Preemie EASY

[catmom]

My lo was born at 31 weeks and was 3 lb.  She was in the NICU for 1 month.  Fortunately, the hospital had her on a 3-hour routine of diaper change, eat, sleep.  She has been home for 1 month and I have kept the 3 hour routine but changed it to eat, diaper change, sleep.  She has slept most the time which was good since she was not supposed to be here yet.  A few days ago was my due date.  I am confused about how to use a lot of this advice for my preemie.  She now weighs 7 lbs and is finding her voice. We think she is an angel baby who occaisionally has a fiesty side (which was very helpful to get her out of the hospital).  I am starting to implement cluster feeding and the dream feed. 

My challenge with EASY is that she is either she won't go to sleep (awake for 2+ hours, especially during the night) or I can't get her to wake up.  When she won't go to sleep at night we use shush-pat.  During the day I either let her stay up or hold her.  She starts to fall asleep until I put her in her crib....oops sounds a lot like accidental parenting.  On the other hand, I feel like she often gets a dream feed during the day or she won't eat at all.  I am sort-of breastfeeding in that I bf and then give her a bottle because she doesn't eat enough from the breast.  I know it is not a supply problem but due to being a preemie she gets tired.  I am hoping this is not a prop which will cause me problems in the future.  Right now a full feed is 80ml if daddy bottle feeds her.  I have tried everything I can think of to keep her awake but it doesn't always work. BF can be 1 minute to 15 minutes.  She sucks and then takes breaks. 

I appreciate any advice or ideas on how to better manage the EASY routine.  I am keeping a log but don't see any patterns other than she eats every 3 hours.  We are hoping she will sleep more during the night.

Another question is do I keep EASY during the day starting at 7 am and follow the schedule and then feed at night on demand?  What if she eats at 6:00 do I then try to hold her off until 10?  I am finding that I am changing the 3 hour routine every day which may be confusing.

[woopster]

Hi Congrats on your baby!!
Mine were born at 28 weeks and were in NICU for 9 weeks.  We came home 3 weeks before their due date.
I didn't bother too much with a routine as such when we first came home - all they did was eat and sleep. They get so tired so quickly.
How long is she awake for during the day?  It may be that she is up too long. The 2+ hours certainly sounds like it.  Can you post some timings?
It took a long time for mine to manage 2 hours awake and DS2 can barely manage it somedays and he's 13 months!
Would you try letting her sleep more? She is really a newborn still, and will be for some time. 

How do you know she isn't eating enough from the breast? I can't really help with that part as bf-ing didn't work too well this time round.

[LŠuren]

https://babywhispererforums.com/index.php?topic=63243.0
Hi Catmom

Thanks to Wendy for helping out    The above is a link to starting EASY with a newborn and it has the "EASY by weight" chart that can be found in the babywhisper book.

With regards to your breastfeeding question, I will get one of the mods to have a look and help you out.

Lauren

[Samuel's mum]

Hi there
I'm a bf mod - so I'm just going to focus on that side of things if that's OK. Calum's mum asked me to drop by.
Well done for keeping up with the breastfeeding. I know it's tricky when your baby has had a long stay in hospital. It is hard work building your supply back up because you've missed those first few weeks of feeding that help build up your prolactin hormone (the hormone that governs milk supply). It's great that you are giving her breastfeeds even if they are only short ones as that will help with your supply - the more time she's on the breast the better. If you do want to move towards more breastfeeding then I might suggest you think about using an SNS system (lact-aid is another brand). This is a product designed to help mothers who want to build up their supply or relactate or increase the amount that they are breastfeeding. It enables you to supplement her feeds with formula or expressed breastmilk while she is still feeding at the breast. You might need to take a look:

http://www.kellymom.com/bf/supply/adoptivebf.html#comparison

This link is about comparing SNS vs lactaid and has some photos. It says 'adoptive' because they are often bought by women who have adopted a baby and want to breastfeed. I think this is worth you thinking about because it will help maintain your own supply as she is sucking at your breast. She gets breastmilk at the same time as supplementing. It would also help her work on her sucking technique as she gets older (because as you know a bottle is a completely different technique).

