Tommy's PregnancyHub

Feeding your premature baby at home

Now you’re home, your baby may be feeding by tube, breast or bottle. Contact the community team or your health visitor if you need help.

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. 

While you're in hospital

If you’re breast or bottle feeding your baby, the healthcare team may ask you to keep a record of how often they feed and for how long. The team at the hospital will help you know when and how often to feed your baby, depending on their individual needs. 

If you’re using formula, you may also need to record how much milk your baby has taken at each feed. If they’re taking enough milk, they should be having 6–8 wet nappies a day.  

But try to remember that when it comes to dirty nappies, every baby is different. Some will poo several times a day, other will poo less often, and some won’t even poo every day. The medical and nursing teams will help you recognise what is normal for your baby and know when to seek help.

You can read about feeding your premature baby in the hospital.

Can I tube feed my baby at home?

With support from the healthcare team, you may be able to tube feed your baby at home if you would like to and your baby is well enough.   

Before you leave the baby unit, the healthcare team will show you how to tube feed your baby and who to contact if you have any problems at home. Once you’re home, the baby unit home team or community nursing team will show you how to help your baby learn to suck. This helps your baby gradually move from tube feeding to breast or bottle feeding.  

Don’t worry if you don’t feel ready to look after your tube-fed baby at home. You can carry on caring for your baby in the baby unit until they are fully breast or bottle feeding until you’re ready to go home.

Breastfeeding at home

Giving your baby breast milk will help with their development and reduce their risk of infection. You may choose to breastfeed or give your baby bottles of expressed milk.

Premature babies can take a few weeks to learn how to breastfeed. If you have had difficulty breastfeeding, it can feel daunting to feed your baby at home without the support of the healthcare team. But there is still help available

What is responsive feeding?

Responsive feeding is the idea that feeding isn’t only about nutrition. It’s also about love, comfort and reassurance between baby and mother. This means focusing all your attention on your baby during feeds and responding to their cues.

For example, you may offer your breast to your baby when your baby is hungry, distressed or irritable. Breastfeeding can help settle your baby during or after an immunisation or blood test, if your baby is unwell or to reassure them in an unfamiliar environment. 

Some parents who aren’t breastfeeding may worry that they are missing an opportunity to bond with their baby. But you can still develop a loving relationship and strong emotional bond with your baby by formula feeding responsively. It is also a good opportunity for dads and partners to be involved in the feeding process. 

The UNICEF UK Baby Friendly Initiative suggests:

  • sitting comfortably, holding your baby close and looking into their eyes while feeding
  • holding your baby fairly upright, supporting their head
  • brushing the teat against your baby’s lips – when they open their mouth wide, allow them to draw in the teat
  • pulling gently on the corner of your baby’s mouth to release the teat if it becomes flattened during feeding
  • offering your baby short breaks during the feed so they have a chance to burp
  • supporting your baby to pace the feed – they can put their tongue over the hole to slow the flow or push the teat out of their mouth when they’ve had enough
  • never forcing your baby to feed or take ‘all’ the milk if they don’t want it
  • feeding your baby skin to skin – this means having your baby on you, their naked skin next to yours with a blanket over both of you for warmth. 

Read more about responsive feeding

How do I know if breastfeeding is going well?

You will know breastfeeding is going well when your baby:

  • is generally calm and relaxed during feeds and is content after most feeds 
  • is feeding for between 5 and 40 minutes at each feed (or a time that is normal for them) 
  • is not showing any signs of jaundice
  • has wet and dirty nappies 
  • is gaining weight 
  • is swallowing frequently during the feed. 

Remember to wind your baby after every feed.

Contact the community team or your health visitor as soon as possible if you have any questions or worries or if you feel you’re not coping. If you find breastfeeding painful, they can give you advice on how to position your baby so they are latching on correctly. Other possible causes of breast pain include thrush, a blocked milk duct or mastitis.

Thrush

If you still find breastfeeding painful after making sure your baby is latching on properly, your health visitor or GP may check to see if you have thrush. This is a fungal infection that can affect cracked or damaged nipples. Babies can also get thrush in their mouths. 

Thrush can cause severe pain in both nipples or breasts after a feed. If you have pain in only 1 breast, thrush is unlikely to be the cause. If your baby has oral thrush, they may: 

  • have creamy white patches on their lips or inside their mouth
  • have nappy rash that doesn’t get better
  • be unsettled when they’re feeding.

If you have thrush, your GP will treat you and your baby at the same time with an antifungal treatment. You can still breastfeed while you’re having treatment. 

To prevent thrush spreading, it’s important to wash your hands carefully after changing nappies. You should also wash any dummies or toys your baby puts in their mouth.  

