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Question Regarding Feedings in NICU

My niece was recently born at 34 1/2 weeks. She has been in the NICU for one week. My sister in law is pumping and taking the milk to the hospital. The hospital sticks to scheduled feedings which I personally have never done with my three children. I assume possibly things are different with a premature baby. My brother has witnessed them feeding her and then forcing the rest of the milk to her through the tube in her nose which she then spits up. They won't let them take the baby home until she stops spitting up. My sister in law is getting discouraged thinking it is her milk. I personally think if she was fed on demand, things would get a lot better. My mother has been there and she woke up crying and they would not let them feed her. Then when it was the scheduled time to eat, she didn't want to. I feel she is spitting up due to her little stomach not being able to handle all the milk they are giving her so quickly. I would love to hear any experiences because they are getting very discouraged at this point.

UPDATE: MY NIECE WENT HOME TODAY. I HAVE NOT GOTTEN ANY DETAILS OTHER THAN THAT. AGAIN, I APPRECIATE SO MUCH EVERYONES WORDS OF ENCOURAGEMENT. I HAVE LEARNED A LOT FROM THIS SITUATION THROUGH THIS WEBSITE AND FOR THAT I AM VERY APPRECIATIVE!

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I wanted to thank everyone so much for their responses. I was hoping to be educated on how things work with premature babies and your responses have been very helpful. I have told my brother that I don't know what to tell him because I imagine everything is different due to her being premature. I will share the responses with my brother and I am sure it will help reassure him that as hard as it is to watch, it is all in the best interest of the baby. The reason I posted this question was because my mother went to see the baby last night and they had to force the milk on her and then she spit up. She said my brother and sister in law just broke down in the waiting room because they don't understand it all and want her to come home so badly. Again, I think these responses will help them and I appreciate everyone taking the time to answer my question.

I am new to this site and don't know how to update things yet but I wanted to again thank all of you so much for taking the time to respond to my concerns. It means so much and it has helped me. I wasn't very detailed in my first request and wanted to let everyone know I have not said a thing to my brother or sister in law about my concerns. I would never do that unless I thought the baby was in danger. The reason I posted this request was for myself to get educated on the differences in premature babies and term babies. My hopes were that things you all said from experience would put my brothers mind at ease that everything was happening exactly the way it needed to. I told him already that I don't know what to tell him because I assume it is all different due to my niece being premature. To try to answer a few questions, she was born 5 lb 12 ounces. I really don't know how much they were feeding her - it was just hard for my brother to witness it. I am a firm believer that there is no way we can "guess" what someone is going through if we haven't gone through it ourselves. My heart truly goes out to all of you that have gone through having a baby in NICU because I don't know what that is like. I am so glad to hear all your positive results and I truly thank you all for taking the time to share it with me. I am really glad my friend recommended this site for me to ask my question because the responses and concern has been amazing. My brother did call me yesterday very ecstatic that they have taken my niece off of the scheduled feedings and are on a "to go home" schedule where they feed her on demand. The hardest part of all this was my brother and sister in law had such concerns with the way things were going but for some reason, they would not ask questions. I am just thrilled - she must be getting better and I am really lucky to have found this website.

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My last child was delivered at 32 weeks and spent 22 long days in the NICU. And I pumped my milk and took it to the hospital everyday as well, but he kept spitting up. Once we took him off the breast milk and put him on Soy he was fine. Today he is five and can have regular milk like all my other children. Good Luck with whatever you decide to do.

C., I think you may be right about the feeding, but the hospital has to stick buy some sort of schedle SP. othe hospital would be a mad house..talk to the Dr. and see if the family was there why cant they feed there baby.just my thoughts. good luck with the little one.G.

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i am a nicu nurse. premature infants cannot be fed on demand. they do not have ability to store sugar for calories like term babies can. they must be fed on an every 3 hour schedule. it is a calorie "game" with them. i understand that it seems that she is being "forced" to take the other milk. she must receive sufficient volume with a sufficient number of calories in order to grow. spitting up/reflux is a very common problem in premature infants. that will not delay her discharge. she must, however, be taking all her feedings by mouth and gaining weight in order to go home.....which will more than likely be around 36-37 wks gestation/adjusted. 34 "weekers" are not suppose to be eating yet...they should still be in utero. your sister is doing the very best thing for her. her breast milk is the best food for her and the easiest to digest. the nicu "experience" is a process. it is difficult and frustrating at times. just encourage your sister and know that the people taking care of your neice are very knowledgable and trained in their very specific specialty. questioning and challenging them in front of your sister could cause her more stress than she is already enduring.

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Hello:

I am the mother of a six year old that was born at approx. 29 weeks and spent approx. 49 days in NICU before going home. My daughter was gavaged (sp?) which is the tube down the throat during some of the stay. With all due respect I would suggest that you not express your contradictory opinions to the new mother. Watching my child struggle and being on pins and needles every three hours when they would weigh her diaper to see if she had enough "output", or if she might have gained just 1/2 ounce in a day or two was enough stress without having more stress and doubts added by folks (well intentioned or not) questioning the NICU staff and doctors actions. NICU babies are fed on schedules in part because, like my daughter, most are born with no natural instinct to suck or eat, so when every day is so important to a premature baby's ability to thrive or not, it's important to "force feed" the infant even if 2/3 or more of it comes back just to keep the status quo for the life of the child. Also many premature babies have lots of intestinal/stomach issues which cause the "spit back". My daughter's intestines weren't fully developed (lining and such), so moving my breast milk through the intestines was difficult which caused a "back up" at the other end. By all means, however, if your sister-in-law is expressing doubts or questions, encourage her to speak with the NICU doctor. The fact is that your sister-in-law is doing the most wonderful thing she can by providing her breast milk b/c any NICU doctor will tell you that even in the fragile state most premature babies are, the use of breast milk (even donated from the milk bank), is so much easier on the baby and causes less "stress" to his or her little still developing system. There were many of days and nights I cried over being hooked to the "hospital grade" double pump wondering if it was even helping her, but when I saw how the other premature babies who were not using breast milk were having even more eating/intestinal troubles it made me resolve to stick with it. ;-)

