One of our preemie's struggles is with gaining weight and maintaining a healthy BMI and growth curve. We struggled with it in the NICU to the point that they did extra rounds of metabolic testing just to be safe.
We have been tested and retested and had care teams from both Cincinnati Children's Hospital and The Children's Hospital in New Orleans check our little guy out and help us with strategies.
I'm going to share some of our family's strategies, but please make sure you take any nutritional plans and discuss them with your child's pediatrician or care team. What works and doesn't work for my son may not work for yours and vice versa.
0 - 24 months
During this time period, all of his bottles and then drinks were made with purified water and a high calorie Neosure formula mixture. My son also suffers from GERD, but not super severe and no thickeners of any kind were ever prescribed. He also had trouble with constipation and had a prescribed stool softener during this period as well.
I used a high calorie formula mixing chart our NICU had given us up to a certain point, and then I found one on the Children's Hospitals of Minnesota site that was recommended on another preemie mom's blog at the time. It goes up to 27 calories per ounce. My little guy was on 30 calories per ounce at one point, but my pediatrician was able to help with the adjustments.
I also delayed any solid food introduction until after a bilateral inguinal hernia repair. So his first solid foods were at Thanksgiving when he was 9 months actual, 7 months adjusted. He began taking an acid reflux medication at 6 months actual, 4 months adjusted.
2 - 3 years old
The magic catch up time when you no longer adjust your preemie's age! Don't let them fool you each child still develops at their own pace preemie or not. This catch up mechanic is true for some and not so true for others. Don't let it discourage you if your preemie isn't automatically "fine" at 2!
During this time, we were really fortunate. My son finally had a diagnosis that let us try some different things to help him. We had some motor delays and feeding texture issues, but a diagnosis of hypotonia and Early Intervention therapy access really helped.
I cannot say enough awesome things about our Kentucky First Steps Developmental Therapist and Physical Therapist. They helped my son and they were a huge step in healing my emotional well-being as well. It is always nice to have reinforcement that the things you are trying to do for your child are good things or the best you can do.
It is so hard to know at these ages what is a texture or sensory problem and what is regular "picky" eating. When your kid is barely clinging to the 1% of his own growth curve, every sickness and refusal to eat is nerve racking. Seek help! Early Intervention, your pediatrician, a children's hospital or a local pediatric therapy group.
4 - 5 years old
This has been the worst period for us since the NICU days where feeding and growth are concerned. We moved and lost access to all the care teams that knew our son best which left us feeling adrift. My dad had a year where he spent all but a few weeks in the hospital after a fall and several bouts of sepsis. These changes in routine were devastating.
We had to add Pediasure to our set of tools for the first time since we had halted the high calorie formula at 2. In addition, we tried some various ways of offering food. Things that worked for him were snack boxes with his favorite healthy and kid-friendly shelf snacks that he can grab when ever he feels hungry at home. We tried to keep household meals on a very regular schedule, and we make sure to bring a snack and a drink anytime we are going to be out for more than an hour.
The kid plates with sections where food won't touch also helped, and then we have made sure to include him in food prep whenever possible, which has helped with willingness to try some new things.
We also did allergy testing to make sure he didn't have any egg or dairy sensitivities, and we packed his lunch for kindergarten so I could tell what he was eating and track the calorie intake.
Balancing High Calorie Intake with Healthy Eating
Another big challenge for our family is still using healthy eating habits while trying to help our son maintain a healthy weight. We try to be careful to make him conscious of what's going on without making him self-conscious about it.
Keeping it all about healthy choices instead of labels (too skinny) that can be scary and develop into bigger problems of identity can be hard.
These feeding and growth challenges really cause my mom guilt to flare about my son's prematurity, but please remember to be kind to yourself.
We have been tested and retested and had care teams from both Cincinnati Children's Hospital and The Children's Hospital in New Orleans check our little guy out and help us with strategies.
