What to do if your baby is not gaining weight well while breastfed?

How premature? Degree of maturity of the newborn

Typically, the baby's body weight is very dependent on the stage of pregnancy. A premature baby is significantly different in appearance from a full-term baby. Premature babies, in addition to low weight and height, are characterized by disproportionality in their physique, their skin is more hyperemic (red), their bones are soft, and there may be non-fusion of cranial sutures. In girls, the labia majora are underdeveloped (they do not cover the labia minora), and in boys, the testicles are not descended into the scrotum.

If a child is born with a body weight of less than 1.5 kg, then he is considered very premature, and with a body weight of less than 1 kg, a child is considered a fetus. To determine the severity of prematurity, in addition to weight and gestational age, other signs are taken into account, such as the presence of pathological conditions, compliance with the degree of maturity, the presence of diseases in the mother, etc. Determining the degree of maturity is a very important sign.

Modern medicine is improving specialized care for such children, and even in the most severe cases there is every chance of even a very premature baby being born.

The degree of maturity is determined by the child’s reaction, the presence of reflexes, the state of muscle tone, motor activity, ability to retain heat, etc. Even premature babies weighing about 2 kg, if they are healthy, can be quite active, have good tone, reflexes, be able to suck, etc. Children born with a body weight of about 1.5 kg can suck from a bottle by the first week of life.

The situation in children is much more difficult if the woman’s pregnancy was fraught with complications and the child could suffer, for example, from intrauterine hypoxia. Such children are usually born in a more severe condition. The most difficult babies are considered to be those born with a body weight of 900 g or less. Despite the apparent severity of the health of these children, doctors have experience in caring for children even with such a body weight. Due to the immaturity of many internal organs and the risk of developing pathological conditions, a premature baby is immediately given a set of measures in order to create the most optimal conditions. After birth, the baby is immediately sucked out of mucus from the upper respiratory tract, and mucus from the stomach can also be sucked out. If the child does not breathe or breathes poorly on his own, he is given artificial ventilation. The baby is also given the necessary medications to maintain his health.

Depending on his condition, the child is placed in a specially designed incubator. The design of the incubator allows you to create a microclimate inside it that is suitable for a premature baby. The temperature is set depending on the degree of prematurity of the child, and air humidity must also be regulated. The incubator allows you to monitor the child’s condition and carry out many manipulations without removing him from it. The length of stay of the baby also depends on the child’s body weight, then the child is transferred to an open incubator, and then transferred to a specialized department.

Data on the physical condition of premature newborns, taking into account gestational age (G.M. Dementyeva, E.B. Korotkaya)1

Premature baby: finally home!

Premature birth is a serious stressful situation not only for the pregnant woman, but also for all members of her family. Your baby, born prematurely, so small and defenseless, needs long-term nursing and treatment, which usually begins in the intensive care unit. Sometimes, from the moment a child is born until the moment he is discharged from the hospital, there are months of intense struggle to preserve life and stabilize his condition, months filled with anxiety for the baby and hope for his recovery. And finally, your baby is home! Of course, you will receive all the necessary recommendations for the care and outpatient treatment of the child from the attending physicians. By following these recommendations, you will help your prematurely born baby adapt to home conditions and ensure his catch-up development. We want to help you with practical advice on caring for a premature baby at home.

Doctors fought with all their might to preserve breastfeeding for your child: they asked you to pump regularly and bring milk to the department where the baby was lying; they were allowed to put the child to the breast if his condition allowed. We hope that you managed to maintain lactation and will successfully continue to feed your baby breast milk at home! If not, don’t be upset! Modern adapted milk formulas can provide normal nutrition to a premature baby even with artificial feeding.

It is very important to organize a protective regime for your baby. At first, your friends, acquaintances and even relatives who do not live with you should limit contact with the child, and it is best not to visit you during the period when the child is adapting to new living conditions. When creating a favorable environment for your baby in your home, you must understand that noise and passive smoking (that is, inhaling tobacco smoke from a smoker’s cigarette in the room) are contraindicated for premature babies.

Your baby should be regularly monitored by a pediatrician at your place of residence. It is very important to establish contact and trust with the doctor. In this case, you can always get the necessary help and professional advice on caring for your baby. Most likely, your child will need help not only from a pediatrician, but also from doctors . Most often, premature babies have problems with several body systems at once and are observed by a neurologist, ophthalmologist, pulmonologist, gastroenterologist and other specialists. Your local pediatrician should promptly refer the child to a specialized consultation to receive recommendations on how to manage the child on an outpatient basis, and, if necessary, for hospitalization in a specialized hospital.

