How to fatten my LO up?

you'll find on the plane, regardless of how you are feeding beforehand, that he will breastfeed as much as you'll let him, at 4 months my LO had a 2 week nursing strike, would only drink from a bottle (all started by me loudly saying "no" when he was biting me :( ) I duly pumped a 20 hour flight's worth of milk on ice for him only to discover that once in the air he happily BF and also refused all the milk as it had been frozen. The motion of the plane relaxes them and pretty much you just give them the boob whenever they wake or cry which equals lots of extra feeds. But you are getting waaaay ahead of yourself, if your son gains weight with the top ups, then you know his tummy can take more in one go, if he wont drink them, you'll know you need to feed more frequently to up the daily intake. You can tweak your feeding routine to suit.

Absolutely no way are you letting him down - quite the opposite. And I'm betting that he's as contented as ever but you never know probably just on the flatter bit of the growth curve before picking up again. Also it sounds like the paed is totally supportive with his feeding and being BF which is great. And at the very least any tests would cancel things out. Are you here all Summer - just wondered as a change in climate can also stimulate the appetite (sounds a bit barking but I remember DD being super hungry in cooler weather)? So glad you were advised to stay off the solids - my exp. was a tail off in weight gain with that initially and that is stress you can def. do without. I now have to email weight updates to the paed which is just lovely (hmm). I'm sorry not much advice but just do understand...I've not tried but I know the stimulants do help them increase intake. Keep smiling xx

ok, first of all you have not let him down. If you ever spew such nonsense ever again, I'm going to come over and wack you in the head! It seems that little J is just a difficult feeder. I know what a difficult time it is for you right now, but please remember all this will pass. I assure you, that at some point in the future, you will leave all this behind you and Jackson will have caught up to his peers. Please don't think that this is your fault in any way. It isn't. Please don't think you're alone either. You're not. Like I'd said earlier, the number one issues that parents of preemies complain of after being discharged from hospital are feeding issues. Preemies are notoriously difficult feeders and unfortunately these issues don't resolve themselves as quickly as we would like. I'm sorry to hear of the extra work now involved in feeding your LO. Personally, I would give it a trial run for a week and if it doesn't work go back to see the pediatrician, get J weighed, and try to think of other alternatives or may be even just accept that J will be little and as long as he is healthy, he will have a slightly different growth curve to most other babies. I personally know of one friend whose LO had also dropped off the growth charts. She too offered her a bottle of expressed BM full of the fattier hind milk after every feed to try to fatten her up and she just wouldn't take. She was a preemie too (surprise surprise). Fast forward two years later, and she has the most adorable little girl who is a right firecracker, is healthy, active and hitting all her developmental milestones. She is still quite a petite little girl, but her parents aren't exactly that big either, and at least her mother isn't worrying about her intake every second of the day, which is what she used to do when her daughter was a baby. The point of this story, is that one day all this stress and aggravation will pass. I agree with Kiwispiers that the issue here isn't the bottle feeding, it's trying to get your LO to increase his intake. Have you discussed using an appetite stimulant with your doctor like periactin? I am a member of bottle/solid refuser board and most of the members who did use periactin found it really helped increase their LO's intake. Big hugs meals. I know how you feel and it's not easy. xxxx <em>edited by lemondrops on 14/06/2011</em>

big hugs BTW

Meals we have had a 50 gram week before, a weekly weigh in is hard because if they have just done a wee or poo or just been fed etc can make at least 50 gram difference. I think your Pediatrician is giving good advice, and being pro-activ in running tests, at least you can be confident with her approach . Please don't feel like your body is too blame, that is simply not the case (I think you know this)! Sounds like maybe your wee guy is not taking enough per feed, at the risk of begin repetitive I really think you should try moving him to the other side when he pops off the first and then trying to move him back when he pops off the second, and also try feeding him immediately before and after each nap. This will boost your supply as well and will be less hassle than pumping (if he co-operates).

Good luck on the doctor's appointment tomorrow meals. Just remember, the only way you can fatten your LO up is to increase volume intake. If he doesn't like the bottle, then switching to any form of bottle feeding will probably backfire. Preemies in general are not the easiest of feeders, so I wouldn't want to shake up a routine that you know works for your LO to one that you're not too sure with. Keep us updated!

