Feeding

• Feeding a premature baby often starts gradually, sometimes with tube feeding before transitioning to breast or bottle. 
• Breast milk offers benefits, but it’s not the only valid choice - babies thrive on formula or donor milk. 
• Bottle feeding allows shared caregiving and is especially helpful if breastfeeding isn’t possible or desired. 
• Combination feeding is common and can be tailored to fit your baby’s needs and your circumstances. 
• Support matters. Lean on nurses, midwives and lactation consultants if needed.  

Feeding a premature baby can often come with questions and concerns, especially in the early days. Our guide provides tips and answers to common concerns about feeding a preemie, from when they can start feeding to what kind of milk, and how to tell if they’re getting enough. 

When can a premature baby start feeding?  

When a baby is born prematurely, how many weeks along they are when they’re born can have an impact on their ability to do many things that full-term babies can do, such as bottle or breastfeeding. 

As a parent, you're bound to worry about making sure your baby gets the nutrients they need to grow, and it can be upsetting to know that your role in feeding your baby is going to look drastically different than you planned. 

It's important to remember that it's completely normal for a premature baby to have feeding difficulties, and you're not alone. 

How to feed your baby in the NICU 

While in the neonatal unit, your baby may be fed using a tube. In premature babies, the coordination of sucking, swallowing, and breathing needed for effective feeding is usually not fully established until about 34 to 36 weeks gestation, although this can vary from one baby to the next. Tube feeding helps them receive enough nutrition to grow and develop. 

During tube feeding, breast milk or formula is given through a tube in your baby’s nose or mouth and into their stomach. 

Tube Feeding (Gavage Feeding) 

If your baby can’t yet suck or swallow effectively, milk will be delivered directly into their stomach through a thin tube (nasogastric or orogastric). This allows them to get vital nutrients without tiring themselves out. 

Types of tube feeding include… 

• Nasogastric tube feeding (also called an NG tube): Baby is fed through a small soft tube, which is placed in the nose and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach. 
• Orogastric tube feeding: Baby is fed through a small soft tube, which is placed in the mouth and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach. 

Very premature or sick babies are sometimes fed using parenteral nutrition (PN). This means that they're fed via an intravenous (IV) line to begin with and a fluid containing nutrients is fed straight into their vein. 

If you’re planning on breastfeeding, you can begin to express your breast milk for them by hand or with a breast pump. Your milk is uniquely suited for your premature baby and can boost immunity and gut health. 

Bottle or breastfeeding when baby is ready 

As your baby grows stronger, they’ll begin to feed by mouth. This transition will be gradual and guided by their cues/medical guidance. 

Skin-to-skin contact supports bonding and helps babies get used to the breast, so get as many bare-skin cuddles in as you can.  

Fortified milk or premature baby formula 

Premature babies need more calories, protein and minerals than full-term infants. Even breast milk may need fortifiers. Some babies will also need specialised formula if breast milk isn’t an option. 

When to ask for help 

Never hesitate to reach out if you’re concerned about: 

• Poor weight gain 
• Decreased feeding interest 
• Excessive vomiting or choking 
• Signs of dehydration (fewer wet nappies) 

Bliss offers a wide range of services to provide support to parents and families of babies born premature or sick. 

Do preemies take longer to breastfeed? 

In short, yes, often they do, and that’s a completely natural process of feeding a premature baby. Breastfeeding is a skill that must be learnt, not just for babies but for parents, too. For premature babies, that skill can take a little longer to develop. Because they’re born before they’ve fully mastered the coordination of sucking, swallowing and breathing - many preemies need more time and support before they can breastfeed effectively. 

If they're premature, your baby may not be well or strong enough to breastfeed as soon as they're born. You may be encouraged to hand express for the first 24 to 48 hours, then at around day two or three, you can begin to use a breast pump to express milk. This will help get your milk supply going and the breast milk you collect can be given to your baby in a bottle or using an NG tube if they're able to have feeds. If not, it can be frozen so you can give it to your baby in a bottle when they're ready. 

Eventually, you should be able to start breastfeeding once you and your baby are ready. When the time comes, you may not know where to start with breastfeeding your baby, especially if they've previously been tube-fed. You can combine tube feeding with breastfeeding until your baby is getting everything they need from the breast only. A nurse, midwife or feeding specialist on the neonatal unit will be able to support you. 

Feeds are a great opportunity to have some skin-to-skin contact with your little one, and methods like Kangaroo Care (skin-to-skin contact when a baby is placed against the parent’s chest) improve lactation and help establish breastfeeding.  

Remember that every baby is different, and it can take time to build your confidence, so it's important to ask for help and support, especially when you first start. 

Can you bottle-feed a premature baby? 

Yes, if your baby has perviously been tube-fed, you can eventually begin to feed your baby with a bottle following the guidance of your healthcare team. Your midwives and team within the NICU are trained to guide you through this - from choosing the right bottle to helping your baby build feeding stamina over time. 

When your baby is ready to move on from tube feeding to feeding from a bottle, how much they eat is not the most important thing. What matters the most is helping them practice and develop positive oral skills – so don’t worry if they aren’t taking in a lot of milk. They will get there! 

Parents can choose to feed their premature or sick baby expressed milk or formula in a bottle, and some parents feed their baby through a combination of breast milk and formula.  

Like other types of feeding, it's important to recognise the cues that your baby is hungry before bottle feeding. When they’re ready for a feed, they may put their fingers into their mouth, make sucking motions (rooting) and become restless. 

Because preemies may have weaker sucking reflexes or tire easily, they often benefit from specific techniques and tools during bottle-feeding: 

Following these steps while bottle feeding can help them to feed successfully and be more comfortable: 

• Make sure you are close to your baby and hold them upright with their head supported in the most comfortable position for you both.  
• Offer the bottle when your baby shows feeding cues.  
• Try paced feeding techniques to help your baby breathe between swallows 
• Gently invite your baby to take the teat. 
• Avoid forcing your baby to take the teat or finish the feed. 
• Use slow-flow bottle teats that mimic the breast and help prevent overwhelm. If the milk comes too quickly, it can be difficult for your baby to coordinate their sucking, swallowing and breathing. 

A nurse or feeding specialist on the unit will show you teats, bottles and positions that can help your baby to do this more effectively.  

However you choose to feed your baby, you’re still meeting their needs. You’re doing something extraordinary. And that matters more than any method. 

Sources 

• Breastfeeding your premature baby - NHS  
• Feeding | Bliss