Feeding your premature baby

Preemie baby feeding challenges

Just because your baby is premature, it doesn't mean they'll have feeding problems. But many preemies need extra time to get the hang of feeding, whether from a bottle or breast.

A baby's suck-swallow-breathe pattern usually becomes coordinated enough to breastfeed around 34 weeks gestation, so if your baby is born around this time, they might be able to breastfeed right away. Your baby's doctor or nurse will be able to tell whether your baby is ready for breast or bottle-feeding, or whether they need to be fed through a nasogastric (NG) tube at first.

Some of the most common things to work through when feeding a preemie baby include keeping up your milk supply and helping your baby learn to latch.

Keeping up your milk supply

If you're hoping to breastfeed, but your baby is too small to do so right after birth, you'll want to stimulate and maintain your milk supply. You'll be able to express breast milk right away, within an hour after your baby is born. When they're stable, you can have the milk fed to them through a tube or with a small bottle.

The best way to maintain your milk supply is to use a hospital-grade pump with a double collection kit (for both breasts). A hospital nurse or lactation consultant will get one for you and show you how to use it. Eventually, you'll want to rent one to use for the first several weeks at home, until you're sure your baby is feeding well at your breast.

Another thing that experts say can help: Being near your baby as much as you can while you pump. Even watching a video of your baby or looking at pictures of them while you pump can help, too. Being close to your baby or looking at photographs or video can stimulate oxytocin (a hormone that helps your milk flow), reduce stress, and increase your milk supply.

Learning to latch

Once your baby is ready to move on to the breast, learning how to latch on and suck can take some time. Your lactation consultant can watch as you do a feeding and provide helpful tips to make sure both you and baby are comfortable and getting the most milk out of each nursing session.

What to expect when feeding your baby in the NICU

If your baby is born around 34 weeks or later, they'll likely be able to breastfeed or bottle-feed. You'll work together with the NICU team to come up with a feeding plan that's right for you and your baby.

Your breast milk is uniquely suited to your premature baby's needs. Sometimes, your baby's provider will suggest adding a supplement to your breast milk or also giving your baby formula to provide extra nutrition.

Here are some other important things to keep in mind when it comes to feeding your preemie when they're in the NICU:

• Your baby may need a feeding tube. If your baby is in the NICU and very premature, they might start off feeding through an NG tube. They'll be able to take expressed breast milk or formula through the tube, which ensures they get as much nourishment as possible before they begin breast or bottle-feeding directly. Some premature babies may get fluids and nutrients through an IV (or a combination of feeding tube and IV) until they're ready for breastfeeding or bottle-feeding.
• Even if your baby can't breastfeed, you can do skin-to-skin. Before your baby is able to breastfeed directly, you can practice kangaroo care. Hold your baby upright on your chest, skin-to-skin. This will help them get more comfortable with skin-to-skin contact like you'll do when nursing, and it will help you produce more milk.
• You'll want to nurse as much as you can once they're ready. Once your baby is able to start nursing at the breast, you'll want to nurse as frequently as you can. Nursing on demand, and about every two hours, helps newborns get the nutrition they need and helps keep up your milk supply.
• You may need to pump after feedings. Some preemies may not take in much milk at each feeding. For this reason, your lactation consultant will likely recommend you also pump after feedings to keep up your milk production and so you have extra milk for any extra feedings your baby might need.
• Pumping a lot can help keep up your milk supply. It's a good idea to pump at least 6 to 8 times a day to encourage milk production. This includes pumping regularly during the night for the first few weeks, too.

  
  In general, you won't want to go more than 4 or 5 hours without pumping. If your breasts feel especially full, particularly in the morning, then you may have waited too long to pump, and that fullness can actually decrease your milk supply.

Hospital staff, including lactation professionals, are super helpful when you start breastfeeding. They can help you learn different breastfeeding positions and show you how to pump. Plus, they can answer any questions and talk through any problems you might be having.

Remember too, that if you or your baby can't breastfeed or you can't pump for any reason, formula is a great option and will provide all the nutrients your preemie baby needs.

Feeding your preemie baby at home

Once your baby is discharged from the hospital, it's time to work on a feeding plan you can do on your own at home.

The first step before you leave the NICU is to check in with your baby's nurse to get an idea of their feeding schedule. That way, you'll know how to structure your days and when your baby is used to being fed.

Here are some other things to keep in mind once you get home from the hospital:

• Learn their cues. In addition to following your baby's schedule, start tuning into your baby's cues. Try to nurse or bottle-feed whenever your baby seems interested – even if that's every hour or so during the early weeks. Pay attention to when your baby wants to eat, and when they'll be ready for the next feeding.

