Experience from those with <30 weekers?

Hi Ladies,
My boys were very premature, 27 weeks. They are now going on 21 weeks old, 8 weeks adjusted. My problem is I struggle with when to expect milestones, what to expect with feeding, what to expect with sleeping, etc... Can some of you with <30 weekers chime in? Sometimes books/people/doc will say go by actual age and some say adjusted. For example with sleeping, is it okay to allow them to go 8 hours at night w/o eating? We were doing feeds religiously every 3-4 hours until about two weeks ago and now we are allowing them to go most of the night(6-8 hours). My one son sleeps well and would let us know if he was hungry, but my other son sometimes wakes and goes back to sleep with a pacifier. My issue is he has such an undemanding personality, I am afraid he's hungry and just not demanding it. What should I expect at this stage? How long should they go during the night? How often should I feed? Also, our doc and doula said it's okay to start rice cereal and we have tired it 3x. It's going pretty well. But, again, I don't want to rush it before they're ready. I just really struggle with where they are and what they should be doing. How did you moms of very premature babies know? Did you go more by actual age or adjusted? Please give examples and suggestions Thanks so much. SC

 

:wavey:

Mine were 31 weekers. We woke them every 3 hours during the day to eat and they generally were up every 2 hours at night. If yours are more willing to sleep, I would say that you are going to need to wake them. Have you asked your Ped for some guidance?

As for the milestones, I think you will see it all over the map. I will say that I went by adjusted age for sleep milestones since sleep comes from the brain and its the brain that needs to mature for them to sleep. The smile took the longest to come and then they started closing the gap on adjusted vs. actual for the rest of their milestones.

 

So--we have 28 weekers who just turned 1---I know exactly what you are going through. I'm glad your boys are doing good. It is definitely a challenging road ahead and can be very confusing for sure. I don't know if I can really answer some of your questions, b/c they haven't really gone away for me!! It's hard to know what age to go by. We kind of go by somewhere in between. But, I just try not to worry unless they aren't meeting the adjusted age. The docs sometimes treat them as actual age and soemtimes adjusted---so it is very hard.

So here is how our feedings were going. Take into account our boys were small and dealt with reflux and weight issues. We fed them every three hours when they were about 3-4 months (actual) (right from the hospital). they were fed every fours hours up until they were about 6- 7 months (babyA) and 8- 9 months (baby B). The one who quit earlier--was bigger and took a lot more. The second one we tried to keep feeding him b/c he wasn't eating much--we had aversion issues, etc. Around 7 months (actual) baby A was sleeping from 7 to 7 with one dream feed around 11:00 pm. We cut the dream feed around 9 months actual for baby A. I would say that if you don't have any weight issues, then let them sleep. I do think they would wake up if they were really hungry.

Solids were hard also. We started about 3 1/2 months adjusted. I also thought it was very early going by adjusted age, but our GI wanted to try and give them extra calories. It went okay...and we had ups and downs for a while. I'd say yours sounds a bit early at 2 months adjusted, but if they are doing okay, then I would just stick to that same routine for a good month or so before really moving on. Unfortunately with babies as early as ours, you really have to try and go by their cues or just keep trying and have lots of patience.

Sorry--kind of confusing rambling...hard to put into words sometimes. In general, One of my DS has always been closer to the actual age developmentally but closer to adjusted for feeding stuff and vice versa for the other one----so talk about not ever knowing what to do!!

Good luck!! Wish I could say it gets easier to figure out.....

 

I have 29 weekers. I've always been told to go by their adjusted age for their milestones. They're hitting their milestones kind of between their adjusted and actual age. So I like to think of it as they're "ahead" of their adjusted instead of "behind" on their actual age.

My boys ate around the clock every 3 hours (I kept them on the same feeding schedule as the NICU had them on) until about 1 month adjusted, 3 1/2 actual. Then they started sleeping from about 10pm until 6m, so about 8 hours. About 2 months adjusted, 4 1/2 actual they began sleeping 12 hours a night. My pedi (who was actually they're doctor in the NICU) has always said it's completely fine because they haven't fallen off their own growth curve. My boys switched to eating every 4 hours (on their own basically) at about 3 months adjusted, 5 1/2 months adjusted.

