Brief Answer:
Ask your obstetrician if IUGR was symmetric or assymetric

Detailed Answer:
Thanks for asking on HealthcareMagic.

Congratulations on having a baby. I understand the baby has been born with intra uterine growth restriction (IUGR). There could have been a number of underlying causes and in order to ascertain the cause I would have needed to evaluate the baby. IUGR is broadly of two types - symmetric and assymetric. The latter is more common and is associated with some sort of compromise to fetal blood supply. On the other hand, symmetrical IUGR could have occurred due to certain intrauterine infections like TORCH. Your obstetrician could help in determining the cause.

Now its time to catch up. Although formula milk can help in rapid weight gain, it is not necessarily a good thing. Let me emphasize on the fact that breast milk is the best possible milk for a baby and there can be no alternatives for the same. Most formula milks are cow milk based and hence difficult to digest. Moreover they make the child more prone to complications and infections. Mother's breast milk is produced on the demand of the baby. Hungrier the baby, more vigorous is the suck. More is the suck, more is the amount of breast milk produced. Giving formula automatically reduces the demand of the baby and thereby the production of breast milk. All you need to do is to switch back to exclusive breast feeding and the production will increase automatically. All you need to do is to monitor the urine output. If the frequency is more than 6 times in 24 hours, you would know that the amount of feeding is adequate. If the amount of passage of urine is less or if the child is lethargic you would need to take the child to a doctor without delay.

For a baby of this age, it is normal to pass stool several times a day or even after each feed. Alternatively the child may pass stool once in 10 days and that is normal too. Unless the stool is hard and pellet like, you need not grow concerned. It is also normal to pass green stool or a combination of yellow stool.

Breast milk also takes care of immunity against common ailments like cough and cold, and diarrhea. So, automatically your worries would be reduced. For a baby of this age, it is normal to pass stool several times a day or even after each feed. Alternatively the child may pass stool once in 10 days and that is normal too. Unless the stool is hard and pellet like, you need not grow concerned. You need not use suppositories but in case you use, it would not be harmful.

If the child seems to have nasal blockage, applying saline drops (like Nasoclear) in each nostril should take care of it. So long as the baby is active and playful, you need not worry.

You should burp the baby for at least 15-20 mins after each feed. All you need to do is to hold the baby head end elevated for this duration. The extra air taken in would escape and the milk will not regurgitate back from the stomach to the food pipe.

Let me know if you have further queries.

Regards

---

Brief Answer:
Suggestions given

Detailed Answer:
Thanks for writing back. You need not bother about how much the baby is getting. Just know that if the breast feeding is adequate the child will pass urine more than 6-8 times in 24 hours. In other words, if the child passes urine adequately you would know that breast feeding is adequate.

Using breast pump is a good option but I think that using nipple shield should suffice. I would discourage formula feeds. Mother's breast milk is produced on the demand of the baby. Hungrier the baby, more vigorous is the suck. More is the suck, more is the amount of breast milk produced. Giving formula automatically reduces the demand of the baby and thereby the production of breast milk. All you need to do is to switch back to exclusive breast feeding and the production will increase automatically. All you need to do is to monitor the urine output.

Let me know if you seek further assistance.

Regards

---

Brief Answer:
Feed using nipple shield

Detailed Answer:
Thanks for writing back. I am not quite sure if the technique is proper. Rather than pumping, I would insist use of nipple shield for directly breast feeding the baby. Mother's breast milk is produced on the demand of the baby. Hungrier the baby, more vigorous is the suck. More is the suck, more is the amount of breast milk produced. Giving formula automatically reduces the demand of the baby and thereby the production of breast milk. All you need to do is to switch back to exclusive breast feeding and the production will increase automatically. All you need to do is to monitor the urine output. If the frequency is more than 6 times in 24 hours, you would know that the amount of feeding is adequate. Let me know if the amount of passed urine is adequate.

The breast feeding should be done from alternate breast each time, feeding from only one breast in a session. Duration of feed 20 min. Gap between feeds 2 hours. Effectively that gives each breast 4 hours to fill.

Regards

---

Brief Answer:
Preterm formula can be tried.

Detailed Answer:
Thanks for writing back. If the child passes urine just twice in 24 hours that is quite unusual. Anyway, discuss with your treating physician about giving XXXXXXX (metoclopramide) tablet thrice daily to increase the breast milk production. She also needs to drink plenty of water and fluids.

In such a case you might try preterm formula like PreNAN 1 or any other stage 1 formula.

Regards

---