  
  Premature babies don't always cry, but they may become restless and move around if it's been two to three hours since they last ate. Wakefulness might be your best indicator that they're getting hungry and ready to eat.

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  Most preemies eat every two to four hours (about eight feedings every 24 hours). This schedule is flexible, and you can definitely nurse more than that if your baby wants to.

• They're likely to sleep a lot. The life of a newborn is little more than eating and sleeping. If your baby is sleeping through a feeding, try unwrapping them or even taking off their clothes to stimulate their need for suckling.
• Check in with your pediatrician or lactation specialist. Make sure to call your child's pediatrician or your lactation consultation (many pediatric offices have one) shortly after coming home. They can help check your breastfeeding technique and ensure everything is going well. And if your baby is using formula, they can double check that it's still the right one for them.

  
  They may also advise you to continue pumping until your baby is exclusively breastfeeding (or bottle-feeding) and growing well without extra supplementation. Pumping will help keep up your milk supply, and you can store your breast milk for extra feedings if needed.

Breastfeeding your preemie baby

As your preemie baby gets stronger and more mature, they'll be able to breastfeed directly, whether you're at home or in the NICU.

You may notice them try to move toward your breast as you hold them. The first time you breastfeed, you might express some milk first and then put your baby to your breast so they're not overwhelmed by a fast milk letdown.

Don't be discouraged if your baby only licks your breast first. It may take a few tries for them to get the hang of sucking.

If you choose to breastfeed your premature baby, your body will automatically produce milk that's specially designed to nourish them. It's higher in vitamins and minerals and contains more fat. Your breast milk will also contain more lysozyme, an enzyme that attacks certain bacteria and helps protect your baby from infections. Plus, your breast milk will have less lactose, which preemies can have a hard time digesting.

If you're exclusively breastfeeding, your pediatrician might recommend a multivitamin and iron supplement for your baby. Ask them to be sure.

Breastfeeding Problem Solver

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Formula feeding your preemie baby

Although doctors recommend breastfeeding as the best source of nutrition for babies under one year old, you may not be able to. This is okay! Formula can provide all the nutrition your baby needs. And both you and baby will benefit from close skin-to-skin contact even if you're not nursing.

Ask your baby's provider about formula feeding your preemie baby. Some premature babies will go home from the hospital with a special formula that has more calories and nutrients. Other preemies can have regular infant formula.

If your baby took bottles in the hospital and did well with them, ask your doctor or nurse if you can bring some of those home. Or, try different bottles to find the one your baby like best.

Warm the formula by putting the bottle in a bowl of warm water or bottle warmer. (Never warm it up in the microwave.) Then test the formula temperature on your wrist to make sure it isn't too hot. If you baby doesn't finish the bottle within one hour, throw it away and use fresh formula for the next feeding.

Combination feeding your premature baby

Combination feeding means feeding your baby with both breast milk and formula. Your baby's doctor might suggest combination feeding for your premature baby if they were born very early or aren't gaining weight well. (They might suggest this even for a baby who wasn't born prematurely.)

Talk with your baby's provider or a lactation consultant before you start combination feeding. They can work with you to determine how much formula to feed your preemie, what kind of formula to use, and how to boost your milk supply so you can continue breastfeeding.

How to reach out for help when feeding your preemie

How you feed your preemie will largely depend on how early your baby was born and whether or not they're working through any health issues. It may take you longer to establish a feeding routine, but your baby will get the hang of it. Taking it slow is okay (and very normal). Making sure you have a good support system around you can also help. Here are some other things you can do to get help when feeding your preemie.

Meet with a lactation consultant. Many pediatric offices have one, and they can help you through the early weeks. Doctors and nurses will be able to answer a lot of your questions, too, but a lactation specialist can provide hands-on help specific to feeding.

Work with your baby's pediatrician. You'll see them multiple times in those first few weeks with your newborn, and you can always call their office to ask questions in between appointments. They might even host mom meet-ups or parenting classes so you can connect with other parents, particularly those who also have preemie babies.

Talk with other preemie parents. Talking with other parents via social media support groups, in the BabyCenter Community, or in your own neighborhood can also be very beneficial. Connecting with other parents who are on similar baby feeding journeys can bring comfort and encouragement – even during those tough moments.

Turn to La Leche League International (LLLI).Opens a new window This organization is a great place to direct all your breastfeeding-related questions. They can introduce you to other moms who are nursing premature children via their local support groups. LLLI also has books and other resources for moms of preterm babies.