Feeding FAQ: 4-6 months – Weaning

Is it time to wean my 4 month premature baby?

My daughter Tilly was born 11 weeks premature and weighed just under 3lb. She now weighs 9lb 13oz and is 4 months old. I am wondering when I should introduce solids – my health visitor is not sure.
What is the normal pattern for babies to sleep through, ie do I need to wake her up at 10/11pm instead of letting her wake up naturally? This can be anything from 9.30pm to 2.15am! Is the 10/11pm feed the last one to drop and would you expect to see them sleep until 5am first before stretching to 7am?
Tilly always cries and moans when she gets tired, about 1.5 hrs after a feed and will not just go off to sleep, she has to be cuddled during the day, and always wants a top-up of milk. Why is this? She is formula-fed on Cow & Gate Nutriprem 2.

In order for Tilly to sleep her longest stretch in the middle of the night it is better to wake her at 10/10:30pm, rather than to wait for her to wake naturally. At her present weight she is now capable of sleeping one longer stretch. If she is woken and feeds well at 10/10:30pm she should begin to stretch herself towards 4-5am. From your sleep diary it would appear she is beginning to lose interest in a feed at 3am so is already showing signs of being able to go longer. Let her sleep a five hour stretch if possible at this time. If she begins to lose interest in her 7am feed you can begin to cut back very slowly on her 4/5am feed. She may push herself later and later or just not wake for a night feed once she is taking more formula in the day.
Every baby has a slightly different pattern of sleeping through. Some need a small top-up at 7:30am if they feed well at 5am. This will keep them on track for the rest of the day. Some babies begin to lose interest in a night feed and can be settled with a cuddle or water if they stir themselves at 4/5am. It is important to increase their daytime feeds when this happens so the ounces they would have taken in the night are not lost.
As Tilly was 11 weeks premature, I would be inclined to leave introducing solid food until she is nearer 6 months. Her digestive system is still quite immature and not yet able to cope with the strain on her gut and kidneys. Physically she needs to have good head and neck control so she is able to sit upright supported in a chair to be fed. She needs to be able to swallow food easily by pushing it from the front to the back of her mouth. She will only be able to do this if supported upright.
Her weight needs to be nearer that of 12-14lbs, and she needs to be showing signs that she is ready for more than milk before considering introducing solid food.
Being able to only last 1.5 hrs awake is quite normal for a baby of Tilly’s size and prematurity. Watch her carefully for the first signs of tiredness. Try to have a 15-20 minute wind-down period of quietness with her before putting her down to sleep. Many babies do cry before sleep, but if you know she is well fed and winded then it is best to let her learn to settle alone. This may take 10-15 minutes, but as long as she is not overtired she will learn how to settle alone in time.
As Tilly often only seems to take 2-3ozs at her feed her need for top-ups is real. Have you tried an Avent variflo teat which may enable her to drink more as she will be sucking at her own rate. I have also had success with Tommee Tippee Variflo teats which fit Avent bottles and are slightly softer.
Having a baby as premature as Tilly is hard work. You need to allow her time to catch up with babies of her age which she will do, but she may lag behind in terms of feeding, sleeping and weaning for her first year-18 months of life. As long as she continues to put on weight the way she is doing, then all the other things such as sleeping through will gradually fall into place.