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Hi C.,

My little one was born on time, but had to go to the NICU because of complications during birth. She was in a level 3 NICU at memorial hermann and they basically stuck to an every 3 hours feeding schedule. They would give Abby 30 minutes to eat as much as she could and then she was finished regardless of how much she ate. She didn't have to have the feeding tube, so I don't know what to tell you about that. I don't think she'll get the nurses to change their policies on their own; she's going to have to speak with one of the NICU doctors. Abby was fed only by the bottle (she was too lethargic to learn how to nurse until we got home, but she did learn) and the strictness was on the time, not the amount. Does your brother know when the doctors make rounds? If we had any questions, we would always try to be there for their rounds, that way we got the info straight from the doctors and we could voice any concerns or questions directly to them. I hope your little niece gets to come home soon--I know how hard it is to have a baby in the NICU.
God bless,
Leslie

my son was born at 34 weeks to the day and he spent 2 weeks in the nicu he could not come home till he learned how to eat on his own. what they do is they put all the babys on a 3 hr feeding sch. they started him off with half an ounce threw a nose tube that led to his belly. when we started every other feeding as bottle feeding what he didn't finish was put in through that tube. i was told that he not only had to eat on his own he also had to be able to hold down at leat 2 ounces without spitting up. this is to make sure they are getting enough to eat. as impatient as i was and as much as it hurt to not have him home i stuck with it and 2 wks to the day he was home with me. tell your sister-in-law to be strong her baby needs her to be. i was with some moms who had been there months one mom had been there almost 3 months. I will keep her in my prayers and i understand what she is going through let her know she is not alone we nicu moms have to stick together. my email is ____@____.com

Well, I have experience on both ends. I am a mother of two who were both premature. One at 34wks and one at 35 1/2 wks. Both stayed in NICU for one week +. Plus i have worked in the newborn nursery/NICU as a nurse. Babies that are admitted to the NICU are all on feeding schedules until they are closer to be going home and then they are fed on a looser schedule that is closer to how mom and dad would feed them. That's not to say that a baby who gets hungry before his time to eat doesn't get fed, because that's not the case. Another thing is that the babies need a certain amount of calories per day in their feedings. The neonatologist will usually order like 10cc or 20cc every 3-4 hrs. If the babies don't tolerate that amt. they could run risk of losing weight and having a orogastric or nasogastric feeding tube placed until they are able to tolerate nipple feedings (where they are fed through a tube that's down the mouth or nose). There can also be intestinal reasons why babies do not tolerate their feedings but I would address these with the doctor. If the feedings are continually spit up or not tolerated by the baby, I would notify the doctor and ask them about it. I am not clear on why this baby would need OGT feedings at this time. The way we did it was if the baby went through quite a few feedings that were not tolerated or that were just not taken by the baby due to sucking issues or other medical issues like breathing problems. Every baby is different, and they can eat anywhere from 5cc to 45cc of milk. My 34 weeker started out eating only 3cc every 3-4 hrs. This amount per feeding is usually increased 5cc every few feedings or as tolerated. But do know that just about all babies do spit up to some degree, especially preemies because their little muscle at the top of the stomach that is for keeping food in, is not developed completely. You just have to know the difference between spitting up because they overeat and the pressure in their little bellies builds up before burping or the nurse if actually forcing them. And remember the nurse is doing as the doctor ordered, BUT it's also the nurses' resposibility to notify the doctor if the baby is not tolerating the amount of feeding that the doctor ordered. Hope this wasn't too confusing. Hope it all works out. Do reassure the mom that this is nothing to do with her. Breast milk is always better for baby (and mom as far as bonding goes) It is only a VERY VERY SLIM possibility that the baby could have allergies to her breast milk. The overfeeding issue should be ruled out before i would even begin to address a breast milk allergy ( which is much less likely than other complications). Best wishes to mom and baby!!

I am a mom of a NICU baby. Your sister in law needs to ask when she can visit with a doctor. It was 3 days before I visited with a doctor. I asked a nurse while I was there for a feeding. I did have to wait b/c he was in rounds. The doctors are more than willing to explain everything about your baby. Once I spoke to a doctor I got a better idea of why my son was there and what obstacles he would need to overcome in ordered to be discharged. (The hospital also provided info on the the NICU it explained terminology and policies etc) My baby was in the NICU for 16 days. I nursed and pumped. If your sister in law feels like it is her milk then have her remove dairy from her diet. I was overwhelmed when my son was in the NICU. It is very difficult to grasp b/c as the mom you want to be the ultimate care giver and you have to let other people care for your baby. Then, your are frustrated b/c your baby isn't healthy, or breathing correctly, not big enough etc. I would guess that they have her on the schedule b/c she needs to gain weight before she goes home. Our experience was wonderful and very positive despite the circumstances of our son's birth. I loved all of the nurses and they had the best interest for each and every baby there. We were at Houston Northwest Medical Center.My husband and I hold a very special place in our hearts for all the nurses in the NICU unit.

I had a baby at 32 weeks and had to pump. My baby was fed the milk with droppers. You might ask the nurses why the droppers are not being used. Say a prayer as will I and the baby should be keeping his milk down better. It is not unusual for premies to spit up. My son did this the first two years of his life.

T.