Another major problem in managing a premature baby is timely vaccination , which protects the baby from infectious diseases. While your child was in the hospital, where there was a struggle to preserve life and adapt to extrauterine existence, a medical exemption from routine preventive vaccinations was justified. In the future, there is no point in delaying vaccination of your baby, or even abandoning it completely. Modern combination vaccines will protect your premature baby from serious problems associated with severe infections that can be life-threatening. Of course, to begin vaccination, which is carried out on premature babies according to an individual program for each patient, permission from medical specialists is required, first of all, from a pediatric neurologist. In addition, during the autumn-winter season, it is necessary to vaccinate adult family members against influenza, that is, carry out the so-called cocoon immunization to protect the baby from severe infection that adults and older children can bring into the house.

The most important component of the recovery process in the first year of a child’s life is timely comprehensive rehabilitation , carried out in multidisciplinary centers with the participation of a team of specialists who determine the scope and duration of this rehabilitation. It should be carried out according to an individual program for each child and include methods of physical influence (physical therapy, massage, physiotherapy) and psychological and pedagogical correction.

According to the recommendations of a family psychologist , the main efforts should be focused on establishing a clear daily routine for mother and child, as well as correct and thorough implementation of medical recommendations. The child’s recovery process largely depends on this. Make a detailed schedule, keep a record of all the medications that the doctor recommends that you and your child take during the day, mark the medications you have already taken so as not to confuse anything. Even if at first it will be quite difficult for you to carry out all the procedures at the same time, in the future the efforts that you direct to following a clear time schedule will help to establish biological rhythms for the baby and his faster adaptation and recovery.

Learn to recognize your child's social cues and develop their psyche. After all, in order to grow healthy, the baby must feel the continuous warm and close attitude of the mother. Try not to accustom him to holding hands, do not rock the baby for a long time. As soon as the child falls asleep, immediately put him to bed. From the first days of your baby’s stay in the house , develop his social behavior and skills, do not reinforce pathological manifestations with your actions: crying, motor agitation, passivity in the constant presence of the mother, etc. Try to communicate with your child as often as possible: while awake, during feeding and during hygiene procedures. Minutes of communication will be the child’s first experience of developmental activities: looking at toys and faces of loved ones; touching various objects and the mother’s face; listening to lullabies and musical fragments; stimulating the baby to respond vocally. Communication with a child, as the highest manifestation of love for him, should be based on a tireless desire to learn about his individuality. Such attention to the child’s emotional sphere and its changes creates the basis for deep mutual understanding between children and parents in the future.

When communicating with a child, it is necessary to use various types of contact: speech, touch, emotional and facial interactions, joint actions with objects. Conduct classes in a calm atmosphere, accompanying them with melodious conversation, stroking, a gentle look and a smile. When addressing your baby, call him by name more often. When communicating with your child, reinforce simple phrases with expressive intonations. Try to make communication feel like a conversation by encouraging your child to respond verbally and repeating after him what he just said. Make sure that the child’s movements during classes are accompanied by an additional effect associated with new tactile sensations, sound reactions, and visual control.

When stimulating a child’s motor activity, it must be borne in mind that it is improved during repeated repetition of the same movements, improving their coordination. When conducting such classes, it is necessary to have free space and the participation of the mother in conducting exercises with the baby. Children born prematurely will benefit from a set of exercises combined with a massage performed by a specialist. It is important to use a surface of different textures: a soft mattress, a hard changing pad, inflatable rings, balls or pillows - with a change in the position of the child, including the fetal position, the position on the back, on the side, on the stomach, on the knees and sitting. Using these tips will help you stimulate your child's exploratory activity and interest in the environment. Place the baby on his stomach more often on surfaces of varying hardness (mother’s stomach, inflatable ring, changing pad). Such a change in the baby’s position is a training of the vestibular apparatus, strengthens the back muscles, encourages him to raise his head and keep it in an upright position. Remember that the baby’s nervous system is quickly depleted. Therefore, the duration of emotional, physical and sensory stress should not exceed 3-5 minutes.

Try to maintain a positive emotional state during communication , because it directly affects the child. Take every opportunity to rest and sleep. Be sure to take time to care for yourself and meet your needs. Many women believe that they need to devote themselves entirely to the child, forgetting about their own needs. No matter how strong this motivation is, this behavior is not entirely correct. The lack of variety of impressions, comfortable home conditions and familiar social surroundings gradually depletes internal psychological resources and interferes with the fulfillment of maternal responsibilities. Despite all the joys of motherhood, accumulated emotional stress causes a feeling of chronic fatigue. If you are unable to cope with your emotions on your own, or periodically experience attacks of acute anxiety, irritation or melancholy, then you should seek professional psychological help . According to the standard of medical and social care, parents of a premature baby can seek advice from specialists at any time: pediatrician, early childhood teacher, family psychologist, social worker and others.

