What kind of nutrition does my premature baby need?
When your baby is first born, the healthcare team may give them fluids and nutrition through an intravenous (IV line) if they are extremely premature or have breathing difficulties. Alternatively, the doctors may decide that they are mature enough to take milk through a small tube that is passed through the nose into the stomach. Breast milk is the best choice for your baby. If you are making milk and your baby is strong enough to suckle, you will be encouraged to breastfeed. If your baby is not ready yet to latch on, you can express milk and this will be fed to your baby through a tube.
Don’t worry or feel guilty if you are not producing milk. Be patient, try expressing 3-hourly, and look after yourself with plenty of food, drink and rest, and the milk is likely to arrive.
If it doesn’t or if your baby is ready to progress with feeds before your milk supply isn’t fully established then the team may talk with you about the possibility of using donated human breast milk or formula feed, until your supply is sufficient. You can feed donor breast milk or formula to them through a bottle if they are strong enough, or through a tube.
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 they 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.
How will my baby feed if she is too weak to breastfeed?
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 they need directly into their blood supply, so that their 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 they are and whether they have any digestive problems. The team can give a sugar and salt solution in this way, or may give a nutrient rich solution called TPN (total parenteral nutrition), which contains the nutrients a baby needs to grow. This decision will depend your baby’s birth weight and how long they think it will take to establish milk feeds.
- Through a tube. Even if your baby is able to digest milk, they will not be mature enough to co-ordinate sucking, swallowing and breathing until about 32-34 weeks, so until then they will need to be fed through a tube. The tube, which is very fine and soft, goes into their stomach - either through the nose and down to the back of the throat (a nasogastric tube) or through the mouth (an orogastric tube). Your baby may continue tube feeding while they are learning to breast, cup or bottle feed, to make sure they get enough food.
Weight gain and growth
Putting on weight is essential in order for your premature baby to grow and develop. A key goal of your baby's health carers 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 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 they are not gaining weight as expected, they will adjust the nutrition accordingly.
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 their health and will help you develop a bond with them.
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 them 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 them 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 for a small baby to digest than baby formula. Preterm babies are particularly vulnerable to necrotizing enterocolitis, so you will be encouraged to breastfeed or express your milk.
- 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 them.
Starting to breastfeed
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 - they will not take much milk at first, so they will need supplements.
Many women succeed in combining breastfeeding with tube, cup or bottle feeding, using milk that they have expressed (or donor milk / formula milk if needs be) 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 them 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 their mouth, and there is evidence that it can help reduce the length of time they spend in hospital.
When there is a problem with breastfeeding
Not everyone finds breastfeeding easy. Some babies - and mothers - take to breastfeeding straight away, 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. Many hospitals have excellent breast feeding support staff who are there to help you overcome practical difficulties you may experience.
If you're struggling with breastfeeding, ring one of these helplines for support and information:
Expressing milk for your premature baby
If your baby was very tiny or is unwell, they 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 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. Once lactation is established, i.e milk is flowing, you might find it easier to use a hand held or electric pump – your nurse will advise you on the best time to try these methods.
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. A baby's stomach is very small, so they 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.
How to express breastmilk
- 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.
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.
Bottle feeding your premature baby
If you bottle feed, the team will prescribe a special preterm 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, their mouth will open and they will begin to suck.
Babies often fall asleep during their feeds. If this happens, try gently stroking their feet or hands, or take a break to change their nappy, as this may help wake them up.
Change sides when feeding
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.
Breastfeeding and expressing helplines
If you're struggling with expressing, ring one of these breastfeeding helplines for support and information:
- Association of Breastfeeding Mothers: 08444 122 949
- La Leche League: 0845 120 2918
- NCT Breastfeeding Helpline: 0300 330 0700