Getting my preemie to eat now that we're home

[LunaLady]

About my baby: born at 33w2d vaginally after I was induced for PE. He had/has no problems and was in the NICU for 25 days learning to eat via bottle (expressed breast milk). 

I thought it was going to be impossible for my baby to fulfill the requirement of eating at amount of food the NICU wanted him to eat so he could come home - but he did.

However, now that we're home he's not eating nearly as well, even though up until the day he came home he was eating like a champ.

We are using the same exact bottle as we used in the NICU, so that hasn't changed. 

He was eating 50-60 mL via bottle every three hours or less, and not needing to be woken up to feed. He would stir and rouse himself and then surely be woken during the diaper change/temp check prior to feeding. Then he'd down his whole bottle in 20-25 minutes.

Now he'll stir when it's coming up on 2.5-3 hrs since his last feeding, but doesn't wake and root around like he did in the NICU even when we change his diaper and such prior to feeding. And when he gets to the bottle, he'll eat for 10 minutes and fall asleep. I feel lucky if he gets 30 mL in before he falls asleep. Burping him, tickling him, changing his diaper again - nothing wakes him up enough to suck and eat more.

What can I do? What's with the change? It's driving me nuts! He was such a vigorous eater, and now I feel like I'm starving my baby :(

[LunaLady]

Also, we have had a handful of very successful sessions of nursing at the breast, and OMG I would love nothing more than to get him exclusively breastfeeding ( the pumping is killing me, I have to pump almost an hour each pumping session to get enough milk, so I'm pumping 8-9 hours a day...........!) but I think he's got so much nipple confusing and gets really frustrated when the milk doesn't come instantly like the bottle does. He refuses to latch and arches his back when I try to put him to the nipple. And my boob is about three times the size of his head, and I have pretty flat nipples, so about everything is working against us here. Nipple shields don't work on my boobs at all. The only way I can perk them up is to pump, but I need to do it for quite a while to get them to stay perked, and then there's no more milk?

STRESSED!

[twinpossible]

Oh honey, I feel the pain! I had this x2 babies (twin girls). An SNS system is a pain in the butt, however, it did get my girls to breastfeed. The NICU nipple openings are so wide that the milk comes out nice and fast with out too much effort on the baby's part. He gets used to that and then is frustrated when your breast does not work as fast. If you invest in an SNS (only about $15) you might find that it will be a great transition tool for you. The tube will keep already pumped milk coming at a nice pace while he sucks on the breast and receives more fresh milk. Our NICU staff warned against using this because they said a tube would break the suck but it did not and it did help us move from bottle to breast. I hope this helps, it can be SO hard worrying about getting our little preemies to eat but as a momma on the other side of this whole ordeal let me say that is does get better! Now I find myself getting annoyed at how much they want to eat because now they eat all the time!!!

[BCmamaof6]

I had the same problem with my 32 weeker once we got home (36 w gest.)

To get him to nurse worked best when he wasn't over-hungry & screaming...but also not too drowsy. I'd swaddle him up start squirting milk into his mouth (by expressing) & then keep manually squeezing milk into his mouth while he was sucking.

Having said that...I never made enough milk for him (I never had a problem nursing any of my other babies...but honestly never made enough milk for him). I think it was a combination of him being a preemie, the crappy start we had in the hospital & that I'd had breast surgery 2 years prior. I never experienced a let-down. And my little guy was such a crappy eater that I began to worry that he was truly starving. I could tell he wasn't gaining the way he should. So I took him to my doctor, who agreed he was not getting enough from me & starving. The milk I did make was all foremilk...so he was only ever getting watery low-cal milk, not the good fatty, fill-you-up kind. So we supplemented with formula (which killed me cause I felt that formula was evil...having been a breastfeeding activist) & once he was getting enough he changed to a much different baby. I still pumped, still breastfed...but HAD TO feed him formula to nourish him.

Hopefully it's getting better for you. (oh & I found domperidone really helped with my supply...don't know if that's an issue for you...)

[dsb76]

Hi,  I'm new to this forum and I'm following the responses you get.

My twins are currently in the NICU (born at 36 wks and having trouble with temperature stability and feeding).  Given the slowness my two have taken to feeding (both nursing and taking a bottle) despite having an incredibly good latch and strong suck when they aren't too sleepy I am concerned about their ability to nurse/transfer milk while nursing once they are home.  I still have a while to go before they are discharged though - neither will take a full feeding from the breast in the allotted 30min so I am also giving expressed milk with a bottle and one gets gavage when she is too tired to take the bottle/breast (and they are both still on the isolette) 

Did any of you rent a baby scale to measure weight at home or try to estimate milk transfer like they do in the NICU?  - I'm not sure if I really believe the whole pre and post weight difference equals milk transfer with breast feeding.  Also - those of you who progressed to exclusively breastfeeding - how quickly did you add breast feeding sessions once home?  My NICU team has recommended only nursing the same number of sessions as I am able to do in the NICU (2-3) and doing the rest bottle feeding and advancing slowly once a week or so.  I'd really like to advance faster but, of course, I want to make sure they get enough to eat.  Sorry for the hijack.

[ShanaV]

Originally Posted by LunaLady 

Also, we have had a handful of very successful sessions of nursing at the breast, and OMG I would love nothing more than to get him exclusively breastfeeding ( the pumping is killing me, I have to pump almost an hour each pumping session to get enough milk, so I'm pumping 8-9 hours a day...........!) but I think he's got so much nipple confusing and gets really frustrated when the milk doesn't come instantly like the bottle does. He refuses to latch and arches his back when I try to put him to the nipple. And my boob is about three times the size of his head, and I have pretty flat nipples, so about everything is working against us here. Nipple shields don't work on my boobs at all. The only way I can perk them up is to pump, but I need to do it for quite a while to get them to stay perked, and then there's no more milk?

STRESSED!

I am so sorry it is going so rough for you, momma! I don't really have much to offer about the not eating the same amount from the bottle issue in your OP, but I can share with you my exp with the above. Maybe it will give you hope.

My boys were born at 30 w 5 d, in the NICU for 6 weeks. Would eat from the bottle (BM) and nurse with a nipple shield. Absolutely refused the bare breast. My boobs are also gigantic, like cantaloupes, especially compared to their baseball sized heads, also with flattish nips. I would alternate bottle/nursing/pumping thru the day and night. The only way I could ensure they were getting a good meal was from a bottle, b/c on the nipple shield they would fall asleep super quickly. It is EXHAUSTING. I should have asked for more help with bottle washing. I recommend that you demand help with that if you haven't already!

I see you are struggling with the nipple shield. I had to balance it *just right* on the boob, arrange the babies' bodies, heads, and a million blankies and pillows for support around the brest friend pillow, then sit in a super uncomfortable position, not moving a muscle, lest the nipple shield fall out of their mouths. Maybe give it another go? I also used the football hold exclusively. Cradle just didn't work. 

It wasn't until they were FIVE MONTHS OLD that they even latched on to the bare boob. Yes, it happened eventually. Just keep at it! For us, I would often try to nurse them, but they just screamed and couldn't feel the nipple in their mouth, and it was horrible. Then one day I had the babies on my pillow, was getting out the shields, and A just latched on! It was in front of his face, and there he went! He never looked back. Spit out all artificial nipples ever since (no bottle, no paci, no shield). Two weeks later V did the same thing! I know the advice is to alternate bare boob/shield/other, but there was no need for me to do anything except nurse straight from the tap after that point. So you never know, something similar may happen for you!

Lastly, don't hesitate to contact LLL. I didn't go to any meeting or even call anyone until AFTER they babies were successfully nursing. I don't know why I didn't call sooner, it would have been SUCH a help! So, get thee to LLL! The mamas there will help you!