Feeding and weight gain in Prem babies

[AndiFR]

Hi there

I am after some info or support on prem babies.
Basically, DS was born at 30weeks, and came home from SCBU at 36weeks. Although he has not lost weight since leaving hospital (he did that in the early weeks after birth) he is not putting on weight very quickly, and definitely considerably slower than when he was in SCBU. Although we are not too worried at this stage, we clearly don't want him to lose weight, and feeding takes up quite a lot of our energy as he is never very interested, and we often need to wake him to feed (so he doesn't go longer than 5 hours).
He is totally breastmilk fed, but due to his lack of weight gain we suspect he is not taking enough from the breast, so the hospital insisted that he has an expressed milk topup (this was initially by tube, and then later we eventually decided to use the bottle). I am now nervous that if we use the bottle too much, that he won't go back to the breast (and he is significantly lazier on the breast than the bottle). I am not sure how to balance his need for nourishment, and our desire for him to use the breast. We are looking for tips/info/encouragement from anyone who may have had a similar experience.... We have read books and talk to pediatricians and breast feeding counsellors... But all they do is completely contradict each other, and none of them seem to suggest a solution that has seemed to work for DS... (they normally suggest more regular feeding or longer on the breast, or offering the second breast but DS isn't interested).
Thanks

Hello Andi. Welcome to mumsnet.
I haven't got long now so may need to get back to you. just wanted to let you know that i think this is a relatively common problem. My dd was born at 32 weeks and came home at 36 weeks with a tube in. I have ended up giving her 3 bottles of lowbirthweight formula (nutriprem 2) per day as she didn't gain weight at all on my breastmilk alone. I'm finding it a real pain to give formula and have to express each time to keep up supply.

I would repost your question in the breast and bottle feeding section to see if you can get some more help there. I will be back this evening and will look out for you then. x

Why do you not feed him more frequently? I would tend to feed 3 hourly at least and avoid the top-up. One breast is fine at a time if that is all he wants. If it is that he is sleepy at the breast then 'switching' sides can stimulate him to feed. You do that frequently through a feed. Plus having him skin-to-skin can help. Best to find one advisor you like and stick with them so that you do not get bombarded with advice. However, there can be a number of solutions before you get the one that works. More frequent feeding is essential though.

AndiFR Prem babies have less of a reflex to suck and therefore it can be hard work to totally breastfeed a prem baby. My baby was v prem (27 weeks) and I never managed to breast feed as she just never had thesize/strength needed to breast feed. Bottles were easier for her. 36 weeks is when I understand they first start to get teh sucking reflex, so it was not that well established before you brought him home.

I totally understand that you want your baby to be breast fed, that is a normal desire, but I fear you maybe making is harder for him. Even with a full term baby some don't like breast feeding once they have tried bottles. IMHO (and believe me this is ONLY my opinion) I think you should look at continuing to express milk as long as you can, and give this via a bottle to ensure that your baby grows healthily. If he is not interested in food and you have to wake him for feeds I get the sense he is not getting enough. Like I said this is simply my opinion, but I feel that you maybe putting a little too much emphasis on 'Breast is best' and not making yours and your babies life easier by feeding with expressed milk. You can continue to express milk as long as you want, providing supply is there (my supply was rubbish, but that again is due to the prem birth)

I had a 2nd baby and when my milk came in, it really came in I was able to express 200ml in 10 mins on top of feeding. However with dd1 20 mins expressing would bring 50ml. Looking at it this way I realsied that DD1 was finding it hard to feed becuase there simply was less supply (I only realsied this after having a 2nd one)

Please don't take offence to what I am saying, keep expressing and keep feeding your baby, that is more important than whether the milk comes from teh breast or bottle.

how old is he now ?

I agree that prem babies can be difficult to breastfeed - and have heard others say that keep trying, but top up with bottles (ebm or formula) until the baby is big/old enough to feed well directly - so when he would be about 4-6 weeks after due date.

Well done for getting this far.

Thanks for all your responses... I have reposted under the breastfeeding section too.

My baby has been home a week and a half, so coming up for 38 weeks.

The more frequent feeding is a challenge, if I wake him say, 3 hourly, he just doesn't bother eating at all!
And taking him off the breast to wind or switch sides, just seems to be an opportunity for him to refuse to attach again.

However, I am still grateful for all the responses and snippets of advice, I will be putting them to the test again, and it is great just to get the support.

many thanks

don't take him off to wind or switch sides then - stick with one side per feed for the time being - he probably doesn't need more than that anyway.

Give him time - it will get better.