Saturday, April 24, 2010

Weight Carries a lot of Weight

Yesterday The Home Health Nurse came by to check up on The Kid and weigh him. He now weighs 9 lbs 13 oz (at five-and-a-half-months of age, or two-and-a-half-months adjusted age). The minimum recommended weight gain is three ounces per week. Here is how The Kid's weight gain has looked the last few weeks:

Last week he gained something like four ounces because he had a few days of bottles fortified to 27 calories (instead of the regular 24 calories).

The two weeks before that he only gained two ounces each week. The first week of only a two ounce gain they told me that it just wasn't enough. He was short on a few feedings that week, so we put the tube back in and made absolutely sure that he was getting full feedings every single day. Then when he only gained two ounces again The Nurse asked The Doc about it, and he said that it was enough. He's five months old, he said, and it's expected that he'll slow down his weight gain.

This week he only gained 1.5 ounces. Not enough. I still keep track of every ML he eats, and he ate more than enough this week. The Nurse said that I need to talk to The Doc about three options: 1) increasing The Kid's feeding volume, 2) fortifying my milk more, or 3) switching fortifiers.

Here are the problems with those options:

1) The Kid barely makes the minimum feeding volume as it is. If he was expected to eat more than 520 ML in 24 hours, we'd have to put the NG tube back in. It's just too much work for him.

2) Breast milk, on average, is normally 20 calories per ounce. I use Similac Neosure to fortify my milk to 24 calories per ounce. The Doc wanted me to fortify it to 27 calories per ounce, but we tried that for a few days and it gave The Kid such a stomach ache that he didn't want to eat at all. He was noticeably bloated. So, we backed down.

3) Apparently there are some other, easier-to-digest fortifiers out there that we can try. When The Kid was teeny-tiny (like in the three-pound range) and they tried to fortify his feedings with Human Milk Fortifier, he had such a hard time digesting it that they were worried about him perforating a bowel. An x-ray showed that his intestines were so gassy that they were all of the way up to his nipples. Poor guy. So, they stopped all tube feedings and just fed him through his IV and they used the "Anderson Tube"--they put a tube down his throat and sucked out all of the air and food from his tiny little gut. Poor Kid. Then, after he was out of danger, they started using Nurtamigen, an already partially-digested fortifier. He could handle that, thank goodness, but it doesn't have as much of the good stuff as Human Milk Fortifier (like protein). So, as soon as The Kid was bigger (I think around 5.5 lbs) they switched him back to the HMF. He was noticeably more gassy, but could handle it. So, now that you have the whole long story, it's easy to see that The Kid has a sensitive tummy.

I, personally, would like to see if The Kid can handle his milk being fortified somewhere between 24 cal and 27 cal before we try anything else. Maybe just adding a teaspoon of formula when mixing a big bottle for the day would help out just enough.

And why, might I rhetorically ask, does it matter so much that he gains just a little bit more weight each week? Let me tell you. If he doesn't get enough nutrition to grow, that means his brain isn't developing how it needs to. And we all know that The Kid's brain needs all of the chances for good health as it can get.

1 comment:

*Alice Anne* said...

Ohhhhh, boy. That just gave me a headache. Poor little guy! So pitiful! Good thing he has such an awesome MAMA. :)