Updated October 2013
Your premature baby - nutrition and feeding
Your premature baby's diet will be carefully balanced to suit her tiny digestive system. Find out more about how to feed your baby, from breastfeeding and expressing to cup and bottle feeding.
What kind of nutrition does my premature baby need?
When your baby is first born, the healthcare team may give her fluids and nutrition through an intravenous (IV line) if she is extremely premature or has breathing difficulties (see below). Alternatively, the doctors may decide that she is mature enough to take milk through a small tube that is passed through the nose into the stomach.
Introducing milk feeds
It is important for milk feeds to be introduced in a timely way - not too quickly but not too slowly - and your team will have the expertise to decide this. This progression must be very gradual because premature babies - especially those born at 34 weeks or less - are slow to cope with milk that goes into their stomachs and have more problems with absorbing nutrients.
Supplements/supplementary formula for premature babies
Babies who are born early miss out on a lot of the nutrition that term babies receive during the final weeks of pregnancy, including key vitamins and minerals that are important to help them grow and become strong.
Breast milk is best for your baby, but she may also need extra vitamins and minerals for growth, so many premature babies are given supplements. There are also formula milks specially designed for premature babies to ensure they get all the nutrients they need.
Feeding early newborns
Through an IV line. A baby who is born very prematurely will initially be fed through an IV line - a thin tube that goes directly into a vein. This carries the nutrients she needs directly into her blood supply, so that her digestive system does not have to process them. This may last anything from a few hours after birth to days, weeks or longer, depending on how premature she is and whether she has any digestive problems.
- Through a tube. Even if your baby is able to digest milk, she will not be mature enough to co-ordinate sucking, swallowing and breathing until about 32-34 weeks, so until then she will need to be fed through a tube. The tube, which is very fine and soft, goes into her stomach - either through her nose and down to the back of her throat (a nasogastric tube) or through her mouth (an orogastric tube). Your baby may continue tube feeding while she is learning to breast, cup or bottle feed, to make sure she gets enough food.
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Breastfeeding your premature baby
Giving birth prematurely does not prevent you from making milk for your baby. The extra stress, fear, discomfort and fatigue that go along with the birth of a premature baby can cause a slow start with milk production, but with patience and support you can express and breastfeed successfully. Breastfeeding your premature baby will boost her health and will help you develop a bond with her.
Why breast milk is best for premature babies
Health professionals generally advise women to breastfeed if they can. Breast milk has many health benefits for premature babies, and is recommended by neonatologists (doctors specialising in new-born babies) wherever possible.
Even if it doesn't appeal to you, it's important to try because of the health benefits for your baby. Even just a few drops at a time will do her good.
If you are using a caring technique called kangaroo care (holding the baby skin to skin to your chest) this can really help to start breastfeeding when your baby is ready.
The benefits of breastfeeding:
- It's good for your preterm baby. Breastfeeding will help to build your baby's health and strength as well as protecting her from viruses and bacteria, which can cause infection. Your milk provides antibodies and other substances that help your baby's immature gut and immune system. Breast milk is easier than baby formula for a small baby to digest.
- It helps you bond with your premature baby. Once your preterm baby is able to feed directly from the breast, you will also get regular skin-to-skin contact with her.
Breastfeeding: what you need to know
When you start breastfeeding or expressing, you will only get a very small amount of milk. Do not be discouraged. With patience you will be able to build this up.
When your baby starts feeding directly from your breast - often from around 32 weeks - she will not take much milk at first, so she will need supplements.
Many women succeed in combining breastfeeding with tube, cup or bottle feeding, so it shouldn't cause problems if you can't be there for every feed.
Practising sucking can help you breastfeed
If you were unwell after your baby's birth, your milk supply may have dried up, but many women get it going again by cuddling their baby and encouraging her to 'practise suck' on their nipples.
Babies can suck from around 28 weeks, and they often find sucking soothing - whether on a dummy, your nipple, or the tip of your little finger. This will also help your baby to prepare for feeding through her mouth, and there is evidence that it can help reduce the length of time she spends in hospital.
Tackling breastfeeding problems
Not everyone finds breastfeeding easy. Some babies - and mothers - take to breastfeeding straightaway, while for others the experience of expressing or getting the baby to latch on (attach) to the nipple becomes a real struggle.
If breastfeeding or expressing isn't going well for you, it's very important that you seek advice as soon as possible to help. A sympathetic breastfeeding adviser should be able to help you work out what's going wrong and provide practical solutions, either in person or by phone or email.
If you're struggling with breastfeeding, ring one of these helplines for support and information:
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Expressing for your premature baby
If your baby was very tiny or is unwell, she may not be able to go on the breast immediately. In this case, the hospital staff will help you start expressing milk.
When to start expressing
To express milk for your baby, it is best to start hand expressing or using a breast pump (hand or electric) as soon as possible after giving birth, ideally within six hours of delivering your baby. You'll need to express frequently - around eight to ten times a day, including once during the night. This will help build up your milk supply for your baby.
