Feeding issues (NICUs and formula)

[krabigirl]

My son, William, is in the NICU after being born at 33 weeks, 5 days, last week. His weight is good - 5 lbs, 7 oz at birth, down to 5 lbs, 1 oz.

He's off oxygen, the caffeine they are giving him has controlled his As & Bs (he's only had one in three days!), and he's off IV fluids and mostly off the bililights.

I've been pumping, and have a great supply, so no worries there. He's been feeding via gavage the past two days, solely breastmilk.

Well, today, I get to the NICU and lo and behold, he is off breastmilk and on Similac Lactose-Free. He'll be on it for at least 24-48 hours. They said he'd been spitting up/puked, but no blood in stool and has been stooling great. The neo put him on the formula because they are unsure if he is affected by something in my diet. The nurse today, however, thinks it's probably a volume issue. He's getting 38 cc every three hours, and he had been getting that in 30 minutes. Now they are giving him it (well, formula now) over an hour.

Needless to say, I'm pretty sad. Pumping is hard enough, especially with a toddler running around and the stress of the NICu. And I had issues bfing my DD, so I was hell-bent on exclusively bfing this one. I am fine with changing my diet - I told them I could go immediately on a bland diet (I don't even drink milk as it is), and they could start using my next milk. But they want to use the formula until they determine if it's a volume issue. (He did spit up twice today, and on formula..hmmm.)

Has anyone dealt with this and gone on to breastfeed their preemie? I'm sure I can deal with this diet-wise. I just wish they wouldn't rush to formula so quickly.

[sparklett]

Hugs mama. My DS (33w, 1d) was given formula twice, but it was because the nurses weren't paying attention, not because there was any sort of issue. DS even developed GERD in the NICU, and they never, ever suggested changing to formula.

Were I in your situation, I would really push to change back to BM.

[buckysprplmonkey]

I'd demand to see a lactation consultant if I were you. From my understanding, breastmilk generally helps GERD and other digestive problems.

They didn't give my 28 weeker any formula at the NICU, but I did spend 7 weeks pumping every three hours with a 2 year old, an 8 year old and an 18 year old to keep track of too. It's hard, but possible and worth it. Many moms go on to EBF after a NICU stay.

HTH- hugs!

[krabigirl]

I was thinking of requesting to see the LC as well - that's a good suggestion. I don't see why they couldn't do the volume test with breast milk. I just don't think the neonatologists will change their minds until the 48-hr period is over. And I agree - I don't see how breastmilk would be WORSE than formula for spitting up or vomiting. I just feel so powerless there. They really won't listen to anyone but the doctors.

And yeah, the pumping is fine. I'm producing quite a bit, and just tried a hands-free pumping bra that I got in the mail, and wow, it's soo much easier on my shoulders. I can even come on here while pumping now.

I just hate to see the milk I work hard to make just sit in the NICU freezer.

DH is going to go there tonight. I am going to see if he can be a bit more forceful about them going back to the breastmilk sooner.

[irangel]

That makes me raging mad. He's spitting up. Normal FT babies spit up. There's nothing wrong with that if he's not in pain and he's gaining weight. As his mother you can disagree with their decisions and order them to do things your way. I'd get bossy and tell them to put my kid back on breastmilk immediately.

[krabigirl]

Thanks. DH is going there tonight and he said he will tell the nurse that he wants him on the breastmilk as soon as possible. I'm not able to go there until tomorrow night (don't have anyone to come watch my 21-month old), so if he's still on the formula, I'll tell them again.

So from what I understand, I *can* demand them to put him back on breastmilk if they won't do it after DH asks? I just don't think they will listen to me. Who should I talk to? The nurses or the neonatologists? And what if they refuse? What rights do I have? I just want him to come home. I'm always afraid that the social worker will come by and "talk" to me about postpartum depression or anxiety if I speak up. (She did when I demanded to know why I couldn't hold him a few days ago, then a doctor came by and let me hold him.)

