Ok mamas, another feeding question ...

[Ann.without.an.e]

If the babies are now eating good and pooping/peeing the right amount but aren't gaining the recommended weight? But they also tend to spit up or refuse the extra via a bottle or aren't hungry to nurse in 3 hours if a bottle was given?? The ped said they need to gain an ounce a day but these girls are little and have a petite mama. Can they potentially still be healthy and growing and doing fine even if it is less than the 7 ounces per week? What if it is more like 3-4 ounces a week? ETA: they seem perfectly content and are capable of expressing hunger. 

Edited March 19, 2023 by Ann.without.an.e

[Kassia]

What your dd is going through sounds so similar to what a friend of mine went through with her single baby.  She is very petite and her DH is smaller than average.  She was on bedrest through most of her pregnancy and her ds was born pretty big but didn't keep up with his growth chart and was labeled as failure to thrive.  They went through hell trying to get him to gain weight and keep up the growth curve but it just wasn't meant to be.  He was fine the way he was and grew up to be on the shorter side of average but perfectly healthy.  

Of course, I don't know if this is the case with your dd's babies and I wouldn't be comfortable saying they are okay if they aren't.  The feeding thing can be so stressful.  I'm glad they seem content and are gaining at least.  

[gardenmom5]

how old are they now?

My babies that I had with anesthesia (e.g. caudel, epidural.  I had two with nothing but a shot of demerol and their feeds were very different) - didn't want to eat for their first month.  They just weren't that hungry. Dudeling was nearly two months before he "woke up" (and those two months feeding was a major production) and really started eating.
Both 1dd and dudeling had peds telling me to wake them up, etc. to get them to eat.

[Ann.without.an.e]

4 minutes ago, gardenmom5 said:

how old are they now?

My babies that I had with anesthesia (e.g. caudel, epidural.  I had two with nothing but a shot of demerol and their feeds were very different) - didn't want to eat for their first month.  They just weren't that hungry. Dudeling was nearly two months before he "woke up" (and those two months feeding was a major production) and really started eating.
Both 1dd and dudeling had peds telling me to wake them up, etc. to get them to eat.

They are going on one month but were induced a month early. Dd didn’t use pain meds in labor. 
She wakes them up at 3 hours to eat if they don’t request to eat sooner. They seem to want to eat every 2-2.5 hours in the evenings. 

[Lucy the Valiant]

Eating and peeing / pooping and not still-hungry after feeding were the goals we worked for, with twins. They were small, but fine. (They were 35w delivery but only 2 days at hospital, not preemie. I can't remember if yours were preemie or not?)

[Paige]

Not everyone will gain at the same pace. I can't recall how many ounces they gained at first but I know there were periods of rapid growth followed by not so much. They were all still wearing 0-3 and 3-6 mos clothes at 1 yr.  My girls are all small, even the not preemie- the pediatrician said she'd watch their skin tone, energy, and milestones, and if those were good she wasn't worried. Because I'm small. I think most pediatricians would have been on my case about their size (15-16lbs at a year among the 3) but they would have been wrong and added unneccessary stress because they are fine and about the same size I was as a baby. This year, a new doctor has been super upset about my 77lb 15yr old but she is still fine. I think they've finally decided to drop it. 

I can't say how your DD's twins are doing, but if they were mine I'd decide based on output, behavior/energy, strength, milestones, and skin tone (nice color, skin pops back after a pinch). I think they are probably big enough to have good color and skin tone. I can't recall how big they are but tiny babies will definitely take a few months to get that good skin color and tone. My babies were very "red" and had saggy skin at first which is normal for premature babies, but around 6lbs they definitely had a normal tone. Even my 5lb full term baby was red until she got a little bigger. 

[fraidycat]

13 minutes ago, Kassia said:

What your dd is going through sounds so similar to what a friend of mine went through with her single baby.  She is very petite and her DH is smaller than average.  She was on bedrest through most of her pregnancy and her ds was born pretty big but didn't keep up with his growth chart and was labeled as failure to thrive.  They went through hell trying to get him to gain weight and keep up the growth curve but it just wasn't meant to be.  He was fine the way he was and grew up to be on the shorter side of average but perfectly healthy.  

Of course, I don't know if this is the case with your dd's babies and I wouldn't be comfortable saying they are okay if they aren't.  The feeding thing can be so stressful.  I'm glad they seem content and are gaining at least.  

This reminded me of the h*ll my SIL put herself through worrying about my niece and the growth chart "milestones" she was supposed to be meeting and "failing" at. It was a very eye-opening and anger-inducing time period. She was growing, was healthy, was eating, sleeping, pooping, peeing, all the things, but the medical professionals were practically bullying my SIL on a regular basis because niece was smaller than they figured she should be. GRRRR. I get angry remembering all that.

My SIL is 5'0" tall, weighed about 90 lbs, fully-clothed, soaking wet. Chances were pretty good that her daughter might end up petite, too. (She is a full-on mini-me of her mother). She's 23 now - healthy and petite, and I had forgotten about the BS they had put my SIL through.

