I'm just wondering how many of you feel that preemies need to be fed
more often than every 3 hours, even if they are not showing hunger
cues?  In Breastfeeding Special Care Babies (Balliere Tindall, London,
1997), Sandra Lang says, "Babies of 36 weeks gestation or less, and who
are excusively breastfeeding or having tub/cup feeds overnight should be
allowed to go 3-4 hours between feeds, as long as this is not medically
contraindicated. Alternate daily weights are recommended for this group
of babies if fed on demand. . . . While it is common for 3 hourly feeds
to be introduced during the time the baby is on a neonatal unit, it is
essential for a mother to be aware that, whe the baby goes home, he may
feed according to his own individual needs (and these may be more
frequent feeds - 10 or more breastfeeds in 24 hours is not unusual. . .
.  As with babies born at term, a 3-4 hourly pattern often emerges but
not always, and when it does not happen, it is for that particular baby,
his own personal pattern of feeding."

I know that Dr. Gordon considers 1/4 - 1/2 oz. a day an adequate weight
gain for a preemie.  However, I know we are under pressure in this
country for the baby to gain at a rate that approaches as close to
possible the fetal growth rate.

I feel, and I know many nursery nurses with whom I work agree with me,
that awakening the baby too frequently doesn't allow him enough time to
rest and that rest is essential for growth.  However, I have been wrong
once or twice in my life, so I would like to know what others think.  It
seems to me that managing "older" preemies (34-36 weeks) is a rather
controversial area of breastfeeding management.  (OK, I know, and which
one isn't?!)

Anyway, I would love to hear perspectives from around the world,
especially in areas with baby friendly hospitals and good follow-up
programs.

Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA