feeding/weight gain

Shepperd2 · June 2013

My 26 weeker has been home for just a week, her due date was this past Tuesday, and i'm worried she's not getting enough to eat. When we went to her first pediatrician appt, she'd only gained 1 ounce since we left the hospital 4 days prior, and she was taking about 2 oz per feeding...barely. She gets so tired and doesn't stay on her 3 hr schedule they had her on in the hospital. Her dr wants her to be taking 3 oz by this next appt on Tuesday and its just.not.happening.

I don't know what to do -- i can't force it down her if she's just going to sleep, and I know she's exhausted. -- her pediatrician is an hour & a half away, and we also had to go to the hospital again for her ROP eye exam yesterday... a 3 hr drive. So over the last week, she's been in the car for like 9 hrs and although she's sleeping the whole time, i know i get tired sitting in the car that long. - its exhausting!

any advice? thanks ladies.

thishappyhouse · June 2013

try not to stress. Going from 2-3 ounces per feeding that quickly sounds fast to me! My DD didnt come home from the hospital until 43 weeks adj. and was definitely on 2oz a feeding at that time and for a few weeks after. Did your Neos give you any goals for feeding in the discharge instructions? how many calories per ounce is she on? I know the total volume is typically a calculation of calories/ounce and weight.

We had alot of feeding issues in the hospital and at home but were able to avoid any major interventions by manipulating her calories and also experimenting with her schedule. With the support of our pediatrician we did a 2-3 day trial where we fed her on demand and it turned out that she naturally wanted to cluster feed in the evenings (a bottle each hour for 3-4 hours). Once we adjudted her schedule we were able to get her back up to her minimum calories and we were getting a 4-5 hour stretch of sleep at night (bonus!).

Are you exclusively bottle feeding or are you nursing too? Have you been able to "dream feed" at all? Some babies eat quite well in a sleepy state.

brachysira · June 2013

3 oz seems like a lot to me. We came home around 35 weeks, and she was eating less than 2 oz for months, I think. I recall we talked in mL in those days, and we would do between 30 and 45, which are both under 2 oz. We never had any trouble with weight gain, but I think we were doing 24 or 26 calories feeds--we supplemented pumped milk by adding preemie formula. She's 5 months and ebf now, but I think she still only eats about 3 oz at a time, although I'm not sure. You could try doing a few feeds a little closer together or ask if you can add more calories, but I really would not try to force more at one feed if she's done.

Brummy14 · June 2013

Our girls came home around their due date, eating 18-20oz a day total. Per feeding, the weren't regularly taking 90mL, I can assure you of that one! We were EBF -- pumped milk with Neosure added to get to a 22cal recipe. We're still on that same recipe -- any now my girls regularly eat 28-32oz/day (oink), and DD2 can take upwards of 6-8oz for her bedtime and overnight feeding.

That said, once we pulled the feeding tubes, our neo told us to just move to on demand feedings -- that these little guys will tell us when they're hungry. We, too, were uncomfortable at first moving from the regimented 3-hour NICU schedule, but they both adjusted pretty quickly. DD2 took a while to work up to full feeds, but the docs were never super concerned that her weight gain slightly lagged her sis. She's also just smaller, in general -- shorter, too -- so, in hindsight, they were eating exactly what they needed for their little individual selves.

Brummy14 · June 2013

Another question -- can the pedi reco a daily minimum volume vs. a per-feeding volume? The per-feeding amount seems silly when not in a hospital setting, and certainly isn't conducive to and on-demand feeding approach. Our neo gave us a minimum daily feeding amount, and basically told us she didn't want to hear from us unless they regularly fell below those levels. They never did.

Brummy14 · June 2013

BostonKisses2:
Brummy14:
Another question -- can the pedi reco a daily minimum volume vs. a per-feeding volume? The per-feeding amount seems silly when not in a hospital setting, and certainly isn't conducive to and on-demand feeding approach. Our neo gave us a minimum daily feeding amount, and basically told us she didn't want to hear from us unless they regularly fell below those levels. They never did.
I agree with asking about this. I know it's really hard to break away from the NICU feeding schedule and not focus on per feed numbers, but it does help when you look at total volume for the day instead of each feed! Some feeds babies are hungrier than others and will take more, so as long as they're reaching their minimum for the day they're fine.
OP, does your LO have reflux? Is it medicated and under control? If she's already on meds, maybe you can talk to the pedi about upping the dose. My kiddo came home unmedicated for her reflux (I still don't know why they thought they could do it), and we had a few miserable weeks before we got her back on meds and the meds kicked in. After that, she was able to take more during feeds and the pain wasn't deterring her from taking her bottle.
If you're not EBF, are you using a different type of bottle than what you used in the NICU? Odd as it sounds, my kiddo had nipple confusion with the bottle nipples. We were using a standard size nipple in the NICU (those disposable kind), but we had Avent bottles at home, which have a wide nipple. Once her reflux was under control again, we thought she'd adjust but she hated the wide nipple. We switched to a standard nipple, and she was fine after that. So maybe that's something else you could look into.

Ditto on asking about reflux. DD2 was definitely struggling with it big time -- and once we were discharged, they were fine with putting her on meds (they wouldn't even entertain the idea until we reached the girls' due date). We battled and battled through feedings with DD2 -- she wouldn't sleep on her back in her crib, so we had her in her bouncy seat those first few weeks for naps.The Zantac has helped a TON -- we've even tried to come off of it (I was convinced it wasn't needed since they had been showing absolutely no symptoms of anything being a problem), and we end right back up with battle feedings where the girls are upset, arching...the whole thing. So, clearly, they still need the stuff.

opheliainwaders · June 2013

I'm just navigating this, but as a point of comparison, DD is now 37.5 weeks, eating every 2.5 to 3 hours, and she RARELY eats more than 2oz per feeding. We're doing a combo of breast and bottle, so our measurements aren't exact, but we would definitely struggle to hit 3oz every feeding!

BigPoppa22 · June 2013

Where was all this feedback on my feeding issue post a few messages down from here! :P

How long did it take each of your LOs to get to the point of being able to drink more than 90 ML per feed? My DS was not a preemie but was in the NICU for 30 days, now been home for 6+ weeks and still maxes out at 90 and only hits 90 like twice per day, usually more like 70-80.

MinaE01 · June 2013

Everyone has given good advice. My question to you is can you find a closer pediatrician? I would think he or she would want to keep a close eye on your LO, meaning some frequent weight checks.

adaelynsnana · June 2013

My son is 5 months old actual age and he is barely taking 3 oz about every 3 hours. The NICU dr sent him home on Similac NeoSure mixed with breast milk and he gained weight ok but it wasn't a lot at first. I wouldn't worry to much as long as she is gaining weight and your dr is okay with it. As for getting her to eat more, if you try to force her to eat to much she will just spit it up and that isn't going to help her weight gain.

Shepperd2 · June 2013

ohhhhhh i wish! There are no pediatricians in my COUNTY!

Shepperd2 · June 2013

Thanks for all the advice ladies! Shes doing better, like i said, a lot of it is just from being so tired. She gained 4 oz this last week, and we have ANOTHER weight check in a week. I thought 3z seemed a bit much as well, i mean she was at the dr ON her due date making her 0 wks adjusted. She does take 3 oz on several feeds now, but i dont worry about it anymore.

...now, im more focused on getting her to latch to the breast...w/ or w/o the shield. obviously she does better w/ the shield, but still just wants to go to sleep w/ it in her mouth as though its a pacifier. -- sooo frustrating!

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