You and DD need to trust your momma and grandmomma intuition. You'll know if something isn't right.

[Ann.without.an.e]

2 minutes ago, Lucy the Valiant said:

Eating and peeing / pooping and not still-hungry after feeding were the goals we worked for, with twins. They were small, but fine. (They were 35w delivery but only 2 days at hospital, not preemie. I can't remember if yours were preemie or not?)

They were considered late term preemie since they were born at 36 weeks so not too little. They were in the nicu for a few days for glucose issues but not too long. 

 

2 minutes ago, Paige said:

Not everyone will gain at the same pace. I can't recall how many ounces they gained at first but I know there were periods of rapid growth followed by not so much. They were all still wearing 0-3 and 3-6 mos clothes at 1 yr.  My girls are all small, even the not preemie- the pediatrician said she'd watch their skin tone, energy, and milestones, and if those were good she wasn't worried. Because I'm small. I think most pediatricians would have been on my case about their size (15-16lbs at a year among the 3) but they would have been wrong and added unneccessary stress because they are fine and about the same size I was as a baby. This year, a new doctor has been super upset about my 77lb 15yr old but she is still fine. I think they've finally decided to drop it. 

I can't say how your DD's twins are doing, but if they were mine I'd decide based on output, behavior/energy, strength, milestones, and skin tone (nice color, skin pops back after a pinch). I think they are probably big enough to have good color and skin tone. I can't recall how big they are but tiny babies will definitely take a few months to get that good skin color and tone. My babies were very "red" and had saggy skin at first which is normal for premature babies, but around 6lbs they definitely had a normal tone. Even my 5lb full term baby was red until she got a little bigger. 

They have good color. Peach is normal baby color lol. Nectarine is still slightly reddish but better than she was in the beginning. 
They are very content. I feel like since they can express hunger when they are hungry then they would be upset and acting hungry if they weren’t getting enough? Especially since they are finally full term?

I just want to make sure I’m not missing something  

[Ann.without.an.e]

DD has just been so anxious about them getting enough. She worries about it. At the same time, she worries about supplementing too much since they don’t nurse as well when she does. It’s a balance to keep your milk supply strong vs supplementing. She pumps but that just isn’t the same. 

[busymama7]

The rule is 4-7 oz a week.  Not sure why 7 is being insisted.   Some babies are smaller and grow slower.   And some are at the opposite side of that extreme (I had a clients baby gain 20 oz in 8 days 😃)

[Ann.without.an.e]

Just now, busymama7 said:

The rule is 4-7 oz a week.  Not sure why 7 is being insisted.   Some babies are smaller and grow slower.   And some are at the opposite side of that extreme (I had a clients baby gain 20 oz in 8 days 😃)

So 4 is ok?? That’s great to know. Everyone and everything says 7…7….7 and I already felt like surely there had to be variables somewhere in that lol

[busymama7]

Just now, Ann.without.an.e said:

DD has just been so anxious about them getting enough. She worries about it. At the same time, she worries about supplementing too much since they don’t nurse as well when she does. It’s a balance to keep your milk supply strong vs supplementing. She pumps but that just isn’t the same. 

Worrying is the antithesis to milk production.  So whatever helps her worry less and be relaxed is the goal.   

[Ann.without.an.e]

Just now, busymama7 said:

Worrying is the antithesis to milk production.  So whatever helps her worry less and be relaxed is the goal.   

I agree ❤️

[busymama7]

3 minutes ago, Ann.without.an.e said:

So 4 is ok?? That’s great to know. Everyone and everything says 7…7….7 and I already felt like surely there had to be variables somewhere in that lol

That is what I have always known and gone off of. I don't see with a quick Google any other recommendations aside from some saying 5-7 instead.  

The thing is, when there is a disruption to feeding like there has been, it can take a minute for it to sort itself out.   I would be most concerned with diapers while this was going on. And I would expect that the weight gain will pick up a week or two *after* they start to fully breastfeed.  Not that they won't gain at all but not as quickly most likely. 

[barnwife]

OMG, this takes me back to when our oldest was a newborn. He lost weight once, then started gaining very slowly. They had me trying everything: feeding only from one side for a 3 hour period, breast compressions, wanted me to supplement etc...it was absolutely stressful. Add in that I am sure I had undiagnosed PPD and it wasn't how I pictured motherhood. 

And one day, DH and I looked at our little baby and realized he was growing (slowly, yes, but growing/gaining), happy, and hitting other milestones. And I said "enough!" I am going to continue BF on demand and trust he is on his own growth curve. And he was

And now he's a fabulous almost-teenager. 

So, yes, now, as a wiser, older mom, I'd be fine with what you have told us for kids of ours. 

 

[rebcoola]

Some of my friends had Doctors that were militant like this but our was like of they are gaining, happy, and filling diapers than it's all good my ODD was a 36 weeker to.

[Lecka]

This sounds fine to me.  
 

[Heartstrings]

Sounds like it might be time for a new pediatrician.  Even within the same practice you’ll find doctors with different ideas.  She could ask on her local moms Facebook page for recommendations based on this certain issue.  She needs a ped that understands that there is a range to what’s normal.   Staying with doctors that are dogmatic like that will only lead to more frustration over the years.  