I am a mom to a preemie born at 25 weeks and after 130 days in the NICU I have some experience :) From my experience I have found that the NICU and its nurses (the neonatalogists are part of the process too, but I'm referring to the more every day NICU experience) have one goal: to get the child home in a satisfactory condition for the child's pediatrician and other specialists. This satisfactory condition hinges largely on weight and calorie intake. As a mother yourself you are familiar with the growth curve and percentile measurements of weight and height that pediatricians follow so diligently each and every time your little one goes into the office. In a hospital setting the best way to guarantee such a condition is to feed on a schedule. My guess is that your niece is fed every three hours. Also many preemies are simply not in a condition to be able to only be fed on demand (if they are struggling to learn to breathe, maintain their own body temperature, etc). All in all, the thought process may initially seem harsh but the goal is weight and calories, weight and calories...all with the child's best interest in mind (I promise). With this in mind, the nurses, neos, and NICU in general are always trying to push the amount being fed a little more. For those little ones, like mine, who are learning to nipple (eat from a bottle) they get close to eating a whole bottle and then the amount per feeding is increased...what could be more frustrating?!
Has your niece's doctors or nurses discussed the possibility of GERD or more simply reflux? In such a little one the doctors cannot always perform the tests to definitively diagnose GERD, but there are other signs that may be enough to cause suspicion (baby arching their back, etc). The spitting up could be caused by reflux (GERD). In addition I assume that whether NG or OG (nasal or oral feeding tube) the additional milk is being processed through a pump of some kind. If so, then perhaps the remaining milk is going in too fast and your brother and sister-in-law can discuss slowing down the remaining milk. Delivering the calories needed is a struggle (even once they get home) and if your brother and sister-in-law are concerned that their daughter is being fed too much too soon, they should ask. I, by no means, am a confrontational person and I prefer to assume that the doctors and nurses are right and have my child's best interest in mind (which I'm sure they do), but I learned to be a little bit more questioning in the NICU. If in doubt, ask. Your brother and sister-in-law are paying good money (whether from their own pocket or through insurance, trust me, I know) for the care of their daughter, and NICU nurses and doctors are there to answer questions and make sure their plan is understood by the parents. Afterall, when these doctors send the little ones home, it is the parents that must be prepared to care for them.
I hope I've been helpful and concise. The NICU experience is an emotional one and no one can leave without having some very strong emotions and beliefs about said experience. Thank you for being a support to your family.

Hello C.,
I am a mother of a preemie baby and my son was in the NICU for three weeks before he was able to be released to come home. With my experience, a lot of preemies have reflex that will sometimes go away after time, and then sometimes they will send her home with a RX for help. My son was fed through the nose for the first week and a half and they they were giving him about 2 Tablespoons of milk at a time. They may have to feed your niece through the nose because she may not be able to handle nursing from the bottle yet. It takes much energy for little ones to suck from a bottle. My son was really healthy when he was born, but he did not have the instinct to nurse because they do not get this until they are about 36 weeks or so. Please tell your sister in law that they best thing that she can do for her daughter is to keep pumpng. They get much more from the mother's breast milk than they can get from formula. If your sister in law is stressing over this, it may also be more harder for her to produce the milk that she needs. They best advise that I can give the parents is to ask many, many questions on why they are doing things and the nursing staff will be glad to answer any questions to put the parents at ease. it is not easy having a newborn in the NICU and not at home.
I will the best of luck and things will get better as time goes on!
J.

Have your sister in law request to talk to the Speech-Language Pathologist and/or Occupational Therapist about the feeding schedule and amount to be fed. Also, she should talk to the pediatrician about her concerns!

Hugs!
J. - an SLP

My daughter was born at 35 weeks, and she was in the NICU for about 1 1/2 weeks. They would only feed her through her nose because her suck was not developed enough for her to complete a feeding and/or her lung development was not complete, so she would tire before finishing a feeding. In other words, (after the first few days) they would try to give her a bottle or let me nurse, and then if she only had an ounce or so, they would complete the feeding through her nose tube. My recollection was that they use scheduled feedings because it is necessary with shift changes, etc. If my daughter was upset, however, they would go ahead and feed her early. They also did not wait until she stopped spitting up to release her. There are three factors that they looked for (1) she was gaining weight, (2) she could breath on her own, and (3) she could eat on her own. Once she was released, I fed her on demand.

It was an incredibly difficult time for me and I remember getting a lot of conflicting advice from the doctors and nurses. I finally learned that my pediatrician would be the one to determine when my daughter could be released. I would encourage your sister-in-law to meet with her pediatrician (or a neonatologist if that is who is in charge of discharge) and discuss her concerns. She also should demand to be given time to try to nurse the baby herself or at least provide "kangaroo care" where she gets skin-to-skin contact with the baby. Good luck to your family.

I hope things get better. My niece was also born at 34 weeks but they fed on demand and she did great. Maybe they should get a second opinion from a doctor and not the nurses. They are probably just stuck in a routine.

The nurses are only doing what they are told to do. Unfortumately, hospitals do make mistakes. I would talk to whoever is takes to get the feeding perfected. This is your sister's baby and she should be able to feed and hold anytime she likes. Have you ever heard of "the sqeeky wheel gets the greese?" Well, I would certainly speak up if I were your sister and brother-in-law. This is bonding time for mother and baby. I say, don't deprive the mother of this valuable time.

What hospital are they at? I had 25 weeker twins at Texas Children Houston. I feel like we got great care in the NICU. They were more than accomidating and they let me feed and hold anytime I wanted. If I told them not to feed my babies because I was arriving to feed them, they would make that adjustment for me. Level 2 is where I had a problem. They fed my babies without me and they separated my babies and moved one to a very crowded, non private location. This made it very difficult and frustrating for me. I instantly found out why they moved one of my babies and it was because the hospitals CEO's baby was "moving in" (straight from delivery). I'm sorry but I had TWO babies and they were in NICU nearly THREE months. I didn't care if the President of the United States' baby was moving in, I wanted my babies together. This one change caused me grief and my baby was moved back with his twin within the hour.

