Breastfeeding Preemies - Breastfeeding a Premature Baby

Breast milk contains all the essential immunological defense factors that a premature baby would need to resist infection: breast milk contains bioactive elements, enzymes, antioxidants, and cellular components that formula does not.

swaddled preemie, swaddled newborn baby, sick newborn
Tiny newborn baby with a drip

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When you experience premature birth, you face the reality of intensive care and breathing tubes.

Mothers are often released from the hospital before their babies are ready to go home; this can be traumatic, especially if the hospital is far from home. So now, maybe you are asking yourself whether you can still breastfeed your baby.

Yes, you can still breastfeed your baby; in fact, breastfeeding your baby is the best thing to do. Breastfeeding a premature baby is even more vital than breastfeeding a full-term baby and holds added advantages.

premature baby in ICU
Premature baby in the hospital 

The notion that bottle feeding is easier for a preterm baby than breastfeeding is false, and intensive care units worldwide are starting to realize this and change their outlook on this matter.

A preemie baby in intensive care may not be able to breastfeed directly from the breast but can still benefit from breast milk via alternative feeding methods.

When choosing whether to breastfeed your preemie

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Many mothers worry about breastfeeding not working for them, the pain and struggles associated with latching, and concerns about milk supply. The course tackles these fears head-on.

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Advantages of Breastfeeding Preemies

  • Breast milk contains all the essential immunological defense factors that a premature baby would need to resist infection: breast milk contains bioactive elements, enzymes, antioxidants, and cellular components that formula does not.
  • Allergy protection: Breast milk protects the gut wall from infection and allergies. Breastfed babies vomit less than their formula-fed counterparts.
  • Studies have shown that breastfeeding a premature baby can improve neurological development.
  • Breast milk is much easier than formula for a premature baby to digest.
  • Your body will automatically produce milk specifically designed to nourish your premature baby, with added calories, vitamins, and protein for premature baby development.
  • Breast milk also contains proteins that promote growth.
  • Enhanced preemie development: Breastfed babies have higher intelligence scores than non-breastfed babies; their cognitive and motor development is also improved.
  • Better vision: Preterm babies are at risk for a disease of the blood vessels in their eyes. Breast milk reduces this risk and may even prevent blindness.
  • Improved oxygen saturation: Breastfed babies take in more oxygen while feeding, so their oxygen levels are higher than formula-fed babies.
  • Improved heart rate: Babies that breastfeed have been found to maintain healthy breathing levels, while formula-fed babies have a lower heart rate and more episodes of bradycardia.
  • Improved temperature control: Breastfed babies regulate their temperature better than formula-fed babies; this is especially helpful for preemies who struggle with temperature fluctuations.

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So You May Be Asking, “How?"

  • You will need to use a breast pump until your baby is mature enough to start feeding on your breasts. (Exclusive pumping guidelines).
  • The expressed milk can be given to your baby via a gavage tube. (Tube that is put directly into a baby’s tummy).
  • After 32 weeks, your baby can be cup fed to get ready for breastfeeding.
  • You will need to start expressing your milk the day after your baby’s birth.
  • You will have to use a good hospital-grade pump. You'll also ultimately want to rent one for the first few weeks at home until you're confident that your baby is feeding well at your breast.
  • It would help if you tried to express at least eight times every 24 hours, each time for as long as it takes to drain each breast.
  • If a mother can express 800ml of milk daily, she can start expressing less (about six times a day).
  • Expressing should continue until the baby has a good strong suck. Otherwise, your breasts will not be stimulated enough to enable a "let down" (initial flow) of milk.
  • A daily weight gain of 25g is good. A breast milk fortifier should be added to the expressed breast milk of a low birth-weight infant. It will provide extra calories, calcium, and phosphorous.
  • Breastfeeding preemies usually feed well in the football hold position, tucked under your arm with their body supported by a pillow.

Milk Storage

  • The hospital should make provision for refrigeration of the milk until needed. Label the expressed milk with your baby's information and date/time of expression. Fresh milk can be stored for six hours at room temperature, 3-4 days in the refrigerator, and two weeks frozen.
  • Defrost the frozen milk under warm water, not hot water.
  • Do not microwave breast milk to heat or thaw it; it will destroy some of its benefits.

Other Breastfeeding Problems in Connection With Premature Birth

  • Sucking and swallowing problems: Most premature infants experience sucking difficulties. Training a baby to latch takes time, but the smell and taste of the breast milk and the contact between mother and baby will help increase milk production. The mother will need to pump after feedings to maintain milk production.
  • Tongue thrusting: This is when a baby repeatedly thrusts out their tongue while trying to latch onto the breast. Other tongue problems discussed here.
  • Premature babies are more prone to food-related allergies.
  • Preemies are more prone to acid reflux.
  • Wet lung syndrome.
  • Heat loss. (read more about kangaroo care below)
  • Premature babies have weak neck muscles, so a mother will need to support her baby's neck by placing her hand behind the neck and her index finger and thumb lightly over the ears. Read the step-by-step latching instructions for preemies.
  • Some premature babies might fall asleep more often during feedings or even before a mother gets a chance to feed her baby. How to wake a sleepy baby for breastfeeding.
  • Non-nutritive sucking can also provide benefits to the premature baby, such as a calming effect, oral development, stimulating the mother’s supply, and bonding.
  • If the baby struggles with nipple confusion, the mother can use a nipple shield to provide a similar feel to the nipple. Weaning off the nipple shield should be done gradually and as soon as possible.

