Feeding schedule vs feeding on demand?

Thank god for this site...I have been a member since January and have referred to this site numerous times to answer some of my questions or simply to see that I am not alone.

In November I gave birth to my second preemie at 31 wks. She is at a very healthy weight of 10 lbs at 6 weeks adjusted. She remained in the NICU for 10 weeks simply because she would not feed from the bottle with every feed. We fought tirelessly with the NICU staff on the issue of feeding. So much so that they were scaring me with chat of a feeding tube if she did not start feeding regularly. My first daughter did the very same thing and she was a preemie as well at 32 weeks (she is now a spunky 3 year old).

My daughter is a very slow eater, sometimes taking 45 minutes to an hour to take 3 oz. Then at other times she can gulp the same amount in 20-30 minutes. I currently feed her on a every four hour schedule (at times waking her to eat). I am curious if anyone else out there has experienced this delayed interest in feeding. And at what point do you allow your child to go to a demand feeding schedule? My daughter is healthy, she has been evaluated from head to toe and is fine...she just does not feed quickly or show a consistant interest in eating.

Any advice or experiences that you can share would be very helpful:)

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I had the same problem with feeding. It would take her about an hour to finish 4-5 oz. I used to feed her about every 3 hours. Once she hit about 2 months adjusted, she would sleep through the night. I probably got 22-24 oz in her every day which I never felt was enough. She was on pumped breast milk until 8 months when she switched to Enfamil Enfacare.

I tried many different bottles and nipples to see if that made a difference. I ended up giving her a bottle and she would drink about 1 1/2 oz. I would then put the bottle aside and let her play for about 30 minutes. I would then give her the bottle again and she would drink another 2-3 oz.

I know I got a little crazy counting how many calories / ounces she got each day. I have to admit that I probably didn't go to demand feeding until she started table food. Even now she is pretty much scheduled on meal and snack times. However, if she tells me "done", then we stop eating.

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I strongly recommend that you get a speech/occupational therapist to look at your daughter.

My son was a 31 weeker who was growth restricted so he only weighed 1lb, 10oz at birth. We have ALWAYS struggled to get him to eat. He has NEVER been interested in eating and rarely shows that he is hungry. We also struggled in the NICU with feeding and came home knowing how to place an NG tube if he needed it. We worked very hard to get him to eat so we never used the NG. It would take my son 45-1hr to eat 3-4oz. At first we started out with a weak suck and weak muscles.

Unfortunately, things only got worse. We learned that he had a cows milk allergy when he was 9 months old. By that point, between being uncomfortable from the allergy and us forcing him to eat, he has developed an oral aversion (getting upset, pushing the bottle away, blowing in the bottle, spitting everything out, etc). In addition, he went 3 months without any weight gain (or loss). He will be 1 yr old next week and weighs 12lbs.

We finally made the decision to get a G-tube and its the best thing we've done (he's had it for 2wks). Eating is no longer stressful for any of us, we can concentrate on positive eating experiences, and he is finally gaining weight.

I don't mean to scare you, I just want to give you as much info about our experience. Do NOT force your daughter to eat... you can create aversions. Since she doesn't appear to be hungry, I would stick with a schedule. We do have somewhat of a schedule, but we do let our son sleep and adjust accordingly.

We would also give my son breaks like you mention with your daughter. A short break is probably ok (5 min), but I wouldn't go 1/2 hr. I strongly suggest a therapist so you can avoid any potential problems like the ones we are having now.

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Thanks so much for you replies.
We have had her evaluated by an occupational therapist and it was determined that she is slightly developmentally delayed with her oro-motor skills. Otherwise her suck and swallowing is normal. She has done remarkably well since coming home a month ago--gaining a pound since home. When we feed her she does not fight or become combative/resistant, at most she will fall asleep and slowly eat as she is in and out of sleepiness. When she is wakeful she eats well but is very distracted by her surroundings = very slow eating.

I am not worried at this time about her needing a feeding tube as she does eat, just very slowly. When she is being fed she will open her mouth for the bottle and eat, she just does not cry for a feeding all the time. I do not remember at what point I stopped worrying about the volume my first daughter ate and let her dictate her feedings.

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Our best feedings are at night, so we feed during the day ( every 3 hours) and do the best we can. Usually, he can make up any needed volume at night (he eats at 6:30pm, then 9:30, 12:30am, he gets up between 5-6am). Although thankfully, lately our son has been surpassing his volume goal, finally! (He is 11 months actual, 8 months corrected). We go to a feeding clinic 1x per month and also meet with a Nutritionist there, they have all been wonderful. Our son too has a normal suck and swallow, but his BPD seems to effect some feeding, as well as him being distracted at times. Like you too, some feeds he takes 4 ounces in 10 minutes and other feeds are sooo long, only to have him eat 2 ounces. Hang in there

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We had some similiar issues- we finially went to on demand feeding when we discovered that Gav actually ate more when he could eat at his leisure. Once we were home for about a month- he settled into a every 2hrs or so pattern, but only about 1.5-2ounces. It was frustrating, but once we got home I felt much more comfortable doing things on his schedule. I guess it would depend on how die hard you are about settling into a strict schedule. Good luck! Aslo- talk to the OT about making sure you are using chin support and other techniques that make it easier for them to eat!

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