Please speak up about "anything". This precious child does not belong to the hospital.

I feel for your sister. I hope things work out for the best for your family.

God Bless!!

I can empathize being the mother of a 33 week gestation preemie that was in the level 2 nursery for 5 weeks. She is now a healthy almost 4 year old so although it is a very scary time, she will make it through this and thrive. I am sure it seems that they are force feeding her but the feeding schedule they keep is to keep her body nurished and to make sure she is getting enough calories. Even though she is spitting some of the milk up,(or prjectile vomitting like mine did) she is retaining some as well. If they fed them on demand, the babies would more than likely not get enough calories and nutrition. A preemie is totally different than a full term baby and may not go by the "rules". Reflux is common in preemies due to the fact that they are not fully "cooked" yet so the digestive tract still has issues. When they finally tried the bottle feeds, my daughter hated the tube feeds but they had to go back to alternating because the babies just do not have the strength it takes to bottle feed every three hours. The energy they use wears them out so they may sleep thru their next feeding which makes it appear that they are just eating when hungry. Many times reflux is a reason to keep the babies longer because when they reflux, they can aspirate the formula into their lungs which can cause pneumonia and other problems. It can even cause them to choke and turn blue when the baby is sucking the bottle because their suck/swallow reflexes are not fully developed if they try to bottle feed the whole time because it wears them out so easily. I know it really does look like they are just getting too much food to handle but they have to monitor the feedings on a strict schedule and monitor the reflux so they can determine the causes such as an allergy or just one of the preemie symptoms.There are so many issues that may seem minor but when happenening together can cause more problems for the baby. If the parents have questions, tell them to most definately speak with the doctors. I had a great experience being forced into an unknown situation. I was eventually forced to stay away and get some rest for myself (cut down the visits to once or twice a day) after i was hospitalized for severe mastitis and exhaustion. I realized I had to take care of myself so I would be well when she came home. She did come home after 5 weeks (it was extended a week because of anemia which required a blood transfusion) on an apnea monitor to be on the cautious side (and sanity of the parents in my opinion) and has grown into a wonderful energetic toddler. She was on reflux medicine until about 8 months old and still had reflux and vomitting a few times a day but continues to grow and gain weight. They will learn what their child needs and works best for them when they are released from the NICU but until them the doctors and nurses do the best they can to get them strong enough to reach that point. My advice is to not rush anything and be patient. As hard as it is to leave your angel in the hospital, it is better to have them stay an extra day or two for precaution than to have them send the baby home early and develop complications which will land her back in the hospital.
For the advice on forcing them to release her by signing an AMA, I STRONGLY advise against this ( I am an RT and work in a major hospital) because if they were to do that on the baby or any patient for that matter, the insurance has the right to not cover costs if the patient suffers any complications or develops a new symptom due to the early release agaist doctors advice. If in the end, you truly beleive you are not getting the best of care, request a second opinion from another physician or the last resort, to be transferred to another hospital that agrees to take you on as a patient.I don't mean to not ever question your care or your gut feelings,just ask tons of questionsand I am sure the staff will make you feel more comfortable. I hope this helps your family through this time and watch out because i always heard that preemies are the most fiesty little headstrong kiddos because of their will to fight to catch up in the beginning and boy, is it ever true! My little one is on the go 24-7 with a zest for life and I would not have it any other way, even though some nights after she was home,in my sleep deprived stupor, I thought about calling the nurses and asking them to get her back on that sleep/feeding schedule that worked so well at the hospital, because waking up every hour was exhausting! (but so worth it!)

Dear C.--The first thing you need to know is that premature babies don't do anything the way full term babies do. It is critical that they receive enough nourishment, but many of them don't have a sucking reflex yet or enough hunger to stimulate their appetites. What the nurses are doing may seem cruel or harsh to you, but it has to be done to ensure that the baby gains enough weight to begin to thrive.

My son was born an 33-1/2 weeks gestation. He was so tiny (less than three pounds), and all he wanted to do was sleep. (Of course! He was supposed to be in my tummy still!) He had to be jiggled and shook, and the nipple of the bottle had to be thrust in and out of his mouth until he latched on to it. Even after we got him home (when he was 6 weeks old), we had to fight to get him to eat. If he couldn't take a certain amount of formula (I had no milk) within 30 minutes, I would have to quit trying. After 30 minutes, a baby spends more calories than he consumes in trying to nurse. If he started losing weight, I would have to take him back to the hospital--an awful prospect.

Anyway, my advice to you is to trust the nurses in the neonatal unit. They know what they're doing and what's best for the baby. She may be spitting up because her digestive tract isn't mature. Premature babies have it so hard. They have to develop outside the womb when full-term babies have safety and security until they're ready to be born.

I appreciate your concern for your new little family member. My prayers are with her and her Moma and Dad.

C.,

My son was also a premature and I pumped the milk and went to feed him. She is your baby and you can feed her when she needs to be fed. Your milk is the best thing she could get. They told me my son would be slower than other babies and that I would have to set my alarm to feed him because he would forget to wake up. Well let me tell you they were wrong, I did stop breast feeding and had to get a special milk but other than that he has grown up and is now a father himself and a Marine SRGT. What I trying to say is you should go with what you feel because you are her mother. Talk to your doctor. My son only weighed 4lbs. and you couldn't even tell now that he was ever that little. They did tube feed him when he was in the hospital but only every other time because he was working so hard that he would loose weight. If she is eatig then they shouldn't be doing both in my opinion. And my son always woke up to eat and I fed him what he could handle and then he would wake up again later. I thin we all should only eat when we need to. Sorry you are having these problems and I hope it all works out for you.

S.