The NHS website has more information about breastfeeding and thrush.

Blocked milk duct

In the early days, your breasts may get too full of milk, making them feel hard and painful. This is called engorgement. If this continues, it can lead to a blocked milk duct, which can cause a tender lump in your breast and pain while breastfeeding.  

Feeding your baby regularly from the affected breast may help to clear the blockage. A warm shower or flannel may help your milk to flow more easily. You could also try gently massaging the lump towards the nipple during feeds. 

Mastitis

If a blocked milk duct doesn’t get better, it can lead to mastitis. Symptoms include flu-like symptoms, such as a high temperature, and painful breasts. If you have these symptoms, it’s important to contact your GP or out-of-hours service as soon as possible. 

Your GP may advise you to:   

  • continue breastfeeding or expressing, massaging the breast to clear any blockage – stopping breastfeeding can make symptoms worse
  • take paracetamol or ibuprofen to relieve pain
  • drink plenty of fluids.

Contact your GP again if your symptoms don’t get better after a few hours or if you feel worse. They may give you a type of antibiotic that you can take while breastfeeding. 

The NHS website has more information about mastitis

Expressing milk at home

You may have expressed milk in hospital if your baby wasn’t able to breastfeed. Now that you’re home you may choose to express milk to store or for someone else to feed to your baby. You can express by hand or you can use an electric or hand pump.

Speak to your health visitor or GP straight away if you’re worried your milk supply is slowing down or stopping. 

Formula feeding your baby

If you’re not breastfeeding, the baby unit team may give you preterm baby formula to use at home. This contains high levels of nutrients for babies born before 34 weeks or who weigh less than 2kg at birth. You can get preterm formula on prescription until 6 months after your baby’s due date (6 months corrected age). Your baby will then usually move on to standard baby formula.

Safety tips for preparing formula milk

  • Wash your hands very carefully before and after mixing feeds.
  • Clean the bottles and teats with clean brushes in hot, soapy water after every feed. Rinse in cold, running water. 
  • Sterilise bottles and teats using a cold-water sterilising solution, a steam steriliser or boiling water. The NHS website has more information on how to sterilise baby bottles.
  • Prepare the milk with care. Use freshly boiled water that has been left to cool for no longer than 30 minutes. This means the water will be at least 70oC, which is hot enough to destroy any bacteria that may be in the powdered milk. Let the milk cool before giving it to your baby.  Never warm milk in a microwave because it can create ‘hot spots’ that can burn your baby’s mouth.  
  • Avoid storing milk. The longer you leave the milk after mixing it, even in the fridge, the more chance there is that bacteria can grow. Make up feeds one at a time, as your baby needs them. 
  • Out and about. Use a thermos flask to take hot water out with you and make the feed up when you need it.

The NHS has more information on preparing baby formula.

More support and information

The UNICEF Baby Friendly Initiative provides useful resources for parents about feeding their baby.

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.
 

Pammi M (2020) Premature newborn care. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/671/pdf/671/Premature%20newborn%20care.pdf

Collins CT, Makrides M, McPhee AJ (2015) Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD003743. DOI: 10.1002/14651858.CD003743.pub2.

Bissell G et al. (2009) Changing practice by the earlier introduction of tube feeding at home. Infant 2009; 5(5): 150- 54.
 
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/

EFCNI, Herber-Jonat S et al. (2018) European Standards of Care for Newborn Health: Family education and training on infant feeding in the unit and after discharge. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/family-education-infant-feeding/
  
UNICEF UK Baby Friendly Initiative (2016) Responsive Feeding: supporting close and loving relationships. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf

UNICEF UK Baby Friendly Initiative. How can I tell that breastfeeding is going well? https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf

NICE (2006) Postnatal care up to 8 weeks after birth. Clinical guideline 37. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg37

NHS. Breastfeeding and thrush. https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-and-thrush/ (Page last reviewed: 6 December 2018. Next review due: 6 December 2021)
  
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 due: 6 December 2021)

EFCNI, van Goudoever JB et al. (2018) European Standards of Care for Newborn Health: The role of preterm formula. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/preterm-formula/

Paediatric Formulary Committee. (2020) BNF for Children (online) Nutriprem® 2. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://bnfc.nice.org.uk/borderline-substance/nutriprem-2.html

NHS. How to make up baby formula. https://www.nhs.uk/conditions/pregnancy-and-baby/making-up-infant-formula/ (Page last reviewed: 24 September 2019. Next review due: 24 Sepember 2022)

Reviw dates

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

Review dates
Reviewed: 01 April 2017 | Next review: 01 April 2020

This content is currently being reviewed by our team. Updated information will be coming soon.