Anastasia's first year (2005)
Eating & Reflux (year 2, 2006)
Back to Sleep! (2007)
And Zane, Too (2008)
Allergies & Getting Big (2009)
Starting School (2010)
It's All Good (2011)Search the Miracle Baby bebsite
Feeding Tips for Preemies
I've had a number of parents ask for my advice on feeding premature babies. Extreme preemies, in particular, are notoriously difficult to feed; many doctors give up and surgically insert a G-tube. This can lead to other feeding problems down the road. (Why learn to eat if a tube automatically brings food to your tummy? Admittedly, this is much more of a problem for infants who never learned to eat anything before they were given a G-tube.)
While a G-tube is sometimes necessary in order to have a healthy baby, it's my opinion that fewer babies would be given G-tubes if their parents had access to good feeding clinics. Without the wonderful folks at our feeding clinic, Anastasia would undoubtedly have a G-tube, too. So if your baby is having trouble eating, I highly recommend asking your pediatrician, neonatologist, or NICU nurses about a feeding clinic. If they have no recommendations, try calling nearby medical universities or children's hospitals, asking for professionals who specialize in eating difficulties.
That said, some parents have found success in copying some of the things we've done to combat Anastasia's eating issues. Although feeding problems should be treated individually, and I am by no means an expert on the subject, it's my hope that here you'll find one or two tips that are useful for your own situation.
For more links related to feeding, please see the Resources section.
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I've searched unsuccessfully for a place to buy these nipples, but a feeding clinic or hospital will usually give them away, or sell them for a small fee. I've also seen them new on eBay. Be sure to get a good supply, as they rather quickly become too soft and must be replaced.
A tip from the clinic: If you supplement with formula, be sure every feeding has about the same mix of breast milk and formula. Don't offer breast milk one feeding, formula the next, as this can upset little tummies.
Other parents of preemies say that distraction is the only thing that works. One friend bemoaned that the only way to get her baby to eat was to place him in front of the television. Whatever works!
I found that adding formula to everything made Anastasia more accepting of new foods. (But don't make the same mistake I did and add formula to things like peas or corn. This creates a liquid with lumps, which little ones tend to gag on.)
The clinic did not recommend rice cereal, as it's not very tasty or nutritious, and tends to cause constipation (an issue for many preemies). I offered Anastasia baby oatmeal, which she loved, but the clinic has since informed me that adult oatmeal has a lot more fiber in it. (Baby oatmeal has the least amount of fiber, adult "quick cooking" oatmeal is in the middle, and old fashioned oatmeal has the most fiber. If you use the latter, make sure you cook it extremely well. If your baby isn't on formula and doesn't get supplemental iron, use baby oatmeal, anyway, as it contains the iron your baby needs.)
At one point, we did add Polycose (a powder that's almost all carbohydrates) to Anastasia's formula to increase the calories. Unfortunately, she did what a smallish number of babies do...She started eating less.
* Formula Before Solids. Although many doctors recommend offering solids to the baby before giving her the bottle, for several months, we found the opposite worked best for Anastasia (who was still getting most of her nutrition from formula). We gave her as much formula as she'd take first, and then offer as many solids as she'll take.
* Cup and Dropper. On our very first feeding clinic visit, we were given a dropper and a special cup, which you can see Anastasia using here:
At first, neither were very useful; Anastasia would just spit out whatever we managed to get into her mouth. However, at about 8 months corrected age, I tried the cup again. Anastasia was taking an ounce or two from her bottle, then refusing to suck any more. So, I took her to the high chair and offered her formula from the pink cup. She loved the newness of it, I think, and got quite a lot from the cup. (It is messy and slow going, I must admit. But it gets those extra calories down!)
Here's a link to the exact cup Anastasia uses: http://www.equipmentshop.com/ProductDetail.asp?ProductID=19
If you can't buy this cup, you could use a small paper cup, and cut an indention in it, like Anastasia's pink cup. This allows you to easily see how much milk the baby is getting in his or her mouth. A small clear cup might work, too.