C., I think you may be right about the feeding, but the hospital has to stick buy some sort of schedle SP. othe hospital would be a mad house..talk to the Dr. and see if the family was there why cant they feed there baby.just my thoughts. good luck with the little one.G.

The job of the nurses and doctors in the NICU is to get your niece to the weight of a full-term baby. They feed her at set times because "you" are supposed to feed an infant every 2 hours, rather they want to or not. We, as mothers who get the privelege of taking our children home, and at our own discretion, feed our children when we know that they are hungry. You might suggest to your brother that the NICU staff alter her feeding schedule a bit. They probably won't because they are the "experts" and we are the know nothing people. My nephew was in the NICU for the first 3 months of his life because he inhaled meconium during his delivery. The bottom line is these experts don't know everything and if the childs parents are distressed by the treatment they have the right to demand changes. I hope that I helped.

I am the mother of a former 24 week preemie. I am also a speech-language pathologist by profession. I understand your anxiety as well as your concern. Reassure your sister that her breast milk is not the reason her daughter is spitting up. Your neice needs her mama's milk for many reasons. The NICU will keep the scheduled feeds to keep tract of the PO intake (per oral). From your description - I would presume they let your neice suck for so long - then the rest is given thru an NG tube. This is usually "easiest" on the staff by letting gravity come into play. With a preemie - not necessarily so. While calories are the up most important for weight gain - and brain growth - their stomach are not necessarily ready for such a rapid intake. 2 suggestions - put the remainer breast milk via a pump - this gives ml/a certain time. Also make sure the head of the Isolette is raised to reduce reflux. It is difficult to go against gravity. Also, ask for Human Milk Fortefier - this is a powered agent that I used to fortify and add calories (24 calories per ounce)to my breast milk. Make sure when they NG the remainer - they are puttting a pacifier in your neices mouth. She needs to make the connection - sucking - feel full. This is called non-nutritive sucking and is vital for PO feeds/breastfeeding at a later date. Please feel free to contact me if your sister or you have any questions. Keep the pacifer near her and use constantly. Preemies have problems coordinating the respiratory triad - suck, swallow and breathe. This will help her coordination without desating and with feeds later on. I will keep your family in my prayers. God Bless. ____@____.com

I have 3 children born years apart. I had a baby born 6 weeks early and I never put him on a regular feeding time, like I hear of today. He did just fine. I only feed him when he woke up on his own. I agree with you it may be to much milk. But did they ever tell you just how many oz of milk the baby was getting before force feed? That would be very important information to know. They usually only drink about an 1 oz at a time first. Anyway all three of my children did just fine not putting them on the new feeding times, sometimes I wonder what doctors are thinking and they need to be the one getting up on that same time table and they would think different. The mother also needs her rest so she can take care of the little one.
My neice said with her first child she did everything the doctor said and when she had her second child came she used her common sense and the baby did just fine.
Use your mother instance and question the doctors and talk to other mothers you will find that mothers are very knowelgable.

I've worked in the NICU for 2 1/2yrs and that is the regular routine. All premies are feed through the nose the SAME WAY!! Its not that they are not able to handle all that milk in their stomaches,if they can't hold it down, since they are prematures, they can have other issues. Its not to be disencouraging but its the truth, especially with premies.If everything is alright, she can handle that and more!!! Because they are premies, they HAVE to be on a strict feeding schedule, they have delicate tummies. I've seen worse and almost at their death beds and make it to weigh 8lbs. Miracles do happen and I've seen it with my own eyes!! Have faith and miracles will happen.

My youngest spent a week in the NICU when she was a day and a half old. I had to breastfeed due to her relux problem. There was never a question on when the baby needed to eat or if they were feeding her. How often is your sister in law there wi/ the infant? if she was there and it was time to feed they wouldn't be able to tell her she couldn't feed her..i understand staying in shifts though. they kicked me out the first night saying i needed to keep my strength so i could take care of her when she came home to me. she couldn't handle formula, so i had no other choice but to breastfeed. i fed her when i was there and i pumped before i left. i pumped when i got home. i did all i could for her. Breast mix was the only way for her. We had a million test ran on her while she was there and left with an apnea monitor which she stayed attached to until she was 9 months old. i was so scared of losing my baby. but, i will say the NICU nurses were incredible with my little girl. My nephew however had a nurse that got too attached to him. he was born way early, and only weighed four pounds. My sister in law had to struggle to keep the baby with her when that nurse was around. She wouldn't allow Lindsey to do much with him when she was there. But in the end it all worked out. There may be some medical reason they are doing what they are. How much does the baby weigh? that could also have something to do with it..

We went through this but not the spitting up. Anything we had a Q about we spoke with the neonatologist who is the specialist in charge of preemies in the hospital. Have they requested to speak with him/her or found out who the md is? The pediatrician has no dealings at this point until the baby is released from the hospital based on my knowledge and experience.

Maybe the hospital is different. They need to ask q's and not get discouraged and only focus on getting that breastmilk to the baby. Everything else sounds very familiar and normal to me except the spitting up and not getting the necessary info from the hospital staff.

My twins were born at 33 weeks. What they do in NICU has a lot to do with the newborns weight...with their ability to suckle, and with their weight gain over time...It also has to do with any other problems the newborn may have had at birth besides low weight...(i.e lung problems, apnea, etc)

My son was under an oxygen hood for 3 days do to a lung disease, he wasn't even allowed to get breast milk or formula, he simply was given IV fluids to keep him stable during this time...IT was so hard to even look at him let alone touch or be around him without bursting into tears at that point.

My daughter started of much stronger. I was able to hold her and breast feed her right away..But...because of how early they were breastfeeding is excessively exhausting on their little bodies so I was only allowed to do so for 10 min at a time and only every other feeding. It was put on hold when my children were discovered to have jaundice and had to be put under the special lamp to correct it.