Doctor of Medical Sciences, Professor Davydova Irina Vladimirovna Doctor of Pedagogical Sciences, Corresponding Member of the Russian Academy of Education Svetlana Borisovna Lazurenko

Advice for parents of a premature baby

• Your child is still a little different from everyone else, but over time and with your help, he will be able to catch up with his peers in his development.
• Fight for breastfeeding, it is very important for such babies
• Particular attention is paid to nutrition; such children eat more slowly and usually in smaller portions, but somewhat more often than full-term children. The interval between feedings should not exceed 4 hours.
• Premature babies are easily susceptible to infections, so you should carefully monitor the cleanliness of the room and limit the number of people who want to visit the baby at first.
• At first, doctors do not recommend putting such weakened babies to sleep on their tummy; it is better to place the child on his back.
• When swimming, the water temperature should be at least 37°C
• In the room where the premature baby is located, the temperature should be about 23-25°C. — Sterilization of bottles and nipples is mandatory for such children; try to follow this rule, especially in the first months of the baby’s life.
• Premature babies benefit greatly from a special massage that can be performed by an experienced specialist. After consultation, parents can perform simple massage techniques on their own.
• Complementary foods and vaccinations are prescribed strictly on the doctor’s recommendation, after assessing the baby’s condition.
• Be sure to follow all the doctor’s recommendations; if necessary, immediately call a doctor at home or an ambulance.

When a premature baby is discharged from the hospital

Children born prematurely stay in the hospital much longer than their full-term peers. Depending on the child’s condition, the duration of stay under the supervision of doctors can range from 7-10 days to 6 months. The decision to discharge is made by the doctor, assessing the baby’s condition. In order for the baby to go home, he needs:

• have no developmental difficulties;
• show stable progress in weight gain (over 3-5 days);
• be able to retain body heat;
• breathe independently, eat;
• weigh more than 2.3 kg.

Another important parameter for the discharge of a premature baby is the parents’ ability to care for the baby and the ability to provide him with all the necessary conditions.

Weight of the premature baby and degree of prematurity

Approximate body weight of the child at different stages of pregnancy:

Depending on body weight, the child is assigned a certain degree of prematurity:

1 Zaitseva M.L., Uzunova A.N. Features of changes in basic anthropometric data in children born prematurely. Pediatric Bulletin of the Southern Urals, Chelyabinsk, 2015.

Height and weight in the table

When born, premature babies differ from their timely born peers in weight and height. The shorter the gestational age at which the baby was born, the lower the indicators.

Weight and height of a premature baby at the time of birth, depending on the week of pregnancy

Babies born before 34 weeks are characterized by severe immaturity of the digestive tract, so their nutrition and rate of weight gain are very different from those of children born before this period.

Children born from 27 to 34 weeks have an immature pulmonary system, so in most cases they breathe with the help of a mechanical ventilation device (ventilator). Such babies are fed through a tube for the next 3-4 months.

The degree of prematurity of the child largely determines the rate at which he gains weight and height in the following months. The immaturity of the nervous, pulmonary, and food systems does not allow the baby to quickly gain the treasured grams in the first months of life. But by 3 months the processes stabilize, and by the age of one year the baby catches up with peers born on time.

Table of weight gain and height of a child during the first year of life, depending on the degree of prematurity

Average weight of children in the first year of life depending on the degree of prematurity

The table of average weight gain and height for premature babies during the first year of life shows approximate figures obtained statistically. Each child is individual and develops at their own speed. It is recommended to focus more on the recommendations of pediatricians and specialists, taking into account the specific situation and the characteristics of the baby.

How to feed a premature baby

We will not talk about parenteral nutrition, that is, nutrition through a dropper, since this area of ​​nursing is exclusively under the responsibility of doctors. Let's talk about how to properly feed a premature baby when he is already able to digest food.

“The best solution would be mother’s milk, this is not even discussed. And here there are two news: good and bad,” says pediatrician Olga Tatarkina.

“The good news is that the female body, which gave birth to a child ahead of time, produces milk that is completely unique in composition. It is even more nutritious, more saturated with essential microelements, proteins, and fats, than the milk of a woman who gave birth at term.

This milk has a very high energy value; it both heals and nourishes. It is impossible to overestimate its importance, so we advise mothers to do their best to stimulate and maintain lactation after premature birth.

The bad news is that due to early labor and stress, the mother does not always produce milk or does not produce enough milk for the baby. In this case, it is necessary, without stopping attempts to establish lactation, to supplement the baby with formula. And it must be a special mixture for premature babies.”

Low birth weight babies – who are they?

In the mother's womb, all children develop according to the same laws of nature, of course, if nothing prevents them from doing so. But some babies are born big, while others are too small. They are called low birth weight because their birth weight does not fit into generally accepted norms. Such babies who were born at term, but with low weight, are often diagnosed with “intrauterine growth retardation.”