The feeding clinic suggested I put the cup to her lips and let her lap up milk, but I've found it works best if I get a little milk in her mouth and then take the cup away and allow her to swallow.
Other great fattening foods: Toby's Tofu Pate (not the "lite" version); bean dip; hummus; cream cheese (kids especially like the flavored berry or salmon types); almond or cashew butter or tahini; guacamole (mashed avocado and mayo); dips (without chunks); pudding; yogurt (especially whole milk varieties); Laughing Cow cheese (soft Swiss cheese); jams or preserves; scrambled eggs with grated cheese and cream cheese; refried beans with cheese, cream cheese, sour cream; chicken, tuna, or egg salad with lots of mayo; shakes made from whipping cream, milk, and ice cream; ice cream; custard; egg nog; oatmeal made with milk, margarine or butter, and brown sugar; cottage cheese (not the low fat or fat free varieties); cheesecake; macaroni and cheese (preferably home made or Velveta brand). And if you're cooking your child things that include milk, definitely use whole milk...or, better yet, cream.
Oh, and something new I've tried: YoBaby. This is a yogurt made of whole milk. It's the highest calorie yogurt I've ever seen, and Anastasia adored it! She would eat it when she'd eat nothing else.
* Adding butter or vegetable oil. Just a little bit added to Anastasia's solids adds precious calories. We also sometimes add ground flax seed to her foods (which has the added benefit of keeping her regular). Some parents prefer flax seed oil. Please talk to your doctor before adding any oils to your baby's diet, however. If your baby ever aspirates, oils can cause serious breathing issues.
Any time I get stuck in a rut with regard to what foods I offer Anastasia, she begins eating less.
Be sure to read the information on baby foods, too.
* Sometimes Bottle, Sometimes Solids. When Anastasia was about 9 months corrected age, we completely changed her feedings. (When the feeding clinic suggested this plan, I was skeptical...but it really worked.) They wanted me to give Anastasia three bottles a day and three solid-food meals a day, alternating. (Example: First meal, bottle; second meal, solids; third meal, bottle; fourth meal, solids.) Because I knew Anastasia took much more from her bottle when she's sleepy, I changed this a bit and started giving her a bottle in the morning, solids for her next three meals, and a bottle in the evening, and another in the middle of the night. Within a few days, Anastasia was eating considerably more in the way of solids. At 10 1/2 months corrected age, Anastasia was eating 4-5 tablespoons of solids per meal. That was an incredible improvement. (Please note that it's important to offer something to drink after each solids meal.)
* Self Feeding. If your baby shows an interest in feeding herself, it's important to let her. I can't count the number of times Anastasia wanted to feed herself, I didn't allow it, and she promptly refused to eat anything more.
When you're worried about calories, it's tough to see food all over the floor...This is why self feeding at the end of the meal is nice. Also, try to offer at least one food that will tend to stay on the spoon. For example, avocado sticks to the spoon, even when a baby turns that spoon upside down and waves it through the air. Things that stick on fork prongs (like chicken or peaches) are also good choices. (Be sure to use blunt edged baby forks.)
Sometimes, when I really needed to get food down her and Anastasia wanted to self feed, but would just end up playing with her food, I held her hand while I fed her. Other times, offering her an empty spoon to play with distracted her enough that I could get food into her.
* Sippy Cup? Although our pediatrician recommended Anastasia start practicing with a sippy cup at about 6 months corrected, Anastasia simply didn't have the sucking ability to use any standard sippy cup. (And I think we tried them all!) So the feeding clinic gave us an old fashioned baby cup. It has an indented lid with a hole in it. It isn't spill proof, but it's not as messy as an adult cup, either. Try it with water (or something else that's easy to clean up) first. Here's the exact, two handled cup we use:
(If you want to buy a feeding cup and a baby cup in the same spot, this company also has cups similar to Anastasia's pink cup: http://www.kcup.com/nosey.htm )
Some babies do really well with a cup and straw, too. To help them learn to suck fluid through the straw, try a cup with soft sides; squeeze it to push a little bit of fluid into the straw. Chances are, the baby will understand how to use the straw pretty quickly.
