A baby girl was born at 34 weeks gestation weighing 1400 g. Mother had not planned to breast feed but managed to express milk for all her baby’s needs. The baby was discharged at 36 weeks fully breast feeding. After initial weight loss she had returned to her birth weight by discharge. On follow up by health visitor baby was noted to only have put on 50 g since discharge after 2 weeks. Health visitor advised formula milk top ups but on discussion with neonatal team, the mother was encouraged to continue demand breast feeding with gaps no longer than ~3.5 h, continue expressing and not introduce formula. Instead 4 sachets of breast milk fortifier (BMF) was started and baby’s weight gain resumed. Four sachets were calculated to be approximately equivalent to half strength BMF. The BMF was given 4 times evenly during daytime, each sachet was dissolved in ~4 ml expressed breast milk and given via teat (not attached to bottle) just before a breast feed. Iron and vitamins were also given. BMF was provided by the neonatal unit at a cost of ~30 p/day.
After 3 weeks BMF was gradually reduced and stopped by 6 weeks corrected. Mother fully breast fed throughout and continued exclusive breast feeding until last contact at 6 months corrected.