Thrush

This is a fungal infection that can be passed between you and your baby. Premature babies are particularly susceptible to thrush because of their weak immune systems.

Symptoms

• A burning sensation on your breasts during feeds.
• Small red spots around your nipple.
• White patches on your baby’s lips or inside his mouth, or red spots around his anus.

What you can do: See your GP for a prescription for antifungal treatment. Good hand washing and hygiene can help to prevent the spread of fungal infections.

Mastitis

If you develop symptoms of this infection you must seek medical treatment.

Symptoms: a tender lump in your breast, a red swollen patch that is painful to touch, and flu-like symptoms such as a temperature.

What you can do: Carry on breastfeeding as the milk flow will help to clear any blockage. Visit your doctor to get a prescription for antibiotics – request one that does not affect breastfeeding.

Blocked duct

Symptom: a tender lump in your breast, pain while breastfeeding.

What you can do: feeding your baby as often as possible may help to clear the blockage, as well as expressing with a pump or your hand.

Expressing milk at home

Expressing your milk is often established while your baby is in hospital and unable to breastfeed. Now that you are home you might want to continue expressing in addition to breastfeeding so that someone else can help with feeding your baby. You can express by hand or use electric or hand pumps. TinyLife have a number of breast pumps available to loan so get in touch if you would like more information on this.

If you are concerned that your milk supply is drying up, talk to your health visitor immediately.

Cup feeding at home

You might have chosen to use a cup rather than introducing a bottle when supplementing breastfeeding. Cup feeding can be done with expressed breast milk, formula, or a combination of both. Hold your baby on your lap in an upright position and hold the rim of the feeding cup against the baby’s lips. With practice, gradually they will learn to lap the milk. Your local neonatal unit or health visitor will be able to provide you with a feeding cup and instructions.

Bottle-feeding at home

If your baby started bottle feeding in hospital, you will already have had some practice. To keep good bottle feeding hygiene:

• Get into a good routine for washing and sterilising the bottles.
• Be prepared: remember to use freshly boiled water to make up the feed and you must allow time for it to cool down to body temperature before giving it to your baby.

Preterm baby formula

Because of the risks associated with powdered formula feeding (see below) for premature babies, it may be recommended that you feed your baby sterile liquid infant formula for the early months. Depending on your baby’s nutritional needs your paediatrician may prescribe special preterm formula until your baby is ready for standard formula.

Safety tips for preparing formula milk:

• Wash your hands. You are touching every piece of equipment, including the teats, bottle, and scoop so you need to wash your hands very carefully before and after mixing feeds.
• Clean the bottles and teats thoroughly.
• Prepare the milk with care. Powdered milk is sometimes contaminated with bacteria which is why the water must be boiled to at least 70^oC (160^oF) to kill off any germs.
• Do not store milk. The longer you leave the milk after mixing it – even in the fridge – the more chance there is that bacteria can grow. It’s safest to make up feeds one at a time as your baby needs them.

More advice on bottle feeding can be found here. www.nhs.uk

Common Feeding Issue

Constipation

Constipation can be an issue for premature babies. This can be related to immature gut function or poor muscle tone and can be more common in babies who are formula fed.

What you can do about constipation

Standard advice for constipation is to give a little cooled boiled water between feeds. Baby massage may be of some help for your baby and a good time for you to interact with them. TinyLife has trained baby massage instructors who are available to help. However, talk to your GP if you are still concerned.

Reflux

Most babies with reflux are less bothered by it than their parents. They grow and develop normally. But for a few babies, reflux is more serious and requires medication. There are ways you can feed and position your baby to minimize spit-up.

• Burp your baby often, especially if you’re feeding them with a bottle.
• Try a different nipple on your baby’s bottle so they swallow less air.
• Hold your baby upright during feeding.
• Try smaller, more frequent feedings.
• Keep your baby still after feeding.

There are some symptoms you should be aware of as they may mean that your baby has other problems digesting food. You should contact your GP if:

• The spit-up is bright yellow or green.
• There’s a large amount of spit-up.
• Your baby arches their back or cries during feeding.
• Your baby vomits with great force (projectile vomiting).
• Your baby refuses to eat or is irritable after feeding.

Colic

Colic is very common in young babies. Colic is the name for frequent episodes of prolonged crying in a baby who seems otherwise healthy. While the cause remains unknown, many parents feel that their baby is crying because they are in pain. It often occurs around the time of feeding.

What you can do about colic

If your baby is crying excessively, contact your GP. This is so your GP can rule out conditions that may be causing your baby’s crying. There are some tips available to help soothe your crying baby. Your GP is unlikely to refer you to a paediatrician unless there are other signs that your baby is unwell, if the problem is getting worse, or continues beyond four months. Having a baby with colic can be extremely challenging. It is important that you understand that it is not your fault and that it is ok to ask for help to give you some relief from the excessive crying. Ask your health visitor for help. Make use of the support groups in your community and talk to other parents if you can. These small things can have a big impact on your ability to cope. Tinyfamily support officers are also here to help. (Contact us here.)

Weight Gain

Premature babies are not discharged from hospital until they are gaining weight steadily and can keep a normal body temperature while clothed and in an open and unheated cot. Some hospitals have a rule on how much the baby must weigh before going home, but this is becoming less common. In general, babies are about 4 pounds (2 kilograms) before they are ready to move out of the incubator. At home, your health visitor will monitor growth and chart it accordingly. If you are concerned about how your baby is growing, speak to your health visitor.

Looking Ahead: Weaning and Introducing Solids

As your baby grows you will begin to think about introducing solid foods. This is a special time for you and your baby, with lots of interaction. Ideally, weaning should begin around 6 months of age and not before the age of 17 weeks. You may receive different advice from different people relating to when to wean your premature baby. To date, there is no definitive research and guidance is consistently under review. Your baby’s cues are very important and you are advised to speak to your health visitor to gain the most recent advice around when to start introducing solid foods. However, there are some tips to help you check if your baby seems ready. NHS Choices suggest 3 signs that show your baby is ready for solid foods alongside breast milk or formula. It is very rare for these signs to appear together before your baby is six months old:

1. Your baby can stay in a sitting position and hold their head steady.
2. Your baby can co-ordinate their eyes, hands, and mouth so they can look at the food, pick it up, and put it in their mouth all by themselves.
3. Your baby can swallow food. Babies who are not ready will push their food back out with their tongue so they get more round their face than they do in their mouths. Do bear in mind though that babies take time to learn and appreciate new tastes and textures and how to move them around their mouths.

First foods

The first foods you may think of introducing might include: mashed or soft cooked fruit and vegetables like parsnip, potato, sweet potato, carrot, apple or pear, all cooled before eating. Soft fruits like peach, melon, baby rice or baby cereal mixed with your baby’s usual milk, are also good. Keep feeding your baby breast milk or infant formula, too. Do not give your baby cow’s milk to drink until they are one year old.

If you are concerned that your baby may have a milk or food allergy you should contact your GP who will be able to advise you further.

The NHS Choices website provides excellent information around weaning and introducing solids.