Prematurity, reflux, overfeeding - HELP

[oikopolis]

I've also posted in Breast and bottle feeding but maybe someone here has some insight...

My son arrived at 34 weeks gestation. As of today, he's 3 weeks, or 37 weeks adjusted. Despite this he has done amazingly well. He is breastfeeding very well and gaining weight very fast.

He has some typical preemie challenges. For one thing he has silent reflux which causes him some discomfort. Also, I have massively strong letdown in my right breast, which has choked him frequently. (I've now learned to pace him by unlatching whenever he sucks too long without taking a break -- that's helped.)

I shared my concerns about his discomfort with the NICU team's feeding specialist. She told me I had too much milk and too strong/frequent a letdown, that I was overfeeding him at the breast, and told me I needed to limit him to no more than 20 mins at the breast every three hours. She told me that his rooting is likely just a manifestation of his need to suck, not of hunger, and that I should give him a dummy if he's still rooting after 20 mins. She said that he's not cueing when he's full because he's premature and doesn't have the satiety switch that a term baby has.

So I tried this approach last night hoping it would make him more comfortable.

It was hell. I cried, he cried, I wanted to jump out of the window, he probably did too. He wailed and wailed. He spat out his dummy 500 times. Eventually I offered him the breast again but by then he was hysterical and so was I.

I don't know. Is he crying because he's hungry? Is he crying because he's having reflux? Is he crying because the extra breastmilk would calm his reflux? Does he feel less pain when overfed?? Is that what it is?

I never want to go through last night again. I felt like I was torturing my child. Should I just ignore the advice of the NICU people and demand feed, and overfeeding be damned? Is is really a massive issue that he's eating more and gaining more than he's "supposed" to? I am so tired and confused that I can't think straight about this anymore.

[TeaandHobnobs]

DS (born 31+5) also had this problem around the same sort of time, and the neonatal outreach nurse said his vomiting was because he was eating more than his tummy could handle. However, she said as long as he was putting on weight it wasn't really a problem (backed up by the consultant a few weeks later). There was no way I could leave him to get upset when he was still rooting after a feed, so I just continued to feed him if he indicated he was hungry. Later on (maybe around 42 weeks?) I did give him a dummy, as I thought he was sucking for comfort but getting milk he didn't need/want, and it has been useful as a calming device - but he does spit it out when he doesn't want it, which is more and more often now!

I don't believe you can "overfeed" him - after all, you are helping him to gain lots of weight which is fantastic!

I only went to the GP about it when I was concerned that DS's vomiting had caused him to lose his voice, and he was prescribed gaviscon (GP recognised that reflux is extremely common in preemies) - however it has been such a pain to administer, and thankfully DS's vomiting has decreased of its own accord recently, so I expect he will grow out of it soon.

Go with your instincts, I say

[TwelveLeggedWalk]

Oh poor laddie. IS he on any anti-reflux meds? I think our DS definitely had no 'off' switch (and now doesn't seem to with solids either!) and, like you suggest, it felt to me sometimes as if he drank milk to cool the acid burn in the same way we have beer water with curry. Would something like Gaviscon or Ranitidine help so that if he does puke it doesn't hurt him so much?

The other thing to consider is if it is reflux or lactose intolerance. I think we pursued the former when it was the latter for a very long time, and also very common in premmies as far as I can understand. COuld you trial a dairy-free diet to see if that helps?

[Poppet45]

Oh hunny, been here and bought the t-shirt with DD who was born 27+3, BFed with a tongue-tie, top-lip tie, shocking refluz (sorry my toddler has killed the ecks key on the computer) and cow's milk protein intolerance (now called a delayed milk allergy). The overfeeding advice is complete nonsense. Babies splutter and choke due to refluz, oral ties that prevent them from controlling the flow of milk properly and very strongly if they have problems with cow's milk proteins from your diet. DD had her tongue tie cut which helped a bit, I also started block feeding for a few weeks to reduce my supply - where you feed from only one side for at least 4 hours, then swap, but the biggest helps for us were me going dairy and soya free, and getting her on proper refluz meds by which I mean the heavy duty ones such as omeprazole. Dairy free isn't half as difficult in practise as it might sound and combined with the meds got us our sanity back and our lovely smilely happy daughter. She's just turned 1 now and is still bfing like a trouper with no choking or upsets at all, get better help and what you're going through can be made much much easier. Good luck.