[skylarsmama]

The nurses gave one of my boys formula twice, with asking me first, and i freaked on them. I would talk to the nicu doctor and insist that your baby get nothing but breastmilk and have it written in the chart.

[pibblestiltskin@ma]

Originally Posted by krabigirl

Has anyone dealt with this and gone on to breastfeed their preemie? I'm sure I can deal with this diet-wise. I just wish they wouldn't rush to formula so quickly.

Congrats on the little one! This sounds much like my ds and he went on to nurse for more than 2 years, Exclusively bf once he got got home. Our NICU didn't switch to formula but did beef up the calories of my bm by adding some.

Does your NICU have a lactation consultant who is specifically assigned to the NICU? Ours had one who specialized in preemie issues who stopped by to check up on us and give advice. Also, I tried to be there for at least one feeding ( I also had a 2 year old at the time so I know it is not easy) and the nurses encouraged me to nurse while the food was going through the tube so that he could make the association between a full tummy and nursing.

[Amys1st]

Talk only to the attending. Bypass the nurses and find out who ordered the formula. Sorry you have to go thru this!

[irangel]

Originally Posted by krabigirl

Thanks. DH is going there tonight and he said he will tell the nurse that he wants him on the breastmilk as soon as possible. I'm not able to go there until tomorrow night (don't have anyone to come watch my 21-month old), so if he's still on the formula, I'll tell them again.

So from what I understand, I *can* demand them to put him back on breastmilk if they won't do it after DH asks? I just don't think they will listen to me. Who should I talk to? The nurses or the neonatologists? And what if they refuse? What rights do I have? I just want him to come home. I'm always afraid that the social worker will come by and "talk" to me about postpartum depression or anxiety if I speak up. (She did when I demanded to know why I couldn't hold him a few days ago, then a doctor came by and let me hold him.)

You are his mom. You have every right to demand they put him on breastmilk. You shouldn't have to ask them to do it. You can tell them to. You can talk with the doctor and tell them you will not allow him to be on formula and they have to listen to you. As his mother you have that authority. The doctor can explain his/her reasoning for using the formula but ultimately it's your decision. In my daughter's chart we had written everywhere "no formula allowed under any circumstances". When they wanted to try using some for her osteopenia the doctor called me and asked permission first.

[krabigirl]

Thanks. Well, it looks like I am going to have to talk to one of the doctors about this. DH told a doctor last night that we wanted him back on my milk asap, and that I've changed my diet (eliminated all dairy, gas-causing veggies, and chocolate for now.) The doctor said he would do so, but as of today, he is still on the lactose-free formula.

When I called the NICU today (can't go until tonight), his nurse tells me that it's a doctor's decision, and the doctor wants him on the lacto-free for one more day, maybe two, and then will re-introduce my breastmilk. He hasn't been vomiting and is gaining now that they are feeding him over a longer period of time, but I want him on breastmilk!! What's the point of pumping if he's not going to eat it?I was told to bring in my new(er) milk, and to bring the old milk home to freeze for when he comes home.

It's still not good enough. I am going to talk to the doctor tonight. I'm so upset about this. You know how it goes in there. They say something will happen for a day or two, and then before I know it, he'll still be on stupid formula next week. And I'm producing a ton..it's so ironic.

The good news is that he's been moved to the feeder/grower room. They tried to nipple him (with a bottle), but he is not interested yet.

[azgirl]

You should definitely talk directly to the Neo. Are you able to be at the hospital for rounds? That is what we did (for 4 months...) that way you are there when the dr. is discussing decisions with the nurse etc. I talked to the Neo everyday. Nurses have to do what they are told...

[krabigirl]

Thanks, AZGirl. Unfortunately, parents can't go into the NICU during rounds (from 7-11 am), but the neos are usually available afterwards. My mom is babysitting my toddler tomorrow, so I'll be able to go in after the rounds. I'll ask to talk to the neo then. I don't think the night-time neo has as much authority.

[sparklett]

I just noticed you're in So. Cal! Hi neighbor!! My DS was born in a So. Cal hospital, too.