We started rice cereal around 1 1/2 months adjusted, 3 months actual but ONLY in their bottles to thicken it to help with their bad reflux. We have attempted a few times to start solids with a spoon (rice cereal, etc) starting at 1 1/2 months adjusted (4 months actual), then again at 2 1/2 months adjusted (5 months actual), but still didn't take to it, oh wait and again at 3 1/2 month adjusted (6 month actual) Their thrust tongue reflex (I think that's what it's called) is just too strong, however they did really seem to like the taste of bananas, so I may have to try again soon (around their 4 1/2 month adjusted, 7 month actual mark). Not too worried about rushing it. When they are ready, they'll be ready.

I'd say to keep an eye on both of them to make sure they are growing on their own growth curves as they begin to sleep longer stretches. As long as they continue, then I'd assume that your doctor would be okay with them sleeping longer stretches and you not having to wake them up. On the other hand, it doesn't hurt to ask the doctor


ETA: Fixed some of my "dates"

ETA Again lol: We started the attempt at solids per recommendation by a pedi (not our normal pedi), however, if I had it to do all over again, I probably wouldn't have bothered w/ trying until they were about 3 1/2 month adjusted (so.. 6 month actual). That was the last time we tried and they seemed to understand more. They were opening their mouths and seemed to enjoy the bananas. Their problem was the swallowing it lol, it just drooled right back out!

 

Ladies, This is all really, really helpful. I am going to read through it all again carefully.
While it's on my mind, how did you do naps at this age (2 months)? Did you have established times you put them down every day or did you let them fall asleep whenever throughout the day? What time did you put them down for the night? We have been doing a late feed and bedtime (11ish), but I'm noticing they're really fussy between the 7-8 and 10-11 feeds and I wonder if they need to go down earlier.

 

I was going to type a lengthy reply, but then I read ShortStackJo's reply and her experience has been almost identical to mine, LOL. Though our boys were closer to 5 months actual (2.5 month adjusted) before they started STTN. At their 4 month checkup (1.5 month adjusted) their pedi suggested rice cereal for their reflux, and we started feeding it to them on a spoon then ever so slowly based on her advice (I have always hated dealing w/ clogged nipples from adding rice to bottles anyway).

They started rolling from tummy to back around late November, but they didn't roll from back to tummy, and roll repeatedly until the past few weeks. They haven't got up on all fours yet to crawl either, but we keep reminding ourselves they are only 6.5 months adjusted.

As for naps, they definitely weren't on anything resembling any kind of schedule at 2 months adjusted. They still aren't on a set nap schedule at 6.5 months adjusted, but that's also because we don't force one. However they do have a pretty predictable nap routine for the past several months. Even though they are almost 9 months old they STILL get cranky and need a nap after being awake 1.5 - 2.5 hours, and that was especially true at 2 months (they usually only went 1 to 1.5 hours then before they needed a nap).

Regarding bed times, we have tried putting them down anywhere from 6:30pm to 8:30pm. I know everybody says sleep begets sleep, but when we were putting them down between 6:30pm and 7pm they were waking consistently between 4am and 4:30am (and causing us to go insane!!). We've been putting them to bed around 8pm for about a month or so, and they usually awake between 5am and 5:30am. Which still sucks, LOL. I would like to push their bedtime back 30 minutes alter, but DH is reluctant so far. I guess we'll just wait for day light savings time to strike again, which is when everything went crazy in the first place as far as super early awakenings.

My only piece of advice at this point is DO NOT ROCK THEM TO SLEEP unless you have to!! We got in that habit as soon as they came home from the NICU, and now it is impossible to break without CIO. I wish we would have let them fuss for 5 minutes early on (and likely have went to sleep) instead of picking them up at the first cry, which morphed into just rocking them right away when it was nap time or bed time.

Congrats on your twins and GL with everything!