I'm going to share some of our family's strategies, but please make sure you take any nutritional plans and discuss them with your child's pediatrician or care team. What works and doesn't work for my son may not work for yours and vice versa.
0 - 24 months
- High Calorie Infant Formula
- Acid Reflux Medication
- Delayed Solid Food Introduction
- Doc Brown Formula Mixing Pitcher
During this time period, all of his bottles and then drinks were made with purified water and a high calorie Neosure formula mixture. My son also suffers from GERD, but not super severe and no thickeners of any kind were ever prescribed. He also had trouble with constipation and had a prescribed stool softener during this period as well.
I used a high calorie formula mixing chart our NICU had given us up to a certain point, and then I found one on the Children's Hospitals of Minnesota site that was recommended on another preemie mom's blog at the time. It goes up to 27 calories per ounce. My little guy was on 30 calories per ounce at one point, but my pediatrician was able to help with the adjustments.
I also delayed any solid food introduction until after a bilateral inguinal hernia repair. So his first solid foods were at Thanksgiving when he was 9 months actual, 7 months adjusted. He began taking an acid reflux medication at 6 months actual, 4 months adjusted.
2 - 3 years old
- Feeding and Developmental Therapy
- Texture exploration
- Patience
The magic catch up time when you no longer adjust your preemie's age! Don't let them fool you each child still develops at their own pace preemie or not. This catch up mechanic is true for some and not so true for others. Don't let it discourage you if your preemie isn't automatically "fine" at 2!
During this time, we were really fortunate. My son finally had a diagnosis that let us try some different things to help him. We had some motor delays and feeding texture issues, but a diagnosis of hypotonia and Early Intervention therapy access really helped.
I cannot say enough awesome things about our Kentucky First Steps Developmental Therapist and Physical Therapist. They helped my son and they were a huge step in healing my emotional well-being as well. It is always nice to have reinforcement that the things you are trying to do for your child are good things or the best you can do.
It is so hard to know at these ages what is a texture or sensory problem and what is regular "picky" eating. When your kid is barely clinging to the 1% of his own growth curve, every sickness and refusal to eat is nerve racking. Seek help! Early Intervention, your pediatrician, a children's hospital or a local pediatric therapy group.
4 - 5 years old
- Kid-friendly patterned "section" plates
- Packed school lunches
- Monthly weight checks with Pediatrician
- Snack boxes with continual access
- Yogurt Raisins
- Crackers
- Pretzels
- Applesauce Pouches
- Fruit cups
- Goldfish crackers
- In the fridge snacks
- Yogurt smoothie drinks
- PediaSure
- Cheese
This has been the worst period for us since the NICU days where feeding and growth are concerned. We moved and lost access to all the care teams that knew our son best which left us feeling adrift. My dad had a year where he spent all but a few weeks in the hospital after a fall and several bouts of sepsis. These changes in routine were devastating.
We had to add Pediasure to our set of tools for the first time since we had halted the high calorie formula at 2. In addition, we tried some various ways of offering food. Things that worked for him were snack boxes with his favorite healthy and kid-friendly shelf snacks that he can grab when ever he feels hungry at home. We tried to keep household meals on a very regular schedule, and we make sure to bring a snack and a drink anytime we are going to be out for more than an hour.
The kid plates with sections where food won't touch also helped, and then we have made sure to include him in food prep whenever possible, which has helped with willingness to try some new things.
We also did allergy testing to make sure he didn't have any egg or dairy sensitivities, and we packed his lunch for kindergarten so I could tell what he was eating and track the calorie intake.
Balancing High Calorie Intake with Healthy Eating
Another big challenge for our family is still using healthy eating habits while trying to help our son maintain a healthy weight. We try to be careful to make him conscious of what's going on without making him self-conscious about it.
Keeping it all about healthy choices instead of labels (too skinny) that can be scary and develop into bigger problems of identity can be hard.
These feeding and growth challenges really cause my mom guilt to flare about my son's prematurity, but please remember to be kind to yourself.
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