Tommy's PregnancyHub

Feeding your premature baby in hospital

Your premature baby’s diet will be carefully balanced to suit their tiny digestive system, while also meeting the needs of their growing body.

This content is mainly aimed that the person that will be trying to breastfeed their baby. But there is also information here about alternative methods of feeding, depending on your family’s health and circumstances.

Some people prefer to use the term ‘chest feeding’. If so, don’t be afraid to speak to your healthcare professional about your preferred use of language. 

What kind of nutrition does my premature baby need?

Premature babies need to put on weight more quickly and get more nutrients than full-term babies, so feeding (nutrition) is important. Your baby’s digestive system (gut) and ability to suckle may not be fully developed so they will need some help to feed. The type of help they will need depends on how early your baby is born and how well they are. 

Nutrition into a vein

Some babies need to have fluids and nutrition through a thin tube into a vein (intravenous or IV line). This ‘drip’ carries the nutrients directly into their blood supply, so that their gut doesn’t have to process them. This is called parenteral nutrition.

Your baby may have this type of nutrition if they are: 

  • born prematurely
  • too ill to have milk
  • have certain problems that need surgery 
  • not growing as much as expected with milk alone.

Your healthcare team will explain why your baby needs parenteral nutrition and how it will help them. Your baby will have this type of nutrition until they’re able to get enough nutrients from milk. For some babies, this may be a few hours or days.

Other babies may need longer-term parenteral nutrition, for example if they have bowel problems or if they need help to put on weight.   

Milk through a tube into the stomach

Even if your baby can digest milk, they may not be ready to co-ordinate sucking, swallowing and breathing and need time to learn. Until then, they may be fed milk through a fine, soft tube that goes through the nose or mouth into the stomach. 

Your breast milk is the best milk for your baby.

If you’re able to express milk, your baby can have this through the feeding tube. You can read more about breastfeeding and expressing below. 

Your baby may continue tube feeding while they are learning to suck, to make sure they get enough food. It may be necessary to give your baby fluids or parenteral nutrition through an IV line while they are learning how to feed. 

Breastfeeding your premature baby

Your healthcare professional will encourage you to breastfeed your baby. A mother’s own milk is always the first choice of feed for babies. Breast milk is vitally important for preterm and sick babies. This is because breast milk, and particularly colostrum (the first milk produced), has many benefits for premature babies, such as helping them to fight infections.

Breastfeeding can also help you to bond with your baby.  

Breastfeeding can be a positive experience. But although for some people it can be easy, this is not the case for everyone. If you are finding it difficult, there is a lot of support available (see below).

Even if you’re not planning to breastfeed, you could express your breast milk for a while to help support your baby’s immune system in the early weeks after birth.  

Why is breast milk recommended 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 just a few drops at a time will do them good.

Here are some of the benefits of breastfeeding.

  • Breast milk contains substances that will help protect them from infection. 
  • It helps baby’s guts to mature. 
  • It is easier for a small baby to digest than baby formula.
  • Babies fed on breast milk are less likely to get a serious illness called necrotising enterocolitis (NEC) than babies fed on formula milk. 

When can I start to breastfeed?

Your healthcare team will help you look for signs that your baby may be ready to breastfeed. These signs may include being alert, mouthing and sucking their hands and fingers.  At first, your baby may not be mature enough to fully feed from your breast, but practicing together will be good for both of you. 

In the meantime, you can express milk to give to your baby through a tube into their stomach. There’s more information about expressing breast milk below.

When you start breastfeeding or expressing, you will only get a very small amount of milk called colostrum. Over time, this will become more mature breast milk. Don’t be discouraged at the small amount of milk you produce at first – this is normal.

In the first few days after birth, your baby only needs small amounts of milk and frequent expressing will help to increase your supply. 

Combining breastfeeding with tube feeding, using milk that you have expressed (or donor milk/formula milk), is a good way to support your baby as they grow and their breastfeeding ability develops.

Kangaroo care (holding your baby to your chest) can help you start breastfeeding when your baby is ready. 

How do I start to breastfeed?

The UNICEF UK Baby Friendly Initiative gives this advice about breastfeeding on the neonatal unit:

  • Try to get as comfy as possible. 
  • Hold your baby close (skin-to-skin contact is perfect) and calm and reassure them by talking gently. 
  • Make sure their nose and toes are facing the same way so they don’t have to twist their head to feed. 
  • Gently support your baby’s head, making sure they can still move their head forward and backward. 
  • Express a little milk on to your nipple and let your baby lick this. 
  • Encourage them to open their mouth by gently rubbing your nipple above their top lip. 
  • When their mouth is wide open, bring them closer so that your nipple reaches back into their mouth. 
  • You will feel a drawing sensation as your baby begins to feed but it should not be painful. Look and listen to them and notice if they are swallowing as this will tell you that they are getting your milk. 
  • If your baby doesn’t seem comfortable, try changing the way you hold them. Ask your midwife to help you find a position that suits you both. 

Is breastfeeding supposed to hurt? 