 

I think I'm one of the few that lets my babies go to bed as late as they do. They go to bed at 10pm & sleep until 10am. We do not have any set nap times because for me it's easy to be able to load them up & go and not worry about being home for nap times. If they are tired, they do sleep in their carseats, just as well, if not better than if they were home. They just nap & sleep where ever they happen to be when they fall asleep.

10am: Wake up & feed both
12pm: Solids (the few times I've attempted)
2pm: Feed again
4pm: Feed again
9pm: Bath time (only every other day unless it's been a messy day)
9:45pm: Feed
10pm: Asleep (they don't require pacis or rocking)

In between those feed times is whatever; nap, jumperoo, exercauser, swing, bouncer, play mat, bumbo time w/ baby einstein on dvd, or their summer infant super seat (only have one though, so I usually put on in a bumbo and pull it up right up next and they play together).


I have begun noticing just in the past couple days that their "naps" are finally beginning to get longer. They used to only last about 30-45 minutes, but they did a bunch of them through out the day. The past few days their naps have been about 1 hour- 2 hours and there is only about 3 of them now, maybe a short 4th one somewhere. But once again, I'm not gonna push their naps on a schedule quite yet.

I think our babies are relatively easy. If I need to adjust their "schedule" then they go right for it.

 

I think naps at that age were all over the place---mine were taking around 4 probably and eventually went down to 3. They are at 2 now, but that's a while away for you probably. THe morning nap has always been pretty consistent---usually between 1-2 hours after they are awake and then the rest of the day was kind of up in the air I think. Once they were down to 3 naps...the first two were pretty consistent and the last one was random and short. Sorry--can't remember when they went to 3 naps.

Our have always kind of gone to sleep around 7-8 pm. I think in the beginning they were maybe up a bit during that time b/c we had them downstairs with us until the 11:00 feed and then thney were definitely out (we would move them upstairs then) and we would just wake them to feed them. You could try putting them "to bed" at 7 and see if that helps their crankiness. Maybe then they will just wake up once to eat. I assume you spent a good bit of time in the nICU also. I kind of kept trying to keep that routine going for a while---and have never had any issues with them sleeping w/o needing rocking and w/o getting up int he middle of the night to play. I've heard a lot of moms deal w/ that, but b/c of the NICU--i think we avoided that and so we kept taht routine going as best as we could.

 

My babies were full term but I work in pediatrics and I have seen hundreds of preemies, so I hope you don't mind me posting my experience. My general rule of thumb that I tell parents is that sleep and eating tends to go much more along the adjusted age than chronological age. Milestones start way behind, and then as time goes on they start to come quicker and converge on to the regular time table. As long as the babies are neurologically normal, the social milestones catch up the quickest. You may have already even started noticing social smile, eye contact, etc. Language tends to catch up next. The last thing to catch up is the gross motor and I would say that for the most part, babies won't reach these milestones until their corrected age or even a little later. The neonatologists when they follow their "grads" actually give babies until age 2 to be on track with their peers but most children are there by 18 months (actual age). This also mimics their growth curves (don't know if your ped has shown you the corrected growth curve, but we stop correcting by age 2).

As for your babies specifically, unless they have great head control and act interested in food I would hold off on the solids. Many full term babies aren't ready for solids at 21 weeks actual, much less preemies, and babies that are breastfed are supposed to be exclusively nursed until 6 mo, so there is no hurry. Their bellies are still fragile and its just another stressor to your day which I am sure is already full. I think it is fine to let them sleep at night as long as the number of feedings in 24 hours is appropriate. Naps will likely be all over the map for a while. According to Healthy Sleep Habits, Happy Child, the sleep "milestones" correlate with corrected age, even for near term babies. This means you may not see a regular nap rhythm for another couple months.

Did your NICU team get you enrolled in any kind of early intervention? Usually this is one way to reassure yourself that they are making progress. When it comes down to it, though, your babies will hit their milestones when they are ready. Just enjoy them and celebrate every new thing they do. All of us, even those of us with term babies, tend to play the comparing game and all it does is stress us out and take our positive energy away from our babies!