feeding a sleepy premmie

[capecath]

DS3 was born at 34+2, 5th Feb. He just got home from neonatal three days ago, but they were a bit hesitant for us to go purely due to him having lost 8% body weight since birth and not having gained. However in last 3 days he has now gained 80g, so weight gain now happening but slow. My bf plan is attempt 20min bf, topup as much as required, express. Using a nipple shield he has a good latch and I have no issues with my milk supply (plenty now in the freezer). He will usually wake between 2-3 hours for feeds, sometimes little less. Problem is, he is so sleepy! I struggle to keep him awake through his topup. Feeling the pressure right now to increase the top ups in order for him to gain weight. Finding it all exhausting and stressful. Any tips in getting him to take more milk from me??

Hi OP! Congratulations on the birth of your DS, and sorry to hear he arrived early. MY DD was born at 29 weeks, so I know it can be really tough feeding small, early, sleepy babies (she's still breastfed now, and it can definitely be done). It is indeed exhausting and stressful juggling all the feeding/expressing while coping with the worry of Is-He-Getting-Enough and the lack of sleep, so give yourself a massive pat on the back for getting this far!

I'm no expert, but to me your plan sounds fine, and it's great that your supply is good. It's great that he's feeding often. I'm not sure about the 20mins. I'd probably just see how long he actively feeds for on the breast (listen out for swallowing and watch jaw movement) and then top-up. It sounds like his weight is being checked regularly (also keep an eye on nappy output). You'll probably need to do that for a little while yet, as he's so young and as he's only just started gaining weight again. Are you being seen regularly by an HV?

One thing that worked for us was changing my DD in the middle of a feed. As soon as she started looking sleepy and stopped sucking, we'd change her nappy, and this would usually wake her up enough for her to feed some more (either breast or top-up, depending on how much she'd already fed). More usual tips are tickling their feet (firmly) or stroking their chin (again, fairly firmly) to wake them up, but that never worked for us, no matter how many healthcare bods told us to do it.

Also, my DD tended to feed much better during the day and took much smaller quantities at night, so we just went along with that. By about 40/41 weeks' gestation, feeds became MUCH easier.

If you haven't already done so, I'd also recommend posting on the Infant Feeding section, as there are lots of knowledgeable people there, and you might get more tips.

What position you are bottle feeding in? I find a sleepy baby is better sitting, on your lap than in the crook of your arm.

80g sounds pretty good for 3 days, isn't a term baby suppose to average 4oz a week? DS was a late preemie (36 weeks) and lost 10% in the first three days, sat at that weight for a week and then started putting on weight and got back to birth weight by a month old, and then gained weight very steadily.

Have you BF your older kids? Don't express too much because your supply will shoot beyond your DS3's needs. How are his nappies looking? DSs were greenish for ages (Until my supply settled).

Changing nappies midfeed is a good idea, getting them naked and doing skin to skin can help simulate their desire for milk but doesn't always work for sleepy babies, tickling toes and ears worked alright. As long as he is having regular feeds you should be Ok, you're feeding on demand and he's waking regularly, if he was sleeping for over 4 h between feeds I'd be concerned but 2-3h sounds good. Preemies are very sleepy until they reach their due date (my doctor friends told me).

It's a hard time and very stressful but he'll get there. Look after yourself as well, I know with three LOs and the baby a preemie you get ignored by the HCPs a lot but give yourself some love as well.

Thanks for the thoughtful and insightful replies. Yes midwife has been 3 days in a row and bee weighed daily hence feeling the pressure. Had yesterday off and then they are back tomorrow. I am hoping to be signed off to hv after that! Encouraging to hear about your weight gain experiences and reaching term! Yes bf ds1 and ds2. Ds1 also premmie, struggled to bf, had little milk and ended up combo feeding. Think that is why I am prob expressing too much now... Trying to cut down slowly... Ds2 was term and bf fed like a dream. We seem to have just had a latching on break thru which is great!

Breast compression while they feed is a good way of upping their intake, i'd also syringe off the fat from my expressed milk stash and feed that to dd too.

Hi, DD was born at 34 weeks, came home at 37 and was a very sleepy feeder until she turned 41 weeks when it all got a lot easier (but still wasn't easy due to poor latch.

With hindsight I think her sleepiness and latching issues were half due to prematurity but half due to undetected tongue tie. Worth getting DS checked for tongue tie? (bearing in mind HCPs can be a bit hit and miss about spotting it... we were told in NICU dd didn't have it, but she definitely did!)

Best of luck