Can a 6wo old really get a decent BF in 7-8 minutes? confused by cues

[FiThomson]

Hi

I am beginning to doubt my BF capabilities and am after some advice. My daughter has been very sleepy since birth (7 weeks prem so still -1 week age adjusted) and has generally always fallen asleep during BFs, but has generally been managing 12-15 minutes before being completely zonked out. The last two days she has generally only been feeding for 7-8 minutes before falling asleep and nothing I can do rouses her enough to get her back on. Sometimes, generally at night, if i put her down to sleep she will wake 20 minutes later and want back on but will be asleep again within a few minutes. Other times, she seems happy with the short feed and settles.

My problem is that I then start to doubt she had fed enough so feed her earlier than I would expect her to otherwise (was regularly going 3-3.5 hours before) but then she will only take another short feed and I am not sure if this is because she is not really hungry yet or if she is, but again gets a good feed in such a short time. I begin to doubt her cues and take her being unsettled at 2 hours + to mean she wants more food but then she might only take a tiny feed again. 

I admit I am not very good at 'going with the flow' so am getting frustrated with not knowing if she is getting a decent feed - on top of this, as she was prem and is still tiny (just under 4 and a half pounds) I worry she feeds too short a time to get a decent amount of hindmilk and that this will affect her weight gain. Can she be getting a decent feed in such a short time, and if not, any tips on how I can get her to take a better feed at each session rather than snacking?

Thanks

Fiona

p.s. I should say we have only been fully BF for last 2.5 weeks as, while in SCBU, she got a mix of BF and EBM via tube and then bottles.

[Samuel's mum]

It is possible she is getting a full feed in only 7-8 minutes but because of her size we obviously need to be cautious. I would try and extend the time if you can and see what happens. And try and respond to her hunger cues when you can. If you get yourself into a pattern where you worry she might not have had a full feed and then you offer early - the cycle continues.
What kind of routine are you using? When she falls asleep during the feed how long has she been awake for at that point? Are you using EASY?

I would start by trying to make the feed as effective as possible. The aim is to get one breast drained as fully as possible, using breast compressions would be helpful (see the FAQ board), using techniques to keep her awake like taking off clothing and pausing to burp and change a nappy (there's another FAQ on sleepy babies). Even if she's not sleepy it might be helpful to pause and burp and then put her back on to the same breast. Are you ever double-sided feeding? If you offer the second side just be cautious that the first side had a really good go.

In hospital no doubt she was on a very clear routine. Her intervals were probably long (like 3.5-4hrs which is what happens in hospital) and perhaps you imagined that routine could be sustained at home. At home fully breastfeeding it would be rare for a baby of her age to continue with her hospital intervals. 2.5-3hrs is pretty standard. 2 hr feeding intervals aren't unusual - perhaps even more frequent during a growth spurt. Because of her history she'll be having a lot of those. A mum who has had a baby in SCBU sometimes returns home and feels they have done something 'wrong' when intervals seem to get shorter and shorter but in fact this is VERY VERY common and it's what happens when a baby starts to behave naturally.

You mentioned that you are not very good at 'going with the flow' and it can be scary for someone who appreciates a routine to find timings are all over the place. But truthfully even with a very solid EASY timings WILL be changeable. It's important for your milk supply and for her growth that you do respond to hunger cues and try to put the clock to one side as much as you can bear. You'll see a lot on these boards that baby whisperer is a 'routine' and not a 'schedule'. As she gets older timings will become more predictable. And you will get more confident about reading her cues. Unsettled at 2hrs+ might well be overtiredness and her seeking the breast for comfort in order to fall asleep but of course it's difficult to say. That wake up after 20 minutes sounds like a classic 'jolt'and she's not so much waking up hungry as looking for comfort to get back to sleep. Are you swaddling? Ask around on the sleep boards about the 20 minute wake-up.
2 hours+ in the day - That's quite a long time for her to be awake. Have a look at some of the newborn routines on the EASY board. Many newborns feed and have a nappy change, a little bit of a look around and then it's time for sleep.

So I would try and devote time to becoming more confident about reading her cues and trying to feed on cue. That should be what happens within an EASY routine anyway. Try and follow your instincts. It's not 'going with the flow' to develop your maternal instincts but something that gives you a much greater sense of control and empowerment. And as she gets bigger and time goes by you will find it easier to develop a routine.

But to answer your simpler question again - she might be getting a full feed but because of her history I probably wouldn't risk it and I would get stuck into the breast compressions, offering again after a pause and trying to feed to cue.

[FiThomson]

Thanks for your help.  She was weighed again this morning and has gained 6oz in a week which the HV is very pleased with and makes me more confident she is getting enough nourishment and through to the hindmilk.  I have been offering the same side when she feeds for short times and then wants more soon after in an attempt to make sure she is getting through to it.  She rarely seems to need the other side at the same sitting.

I must have been unclear in my post as she is never awake 2+ hours.  It can be as little as 20 minutes (including feeding) and as much as 1 1/4 hours (again including feeding) but probably averages 45 minutes.  We are following EASY as much as possible, feeding her when she wakes hungry and then doing nappy change before heading back to sleep - a quick nappy change is about as much A time as she can handle at the moment.  In fact our day consists of nothing more than feeding, nappy changes and settling off to sleep, repeated every 2.5 to 3.5 hours depending on when she seems to want to feed.

I think you are right that the return from hospital where she was on a 4 hour schedule makes it a little harder.  Having a 2yo and having BF before (albeit only for 2.5 months) I expected to BF on demand but think I have been thrown by the fact that for the first 2 weeks she was home she fed solidly for 15 minutes + and then slept through to her next feed at 3-3.5 hours.  It is in the last 3-4 days that she has started this short feed cycle.

I am going to try the breast compressions to encourage her to take more at a feed but maybe she just gets too sleepy and we will have to stick with the short feed, little doze, another short feed pattern until she can manage to stay awake for a little longer.

Thanks again for your advice.

Fiona

[x95stocchier]

I also wanted to say that my DD fed consistently for only 8 min from about 2 wks and has gained very well and very fast.  (she was not premature, though).  But just to say some young los can get enough in a short amount of time....do you have a quick letdown?  ...espec if you bf before, you might have a quick letdown and she's not wasting time getting things going.  My lo is getting milk within 30 seconds on the breast, so she can get a feed pretty efficiently.

DS was a different story, I often worried he was hungry because of a short feed or a lazy feed, and I got into that cycle of too many short feeds in a day.  Once I stretched him out to a 2.5 to 3 hr EASY, I was a bit  more confident he was not hungry, but needed sleep, comfort, or whatever.  Once you start to see good gaining and gain a bit of confidence in her EASY, I think the fear will subside some.  But as pp said, with her age/size/history, you'll want to be a bit careful and take that into consideration.

[Samuel's mum]

That's good news about the weight gain. That tells you everything you need to know. Sorry I got the wrong end of the stick about the A time. I thought that was a bit extreme!!