* Humor. Retaining your sense of humor during feedings will not only help you not be so stressed and frustrated, but it may help your child eat more. As soon as Anastasia used to start turning away from her bottle or spoon, I'd find that if I reacted in a silly fashion (making funny noises, silly faces, singing high notes, etc.) she'll smile or laugh and then eat a little more. Perhaps this worked because it kept feedings from becoming a power struggle. Or perhaps it worked because everyone was more relaxed and eating becomes less stressful. Or maybe it just distracted the babe.
* Don't push your baby. There are plenty of times I got extremely frustrated because Anastasia wouldn't eat. At those times, it's tempting to force the bottle or spoon in the baby's mouth and somehow make her eat. But not only is it almost impossible to make a baby eat if she doesn't want to, trying to force food down her will likely lead to oral aversions. In other words, pushing your baby will only exacerbate your child's eating problems and lead to long-term difficulties.
This doesn't mean that when Anastasia turned away from the nipple that I automatically gave up. Instead, I made sure she didn't need a burp or a diaper change, then offered her the nipple again. If she still refused, then we ended the feeding. Patience - lots of it - is necessary when feeding babies with eating issues.
Parents magazine has an interesting article on teaching "Healthy Eating at Home." Despite the fact this article is geared toward kids who eat normally, it includes many scientifically backed-up ideas that can be used for kids who don't eat enough:
* In a study of grown women, those who ate off pretty plates ate more food. Why not try using plates your kids love (Elmo or Winnie the Pooh, anyone?) and see if it induces them to eat more, too?
* If your child indicates she's thirsty, don't ask what she wants to drink. Simply bring her a beverage of your choice and place it in a very large container. Study after study shows the more food or drink people are offered, the more they consume. If you give your child a 20 oz. container, studies indicate she'll drink more than if you give her a 6 oz. container. (Though, of course, you shouldn't expect her to drink the full 20 oz!.
* When it comes to foods you really want your child to eat, pile them on the plate. Don't simply given him the portion you expect him to eat. By giving your child more than you expect him to eat, he's more likely to eat more.
* Don't insist your child use utensils. Some experts believe children get more enjoyment from food if they use their hands to eat. And for kids with eating issues, more enjoyment usually means more calories.
* Make up fun names for ordinary foods. In the Parents article, Dr. Brian Wansink, Ph.D., says "In one experiment I did, preschoolers ate twice as many vegetables when we called them things like X-Ray Vision Carrots, Power Peas, Tomato Bursts, and, yes, Dinosaur Trees." In your household you can do this not just with vegetables, but with fattening foods, too.
* Dr. Wansink also says he puts two different types of vegetables on his children's plates. "They seem to respond better when they feel like they're part of the decision-making process," his wife says. In your household, try putting at least two types of fattening foods on your child's plate.
Most are undoubtedly well-meant, but when your child has feeding issues, you're going to get some interesting comments. Some people think you must be a bad (or stupid) parent, because the idea that "babies will eat what they need" has been pounded into people's brains by baby magazines and books. Others say, "Oh, but she looks great!" As if to say you shouldn't worry, even though myriad of doctors say you should. Still others will be shocked that you aren't feeding your baby only "good foods" like fruits and vegetables; they simply can't imagine the situation could be serious enough that your primary concern is calories - no matter where they come from. Some people will balk that you let your infant watch TV (for example) while he's eating. "The American Academy of Pediatrics says children under 2 shouldn't watch TV at all!" they say. True, you reply. But that's the only way you seem to be able to get those calories down ...
Hang in there and try to find other parents who have children with eating issues. Only they can fully understand how difficult the situation is on you and your child. Here are two good forums made up of parents who know what you're going through: