Question for EP Mamas of Preemies

[mountainborn]

Hi there,

A close neighbor of mine had her baby around Thanksgiving, 6 weeks early. She was 4 lbs 2 oz at birth. In spite of a number of negatives re: lack of knowledge or hospital support (didn't show mama the breast pump until 3 days pp...etc.) she is now exclusively pumping and has been for about two months. She has declined help with transitioning to the breast, I think this is what she is most comfortable with at this point. I'm so glad that she is choosing breast-milk!

Here's my question. Lately I've noticed that the baby's anterior fontanel looks a little red and sunken. She's tiny, but I'm not sure if that is her prematurity or low weight gain. What is an appropriate weight gain & diaper count for a breastfed 3 1/2 mo preemie? I don't want to start the conversation without having a ballpark idea of what's normal. I would like to trust that her pediatrician is on top of things, but since s/he has had a poor track record so far with bad breastfeeding advice I can't put a lot of hope there.

The other reason I feel worried may sound silly, but she (the baby) always has this very worried and confused look on her little thin face. I might be reading too much into it but it reminds me so much of my son during his first 5 weeks when I was EPing. When he finally latched and I was able to nurse on demand he transformed overnight into this giant smiling butterball. I'm not saying it was the bottle itself necessarily, just that he wasn't getting enough food that way. I probably wasn't pumping frequently enough for his giant appetite. So it makes me wonder if she is getting enough. I know, could be me just reliving my own experience.

Feedback?

[kathteach]

I think if you're worried about your friend's baby's fontanel, you could just ask outright. It makes no sense to me at all that EP'ing would be the cause.

Pediatricians monitor premature infants' growth very carefully. Most moms of preemies are instinctively concerned about weight gain as well. Unless your friend is not visiting her pediatrician regularly, or is in serious denial or dealing with psychological trauma, I'd think it would be really odd that she wouldn't be aware of her child's health. I think moms know their children better than any outside individual. We know every mole, wrinkle, dimple, and spots on their pupils.

If your friend is pumping the recommended every 2 to 3 hours it's likely at 3 1/2 months that she has an oversupply. It's still so early.


I EP'ed for 11 months for DS1. He was a huge chunk, healthy and happy. Your friend's baby may look pinched because she missed out on some important womb time. Preemies are usually long and thin because they miss that time at the end when the fat packs on. Even with fortified breastmilk or formula it takes time for them to gain. My DS2 was born 7 weeks early and almost tripled his weight in three months, but it is only now at five months that he is chunky and looks like a "normal baby." For a long time you could tell he wasn't a happy guy. Preemies go through a lot. They just need to be held and loved and fed. Normal milestones don't apply to them. My friend's baby was born at 27 weeks and she is older than my DS (they had the same EDD though) but only weighs EIGHT pounds while mine is fourteen.

What if your friend was using formula and her baby still had the fontanel issue? Would you still be concerned the baby wasn't getting enough food? It's hard for me to believe that Mom would feed baby pumped milk, baby would down it, and mom wouldn't be aware of hunger signals if the baby wanted more. Actually EP babies tend to eat more than their peers who feed directly from the breast because the ease of the flow of the bottle makes them ingest more than they normally would at the breast.

Last of all, I'm glad you had success transitioning from EP'ing but believe me transitioning from bottle-feeding a preemie to exclusively breastfeeding is extremely difficult even with the most dedication and expert LC help. You say your friend doesn't show interest but there may be a backstory there and she feels badly about it.

[mountainborn]

Thanks Katherine, for replying. I get the feeling from your tone that I offended you and I apologize for that.

I figured the part about EPing for my son and him being hungry would come out wrong. I don't think he was hungry because I was pumping, just because - for him - I wasn't getting as much out as I was able to later with nursing. Do I think this is the case with all EP babies? No. I do feel like I got a very very small glimpse in that time of what it takes to EP and that is why I have the utmost respect for any mother who does it long term.

Would I be concerned if I noticed a sunken fontanel on a formula fed baby? Yes, of course I would.

I wrote the post because I was wondering if the diaper count for a baby this age getting enough was the same as a younger baby. I didn't want to ask about the baby's weight and then if she had questions respond with...uh, well, I'm not sure how to tell if she's getting enough... That doesn't seem very helpful.

Re: a backstory, of course there is one. Not everyone can afford an LC. Also, she has some disabilities and bottle feeding allows her husband to take over during the night and give her more breaks. I don't need to know all her reasons and I'm certainly not judging her for her decision.

I know that this mother loves her baby as only a mother can. I also know that she has been through a lot herself and has received a lot of conflicting information from doctors and pediatricians and my only desire is to support her .

Again I apologize if my first post seemed negative towards EPing or condescending re: this mother and her instincts. That wasn't how I meant it.

[kathteach]

Oh Anna you are so sweet. I feel like a total jerk now. I was very sensitive about not bf'ing DS1 so I guess it all came back. Thank you for being so gracious.

I found this at kellymom: http://www.kellymom.com/bf/supply/enoughmilk-older.html

Maybe it will allay some of your worries. Also about weight gain, I know that when DS2 went to the doctor's, he assessed his weight gain on the charts, but corrected for prematurity. For example, at 2 months Desmond would have been in the 2nd %ile (yikes!) but when the doc adjusted/corrected for prematurity he matched a healthy full-term baby's weight.

I wish you and your friend the best. Please let us know what happens, and what you decide to do.

[mountainborn]

Hi Katherine,

Oh, you're not a jerk. I get what you're saying about feeling sensitive. It is a huge thing to have such a desire to nurse and not be able to. I can remember sobbing on my couch just over the possibility that things might never work. I don't know what I would have done in the long run if ds hadn't started latching correctly. I certainly didn't know any EPers then and most of my friends (except one!) were telling me to quit, so I probably wouldn't have stuck it out pumping very much longer.

I think your post actually made me think more about my motivations for saying something, and made me want to be more careful to not assume things. I haven't approached the mom this week, mostly because I've been having a hard time myself. I lost a baby at 11 weeks in February and it has been hitting me hard. I wonder if some of my concern is just misplaced, because I don't have my own pregnancy/new baby to fuss over.

I do want to check in with her when I'm feeling better, because she always seems to really appreciate help or encouragement but will not usually ask for it herself.