While in NICU I noticed that the only children being fed through a tube where the one that were unable to suckle on their own regardles of whether it was their mothers' breast or a bottle (and the NICU has special bottles for their smaller infants).

They are probably trying to encourage your neice to eat more to gain weight so she will be able to leave the NICU. My question to you is...Why is your brother asking the nurses in the NICU these questions? They should be forthcoming with the answers and if he doesn't get answers he likes he needs to tell them he is not comfortable with what they are doing to his daughter and he wants them to work with his family more to help his daughter come home. If he still does not get a response he likes then he needs to bring the NICU doctor into the conversation to find out why things are not including his family and why they are seemingly making his daughter suffer to "get her better".

Let me know how it goes.

Good Luck

Please contact a local lactation consultant, ASAP!

The nurses are going by the doctor's orders (pediatrician), so that is the person your niece really needs to talk to. I have heard of mothers being allowed into NICU; they had to go through a screening and sterilization process, but they were allowed in!

This pediatrician is definitely one I would not want doctoring my children!

My first daughter was born at 35 weeks. She spent 10-11 days in the NICU. And yes, I remember pretty scheduled feedings. I would go and nurse her when I could at visiting time and then pump constantly it seemed to have ebm on hand when I couldn't be there. Please tell your sister in law to hang in there. Your niece will be able to go home and then she will be able to feed her when she chooses - it is not a piece of cake but it is so much easier when the baby gets to leave the NICU and be home with Mom and Dad. I wish I could give more advice on the spitting-up part but my daughter didn't really do that. Good luck and congrats on your new niece.

I have had four preemies and since you feel better about it now I hate to tell you this. but this isn't normal. At her gestation (now almost 36 weeks) she should not be tube fed. They tube feed only when the baby cannot suck a bottle (Sounds like she is sucking) and when they feel too busy to take the time to feed her.

Are they inserting the tube every time or just leaving it in there? The trauma of having it inserted could make her spit up. Also, she might be full, and spitting up because she is full. She might have reflux which is common in preemies but not a reason to keep her hospitalized UNLESS she is loosing weight instead of gaining it, in which case she should be on GERD meds.

Which hospital is she at? I deliver at The Women's Hospital and have lots of problems with the NICU- they wanted to keep my babies there even when they didn't need to be there and made up excuses. When my babies were holding their temp they would not transition them out of the isolette, even though they need that to be able to go home. In fact, they weren't even giving my breastmilk. Every time I went my breastmilk was STILL in the freezer! And they wouldn't let me nurse in the NICU- I had to wait until after the baby came home with me and by then the baby was so attached to a bottle refused to nurse.

As for feeding on demand, that would be what's best for the baby AS LONG AS it's not longer then three hours between feedings and make sure she eats X ounce of formula in a 12 hour period. The nurses just can't do that. They have too many babies to feed, they have to be on a schedule. However, if mom wants to do it, she can make sure she stays up there as much as possible and feed the baby smaller amounts (whatever the baby will take) and more frequently. A baby with reflux should be fed this way anyway. The staff will say that she can't do that because of their 'schedule' but it is HER baby and she can feed the baby if it is medically safe to do so. She can tell them she will have the baby transfered if they don't 'get with it.'

You might also want to checkout the www.ivillage.com message boards as they have a preemie board. http://messageboards.ivillage.com/n/main.asp?webtag=iv-pp... There you can talk to lots of women who have NICU and preemie babies.

S., preterm labor at 26 weeks with my angels,
Faith delivered at 32 weeks, lost the tube feeding at 33 weeks, Hope delivered at 34 weeks, never tube fed, Grace and Job delivered at 36 weeks no tube feeding

having a baby in the NICU is a scary thing in its self
My son was born at 33 weeks so I completely understand the discouraging portion. However, for the time being the baby needs to be on a scheduled feeding because she is way to little to let remind herself that she needs to it. Her little body is having a hard enough time remembering to breath right now. The best way to get the baby from spitting up is to burp her constantly again because her little body can do it on its own. The second is to position her correctly or comfortably for her when she is feeding. Then when she is done and ready to go back to sleep lay her up at an angle where her head is a little higher than everything else. I dont know if this will work for you neice but it worked for my son

My daughter is now 12 yrs old. She was born at 24-25 wks and stayed 72 days in NICU. She is great now with no problems-vision is the main concern. I can't remember the amount of food but I remember I was lucky if I pumped enough to fill one of those NICU's bottles! I kept on and was so glad the day she finally got to take breastmilk. I did not get to breastfeed her long when she came home but I know that helped her to be a healthy child. I started going late at night (after 8 pm) for my visits-the nurses were not so hurried and everything seemed calmer. One nurse offered to let me hold her "skin-to-skin". That is the day she started getting better faster and came home w/in 2 weeks. They are right when they tell you they will come home around the original due date. She had to be eating on her own, breathing on her on and weigh 5 lbs. I would also advice her to go to the library and check out books on preemies-Max Lucado has a good one. I can't find any of mine right now to remember the titles. Another word of advise is to keep a diary/log of visits and what is said at each. She needs to listen to what the hospital says but also listen to her own voice but don't be so assertive she makes the NICU angry. They are partners in this until she is released!

I can tell you little about the baby's medical condition, as my experiences in that regard were very different. However, my children did both have medical problems at birth, and while mommy's breast milk is best for baby, the longer the baby is away from the breast, the harder it will be to successful transition to the breast from bottle feeding. I think you are right that the baby needs to be fed on demand, and there will be less spit ups. It took me several weeks and several lactation consultants to get my son on the breast, all the while pumping, after just one week separated from me in the hospital. I hope your SIL is a very determined mother who will keep trying untill she is successful, as there are few things more important than the nursing relationship with mommy and baby.

