Nutrition for Preterm One Year Old

I have a 1 year old son who was born at 24 weeks gestation. Being born so prematurely, he has had a lot of feeding problems. He couldn't tolerate breast milk or formula for almost 3 months. Now that he's older, I'm concerned that he may not be eating enough. He's never been a good eater, but he does eat. He seems to be gaining weight. He started out at 1 lb 4 oz and now weighs almost 16 lbs.

My concern is that when I see a full-term baby at 2 months taking almost 8 oz of formula and gaining weight so rapidly, I compare to my son who I can barely get to take 4 1/2 - 5 oz at any one time. I still have his formula concentrated to 24 calories so I know that he's getting more calories per feeding than most.

I also have been trying spoon feeding jar food for months and am meeting with resistance. He will eat, but not very well. I give him 1/2 jar of a dinner or vegetable and 1/2 jar of fruit or dessert. That's only 4 oz of food and he may only take half of what I offer him.

Throughout a normal day, he takes a little cereal in the morning, a bottle midmorning, 1/2 of the food I offer at noon, another bottle in between feedings, 1/2 of the food I offer in the evening and then a 6 oz bottle of cereal at bedtime. The last two days, he will only take 2 - 2 1/2 oz of the cereal.

I'm getting very concerned as I thought as he grew, his appetite would grow with him. I understand that children's feeding habits don't necessarily fit a routine cycle, but with his special nutritional needs, I'm afraid that he's not getting enough.

Another thing, he will eat whatever mommy and daddy are eating for lunch or dinner. Is he trying to just tell me that he doesn't need to eat as often as I'm trying to feed him, or is he trying to tell me that he wants our food instead of baby jar food? I'm a first time mother and I'm totally lost. I want the best for him after all that he's already been through. I want to ensure that he is as healthy as he can be so he can continue to catch up to his peers.

Any advice as to how I should handle this situation would be greatly appreciated. Maybe I'm just being a paranoid preemie mother! Thanks for your consideration.

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Sue Gilbert

Sue Gilbert works as a consulting nutritionist. For many years she worked with Earth's Best Organic Baby Food, integrating nutrition and... Read more

Dear Teresa,

It is very understandable that you should be so concerned about your son. You have experienced how fragile life can be and are proceeding carefully. Your son was born at an extremely low birth weight (ELBW), he wasn't simply premature. He went through a long period of artificial feeding which undoubtedly had an effect on him. Such premature infants show different growth patterns than full term infants even when corrected for gestational age. ELBW infants are unlikely to show catch up growth during the first three years of their life, so please don't go comparing your son to full term babies. However, just because he is small now, or for the next couple of years, doesn't necessarily mean he will always be small. Often premature infants are equal to their peers by age 7 or 8.

You do have special nutritional/developmental considerations for your son. Some evidence has suggested that calcium and phosphorus needs may differ from full-term babies during the first year. Particularly for preterm infants fed unfortified human milk bone mineralization has been reported to be lower. You may want to ask your pediatrician about monitoring the bone mineral status of your son for a while.

It may be helpful for you to enlist the aid of a pediatric registered dietitian to help evaluate your son and his feeding development. Critical times for nutritional evaluation include the key developmental stages of feeding. That includes the introduction of semisolids (which your son is taking, although reluctantly) and the weaning from the bottle to the cup and to table foods. If your son can be assessed now by the dietitian, she can help you determine his readiness for change and help in selecting appropriate food.

With premature infants it is important not to rush. Perhaps you have begun baby foods a little too soon or too forcefully for your son which may be why he is reluctant to eat them. Premature babies are sensitive and may retreat from anything new. Allow him to get very used to one food before trying something new. For example, pick one cereal and stick with it, using the same consistency, keeping it smooth and thin. Very slowly increase its thickness.

Add fruits and vegetables, careful to start one at a time and offer the same food several days in a row until he gets really used to it. Use the same spoon, use only smoothly pureed foods. After he has had lots of time with pureed foods, you can very gradually add lumps. He won't eat much, only a few tablespoons at a time. He is still little. Allow him to decide how much he needs. It will help him key into hunger and satiety cues which he probably didn't learn to do when he was being artificially fed at the hospital. He may be 18 months before you really get to table foods.

So long as you gradually challenge your baby with eating all along and you are sensitive to his needs and you engage him in the process without forcing it on him, you should have no problem of getting stuck on pureed foods (which can happen with full term babies who are not offered chunky foods at around 9 to 10 months). Continue to offer him formula, although switching to a regular concentration if appropriate now, and may help to increase his appetite for more cereal and other solids. Don't make the switch to whole milk until he is well established on table foods. You can make the switch gradually by cutting the formula little by little with milk.

If your son is showing an interest in eating the food you and your husband are eating then certainly follow his lead. Just be sure the food he is offered is nutritionally and texturally appropriate for him. Are you pureeing the table food for him or is he eating it chunks and all? If this is the case, then perhaps your son is an exception to the rule and he is wanting a more textured type of food. If you find that he is more receptive to eating table foods, than go with his lead, being sure to continue with the formula as his liquid. Perhaps the dietitian can help you determine his readiness for the chunkier table foods.

I am wondering if you are giving a 6 ounce bottle of formula at bedtime since your email said-"and then a 6 ounce bottle of cereal at bedtime.", or if this was a misprint on your part? I strongly discourage feeding cereal out of a bottle and would suggest that if you are doing that you eliminate this practice and make the bottle only formula.

You don't seem to be a paranoid preemie mom, only one looking for the proper information. I hope what I have provided helps. I think you will need to be patient about the catch up part. Your son will slowly do that, although it may take years. Listening to his cues and working to provide him with the appropriate foods will help to ensure that he is getting the best nutrition to support that catching up. Meanwhile, enjoy him for who he is now as I am sure you do beyond measure!

Thank you for writing.

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