Breastfeeding Preemies and Kangaroo Care

  • Kangaroo mother care is recommended, especially for premature babies. It has many advantages, including the fact that it encourages a baby to spend more time at the breast.
  • The baby wears only a nappy and a hat. They are placed against the mother's skin so that her baby can breastfeed anytime they want to.
  • A baby cared for in this way will maintain body temperature.
  • Babies cared for in this way will also cry less and sleep more.
  • This method has also been found to increase the mother's breast milk supply by 50%.
  • Daddies can also use this method to encourage bonding.
skin to skin, breastfeeding, attachment parenting
Baby and mother Skin-to-skin

Skin-to-skin contact and kangaroo care information.

Signs That Preemie Babies Are Ready to Breastfeed

  • Babies can root, grasp for the areola and latch on as early as 28 weeks.
  • Your baby will start to turn their head when you touch their mouth or cheek and will open their mouth.
  • Your baby appears to be more awake during feedings.
  • Your baby seems comfortable during feedings.
  • It is a myth that bottle feeding is the only transition before the baby can breastfeed.
  • Babies should also never be evaluated for readiness to breastfeed according to their weight or age; each baby is different.
  • Once a baby shows signs of readiness, the mother can put her baby on a breast that has been pumped so that the baby does not struggle with a fast milk flow while practicing breastfeeding. The mother can gradually start to pump less and less milk before feeding until it is not necessary anymore.

Breastfeeding a Premature Baby for the First Time

Feeding Methods for Feeding Preemies

Oral feeding methods:

  • Breastfeeding should be the first choice: Many preemies can feed at the breast from birth.
  • Bottle-feeding: Special bottles are available that resemble the breast and the flow of the breast. These bottles will make transitioning to the breast easier when the baby can breastfeed.
  • Supplemental nursing system: This device can be used while breastfeeding to supplement the mother’s breast milk with fortifier or expressed hindmilk or to help increase the mother’s milk supply, if necessary.
  • Cup feeding: This method is preferred over bottle feeding; it can prevent nipple confusion.

Non-oral Feeding Methods:

  • Gastric nasal tube: This is used when a baby struggles to swallow. The milk is delivered to the stomach directly via a tube in the nose. A Naso-jejunal tube is a tube that is sent to the small intestine; this helps the baby hold food in the stomach longer; this type of tube delivers a constant supply of milk rather than a once-off large amount.
  • Enteral feeding: This is through an IV rather than the digestive tract.

It can be helpful to stay in contact with other parents of premature children. Surround yourself with those who have experienced the same breastfeeding issues while breastfeeding preemies.


Breastfeeding a Premature Baby
by Stephanie
(United States)

I had a baby four weeks early, but due to pregnancy complications, I didn't have enough amniotic fluid for the baby. By 36wks the baby was full grown and healthy; no NICU nothing, but he weighed and measured a baby eight weeks early.

He is four weeks now, and because of his small size, in the beginning, I couldn't get him to latch on, and now at four weeks, I am still struggling. He seals his tongue against the roof of his mouth.

I even have difficulty getting him to take a bottle because of his tongue. He is the size of a newborn now, so should I give him more time?

My milk supply is decreasing, and because of my small breasts, the pump doesn't work at all; I am getting discouraged. I have a meager supply of milk and feel like giving up, but I know it is better for the baby. I try hand expressing, but I still only get about 1 tbsp every 2hrs. Please help. I don’t want to give up.

I breastfed all of my other children and had no problem and tons of milk. I feel like I'm failing my baby right now. Thank you for listening to my ramble.


Re: Breastfeeding a premature baby
by Tracy

Hi Stephanie, I had similar problems with my firstborn. It can get very frustrating.

First of all, you can stop stressing. You say your milk supply is going down - this is no biggy. I say this because as long as you are still producing small amounts of milk, by the time your baby starts latching on correctly, you will produce more milk. Breast milk supply can increase quickly within a few hours, with an increase in demand.

I have recently reviewed a product called "sacred tea" Have you heard of it? I, myself, sometimes struggle with a lower supply. I first tried Fenugreek capsules but saw almost no difference, then I tried this tea, and after the first night, I noticed a considerable increase. It contains all-natural organic ingredients like Fenugreek, alfalfa, and blessed thistle; this tea on its own should increase your supply quite a bit.

You can use an SNS system (mentioned above in the article) to encourage your baby onto the breast. You can fill the SNS with donor breast milk or formula.

Also, allow your baby to comfort nurse as much as possible.

Hang in there. Before you know it, you'll be breastfeeding him just like your other children did.