IUGR - slow weight gain - breast/bottle dilemma

[Bobo23]

Our LO has been back from hospital a week and is exclusively breast fed. He weighed 1250 at birth at 34 weeks (severe IUGR) and is now 40 weeks and is 1860g.

The health visitor has just been round and he's only gained 90g since being back from hospital.

She says we should be putting him on formula after his feeds if he hasn't gained more weight by wednesday. She thought it might be partly to do with him not latching on properly and getting the richer part of the feed so she had a look at his positioning and gave me some tips.

I'm really upset as I was hoping he would be exclusively breastfed and I'm also really upset cos he's so small and I feel so useless.

Anyone have any experiences to share? Feeling really down.

DS1 waas also born at 34 weeks weighing 1.4 KG and I went through similar discussions with the HV bout breast feeding. One week he only put on 25g and all hell broke loose with me.

However I discivered that if I fed him just before he was weighed then hey presto he could be up to 5 oz heavier. and so it went on.

Its hard enough with a prem baby to breast feed and I went throught this twice and fed both until they were one year plus each time. I had a HV who adfmitted to me that she had never dealt with a prem baby on her own before and was lost as to what to expect.

With ds 1 I never used formula until he was 6 months plus and that was just in powdered baby foods. With ds 2 I was less concerned once I had established feeding.

I did speak to a breast feedin counsellor about this and she was fantacstic and had all the answers to the HV pressure.

Do whats right for you and getting stressed about it will make the milk supply less. Please don't feel guity which ever way you go with this

Bobo - I had an IUGR baby 4 years ago, she was about 2kg at 37 weeks so a bit bigger and later than your ds.

DD didn't breastfeed at all - couldn't/wouldn't latch and I was too worried about weight gain to persist. I expressed as much as I could for as long as I could but supplemented it with formula and formula took over completely by 2 months.

Probably not what you want to hear and hopefully there'll be people who will come on who did breastfeed successfully with small babies. But in the meantime, have you seen a breastfeeding counsellor ? They may be able to check latch and give advice. Otherwise, keep feeding him and maybe top up afterwards and hopefully, as he gets bigger, he'll be able to feed more from you and you can reduce/eliminate the top up.

Whatever you do though is don't feel useless. You have to do what you need to do in the circumstances. Its bad luck you had a baby with IUGR (I am now almost 37 weeks pregnant with number 2 and the baby is normal sized)

DD is 4 now and absolutely fine - you wouldn't know she had been born so little or that she had been almost totally formula fed.

Good luck - get on to a breastfeeding counsellor asap.

Oh there you go - in the time it took me to waffle on someone with better experience came along !

I think Rascal bf her IUGR baby successfully if she's about.

My ds was 2lb 7 when born at 34 wks, also severe IUGR. Unfortunately my milk supply diminished before ds even got out of hospital depite me trying to express for hours on end. It really upset me as I wanted to bf him exclusively but there was nothing else I could do but put him onto formula. Agree to contact your bf co-ordinator at the hospital or la leache may be able to help.

Ds is also absolutely fine despite being ff. Has has had less illnesses than his cousin who was exclusively bf for 6 months, has a real healthy appetite and now in 75th centile for weight (couldn't believe it when he was weighed last week).

Good luck

Bobo

Congratulations on getting home with your lo and a big cheer for establishing bf. Unless you are totally happy with your hv's credentials in this area I would be inclined to at least discuss this with the SCBU your son was in (perhaps one of the staff who supported you in feeding him)- ours made it clear we were welcome to call with any queries or alternatively speak to his consultant, or the infant feeding co-ordinator at your hospital if there is one. 90g for a baby who weighs less than 1.9kg in total sounds acceptable, particularly when comparing his current weight to birth weight - if he's now six weeks old then the figures you give suggest weight gain of about 100g a week in any case. For your HV to suggest supplementing, on the facts you've given, does not sound like support but butt-covering. How are your ds' nappies - if regularly wet and dirty maybe you continue for some time and see how the weight gain goes. If you are being pressured by the HV you can always insist on a referral to a paed for a second opinion. They are not always massively knowledgeable about bfing but should have a much more informed view than your HV of appropriate weight gain patterns at this early stage. I see you've posted on the breastfeeding board as well so should get some good feedback there.