In the first few days after giving birth, mothers may make just drops of milk each time you use the breast pump so it is easy to get discouraged, but remember that these drops are very valuable to your baby's health. Her stomach starts off around the size of a pea, so she will need very small amounts regularly. The amount of breast milk you produce will grow slowly, so be patient and don't assume you are not able to produce enough milk.
Colostrum is the perfect first milk for your premature baby
Initially you will only produce a few drops of colostrum - a sticky substance that is especially rich in nutrients - but once your milk comes in, a couple of days after the birth, the amount will increase.
Expressing: what you need to know
- You can express your milk using a hand pump, an electric pump or your hand to gently squeeze the milk out. (It's easiest to use your hand during the first few days to extract the colostrum.)
- You can rent 'hospital grade' breast pumps by the week or month. They are more effective than those that you buy on the high street and allow you to pump both breasts at the same time.
- You can bring expressed milk into the unit, and keep it in the fridge or freeze it for later use.
- You and the healthcare team can use your milk instead of, or as well as, your baby's other feeds.
Storing your expressed milk
You can store breast milk that has been expressed into a sterile container:
- in the fridge for up to five days at 4°C or lower
- for two weeks in the ice compartment of a fridge
- for up to six months in a freezer
When you remove milk from the freezer you can store it in the refrigerator for up to 24 hours.
Your hospital will let you know how they will store your expressed breast milk and how they would like it labelled and packed.
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Cup feeding your premature baby
Cup feeding is less common than bottle feeding, and is not offered in all units. Cup feeding can be done with expressed breast milk or formula, or a combination of both.
How to cup feed your premature baby
Cuddle your baby in an upright position and hold the rim of the feeding cup against her lips. With practice, gradually she will learn to lap the milk.
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Bottle feeding your premature baby
If you bottle feed, the team will prescribe a special low birth-weight formula. Most babies will have moved on to full-term formula or breastfeeding by the time they are discharged.
How to bottle feed your premature baby
Before you begin to bottle feed, get yourself and your baby into a comfortable position, with the baby held close to you. Normally, if you touch the baby's mouth with the teat, her mouth will open and she will begin to suck.
Babies often fall asleep during their feeds. If this happens, try gently stroking her feet or hands, or take a break to change her nappy, as this may help wake her up.
With breastfeeding you naturally move your baby from left to right to feed from both breasts. Try and remember to do the same with bottle feeding as it will help your baby's physical development.
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Weight gain and growth
Putting on weight is essential in order for your premature baby to grow and develop. A key goal of baby care is to optimise your baby's nutrition and growth. An important way for the healthcare team to assess your baby's progress is to measure her weight gain. Premature babies have more difficulty gaining weight because they use the available calories for healing as well as growing.
The healthcare team will monitor your baby's weight very carefully. If she is not gaining weight as expected, they will adjust her nutrition accordingly.
Breastfeeding and expressing helplines and support
If you're struggling with expressing, ring one of these breastfeeding helplines for support and information:
To hire hospital grade breastpumps
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In this section
Your baby's time in hospital:
You can also read about
The following organisations can give you more information about the topics covered in this section.
BMJ Clinical Evidence (2011) Premature Newborn Care, Treatment, Details, http://bestpractice.bmj.com/best-practice/monograph/671/treatment/details/patientgroup/d5e1634/0.html
Callen et al (2005) 'A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants', Advances in Neonatal Care, 5(2):72-888
GOSH (2010) Breastfeeding and expressing milk, Great Ormond Street Hospital for Children NHS Trust: Information for Families
Groh-Wargo S and Sapsford A (2009) Enteral Nutrition Support of the Preterm Infant in the Neonatal Intensive Care Unit, Nutrition in Clinical Practice; 24:363
Henderson G, Anthony MY, McGuire W (2008) Formula milk versus maternal breast milk for feeding preterm or low birth weight infants Cochrane Summaries, The Cochrane Library
Hummel P, Fortado D (2005) Impacting Infant Head Shapes: Preventing Positional Plagiocephaly and Dolichocephaly in the NICU, Advances in Neonatal Care, Vol 5, No 6, p329-340
McGuire W, Henderson G, Fowlie PW (2004) Feeding the preterm infant, British Medical Journal, Vol 329, No 7476, p1227-30
MedlinePlus (accessed Feb 2012) Premature Infant, US National Library of Medicine, National Institute of Health http://www.nlm.nih.gov/medlineplus/ency/article/001562.htm
NHS Choices (accessed Feb 2012) Breastfeeding, Breastfeeding Tips, Expressing breastmilk, http://www.nhs.uk/Planners/breastfeeding/Pages/expressing-breast-milk.aspx
Parker LA et al (2012) 'Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birthweight infants: a pilot study', Journal of Perinatology, 32:205-209
Personal communication, Dr James Boardman, Consultant Neonatologist, Royal Infirmary Edinburgh, 8 June 2011
Renfrew MJ, Craig D, Dyson L et al (2009) Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis, Health Technology Assessment, Vol 13, No 40, www.hta.ac.uk
Rennie JM (2005) Roberton's Textbook of Neonatology, England, Churchill Livingstone