You might want to also think about using a breast pump to help build up your supply and you can pump at the end of feeds to increase the quantity your breasts make (it's all  demand = supply).

A 3 hour EASY is tough for some 'newborns' which she effectively is. Many mums on the bf board start with a 2 -2.5 hour feeding cycle. Some mums of newborns aren't able to keep their LOs awake at the breast so take a few weeks before EASY can be established. I think the main thing is that if you are committed to EASY you could work on developing her ability to fall asleep 'independently' if that's what you want to do and as she is able to stay awake more then EASY will be easier to establish.

With regard to night feeds - If she's only waking 2 or 3 times and you feel she is genuinely showing hunger signs then I would feed her. If you feel she's waking up more than that and is just using the feed to help her get back to sleep and then takes very little then I would use other methods. With a 7lb baby with her history I wouldn't advocate you 'hold her off' if she's clearly showing she's hungry. With breastfeeding you don't want to completely miss her hunger cues or your milk supply will not develop to meet her needs - especially during a growth spurt. Even if you weren't breastfeeding at all I wouldn't suggest you hold her off if she is showing she's clearly hungry at this point.
If you want more help with bf visit us on the bf board. On the FAQ page there are numbers for helplines and the la Leche League. They could tell you more about using SNS and the advice is free.
HTH

[catmom]

Thanks for the advice. I can add a few details that i left out....

I am using a breast pump.  There were a few times early on when I would wake up in the morning and pump 13 oz.  I have been reducing my supply as I have a freezer full of milk.  I still pump and use the fresh milk (instead of the frozen) for the bottles.  When I give her a bottle it is EBM with formula added to increase the calories (per doctor's direction) I also should mention that I use a breast shield when she bf. A lc suggested it because her mouth was small and I had a strong flow.  I changed from the extra small size to the small size recently which seems to work better.  I plan to go back to the lc in a few weeks to get help to eliminate the shield.  I don't think she is eating enough from the breast as she almost always takes a bottle afterward.  I want to increase her calories during the day so she can sleep at night.  The doctor said she should be sleeping 4-6 hours during the night which makes me think I may improve what I am doing to acheive that result. 

I find I am not able to control *no big surprise* when she sleeps and when she is awake.  If she is awake during the day I don't put her down as I am trying to use the "steal from peter to pay paul" idea mentioned in Tracy's book to help her sleep at night.  Is this too early to implement?

I without question committed to EASY.  I have read and reread the section Lauren references several times.  Thanks for pointing it out, it makes me feel better that I am at least looking in the right place.  What confuses me is that you put the baby to bed after the dream feed at 10-11 and then the next feed is at 7 am which is 8-9 hours.  If she needs to eat every 3 hours then do you feed on demand and go back to EASY the next day at 7am?  I am letting her sleep until she crys that she is hungry then I feed her about every 3 hours. 

Since you are all so helpful, I will post my log in case I am missing something.  The only trend I see is she likes to get up at 2am.  She frequently cries to say she is hungry or her diaper needs changing.  If she has had a growth spurt I have not recognized it.  I am logging how much time she is awake but not really when or how much each EAS takes. I do know she rarely takes more than 10 minutes to eat from the bottle.  I have not been logging this...should I?  I break it down by the day starting with the earliest am:

time    bf time    bottle ml    diaper change   awake time
8/10
2am       skip            70               yes                  120 min
6am      13 min        0                 yes                  none
9am      8 min         30                yes                  none
12:10   16 min         15                yes                  15 min
3pm      0                0                  yes                 none - tried to wake, didn't work
4:50     15 min         25                yes x2             50 min
8          skip             70                yes                 10 min
11:30p  18 min         0                  yes                 150 min - shush pat to put to sleep
***I think she is confusing night and day

8/11
2:50a   skip           70                  no                    none
7:20a   skip           70                  yes                   none
11a      skip          57                   yes                   10 min
1:50p  skip           55                   yes                    none
5:10p  4 min         40                  yes                   none
8p      14 min         0                   yes                  none
11p     1 min         skip                 yes                  none

8/12
2:10a   skip           60                  yes                  none
5a        6 min         skip                no                  none
7:50a   10 min        30                 yes                 none
11:25a  8 min         15                 yes                 none
2p        skip            70                yes                 none
5p        skip            54                yes                  10 min
8:10p    3 min        52                 yes                 none
10:40p  13 min      30                 yes                   70 min
*again confusing night with day?!