I also leave a slightly over wet nappy on to add to the gram-athon. Unfortunately DD did a massive poo last time which didn't help our cause as I had to change her just before. I tried to look stern but she just gave a cheeky grin. Hope he makes a dent in the scales...and I totally second what you say about pumping. When I brought her home from hospital I was meant to BF, top up with bottle of BM and express myself. Having already solely expressed for two months I was dreading the work involved, esp with another DD - those who do express and bottlefeed are just incredible. I managed to give myself mastitis within two days because I missed an expression and was just thankful that she liked the boob and we didn't look back.

ha, take him for his weigh in just before he poos, if he is like my LO before solids and going only once per week that'd add another 100-200grams. :) Hopefully your Dr will say all is well with the weight and you'll be able to quietly tweak your breastfeeding patterns to get him drinking as much as he can. Once you do start solids you can make things like breastmilk custard etc as another way to sneak more milk in. :)

Meals I agree, I wasn't suggesting you do this, rather that you could do this IF the only other option was to bottle feed formula and you didn't want to do that. Keeping him on the boob would be easier and more sustainable. You could look at when in your routine you are feeding, maybe he would take a bigger feed at a different point in his sleep wake cycle? <em>edited by kiwispiers on 13/06/2011</em>

What I should have said is the AVERAGE fat content of BM is slightly higher than that of formula, so over a period of a day your average would be 22 cal per ounce (30mL) vs 20 cal per ounce in formula, and the fat content would AVERAGE 1.2 grams per ounce vs 1.06 in formula. Not a big difference , my point was that formula would not necessarily be higher calories but your Dr might not know that. And apprently, feeding more frequently will result in a higher fat content, however as far as I read it: "Does the amount of fat in mom's milk make a difference when it comes to baby's growth? The research tells us that baby's milk intake (the volume of milk - not the amount of fat in that milk) is the only thing that has been correlated with infant growth in exclusively breastfed babies. As noted earlier, average fat content of human milk is highly variable, but has not proven to be significant when calculating baby's total energy intake or weight gain. (Aksit 2002, Butte 1984, Cregan 1999, Mitoulas 2003, Mitoulas 2002.) " As far as adding formula or oil, yes it will change the flavour of the milk. Formula does not taste anything like BM. Whether or not your LO cares is another question. My EBF guy won't even drink EBM if it has been frozen (for some women freezing the milk results in a soapy taste). A final thought though, is that bottle feeding, being linked to overeating, applies also to EBM and so presumably in theory a switch to exclusively bottlefeeding could result in more milk consumption regardless of whether it were BM or formula. That said, if your little one doesn't take much from a bottle then it is not going to work well in your case.

Also meals, as I know you want to be prepared/informed of all possibilities, you might want to research the use of periactin. It's an anti histamine that is routinely prescribed in FTT and tube fed infants to stimulate appetite. Now I'm not suggesting that you need to do this at this stage, as Jackson is clearly gaining weight and hitting his developmental milestones. But the point of the matter is, regardless of whether you FF or BF, the only way you can increase intake is if J asks for it. It's about getting J to take in more not about switching him to a bottle. Just food for thought ;)

You can point out that the fat content of breastmilk is higher than that of formula. Actually, that statement is sort of inaccurate - note my post below.

BM has an [b'>average[/b'> of 20kcal per 30ml. So 120 ml has around 80kcal. This is just an average though, the actual caloric content of BM varies depending on whether it's fore milk or hind milk, the mother's diet, time of day, etc. etc. Formula is designed to mimic breastmilk, and so it also contains 20kcal per 30 ml.

You can point out that the fat content of breastmilk is higher than that of formula. The only logical reason for adding formula to the mix is if you couldn't express enough milk and your baby was unable to breastfeed enough so there would be several steps before that (extra feeds, looking at latch etc). You might find that even feeding 2 1/2 hourly rather than 3 hourly would increase your overall daily output. I still think a 120g week gain is age appropriate so will be interested to see what your Dr thinks he should be gaining (not that I know anything about prems). I think you should try offering both breasts per feed (switching when baby pops off the first side and then switching back again when baby pops off the second) and maybe offering a quick feed before a nap (if you're feeding on waking) for a couple of weeks and see if there is a change is weight gain. It will be way less hassle than the time you would spend preparing, and feeding solids and the solids poos make BM poo seem almost edible in comparison :(

Here is a link with more info on ways to boost your babies weight, note one of the suggested things is to decrease intake of solids.(presumably so that your baby drinks more milk instead). Interesting too that feeding more often ups the fat content of your milk, perhaps why my DS went up in weight when he became a snacker. http://www.kellymom.com/babyconcerns/growth/weight-gain_increase.html I'm going to write a friend of mine back home who is an LC/NICU consultant nurse so will ask her about the coconut oil, the fats in BM are probably more easily absorbed and also full of fat soluble vitamins and there are lots of nutrients in the "foremilk" too so so ultimately more breastmilk would be the ideal. Meanwhile why don't you wait and see if your pediatrician is concerned about the weight, you don't want to rush solids if you don't need to.