My first child was born a early, 2 days late to be called premature. She was in NICU for 8 days until I finally forced the issue and took her home. They wouldn't let her go home until she stopped "gagging". The day she was supposed to go home, she was given something orally and gagged on it. The nurse noted and it and therefore stopped her from going home. I waited until the doctor came and told him what happened. Then I asked...What are you doing for her that I can't do at home? (I had already taken the class that they wanted us to take in order to take her home and she was going home on a monitor.) The doctor couldn't give me a sound reason to answer my question. He then released her. I don't know if they were waiting as a precaution because they didn't think WE were ready for her? I don't know. My second child wasn't going to be released because the doctor was out to lunch for over 2 hours. My husband and I insisted on signing a medical release form without the doctor's consent (which you have every right to do). It's called AMA form (against medical advice). They amazingly found the doctor to release him. They have their rules, which are appropriate and should normally be followed. But, they don't have control, you or rather your brother and sister do. I learned this through experience. They can't even hold a patient against their will, though they will try. They did this with my grandfather as well. They have to do what they think is best, but we as parents have do to likewise. Your brother has every right to take that child home, especially if the ONLY reason is her spitting up. Give me a break, my daughter also had reflux and spit up all the time. It's not a reason to keep her in NICU. They will have to insist on it and be strong enough to stand up for themselves no matter what. They will also have to be strong enough to handle the consequences if something goes wrong later on and not "blame" the hospital for giving in to them, etc. If they are that type of people, then they shouldn't do this. I don't approve of people making their own decisions and then blaming someone else if something goes wrong later on. Anyway, that was my experience and I wish I had been told all of my rights sooner, or I would have taken my child home sooner to be in a much more loving atmosphere. NICU is only doing what they are trained and told to do. Fight the system, not the nurse.

My son was born early and stayed in the NICU for 2months. He was on a schedule as well and it worked just fine. I expressed milk for him in which I fed him through a bottle then I beging to actually breast feed him. If you have these concerns address the nurse or supervisor. They will better be able to answer your questions. Having a baby in NICU is hard enough without all the added stress.

As a mom who has had 2 kids in NICU it is a very difficult time for everyone in the family. How much are they feeding the baby? I know that they have to be able to eat so much per their body weight. Please let your family know especially mom and dad that if they have any concerns to ask and ask until they get an answer that makes since to them, talk with the nurses and the doctors. If you have anymore question please fill free to ask.

K.

C.,
From what I read of your post, these are your feelings, and at this time, with a little one in the NICU (niece) we tend to run high on our feelings. I have never personally had a baby in the NICU and I can't even begin to think how hard it would be.
I am a postpartum nurse and have occasionally worked in the NICU at our hospital, on the babies that are about to be discharged as I have not got the knowledge or experience to look after the really tiny babies. Our NICU has an NNP (Neonatal Practitioner) there at all hours that you are able to talk to. These nurses (NICU nurses) want to do what is best for the babies, they want to see the babies go home and be loved on. The NICU nurses had a baby die a couple of months ago and we all heard about it and they were shattered. They all cried and had a debriefing session, to talk about it and everything, nurses are not robots we have feeling too. What a lot of the posts have said is true, a lot of premie babies have very immature systems and the Dr's do what is best for the baby (remember the hypocratic oath - do no harm) they take this seriously. I get the feeling from a lot of people, that they think that the Dr's and nurses are deliberately trying to harm the babies.
Also premies get tired very very very easily, just the act of trying to feed tires them and they can shut down and not want to eat. Any sort of over stimulus (just the act of trying to suck on a breast or bottle for 5 minutes) can cause them to want to sleep for 2 hours till the next feeding. They keep them in the isolets a lot as this is kind of like being in the womb (no stimulation - low lighting - low noise - warm) Over stimulation is very harmful to premies, they can lose so much weight from this.
Granted your sister-in-law and brother need to touch and hold their baby so be there for the feedings so that they can do it then.
As for the nurses not having time to feed the babies so they do it on demand because it is easier for them, with the really sick and very premie babies the nurse ratio is 1 to 1 and sometimes 1 - 2. This may seem low but they want to be able to do the correct feeding and monitoring of the babies, this would not be possible with a higher ratio. They also have a Charge Nurse, who can if a nurse is busy can feed a baby or do something that is needed for that nurse(baby).
Enough said. These nurses are very dedicated people and want what is best for your baby (niece) too.
It also sounds like your sister-in-law and brother really needs to have a good talk to the Dr to get the right information. Sometimes parents don't understand(that is totally understandable) as they haven't been to medical school. Get down and talk with the Dr as the nurses why they do this and why they do that. Get more involved and ask questions this is one of the best ways to get informed, if it doesn't seem right then question it. The best way to feel like you are there helping your baby is to get involved, be there, pump that precious breast milk(it is absolutely the best thing for your niece to be eating - unless there is a problem and the Dr's will inform you of that)ask lots of questions, get lots of rest and prepare for the day that that precious baby will come home.
I may seem harsh but nurses and Dr's are there to help and I see so many parents come in with a bent against the nurses and Dr's. Approach this in the right way and it can be a very positive experience instead of a negative experience.

Best of luck to you and your brother and sister-in-law and your precious niece.

I know this may be a little late, but there is a chance that the baby cannot mandle milk (not breastmilk, but cow's milk) my son did the same thing till I stopped all dairy products in my diet for a week, then I gradually brought them back, it worked for him, no one else thought of this, it took a visit to a co-worker that was a lactation consultant talking sabout him and she suggested this. No matter what, it is NOT HER MILK, but it MAY be the cows milk in her diet, never hurts to try, right?? Preemies are more senstive to those foods that have a high rate of allergic reactions than others (nuts, wheat, cows milk, etc. Try it, it may surprise her, if not, you found out that it is not that, and she can go back to normanl eating habits in about a week or so.

