Preemie questions--formula suggested

Hello all,

My friend Kim had her third baby, Josie, 7 weeks early. Josie is now
6 weeks old. She is (was until last night) exclusively breastfed.
Kim took her to the doctor yesterday for a weight check, and she had
gained a pound in 2 weeks. Kim was really excited about that, as the
doctor had told her that Josie should gain 1/2 to 1 ounce a day, and
she ended up gaining more than that. But then the doctor was sort of
pinching josie's skin and saying it was still kind of loose and that
she should try to get her to gain more weight by giving her formula
after every breastfeeding session. !

Kim says that Josie will nurse 5 or 10 minutes a side every 2 hours,
fairly consistently throughout the day. She's tried this formula
supplementation for the past day, and Josie has taken at most 1/2 an
ounce at a time, and she gags at the bottle and just generally doesn't
want to eat it. Kim called me just now wanting advice, because she
just feels like it's stupid to try to force her to eat, especially
when Josie gained more than they were hoping for. Plus, she's
confused by why the doctor is even asking her to do this. She plans
to call the doctor tomorrow.

I don't know much about preemies, so I didn't have much to offer. I
told her that I thought the supplementation might eventually lead to
her having lower supply, which would be terrible because everything
seems to be going fine. I told her if it were me I would not offer
formula but would just try to breastfeed as much as josie would take.
But then again, I don't know and Kim is just wanting to do the things
that Josie needs her to do to grow. Kim did say she had a growth
spurt last week, and her supply had caught up fine. Josie seems to be
"emptying" her breasts at each feeding, in that they are soft after.
Another thing, Josie has been sleeping a few 3 hour stretches today,
after eating the formula, which to me means she's not getting as much
breastmilk, which is not the way to help her gain weight in my
opinion.

I told her I'd ask here and see what advice was offered.

Thanks for any help anyone can give,
Lora

ack, it's a complete no brainer, no formula is needed at all, it would
be very very unlikely that the baby could gain such a good amount of
weight yet be dehydrated, which I think must be what the skin pinching
must be a test for, but it's not the primary sign, if baby is producing
6-8 wet nappies in a day then she's fine. With the skin thing, I don't
think you'd expect a 6 week old 33 weeker to have the same features as a
6 week older full term baby, the kind of fat laid down in the last weeks
of pregnancy are a different type of fat (called brown fat), I don't
know exact details, but being on the outside and gaining that way, is
going to be different to doing the same on the inside - I'm now expert
on premies, but most weight charts have curves before the term line
where you put plot premies and the line is curving slower than it is
during the time after the birth - which implies that the expected weight
gain would be less - this baby has met the upper range of what's
expected for a term baby - this doctor is really way off to be saying
supplement and that's very sad as the formula that has already been
given will have changed the babies gut flora and it takes a month for
that to return to how it was if she gives no further formula. The fact
she takes half an ounce is definitely not an indicator she needs half an
ounce, it's much more an indicator that she needs nothing as sucking
when a bottle is inserted is a natural response. As a baby who is really
only at 39 weeks gestation, she'd also be really vulnerable to
developing problems due to having been given a bottle. Tell her to stop
the formula now and get another doctor!

Cheers
Anne

On Jun 27, 7:47?pm, Lora R wrote:
Hello all,

My friend Kim had her third baby, Josie, 7 weeks early. Josie is now
6 weeks old. She is (was until last night) exclusively breastfed.
Kim took her to the doctor yesterday for a weight check, and she had
gained a pound in 2 weeks. Kim was really excited about that, as the
doctor had told her that Josie should gain 1/2 to 1 ounce a day, and
she ended up gaining more than that. But then the doctor was sort of
pinching josie's skin and saying it was still kind of loose and that
she should try to get her to gain more weight by giving her formula
after every breastfeeding session. !

Kim says that Josie will nurse 5 or 10 minutes a side every 2 hours,
fairly consistently throughout the day. She's tried this formula
supplementation for the past day, and Josie has taken at most 1/2 an
ounce at a time, and she gags at the bottle and just generally doesn't
want to eat it. Kim called me just now wanting advice, because she
just feels like it's stupid to try to force her to eat, especially
when Josie gained more than they were hoping for. Plus, she's
confused by why the doctor is even asking her to do this. She plans
to call the doctor tomorrow.

I don't know much about preemies, so I didn't have much to offer. I
told her that I thought the supplementation might eventually lead to
her having lower supply, which would be terrible because everything
seems to be going fine. I told her if it were me I would not offer
formula but would just try to breastfeed as much as josie would take.
But then again, I don't know and Kim is just wanting to do the things
that Josie needs her to do to grow. Kim did say she had a growth
spurt last week, and her supply had caught up fine. Josie seems to be
"emptying" her breasts at each feeding, in that they are soft after.
Another thing, Josie has been sleeping a few 3 hour stretches today,
after eating the formula, which to me means she's not getting as much
breastmilk, which is not the way to help her gain weight in my
opinion.

I told her I'd ask here and see what advice was offered.

Thanks for any help anyone can give,
Lora

I would start by checking to see if the hospital where baby was born
has a lactation consulting/breastfeeding education department. Our
hospital offered this service free to mothers who delivered there for
as long as they were needed. Unfortunately, a lot of pediatricians
don't know as much about breastfeeding as they should and some feel
better knowing what and how much baby is eating exactly for their own
comfort levels. Here are a few links you can check out that may help.
You may be able to find help through the LaLeche League as well.

http://www.lalecheleague.org/NB/NBpremature.html

and kellymom.com

AOL also has some breastfeeding help boards where some women have
dealt with breastfeeding premature infants. You need to remember that
they, or at least most, are only parents and not medical professionals
and that they can really only share advice they are familiar with and
experiences they have had. I don't know how to get you to those boards
though without AOL, but I'm sure you can eventually find it possibly
going through aol.com.

Lora R wrote:

But then the doctor was sort of
pinching josie's skin and saying it was still kind of loose and that
she should try to get her to gain more weight by giving her formula
after every breastfeeding session. !

This *may* mean that more breastfeeding is
needed.

Kim says that Josie will nurse 5 or 10 minutes a side every 2 hours,
fairly consistently throughout the day.

I would trust baby. Every 2 hours sounds like
a great schedule at this age.

I don't know much about preemies, so I didn't have much to offer. I
told her that I thought the supplementation might eventually lead to
her having lower supply, which would be terrible because everything
seems to be going fine.

This is correct. Every ounce that baby needs
that the breast is not offering is an ounce
that the breast is not producing, therefore
leading to inadequate supply for baby.

I told her I'd ask here and see what advice was offered.

I think your suggestions to her are exactly
correct.

-- Anita --