Breastfeeding shouldn’t hurt, but there are a number of reasons why it can. Breast pain may be caused by the following.

  • If your baby is not latching on (attaching) to the nipple correctly.
  • Engorgement. It can take a few days for your milk supply to match your baby's needs, which may lead to your breasts getting overly full. Expressing a little may help.
  • Blocked breast milk ducts can cause small tender lumps in the breast. Feeding your baby will help or you could try a warm flannel or a warm shower to encourage the flow.

Your healthcare team on the baby unit can help you with breastfeeding and any problems you might have. 

What if I’m finding it difficult to breastfeed?

Not everyone finds breastfeeding easy. Some babies and parents take to breastfeeding straight away, but others find it difficult. 

If you’re finding breastfeeding or expressing difficult, ask for help as soon as possible. The staff in the neonatal unit are trained to provide help and support, and your hospital may have specialist breastfeeding support staff. There are also support organisations who can give support in person or by phone or email. You can find a list of organisations at the bottom of this page.

Expressing milk for your premature baby

If your baby is very tiny or unwell, they may not be able to breastfeed straight away. But you can express your milk to give to your baby through a tube into their stomach. 

When should I start expressing?

It’s best to start expressing as soon as possible after the birth and to express frequently to build up your milk supply. If you can, try to express at least 8–10 times in a 24-hour period.   

The healthcare team will help you get into a daily routine of expressing milk for your baby. In the first few days, you will only make small amounts of a thick, yellow, nutrient-rich milk called colostrum. Don’t worry about the amount you’re producing – it’s normal to just produce a small volume. Once your milk ‘comes in’ after a couple of days, it will be paler in colour and you will slowly start to produce larger amounts.  

How do I express breast milk?

The healthcare team will show you how to express your milk. You can use a hand pump, an electric pump or your hand to gently squeeze the milk out. You can discuss which option is best for you with your midwife or breastfeeding support team. You may be able to borrow or hire electric breast pumps from the hospital.

Storing your expressed milk

You can store breast milk that has been expressed into a sterile container. Your baby unit will have their own policy on how to store your expressed milk. Staff will be able to guide you. 

You can bring expressed milk into the baby unit from home in a cool bag and keep it in the fridge or freezer to use later. Your hospital will let you know how to label and pack your milk.

The UNICEF UK Baby Friendly Initiative gives this advice about expressing on the neonatal unit:

  • Ask the nurse or midwife to check that you are using the best technique if hand expressing and that pump equipment including funnel size is working for you. 
  • Stay close to your baby when expressing or have a picture of your baby or a piece of their clothing nearby. 
  • If you can, get someone to give you a nice back rub before your express. 
  • Close your eyes and imagine gently kissing your baby from their toes up to the top of their head. 
  • Have a big glass of water before you go to bed so you will need to get up to go to the toilet in the night to fit in a night-time expression. 
  • Express in clusters (2 to 3 times close together) to give you a bit of space. But don’t leave it longer than 5 hours between expressions. 
  • If your milk supply suddenly drops, try not to panic. This doesn’t mean that it has gone away. Spending time doing skin-to-skin with your baby, massaging your breasts or doing something you enjoy will help you relax and restart your milk flow. 

What can I do if I’m having problems expressing?

There are things you can try if you’re finding it hard to express.

It’s important to be as comfortable as possible. Try not to rush. If you’re feeling rushed it may be harder to get your milk to flow. Try to set aside some time when you don’t feel pressured. When you start expressing, try to allow at least 30 to 45 minutes for each session. Once you get used to it, it’ll probably take you around 15 to 20 minutes to empty both breasts. But try not to focus on timings too much. Some pumps allow you to express from both breasts at the same time.

Some mums find it helpful to sit near to their baby or look at a photo or video of them while expressing. Some mums prefer to express in the expressing rooms, which are warm, quiet rooms away from any noise or distraction.

You can find out more by reading You and your baby: supporting love and nurture on the neonatal unit, from the UNICEF UK Baby Friendly Initiative.

 

Using donor breast milk

If your baby needs more milk, your healthcare team may suggest using donated human breastmilk or formula until your supply increases. They will explain the benefits and risks of these options to help you decide what’s best for your baby. 

In the UK, NHS an non-profit milk banks, all donor breast milk is rigorously screened to make sure it is safe and suitable for the babies that take it.

If donor breast milk is not available, your baby can have IV fluids and nutrition or formula milk until you're producing enough breast milk.

It's recommended you do not buy donor milk over the internet. This is because the source cannot be confirmed and you cannot be sure whether the donor or the milk has been screened for infections. 

The United Kingdom Association for Milk Banking (UKAMB) and the Hearts Milk Bank has more information about donor breast milk.

How do I bottle feed my premature baby?

Before you begin to bottle feed, get yourself and your baby into a comfortable position with your baby held close to you. If you touch the baby's mouth with the teat, their mouth should open and they will begin to suck.

With breastfeeding, it is important to move your baby from left to right to feed from both breasts. Moving your baby to the left and right sides of your body while bottle feeding will help their physical development.