Separately, we should consider such a concept as a premature low birth weight baby. These babies are usually born weighing less than 2.5 kg and require special attention and care. Premature babies gain weight and develop in general according to separate, specially developed standards. They begin to hold their heads up, sit up, crawl and walk later than their peers.

As a rule, babies who were born small continue to be reluctant to gain weight. This problem is of great concern to their parents, as it may indicate deviations in their physical development.

What is different about a premature baby?

Outwardly, babies born prematurely resemble small chicks due to the discrepancy in body proportions:

• large head and short limbs;
• height less than 45 cm;
• the skin is red;
• an abundance of vellus hair on the body;
• the baby's ears are anatomically pressed to the head;
• the posterior fontanel, located on the back of the head, is open;
• muscle tone is reduced.

In case of deep and extreme prematurity, the following signs are added to the above signs:

• the nipple of the breast does not stand out above the skin level;
• grooves on the sole are present only on a certain part;
• nails do not completely cover the nail bed;
• anatomical underdevelopment of the genital organs: in girls, the genital opening is not covered by the labia, and in boys, the testicles are not lowered into the scrotum.

However, the problems of prematurity are not only deviations in appearance; the problem lies in more serious issues, immaturity in the development of organs and systems.

central nervous system

At birth ahead of schedule, the central nervous system does not have time to go through all stages of development, therefore physiological reflexes are characterized by rapid extinction, accordingly, thermoregulation is disrupted, tone decreases, and pathological reflexes develop.

Respiratory system

Due to the premature birth of the baby, the lungs are not able to expand on their own due to the lack of a substance that helps expand during the first breath and is called surfactant. In the absence of this substance, respiratory failure syndrome develops and infections occur. Such a critical condition requires urgent resuscitation measures.

The cardiovascular system

The formation of the cardiovascular system occurs in the early stages of pregnancy, but certain factors can lead to abnormal development and malformations.

Gastrointestinal tract

As a rule, immaturity of the gastrointestinal tract leads to a lack of enzyme function, metabolic disorders, dysbiosis, and decreased enzyme function. Therefore, premature babies suffer from bloating, frequent regurgitation, and vomiting, which leads to dehydration and death if treatment is not timely.

Such children are cared for by doctors - neonatologists, namely specialists who deal with the problems of newborns from the first moments of birth to 28 days of his life, then pediatricians are involved in observation and treatment.

Features of feeding children born prematurely

Depending on the degree of prematurity of the child, that is, the week of pregnancy in which the baby was born, different complementary feeding options can be used:

• breastfeeding from the first days of life (1st degree of prematurity, presence of a sucking reflex);
• bottle feeding (2nd degree of prematurity, feeding with expressed breast milk);
• feeding through a special tube (3-4 degrees of prematurity).

The option of feeding a child is determined by a doctor in the first hours of the baby’s life and is based on the general condition of the child, his ability to feed independently, and the maturity of the main body systems.

Breast milk is considered the preferred product for feeding premature babies. If possible, breastfeeding should be maintained for as long as possible.

While in the maternity hospital, feeding of premature babies is monitored by doctors, and if necessary, adjustments are made to the amount of food offered. Upon discharge from the hospital, doctors give their nutritional recommendations, and the process comes under the control of the parents.

The required amount of milk per day is calculated based on the child’s weight and age.

Offering your baby the exact amount of food per feeding is quite difficult, especially when breastfeeding.

• When breastfeeding, you need to focus on the child's behavior: he will not eat more than he should.
• When artificial feeding, it is recommended to pour formula or milk in an amount exceeding the norm by 10-15 ml, taking into account that the baby will not drink everything.

Feeding a premature baby is an important factor in the baby's development. It is recommended to develop a nutritional and complementary feeding plan together with a pediatrician, taking into account the characteristics of a particular baby.

Signs

A child under one year of age may not gain weight well and appear thin compared to other children. Parents may worry about this case, although the baby's length and weight are determined genetically. But still, if the child’s parameters differ greatly from the established norms, which can be found in special tables, then you should seek help from a doctor.

Signs that your baby is not gaining weight well include:

• Weight does not fit within the specified framework (up to 4 months increase up to 0.6-0.9 kg, 6 months up to 0.4-0.6 kg, at 6 - 9 months 0.3-0.5 kg, up to 1 year 0.1-0.3 kg).
• There are no folds on the body, the skin is wrinkled and dry, not smooth and inelastic, pale.
• There is no physical activity, the child often cries, has poor appetite and sleep.

These signs together form a condition in the child’s body that requires a visit to the doctor so that the doctor can make a verdict. To eliminate it, you will need to do simple exercises and follow the rules so that the child gains weight and looks normal.

But if the baby grows with a good appetite, he has a cheerful mood, but there is a slight lag in weight, know that this is normal. He is inclined to have a different body constitution, so there is no need to do anything special.