I would go with LD's idea of adding an extra scoop of formula to the EBM first, safer and more effective way to give extra calories at this age IMHO. Just make sure you talk to a pediatrician/LC/midwife on the measurements. I personally would not go beyond a scoop (equivalent to 30ml formula) to every 120 ml EBM, and that is still considered on the high side. Adding formula changes the concentration of key salts, nutrients in the EBM so you need to make sure they are not too high to overtire their kidneys or cause constipation etc. A much easier solution would be to add a tablespoon of vegetable or coconut oil to the milk. That would increase the caloric content but not impact the salt concentration of the milk. That may sound extreme but when you think of it almost 90% of the calories in BM comes from fat. So it is pretty obvious that babies can digest fats effectively. Starches just tend to bung them up. I would also head that route before introducing LO to solids like apples etc. JMO, but by peeling apples and boiling them for a long period of time, you tend to lose out on most of the nutritional benefit anyway, and you lose out doubly because they're certainly not as calorie dense as milk. <em>edited by lemondrops on 12/06/2011</em>

Meals, how's little J doing? Have you started solids? Been thinking of you.

I started with fruit, (peaches and pears) simple carbs(sugars) are much easier for a baby to digest than complex carbs(starch) and less likely to result in constipation and gas. People say go vegies before fruits so as not to delvelop a sweet tooth but if you've ever tasted breastmilk you'll know that BF babies already love sweet. We had no problems introducing vegies and meats. In the interests of "fattening" the sweeter fruits I guess are higher in calories. We also did well with mashed avocado although with your baby being younger that might not be so easy texture-wise. Stodgy vegies like potato, sweet potato, carrot, corn are still quite high in starches. Breastmilk will help your baby break them down as they don't make their own digestive enzyme for them until later so make sure to BF before each "meal". I would go with LD's idea of adding an extra scoop of formula to the EBM first, safer and more effective way to give extra calories at this age IMHO.

It sounds like he's doing really well Meals, esp if happy - but I know how you feel. I just had my prem DD at the paed for her 9 month check and had to mount the same defence about weight gain. At 9 months (6 corrected) she was 5.85kg - I went nuts at the nurse who tried to write 5.7 in her book (DD started kicking and lifting herself off the scales and it went down). I worked b****y hard for that 150 grams...she now has some formula but is largely breastfed plus weaning now. She is growing steadily but had appeared to plateau a bit - he made the usual (predicatable) comments about upping momentum on her feeding (increasing formula and food). I tried last week but poor love got so bunged up I had to stop - I breastfed her solely for 24 hours, she did a massive nappy and was happy and comfortable for the first time in several days. I guess what I'm trying to say is that trying to force it doesn't always work, so I would take it easy when trying solids. If he's happy and active and content then that's the most important thing. McB - I am so relieved to read your post as my daughter is going to be about 6kg + at 1 year old and was 900 grams at birth. Meals I think it's ok if they put on, then level off - that's certainly what my LO is doing. No one comments if it's a baby on the 75 % percentile but it is the usual pattern, it's just more worrying with our skinny marinkies. If he doesn't like bottles then formula might not help him gain unless maybe you try a cup? But you know in my experience DD's weight gain has not accelerated since I went for 2 formula feeds/ day (largely because I return to work in September and don't want her to go into reverse cycling shocker at night!) - DD's best weight gain was when I was doing breast compressions and returning to the same side etc etc all the things people have suggested. As for the charts - we're not on them either...I try to be blase about it but underneath am rather sensitive and stressed. Good luck with the appt - I hope the paed is understanding and it goes well xx

My first prem was 762 grams( 1 lb 10.5 ozs) daughter who is now nearly 23 was only around 13 lbs ( 5.9kilo )at 1 year old. My advice is if the baby is feeding well and you are following the doctors advice,( you may be sent to see someone who specialises with this ) and baby is putting on weight forget the numbers . My daughter was put on something similar to " Complan " used for older people" but did not make much of a difference.She is small in stature now but myself and my husband are not tall. I would introduce solids now at 6 month 4 corrected but today's advice 2011 may be different. Unless child is ill do not worry once weight is going on. I'm really after just some ideas and thoughts... Obviously I've made an appointment with his peadiatrician, but I'm not sure what her advice will be and would like some of your thoughts. My little man is obviously the runt of the litter... at 6 months old (4 months corrected) he's still only just 5.2kg. Unfortunately this means he's now fallen off the WHO growth chart for his corrected age (doesn't even rate a mention on the actual age rating!). He's exclusively bf and won't take any more after a feed - he's full up! He's a perfectly healthy, happy little man. 6-8 well wet nappy's per day (clear urine). One poo daily. He has 7-8 feeds per day. Will stretch to between 5-6 hours overnight after a dreamfeed. He is the most content, happy, smiley baby. Rarely cries and when he does it's quite easy to determine whether it's hunger or tiredness. Should I expect the pead to want to put him on formula (unfortunately he's not much of a bottle fan - boobie man all the way although will take a bottle ocassionally)? Start solids early? (Based on his corrected age it would be the earliest we could possible start)? ??? TIA :) <em>edited by McB on 09/06/2011</em>