[Elizabeth86]

2 hours ago, busymama7 said:

Worrying is the antithesis to milk production.  So whatever helps her worry less and be relaxed is the goal.   

Absolutely 

[Faith-manor]

I think a second opinion might be wise. I am not willing to give any other advice than that, but I do know from experience that a pediatrician who doesn't specialize in preemies and multiples can be very short sighted and demanding about growth patterns. We had this happen with our middle son. I had had a rough pregnancy, and a VERY dangerous delivery which left me too weak to really nurse him and not in good enough health to produce any kind of milk supply. A nurse helped me express colostrum for him, and I tried my best for six weeks to pump a little breast milk to put in his bottles with his formula, but I was in such bad shape, it was really pretty fruitless. He was projectile vomiting a lot, and our pediatrician would just hammer at me about weight gain (npnreal advice or assistance from the guy at all) and labeled him failure to thrive, made a lot of very scary predictions about him. I called my CNM, a very wise woman who knew a hell of a lot more about a wide variety of baby issues than it seemed the pediatrician did, and she sent us to a specialist pediatrician who dealt mostly with struggling, ill and disabled babies and a lot of preemies. He was so helpful, figured out what ds was reacting to, got us on the right formula, and didn't freak out when ds had a slower weight gain than "normal" for a while afterward. He said babies take some time to work it out when they have had a rough start. He was vigilant, but relaxed and supportive which was exactly what both of us needed.

So that is all I can say. 2nd opinion with a pediatrician that has more experience with multiples, and preemie babies. Maybe she could ask her OBGYN for recommendations.

 

[denarii]

My twins were 36+6wkrs and my daughter was 4lb12oz (smaller of the two). She didn't start reaching her growth goal of 6oz a week until she was over a month old and my dr was okay with that. 

I think expecting 7oz a week for a premie is excessive. 

[Ann.without.an.e]

1 hour ago, denarii said:

My twins were 36+6wkrs and my daughter was 4lb12oz (smaller of the two). She didn't start reaching her growth goal of 6oz a week until she was over a month old and my dr was okay with that. 

I think expecting 7oz a week for a premie is excessive. 

 

See, this just makes sense to me too. If a 7-8 pound baby is supposed to gain 7 ounces a week, then that seems like a reach for a 4-5 pound baby. They should make it a percentage of current weight? That makes more sense right?

[Ann.without.an.e]

Also totally OT but little bit has decided that swaddles are not for her lol. We’re trying to keep her extra warm but she kicks out of her Velcro swaddle and seems utterly frustrated when we put her back in it. 
 

[KSera]

35 minutes ago, Ann.without.an.e said:

Also totally OT but little bit has decided that swaddles are not for her lol. We’re trying to keep her extra warm but she kicks out of her Velcro swaddle and seems utterly frustrated when we put her back in it. 
 

If she settles fine without, I would ditch the swaddle and just dress her in a onesie under a warm sleeper plus hat. I’d be nervous about the risk of her getting tangled in a swaddle if she’s able to kick out of it.

[ktgrok]

18 hours ago, Ann.without.an.e said:

If the babies are now eating good and pooping/peeing the right amount but aren't gaining the recommended weight? But they also tend to spit up or refuse the extra via a bottle or aren't hungry to nurse in 3 hours if a bottle was given?? The ped said they need to gain an ounce a day but these girls are little and have a petite mama. Can they potentially still be healthy and growing and doing fine even if it is less than the 7 ounces per week? What if it is more like 3-4 ounces a week? ETA: they seem perfectly content and are capable of expressing hunger. 

A quick google says for breastfed infants 4-7 oz a week is the goal. So if they are at 4 oz, that would be within the norm. 

[ktgrok]

1 hour ago, Ann.without.an.e said:

 

See, this just makes sense to me too. If a 7-8 pound baby is supposed to gain 7 ounces a week, then that seems like a reach for a 4-5 pound baby. They should make it a percentage of current weight? That makes more sense right?

I was thinking the same thing! In the vet world we didn't expect a toy poodle to gain as much as a great dane per week, lol. 

 

[Starr]

The pediatrician is going to encourage for the higher amount if it works. I would  go with all the nursing they will do since it sounds like the bottle feeding is interfering with the nursing. This isn't medical advice. And keep up with doctors check ups so the doctor can see the babes in person and evaluate. 

[denarii]

2 hours ago, Ann.without.an.e said:

 

See, this just makes sense to me too. If a 7-8 pound baby is supposed to gain 7 ounces a week, then that seems like a reach for a 4-5 pound baby. They should make it a percentage of current weight? That makes more sense right?

Yup. My sister's 9lb10oz daughter exceeded her birth weight by two weeks old 😂

I think it helped that the dr who was comfortable with their slower weight gain had had a micro premie of his own and his care was just wonderful. 

I was told to judge their well-being by more than just weight gain. Are they satisfied when they feed? Are they alert when they are awake? Plenty of wet diapers?