Good Luck

Mary

All babies are individual and unique and preemies are even more unique. Even though she is not extremely premature, she is at the gestation where most babies just start to organize the whole suck, swallow, breathe thing. She is getting the amount of milk she needs to grow adequately at this point. If she was allowed to feed on demand she would probably not wake up very often due to her gestation. I know it is an extremely hard to handle situation and the parents feel like they have no control over their own child. Honestly as a nurse that has worked with these babies for years the doctors and nurses have her best interest at heart. The things you have described are normal for a preterm baby but they may want to talk to the doctor about the spitting up, she may have reflux!

Two of my daughters were premature and I pumped.
Yes they did try to feed them thru a tube also.
I would talk with the Peditritian, the Dr. is the
one incharge not the nurse. New babies need to be feed
on demand not schedule, that's later down the road.

Oh me this is so typical of the "know it all nurses".. First off this is your sis-in-law and brothers baby THEY DO have control. Tell them DO NOT let the nurses go against their wishes. When it all comes down to it we are in control. I know it has been this way for years, most people just do not know or choose not to exercise their rights. My son and daughter-in-law went through the same thing when their oldest was born they told her when and how much I walked in the hospital room and she was crying when I ask what was wrong she relayed to me that they would not let her tend her baby as she saw fit.I told her NO MAMM that is your child next time they come in and TELL her about his feedings tell them to bump a stump. Needless to say she took control and the rest of their hospital stay was pleasant. BrendaS

My last child was delivered at 32 weeks and spent 22 long days in the NICU. And I pumped my milk and took it to the hospital everyday as well, but he kept spitting up. Once we took him off the breast milk and put him on Soy he was fine. Today he is five and can have regular milk like all my other children. Good Luck with whatever you decide to do.

C.,

You have to remember or maybe you did not know; You and your husband have the right to agree or disagree to the care of your child.

As far as the feeding schedule you can tell the hospital how to feed. If it is something the hospital cannot accommodate then as long as you or an authorized care person ( you your husband your mom, even your sister in law instead of having to pump if you and her like, whomever the parents decide) is there to feed they cannot deny your request as long as it is not life threatening even then it can go to the hospital board.

Make sure when you talk to someone about complaints about the care of your precious one it is with the Doctor not the nurses (Doc writes the orders not the nurses. Nurses can only follow Standard Operating Procedures SOP's that are good for most not all.) In order to get specific written orders for your precious one you MUST have the doctor change the orders.

Make the doctor explain in complete detail so you understand why all care is happening. Don't let the Doc tell you they know what is best. Explain to the staff that your child's care is a group effort between you and the hospital staff. Make sure you understand why any proceedure including the tube feeding or just bathing is done. Let all involved in your little ones care know you are in charge, after all you are paying them for thier care.

These are all your rights as a parent. Most hospitals don't really want you to know this.

I am the mother of a preemie who is know a healthy 24 yo and it took a lot of challenging with the doctors to let him grow and develop at his own pace and not the "Standard Procedures". It also takes a lot of work from the family. The hospitals will sometimes do what is easier for them rather what is best for the individual child. It takes your active participation to get what is best for your baby.

I wish you the best.

J.

My son was born at 28 weeks. He was just over 2 lbs. I had to pump for a total of 5 months. He didn't get the whole "suck-swallow-breath" thing down for a while, plus he would spit up. He would have major reaction after some feedings. In fact, for a while, they thought he might be allergic to my milk. He eventually got it, and did great.
The thing is, premature babies really are very different. The nurses are doing everything right. For them to have to tube feed in order to finish the bottle is the right thing to do for now. It's scary, but it sometimes has to be done. Every calorie counts.
It takes a while for a preemie's system to catch up. Let your sister-in-law know that she's doing the right thing by pumping, and don't let her get discouraged. Let the nurses do what they do best. They are guardian angels sent to protect the most vulnerable creatures in the world.

C.,
My friend had a very simular issue with her son who was born 3 months early. It turned out that her milk was having a chemical reaction with the plastic bottles the NICU gave her for pumping and storeage. They ended up changing to formula and he did fine. Another option could have been trying glass bottles. Good luck to your sister in law.

My oldest daughter was in the NeoICU for several weeks (she is 14 yrs now). They know what they are doing with regard to premees (sp?). It is a difficult, discouraging time. The spitting up does not have anything to do with your sister-in-laws milk nor on demand vs scheduled feeding. This should be discussed further with the hospitals pediatrician. There are also some books on premee care now that they did not have when my child was a premee. Premees are different that normal babies,and you sister in law needs more information. She should also interact with the NCIU staff more and just casually talk to them when she can. This will help, as well. Good luck. You all will survive, but it seems like the longest time in the world before the baby can come home, but it will happen.
Good luck.

i'm so sorry that you are having a hard time. my son was born at 34 weeks, and it is tough.

Please encourage your sil to keep pumping. she needs all the help she can get. extra pumping bottles, help washing and storing and transporting the milk, help at home and help getting sleep and eating well.

it is just a tough, tough time. but breastfeeding is a job that only she can do, and the best thing she can do at this time. it's just a time to do the best you can, take it one day at a time, until it is just a memory.

your neice will be fine. i know it is scary, but my son is now a rough and tumble, 3-year old boy.

Hi My son spent 15 days in the NICU at TCH and they did keep him on a very strict feeding schedule. But If I were your sisterin law I would ask why she still has a feeding tube in if she can nurse? I personaly don't understnad why you would tube a kid that can suck. I'm a speech therapist as well and once a kid gets sucking down there is no other need to tube them unless they aren't eating enough to sustain life, but as long as she's getting at least 2-3 oz every 2-3 hours she's ding great in my opinion. I would suggest your sister be there when the dr. does rounds next time and talk to him.
hth
J.

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