Slow Weight Gain With A Premature Baby – What To Do

Reading Time: 6 minutes

Babies born under 37 weeks gestation may have challenges gaining weight during the first few weeks home. 

These challenges are easy to fix by following the five simple steps I explain below. (If your baby was not born prematurely, click here to find the right plan for your baby.)

Step #1 Check If Baby Is Oversleeping

I know it’s a bit surprising, because generally speaking you don’t want to wake up a sleeping baby. However, there are times where you should not let your baby oversleep.

I’ll explain.

If your baby is sleeping too long, they are not breastfeeding enough. And by not feeding enough, they actually start having less and less energy.

This forms a negative loop, because when a premature baby under 6 weeks becomes too tired to feed, they just keep sleeping.

So how do you tell if your baby is sleeping “the right” number of hours, or sleeping too long?

Ask yourself two questions:

1. Is your baby sleeping for more than 6 hours straight in a 24 hour period?
2. Is your baby having six or less breastfeeds in a 24 hour period?

If you’ve answered “yes” to one (or both) of these questions, it’s time to wake your baby. Don’t worry – it’s for their own good because they need more feeds!

This will not just get your baby back on track with weight gain, it will also help fix their sleeping routine because they won’t be so tired all the time.

So until your baby is 6 weeks old, I recommend you follow these four simple rules until your weight issues have turned around!:

1. During the day, wake your baby up every 3 hours
2. Allow 4-6 hours sleep at night.
3. Remember only one big sleep (6 hours maximum) each 24 hours.
4. Fit 7-8 breastfeeds in a 24 hour period.

Once your baby is over 6 weeks, the rules slightly change:

1. During the day, let your baby sleep up to four hours straight.
2. At night, allow one big sleep – 6-8 hours
3. Fit 6-8 breastfeeds in a 24 hour period.

Again, only follow these rules until your weight issues have turned around! (Usually it only takes a week or two!)

IMPORTANT SAFETY NOTE: If you can’t wake your baby up to feed – then it is time to get some help from your Doctor. DO NOT DEALY. Get your bub checked out today!

Now that you know how to make sure your baby doesn’t get into a negative loop over being too tired to feed well, and then sleeping too much because they’re so tired, let’s look at step #2.

Step #2 Check If Feeding Sessions Are Too Long

As odd as it may seem, letting the breastfeeding sessions go for too long can cause just as much problems as one that runs too short.

What I’m describing here can happen with any premature baby, yet is more common with those who wake well (and sometimes seem to be awake all the time!)

Here’s what you should look out for.

In the first six weeks, your baby only has enough effective energy to be awake one hour at a time. What I mean by that is that after one hour of being awake, their body needs the sleep before they can effectively suck milk again.

Which means that during the first six weeks, breastfeeding, changing your baby’s nappy, and settling them back to sleep should all happen within a one hour window. 

This doesn’t come naturally for many babies. So some pre-planning will be called for – which is what I’m here for! Here’s what you do:

• Use both sides at a breastfeed (sometimes you will do both sides twice!)
• Watch your baby sucking, usually your baby will get tired after about 15-20minutes.
• If your baby is getting sleepy you can squeeze and HOLD your breast while they are feeding. This can push more milk in when they suck.
• Once your baby gets tired they will either come off themselves or you can take them off.
• Change their nappy during the break. This will naturally wake them to wake up for another go at the breast.
• Start with the other breast for about 10 minutes or less. Once you see your baby sleepy again, take your baby off.
• If your baby stays asleep – then off to bed. If not, pick a side and your baby can have a third go.
• All done, off to bed – all in under one hour! Yay you!

A little tip: If your baby is so tired they only manage five minutes on the breast before falling asleep, that’s ok. Take your baby off when asleep, and allow them to wake again and get back on. This is ok. If that’s all your baby can manage at this time then that’s all they can manage! 🙂

By following the above key points you make sure your feeding sessions are more effective – and soon slow weight gain will be a thing of the past!

But there’s one more thing you can do to help make sure your baby gets more ilk every time they feed without you needing to change anything!

Step #3 Help Baby Take More Milk – Simple Trick

By following steps 1 and 2 you have maximised your baby’s time at the breast, and made it as effective as can be. Your baby’s ability to take milk has already increased!