How do I know whether my baby is getting enough nutrients?

The healthcare team will regularly check:

  • what nutrients your baby needs
  • how your baby is growing
  • how your baby is feeding.

They will continue to check your baby while they’re in the baby unit and after they’ve gone home, to make sure they’re getting the right kind of nutrition. 

Nutritional supplements 

Some premature babies need extra nutrients to help them grow and develop. This may be because their gut is not developed enough to absorb some nutrients or they may need extra nutrients because they are unwell.  

If your baby isn’t getting the right amount of nutrients from milk, the healthcare team may recommend giving them supplements. These come as powders or liquids that you mix with your baby’s usual milk. 

Most premature babies find it difficult to get enough vitamins from milk, even if they’re feeding well, so they will usually have vitamin supplements. This is very important to help their bones develop normally. You may need to carry on giving your baby supplements after you’ve taken them home. The healthcare team will talk to you about this before your baby leaves the baby unit. 

How do I know if my baby is getting enough milk? 

  • You can hear and see your baby swallowing.
  • Your baby's cheeks stay rounded, not hollow, during sucking.
  • They seem calm and relaxed during feeds.
  • Their mouth looks moist after feeds.
  • Your baby appears content and satisfied after most feeds.

Other signs your baby is feeding well

  • Your baby gains weight steadily after the first 2 weeks – it's normal for babies to lose some of their birth weight in the first 2 weeks.
  • They look healthy and alert when they're awake.
  • Towards the end of the first week, your baby’s poo will change from dark and sticky to yellow seedy / brown.
  • Having several wet nappies a day. 
     

Find out more about feeding your premature baby when you take them home

More support and information

The UNICEF Baby Friendly Initiative provides useful a range of resources for parents.

Breastfeeding

La leche League GB provides breastfeeding support from pregnancy onwards. 

The Breastfeeding Companion provides tips and advice for struggling mothers.

The Breastfeeding Network provides support and information about breastfeeding. They also provide a helpline and webchat service.

The Association of Breastfeeding Mothers are a group of trained volunteers supporting breastfeeding mums and their families. They provide online information, a helpline, webchat and local support groups.

Twins Trust is a charity supporting families with twins and triplets. They provide information about pregnancy and parenthood, including breastfeeding.

The National Childbirth Trust (NCT) is a charity that provides information and support on all aspects of pregnancy, birth and early parenthood, including breastfeeding.

The UK Association for Milk Banking has information about using donated breast milk if your baby is premature or ill, and how to donate breast milk. 

Bottle feeding

The First Steps Nutrition Trust is an independent public health charity that provides information and resources about eating well, including infant milks.

 

NICE (2020) Neonatal parenteral nutrition. NICE guideline 154. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng154

Foster JP, Psaila K, Patterson T. (2016) Non‐nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD001071. DOI: 10.1002/14651858.CD001071.pub3.

EFCNI, Embleton ND et al. (2018) European Standards of Care for Newborn Health: Establishment of enteral feeding in preterm infants. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/enteral-feeding-preterm-infants/

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NHS. Breastfeeding your premature baby. https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-premature-baby/ (Page last reviewed: 10 October 2019. Next review due: 10 October 2022.)

Quigley M, Embleton ND, McGuire W. (2019) Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD002971. DOI: 10.1002/14651858.CD002971.pub5.

EFCNI, Herber-Jonat S et al. (2018) European Standards of Care for Newborn Health: Providing mother’s own milk (MOM) for preterm and ill term infants. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/mom/

The Unicef Baby Friendly Initiative. (March 2021) You and your baby: supporting love and nurture on the neonatal unit. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2015/08/neonatal_leaflet_online.pdf

NHS. Breast pain and breastfeeding. https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-problems/breast-pain/ (Page last reviewed: 6 December 2018. Next review: 6 December 2021)
 
NHS. Expressing and storing breast milk. https://www.nhs.uk/conditions/pregnancy-and-baby/expressing-storing-breast-milk/ (Page last reviewed: 16 October 2019. Next review: 16 October 2022.)
  
NHS start 4 life. Expressing and bottle feeding. https://www.nhs.uk/start4life/baby/breastfeeding/expressing-and-bottle-feeding/expressing-breast-milk/
  
European Foundation for the Care of Newborn Infants (2018) Nutrition: overview. https://newborn-health-standards.org/standards/nutrition/overview/   

EFCNI, Lapillonne A et al. (2018) European Standards of Care for Newborn Health: The role of nutrient supplements for preterm infants. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/role-nutrient-supply/

Brown JVE et al. (2016) Multi‐nutrient fortification of human milk for preterm infants. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD000343. DOI: 10.1002/14651858.CD000343.pub3.

NHS. Breastfeeding: is my baby getting enough milk? https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-problems/enough-milk/ (Page last reviewed: 3 December 2018. Next review: 3 December 2021)

Review dates
Last reviewed: 23 August 2021
Next review: 23 August 2024