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Breast Feeding

Preemie breastfeeding

12/12/2001

Question:

My daughter was born at 27 weeks gestation and weighed 1lb 6oz. I have been pumping and giving her breastmilk through a bottle. I`ve tried breastfeeding her on several occasions and she just doesn`t seem interested but I still want her to have the breastmilk. I am now taking Reglan to get my milk to come in. She is now 5 months old and weighs 6lb 3oz. She`s taking 2 different diuretics, caffeine, sodium, and zantac. She seems to be healthy. Our concern is her lack of weight gain. She is eating 2oz of breastmilk every 3 hours and I am putting 1cc of corn oil in her milk for calories. Is there anything else I can do to help increase her weight gain? or does her weight gain seem to be normal?

Answer:

First of all, congratulations on the birth of your daughter and for your persistence in providing her with breast milk for the past five months. Having a baby 13 weeks early is very difficult and I`m sure you must be pleased to have her home with you. You seem to have two main questions; how to establish direct breastfeeding and how to tell if your milk supply, and your infant`s weight gain, are adequate. I`ll address each of these issues. First, your use of Reglan suggests you have had some contact with a lactation consultant. If you want to establish direct breastfeeding I suggest you find a lactation consultant who will work with you. As your daughter is used to artificial nipples, a nipple shield might be helpful in making the transition from bottle to breast. A lactation consultant can help you get the right one and show you how to use it. Research has shown nipples shields to be very helpful. Additionally, you want to offer your daughter direct breastfeeding as often as possible, especially when she is hungry. If you are concerned about how much milk she is getting the lactation consultant can help you obtain a small scale that you can use at home to weight her before and after feedings. This will tell you how much milk she has gotten and let you know if you need to supplement the feeding with a bottle. It may take awhile to have her on full breastfeeding but it is possible. Having her breastfeed will also help with your milk supply. If you continue to give your daughter breast milk from a bottle, one way of increasing the calories in the breast milk is to be sure you are pumping long enough. Along with the Reglan, you should be pumping 6-8 times a day and continue pumping for a few minutes after the milk flow stops. Fat comes into the milk at the end of a feeding/pumping session, so if you are not pumping or feeding long enough, there won`t be a great deal of fat (or calories) in the milk. A lactation consultant can also help you with this. The best person to address the question of your daughter`s weight gain is your pediatrician or nurse practitioner. They know what her weight pattern has been and can, along with the lactation consultant, guide you in this area. I wish you the best of luck. The most important thing is to enjoy your daughter and know what a good job you are doing.

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Response by:

Donna   Dowling, PhD,RN Donna Dowling, PhD,RN
Associate Professor of Nursing
Frances Payne Bolton School of Nursing
Case Western Reserve University