In this step, we will help your baby receive even more milk every time he breastfeeds.

We want to make it as easy as possible for your baby to remove milk from your breast. Because the easier it is, the more milk baby will take before getting tired!

And here’s something fascinating.

The more milk you have in your breasts, the easier for your baby to remove it and put on weight!

So the solution is simple… We need to tell your body to make more milk! The more milk you have, the more milk the baby will take (even without changing any other factor!)

And how do we do that? By expressing more milk – over and above breastfeeding. Here are my guidelines:

• You can express by hand or pump.  You will find all the how-to’s on both in this blog post
• Express during the day, after your baby breastfeeds.  Leave the night time for resting and for breastfeeding your baby!
• Expressing for 10 minutes each side is enough. Every mother will get a different amount.  Have a go and see what you get.  
• Don’t be disappointed if you get nothing. This does not mean there is nothing there!  Your hand or a pump is not as good as your baby sucking. Any extra amount is great for your baby!

Once you begin expressing, your body will immediately start making more milk (even when you get very little when you express!) This milk is available to your baby, who will now be taking more milk without getting any more tired! WOW!!!

Step #4 Do You Need To Top Up?

An obvious by-product of expressing milk is… that you have more milk on your hands! What should you do with it?

Should you give your baby this extra milk? Or would adding a bottle into the mix confuse them? As always, I’m here to give you the simple answer!

When I consult a mother with a premature baby who now needs to gain more weight, I look at how close to the mark the baby is.

If the baby doesn’t need to gain too much weight, I don’t recommend adding the expressed milk.

A bottle adds confusion to the flow of each feeding session, because you need to intervene, take the baby off the breast, and give them the bottle instead. When the weight gain problem is not serious, the benefits of the extra milk are outweighed by the fuss.

This changes when the gap from the mark is bigger. Then, topping up with your own milk can be a game changer.

If a baby under six weeks is not back to birth weight by three weeks, I would be giving them extra milk in a bottle.

After that, babies should put on average 150 grams a week. Anything below 100 and I would be topping up as well.

If you’re borderline, the simplest thing to do is TRY!

Try following steps 1-3 without giving your baby the extra milk in a bottle. Weigh them again after a week, or even after 3-4 days. If the pace is still unsatisfactory, it’s time to add the bottle at the end of the session.

And here’s the right way to do it to minimise stress and confusion:

1. Make sure the teat you use is marked with “slow flow” or for “newborns”.
2. If you don’t want to use a bottle, you can give your baby extra milk using a cup, syringe or supply line. (It is best to get some help with these ways, call or text me 0414 403 208 and I’ll walk you through it.)
3. Top up with the extra milk after the breastfeed. Breastfeed for 45 minutes, then give the bottle in the last 15 minutes of the feed before they go back to bed.
4. Don’t worry about offering the bottle at night. Offering it at the end of feeding sessions during the day usually does the trick!

While on the topic of giving your baby extra milk, it is normal to think about using formula. If you are, here’s a blog post I wrote for you about finding the right balance.

Step #5 Are You Seeing Enough Poo and Wee?

By following steps 1-4 you should notice an increase in poo and wee. And now you’re at step 5 – where we measure the results of your hard work!

And since breasts don’t come with a gauge yet, the closest thing nature gives us for measuring how much milk your baby is taking is…

Counting nappies!

All you have to do is count nappies, and compare to the amounts below:

• Wee: 6-8 times a day (or their nappy will be wet at each change.)
• Poo: This is a little less frequent than wee but still DAILY. On average a baby 5 days to six week will poo three times a day. It will be yellow and soft.
• A baby over 6 weeks will wee as above, but poo less. You may not see a poo every day. 

I have written heaps more on poo and wee! Check out my blog, Is my baby getting enough milk?

Meeting the poo and wee requirement is the BIGGEST sign your baby is getting enough!

Remember, slow weight gain can happen, especially if your baby is born prematurely. Following the five steps above should turn things around in no time.

If not getting back on track, or have any question whatsoever – don’t hesitate! Give me a text or call 0414 403 208 for a free 15 minute phone consultation. I look forward to hearing from you.

Loretta