Do you have a Neo. that is assigned to you? If so, talk to that person. If you don't get results, talk to the person in charge.

Have you befriended a nurse yet? Sometimes it helps to have a nurse advocate for you (we befriended the head nurse for the night shift and our stay was MUCH easier after that).

I would suggest you hop on the phone right now and call the NICU and tell them that you want to talk with the neonatologist about the milk issue first thing in the morning after rounds. They'll put it in the notes and the neo. will hopefully be available to talk to you.

I'm so sorry this is happening to you. The last thing you should have to worry about right now is something as basic as this.

[krabigirl]

I am going to talk to the neo assigned to him today. I will be there a bit after rounds, since my mom will be at my house to watch DD.

Funny that you asked about the nurses. Last night, I met a wonderful nurse. He's been moved to the feeder/grower room, and she immediately showed me how to take his temp, told me I could change diapers and pick him up myself, as long as he isn't feeding (until the vomiting has stopped for a few days.)

She also said he is NOT doing much better on the formula, and that the doc is probably going to put him back on BM. They are going to start investigating reflux issues. (finally...)

Since it takes a few days for the dairy and chocolate to leave my system, I am not sure when exactly they would start him, but since the formula isn't helping, what's the point? The nurse was great. There are two other nurses that I also get on with, but they weren't as proactive as her about helping me.

Wish me luck when I talk to the neo today.

I'll let you know

[Amys1st]

Glad he moved! I see nursing in your future....


I remember when Maggie went to Feed n Grow. We sang to the tune of London Bridge for days after...

Move her into feed and grow...

feed & grow

feed & grow

Move her into feed and grow My Fair Maggieeeeeee


Sadly this was DH who invented this song! Way too much time listending to the preschool tunes at the time (Liz was 3) Of course now that she blars that Hanna Montana CD, I miss the preschool tunes..

I needed to make you smile there so the reason for the Off Topic!

[sbrinton]

Some NICUs, doctors and nurses seem to have a bias against breastmilk. This is just silly, as for the vast majority of babies, especially preemies, breastmilk is the best thing.

Keep pumping! There is a point even if your baby can't have the milk yet! In a few weeks he will be home and it will be up to you what he eats.

If you disagree with the doctors putting him on formula, I would definitely figure out who you can talk about about a second opinion. Be very clear what you want. The La Leche League website has lots of info about why breastmilk is best for preemies.

There are many ways to treat reflux other than switching to formula or adding rice cereal. Positioning, medications, chiropractic and cranio sacral massage can all make a difference.

[krabigirl]

Amy - thanks for sharing that story! How cute! It is a very happy time when they are moved

Sara - I think you are right. I do think they are biased, at least in this NICU, against breastmilk, because they don't know exactly what I'm taking in. They do seem to know formula. I will keep pumping, because even if they don't use it in the NICU (which I think they will, I just don't know when), I will have TONS to use when he gets home. :

I was there for about 2 1/2 hours, and was able to hold him during his feeding. I let him use a paci so he could get used to sucking while eating. He did vomit after we put him back, so the nurses do know that the formula isn't helping at all. Today's nurse thinks it's simply a volume issue.

I wasn't able to talk to the attending doctor. I waited and waited, but there were several critical preemies being brought into the main room, and one had to be transported to another hospital. I'm just waiting for a call now.

Good news is that they plan to move him to an open crib by this evening, or tomorrow if it's not possible!

[krabigirl]

Good news! I just got off the phone with the head nurse, and the attending neo has put in the order to start William back on breastmilk!!! :

They really don't even think he is allergic to anything at this point, or even that he has reflux. They are going to slow down his feeds a bit or lessen the volume. I think he was just getting too much.

I hope this lasts - but at least I feel good to know that he will be getting some antibodies in his next feeding!!

[sbrinton]

My little guy fed almost constantly but just a little at a time. Maybe 5-10 minutes out of every hour. That was enough to wear him out and he would just sleep. And then nurse. And the sleep. And then nurse....