Routines with baby (premature) twins

[katiemelville]

Hi all

I've just joined up to mumsnet and wanted some advice from those who have been there and done it! I've got twin girls who were born 8 week premature and came home 4 weeks ago. They were 3lb 9oz when born and are now 5lb 12oz, and it was their due date yesterday.

As they are still so small we've been demand feeding them and letting them do as they please but I feel we need to start in some sort of routine at some point and wondering firstly when was best, and secondly what routines have worked for others in similar situations.

I'm also worried about making the transition to a routine and what happens if they don't feed enough or sleep when they're supposed to. Do we wake them anyway, or hold off on a feed until next time? I don't know whats reasonable? I guess a lot of it is my own judgement in regards to my babies?

They are now on nutriprem formula after 8 weeks of expressed breastmilk which is also a bit of a nightmare. Waiting half an hour for boiled water to cool down in the middle of the night with hungry babies isn't reasonable, as the instructions state? What do other people do? I'm going to try to get some made up formula from the doctor next week but I know I may not be prescribed it as they can be quite tight with it.

Any advice or thoughts would be hugely appreciated!

Katie :-)

Hey KAtie, congratulations!! My two were 10 weeks early and are now 9 months, and I definitely didn't write anything as coherent as you 4 weeks after mine came home!

What routine were they on in hospital? Ours were on 4 hourly 6/10/2/6/10/2 and with a few blips that's how we got through the first few weeks (bf then bottle each feed). There were times when they cluster fed through the evenings and failed to sleep and so on, but it gave us a framework and from that as they got older we started to realise that they would have a short nap in the mornings, a longer nap at lunchtime etc. It was about 3-4 months after they were born before we started implementing a bath-feed-bed routine, which we stuck to religiously and meant that we eventualy got our evenings back. Even 9 months on there are elements of the 4 hour routine which we stick to, although it's governed more by 3 meals a day. I also bought Gina Ford's book, which I ignored about 95% of but it did tell me what could be possible at various weights etc.

ARe you still in touch with your hospital? They should tell you what sort of volumes to aim for over the course of 24 hours and also whether it's worth waking them to feed to make sure they get enough. Do you have to fit any meds in too? To be honest at this stage it's just about surviving and getting them growing, no matter how.

As for the feeds, our NICU unit made SMA Prem formula up in batches, and although they told us 'this is not how we have to advise you to do it' if it was good enough for the sickest babies it was good enough for ours. I had no idea you could buy pre-made premmie forumla! We bought a kettle with a digital display (I think it's braun) which we kept for JUST feeds, and so we could see when the water was at 75 degrees or so. Then we made up 3 feeds' worth, stood the bottles in a sink of cold cold water to cool quickly, then put them in a small beer fridge on the landing upstairs which made it easy at nights and also meant the door wasn't being opened every 2 seconds. We were scrupulous with sterilising and keeping things at the right temperature and have never had a problem, but obviously it's a judgement call.

Any other questions do ask and good luck, these days feel like they go on forever but I can honestly barely picture them now

My boys were 8 weeks prem. They needed much more sleep than other babies seemed to for most of their first year (may just have been them!) I think in the early days you may still have to wake them for feeds a bit. I also found Gina useful as a guide, but veered off it dramatically as required. Up in the morning at a reasonable time, bed/bath at 7 was what I worked to from fairly early.

Making up feeds - you need very hot water to kill off rare but dangerous bugs that may be in the milk. I made up in half volume hot water then added other half volume from pre-boiled water kept in sterile bottles in fridge. Combination temp was almost perfect. Lots of bottles to re-sterilise, but that isn't too difficult with microwave steriliser.

My boys are 3 now. Unbelievably I look back at those early, endless days with much fondness

Thankyou! Hearing others' experiences is so helpful, everyone seems to find what works for them, so I think we need to do the same! I think I'm going to wait until the girls get a little bigger and them impliment a routine, loosely based on Gina Ford.

Since the time I posted both babies have become really constipated on the nurtiprem so we've moved on to ready made which seems to be better and saves the hassle of making up the ready made, which was a nightmare, especially when our steriliser broke. Having a digital kettle is a really good idea though, I may invest next payday. I'm off to see the doctor for jabs tomorrow and going to request ready made on prescription and really plead my case. We've then got a check at the special care unit on tues and so will ask lots of questions then.

We are doing meds for the girls as well, its not as horrid as it used to be when I first started, practice I guess.

Even through the tough nights I tell myself to enjoy it as it won't last forever!!

Thanks hugely again, I love hearing others who have been there...

Katie xx

Can I butt in and ask how you guys got your bubs onto 4 hour routines, or feeding routines in general? My 8 weekers are fed on demand and it's usually about 3 hours, plus or minus about 20 minutes. I'd love to be be on 4 hours. How do you get them to go 4 hours? If they get hungry in the meantime do you just walk the floor, let them suck the dummy etc?

Some need a 3 hour routine. My dd is 6mo and its only now we are adding solids that shes moved her milk times.

Dd had milk at 7 / 10 / 1 / 4 / 7 then til she was 3mo we woke her for a dream feed at 11pm and she woke naturally at 3am.

Congratulations Katie
We did the same as Rattling for making up feeds.
My 2 were 10 weeks early and were on 3 hourly feeds when we got them home - I used to feed on demand but feed the hungry baby then feed the other one just so they were being fed at similar times. They pretty much stuck to being fed every 2-3 hours throughout the day. They are nearly 2 now and still need food every 3 hours although they have cheese on toast or fruit now instead of milk.
Good Luck

My twins are still demand feeding often between 2-3 hours, sometimes going 4 hours and on some occasions potentially longer if we didn't wake them (obviously not through the night though, only ever during the day, that would just be too convenient!!).

If they're having a mix of EBM and Formula can they have too much? They're feeding more than the recomended amount (150-200ml per Kg per day). I guess for tiny premature babies ths can only be a good thing? Wondered if too much formula might do them harm? Like I say though I do have an appt at the hospital for a 6 week check on Wed so will ask then.

I think I'm going to start feeding them every three hours which I'm hoping will even it all out a bit, and go with the times that Gnocchi suggests. So I'll wake them if they don't wake themselves. They still sleep a lot so I'm unable to put in any nap times etc as yet.

Will let you know how I go, and may request advice as need be!!

Im not sure about overfeeding
..I dont think its possible to overfeed an EBF baby but I do think a FF baby can be overfed. DD has always taken more milk than it says on the tin, but she grows very quickly and is very very long, so clearly needs the calories.

I found by regulating what times she fed, I knew when she needed more, as if 4oz was no longer seeing her through the three hours, I knew it was time to up it to 5oz.

Another reason to regulate the feeding, I really want to get them both to that point, its just the transition to it that might be tough!

Mine are pretty long too, I'm 6 foot one and my partner 6 foot 7 so think we're gonna have some very long and tall babies!