I had similar 'advice' when my LO came home. She was 1.45kg at 33 weeks and weighed a little under 1.8kg when allowed home after a month (so about 300g in that time) and weight gain continued to be slow after that. I was advised to top up with formula after BF and after much deliberation tried it - she just wasn't interested and actually gained even less weight! We went back to exlcusive BF and kept it up for six months. Obviously I would not advise ignoring advice from a medical professional if your little one seemed to be unwell due to not gaining enough weight but if you are happy that he is alert, and getting enough wet nappies, I would trust your instinct and if you are keen to keep BF exclusive, you hopefully can. Good luck with it and I am glad you have your LO home with you.

Bobo, post on the Breast/bottle feeding topic. There are some wonderful breastfeeding counsellors/supporters who post on MN.

Most importantly, you need to speak - RL, not online - with a BFC/supporter. The NCT and BfN both run peer support groups, where you can feed in comfort and get good advice from trained experts. Contact them to find out where your local groups are.

Great news - LO put on 80 grammes over two days so the HV said not to bother with any form of topping up... I think she was v impressed with the weight gain...

Gold Top!

Bobo - sorry only just seen this!

As Trixiethepixie said I managed to exclusively breastfeed babyrascal who was born at 30 + 6 with severe IUGR - weighing a titchy 2lb 1oz, until she was 7.5mths and at just over 14mths she is still breastfed twice a day (before bed and around 4am) - with the odd sneaky feed in the day if we are having acuddle and showing no sign of stopping any time soon.

It makes me so angry when I hear the crap some HV come out with. In my experience many simply don't know the first thing about breastfeeding or premature babies so couple the two together and they go bananas!

DD was slow to gain weight (although over the year she has put on a respectable 3.5oz per week if you average her weight gain out). Some weeks were better than others. At 14mths she weighs 15lb 10oz so still extremely small BUT perfect developmentally and as bright as a button. All of which I attribute solely to 'Boobie' (well that and my fab parenting skills

I have been where you are and it's soooo difficult but hang on in there it is so worth it. In the UK there are far too many people - esp HV's who are preoccupied with weight gain.

There are loads of thread on here if you search under my name where I received lots of fab advice from fellow mumsnetters

Keep up the good work you are doing AMAZING!

Where abouts in the country are you? - just out of interest as I have set up a prem baby support group in my local area.

Just a quick update - LO put on a monster 280 grammes in the last week! I think I've convinced the health visitor that breast is best for him!

Meanwhile I'm eating vast amounts of food to keep up with his voracious appetite...

Rascal1979 I'm in Brighton...

That's a truly amazing weight gain! Well done to you both!

Wow well done Bobo!! and babyBobo

I'm in Manchester..what a shame. Does your hospital have a support group?

Well done Bobo and Babybobo, so glad it is working out and you got the help you needed on Mnet.

Hi

DD was born weighing 1.7kg at 36 weeks also due to IUGR. Went home weighing 1.7kg- after intial weight loss. I BF exclusively for 8 weeks (with expressed bottle inthe evening) but then the stress of HV virtually accusing me of starving my baby (even though she was permanently attatched to me!) became too much and I caved in and introduced one bottle of formula to replace the expressed bottle. DD'd weight gain was painfully slow for the first 6 months (below 0.4th percentile in red book). At 16 weeks- uncorrected- (after she had had emergency op for twisted hernias a few weeks earlier)she still only weighed about 3kg so introduced a second bottle of formula. I still bf to some extent until she was about 10 months and for me I think that was the only way I could have carried on.

I feel that all the pressure piled on by HV was stresing me out further and didn't help the situation. Also I also feel that IUGR babies must have something in their metabolism to protect them in the womb- therefore it stands to reason theat they are not going to be the quickest gainers of weight.

I felt a complete failure that I had failed to 'carry my baby properly' and then couldn't feed her properly either so you have my complete sympathies.

Also IMHO however slow the weight gain, surely that is better than the opposite!!
FTR my DD is now a cheeky 3 yr old who weighs about 2stone (9th-25th centile I think)

Follow your instincts if your LO is alert and content then take HV 'advice' with a large pinch of salt!

HTH

ps just seen that this thread is a couple of weeks old now- how are you and your LO geting on ?

We're getting on really well! The health visitor just came and he is 2.84 Kg now which means he's gained 440 grammes in under two weeks... He's also grown 6m in length in the last month. Yay!