost and try to get back on the chart. I'm just worried that he will fall so far behind he'll never catch up (with whom I'm not sure, but don't want him to be 'stunted' because I've been stubborn about exclusively breastfeeding). What would you do? Is Tiktok around or anyone with some experience of small babies?

The routine we had was a main feed every 4 hours (and this included setting alarms for the night). A main feed meant breastfeeding from 1 side only followed by a bottle. I then breastfed on demand in between these main feeds (and there was plenty of that). If they don't want to breastfeed at a main feed then don't give them the bottle, they only get the bottle once they have breastfed.

The benefits of this are

• You know they are getting a certain amount of formula each day, and you can adjust the amount they get according to their weight gain (or lack of it).
• You are still breastfeeding regularly throughout the day.
• They are less likely to give up breastfeeding because they only have the formula once they have breastfed.
• They are still breastfeeding on demand in between main feeds so if they are more hungry on a particular day you can just breastfeed more in between main feeds.

Unfortunately I have had to follow this routine with 2 babies now and it works really well. I will admit that with the second I felt I was reducing my supply once the bottles were introduced, and I did feel really dissapointed about that, but at the end of the day I felt it was better than him losing lots of weight. I'm sure lots of people will say it wasn't necessary but at the end of the day I feel it has worked really well for us.

thanks for all this advice. have just got back from the dreaded weigh in and he's put on 6 oz without top ups this week and he did a huge poop last night (should've kept it in!). am pleased, but i think i will start the ebm top ups again. even if it means only a couple of ounces more gain it's worth it. was thinking formula would be more calories and give more of a boost but according to tiktok it's no different. more work though.

That six ounce weight gain, on top of last week's nine ounces, seems to confirm that your ds has truly turned a corner

for your DS weight gain. Fingers crossed that things continue to go well for you both, whatever you decide to do re feeding

I was in a similar situation back in January. My tiny DD never had a big gain like 9 oz, but she has consistently gained 4-7 oz a week. I was told that as long as she seemed to be following an imaginary line underneath the chart all was well.

I topped up with EBM for the first few weeks and since then exclusively breastfed. But it has been hard going, tiny babies like this are supposedly very demanding. I was advised by the paediatrician to feed every three hours, but from my own research, I chose to change that to every two hours by day and every four hours by night. So ten feeds a day rather than eight, and we both got a bit more sleep at night. After a while she just demanded more or less constant feeding.

DD's weight slowly crept up toward the bottom line on the chart and has now reached the 9th centile at six months on breastmilk alone So it can be done. But it was really tough.

tiktok\jammie hope he keeps this up. now he's shown it's possible there's no excuse.
upwind - well done to you. it really is tough and exhausting. i think you're right about three hourly being too long. was doing that in the beginning on advice of paeds and he just didn't have the energy to feed for very long. had to give him a livener of ebm to wake him enough for the feed. can only dream of the 9th centile at the mo!
btw how much top up were you all giving? i was doing 20 mls or so, but that was a couple of weeks ago. are you supposed to increase it as they get bigger?

If you were topping up with 20ml then you will be horrified at how much I top up with . I can't remember first time round, but it was a lot. With my second I started off with 2oz and now give 3oz. Thats still less than half the amount of formula for a fully formula fed baby, and although it seems like a lot I just have to keep reminding myself it means that half the growth is down to breastfeeding. I still seem to spend at least the same time breastfeeding as other people though, so there isn't much time for anything other than feeding!

well sometimes the 20 mls is really hard to get down and sometimes it doesn't touch the sides, obviously depends on how well the bf went. the reason I was doing 20 mls was that when we stayed over at the hospital they said do 20 mins bf on one side and then give 20 mls top up every 3 hours. no idea where they got that amount from or what it was based on. should have asked but was still in shock about being kept in. thought we were just going to have a chat and get a bit of advice. anyway, it worked for a couple of feeds, but then he wasn't satisfied with that three hour gap and was demanding more in between so ended up feeding on demand as usual and topping him up with the 20 ml ebm every 3 hours.

I think they calculate what they need based on age and weight. With my second, I just increased the amount when it got to the point where I was breastfeeding for what seemed like all day and night as well.