8/13
2a       skip           80                   yes                 75 min
6:30a   10 min      30                  yes                  90 min
9:30    8 min         30                 yes                 none
12:45   4 min        30                 yes                   60 min
4:10p   8 min       30                  yes                 none
7p        skip         70                  yes                 none
9p        8 min       skip               yes                 none
11p      skip          70                yes                 none

8/14 * I decided to increase amt to try to increase calories during the day
2a      skip             80              yes                 none
6:43a  11 min        25               yes                 75 min
9:50    6 min         40               yes                 70 min
1p       2 min         45               yes                 20 min
4p       7 min         0                 yes                 40 min
7p       skip           80                yes                 40 min
9p       0 min         40               yes                 none
10p     skip            60               no                  120 min
 (more food = less sleep???)

8/15
1:20a  skip            80               yes                  5 min  (yeah broke the 2am 'habit', maybe)
5:45   15 min        skip              no                  none
8:45   15 min         40               yes                 none
12      1 min          40                yes                  90 min
2:50p  4 min         45                yes                 none
6:15p  skip            80               yes                 none
9:05p  skip             80              yes                 5 min
11p     2 min           80             yes                  none

Ok....I think that should give you an idea of what I am doing.  Overall, we are doing great!  We are paying attention to avoid accidental parenting and she is on a regular 3 hour routine.  Maybe my expectations are too high for sleeping longer at night.  I really can't complain but do believe in always striving to improve.

DH and I are both want to teach her independent sleep.  Earlier this week we moved her from her cradle in our room to her crib in her room.  Her doctor recommend this to help her sleep longer at night (said she can't smell us during the night in her room which would help).  She usually doesn't mind her crib unless she is wide awake and wants our attention.  I think she is learning the "I want to be held" cry.

A few more bf questions for Samuel's mum...  I believe she has a good latch because I use the shield and it doesn't hurt.  Sounds stupid but when I bf she always has it leak out of her mouth and she gets wet...is this common and will it stop as she gets bigger/better at bf? 

One side has a lot more milk than the other, I can not see a trend of her eating more/less on that side.  I know it has less based on the pumping.  Ironically, it was the side that pumped the most at the beginning so at some point it switched.  Is this to be expected?  Will it switch again?     

Thanks for all the support!
 
         
   
 

[Samuel's mum]

If she needs to eat every 3 hours then do you feed on demand and go back to EASY the next day at 7am?  I am letting her sleep until she crys that she is hungry then I feed her about every 3 hours.

Basically at night you do 'feed on demand' to a certain extent as she will wake up when she is clearly hungry. When she's a bit older you can experiment with trying to settle her to sleep without feeding her but if she is waking and is clearly hungry then I would feed her. At night it's not 'EASY' as she goes back to sleep straight after/during the feed. This is normal.

Sounds stupid but when I bf she always has it leak out of her mouth and she gets wet...is this common and will it stop as she gets bigger/better at bf?

To be honest it shouldn't be leaking out while she is feeding as a good latch is airtight (that's one of the reasons bf babies are less suspectible to gas/wind). I would ask your LC about this. It's a great idea to get help with weaning off the shield. They are a complete hassle and can sometimes affect your baby's ability to stimulate your supply.

I have been reducing my supply as I have a freezer full of milk.

Don't forget that pumping isn't just about getting milk to store it's also about milk production. Some people pump to keep up their supply and don't even keep what they pump.

One side has a lot more milk than the other, I can not see a trend of her eating more/less on that side.  I know it has less based on the pumping.  Ironically, it was the side that pumped the most at the beginning so at some point it switched.  Is this to be expected?  Will it switch again?

It's really common for a bf mum to have a more dominant side when it comes to milk production. It might switch again. Mine always stayed one side.

HTH