15 wks actual, v slow to gain weight, BF well, refuses formula

[Saritabean]

Looking for some reassurance/advice...!

My DD was born at 29+4 due to Pre-eclampsia. We have been really lucky in many ways as she has not had significant health problems apart from her bowel being v slow to get going due to her immaturity and as a result poor weight gain. She is exclusively breast fed, only taking a small amount of EBM in a bottle with her vits/iron etc (gulps it with no probs!) once a day.

She is 15 weeks actual, 4.5 weeks corrected and is below the 0.4th centile. She was 2lb 5oz at birth and weighs 5lb today (yey!), but it is v slow going and she's not following her curve (1-1.5oz per week).

We have tried giving her some nutriprem, but she refuses it or throws it back!!! She's breast feeding really really well and now my milk has decreased to her demand (I was able to express 150ml/5oz from each boob - far too much- by the time she was able to latch on...!), so I'm pretty sure she is getting good milk.

In the last 2 -3 weeks she is pooing a lot less- once every 2-3 days and it is browny/yellow and quite liquid (it was yellow mushy milk poo on the unit once she was on full NG feeds before she could BF). when she hasn't pooed for a while she is v windy/unsettled and possets lots and has the occasional large vomit if been crying lots (last 24hrs been a nightmare as due a poo!!). She's definitively getting enough milk volume as heavy wet nappies with each feed and goes 3hrly feeds.

Has anyone else experienced similar...
A) good BF with such slow weight gain... I am hoping she will get to a certain weight and it will suddenly take off...?!
B) change in poo habit... Why is it not creamy milk poo anymore?!

Questions:

1. when does the unsettled/fussiness get better?!
2. they're going to test her poo for lactose intolerance and said if its positive then I should go lactose free... My understanding was that what I eat would not make any difference to the amount of lactose in my breast milk...?
3. as long as she is actually gaining weight, despite the fact that she may be petite in future, are there any other risks...?

Sorry for the complicated and long winded post with lots of questions... Any replies welcome!!

Hi Sarita

I'm no expert, but with a DS aged 7 weeks (minus 1 week corrected!), I thought it might help to share my experience...

DS is exclusively breastfed, and did not react at all well to formula in hospital. He is a very windy baby - I wonder if this is because his mouth is so little compared to my nipple/breast that he cannot get a good latch (although his latching technique is pretty good). In the last three weeks, he has become very sicky - bringing up quite a bit after every feed, sometimes digested, sometimes milk he had just taken in (which is soooo frustrating).

He has continued to gain about 3 oz per week, but is still dropping down the centiles.

I would say if you are happy with her nappy output, and she seems happy (bar the posseting / occasional vomit), and she isn't losing weight, be confident that she is doing fine . I suppose she may just end up one of the petite ones - after all, the centiles only tell you that x% of babies are bigger / smaller than yours, but some babies have to be that size! I think DS will continue to be at the small end for weight, but he may start gaining faster later on - or he may end up very tall but slim (like his dad and uncles).

Re the posseting / vomiting and wind, I believe that this can be due to the immaturity of their systems to a certain extent, and they will probably grow out of it.

Like I said, I'm not an expert! But I hope that offers some comfort that I am in the same boat.

Stay confident! You sound like you are doing a great job

Thanks teaandHobnobs for the reassurance, as you know it can be hard to stick to your guns and stay positive when everyone else is questioning it! She's seeing the consultant tomorow so we'll see what he says too.

Hi saritabean
I don't really have much advice to give I'm afraid but I think if you re post in the breast and bottle feeding section you will get lots of help from the ladies over there.

My own opinion is that if she's poo ing less then that implies she's starting to absorb more?? But that's just my personal thinking.

You're doing so well to be BFing her so well done for that.

As I'm typing I've remembered that my prem DD had fortifier added to her bottles of ebm when they weren't happy with her weight gain. I think it has to be prescribed. But might be worth asking about.

All the best. I hope her weight gain does just suddenly take off, so you can really relax and enjoy her.

Thanks kd0706, had just thought the same about re-post! Thanks for reassuring words.

My 29 week Dd had a special high calorie milk prescribed once she (eventually) came out of hospital. She had a mixture of that and BM and it did help so do ask about that - does a nurse from the hospital still visit you? I found the HV I dealt with knew very little about prems.
The other thing is, weight gain can take a long, long time. My DD bumped along the bottom for what seemed like forever and only really had a real growth spurt at about 4. I know that seems like a lifetime away but you do eventually accept that if they are relatively healthy it really doesn't matter what size they are (whilst still agonizing over every little bit of food!).