Feeding a baby is one of life’s most rewarding experiences and something parents are anxious to do with their newborn infants. It is important to recognize, however, that preterm babies commonly require feeding support with tube feedings until they are ready to use a nipple. Although we commonly think of feeding as “just something babies do” it is a complicated and energy intensive skill that takes time to develop. Just like learning to walk, all babies develop this skill on their own schedule. Although it is exciting to watch a baby learn to feed, it can be stressful as well. Feeding is usually the last skill that babies must master before being discharged home and waiting for that to happen can be stressful.
We practice cue-based feeding - an individual approach to infant feeding that provides an objective way to evaluate your baby’s readiness for and tolerance of oral feedings, ensuring that feedings are advanced as your baby demonstrates readiness. Cue-based feeding results in earlier achievement of full oral feeding.
It is clear that breast milk offers special benefits to your baby and we encourage all mothers to breastfeed if possible. Breast milk has been shown to decrease the risk for infections and is easily digested. If your baby is born before 35 weeks we will likely need to fortify your breast milk with extra nutrients to meet your baby’s full nutritional needs. If you choose not to breastfeed or are unable to breastfeed we can either use banked breast milk or special premature infant formulas. All of these will assure that your baby gets all of the nutrition they need.
Absolutely! Our doctors, nurses and lactation specialist will provide you with all the information and support you need to help you nurse your baby. If your baby is not ready to breastfeed we will make sure that you have a breast pump available. Using a high-quality breast pump is vital to stimulate your milk production until your baby is able to nurse.
Even babies born extremely premature will commonly demonstrate sucking behavior shortly after birth. This is called non-nutritive (not for nutrition) sucking. This type of sucking is different from the feeding behavior required for an infant to feed. Nutritive (feeding) sucking usually doesn’t begin to develop until 32-34 weeks gestation and commonly takes several more weeks for the infant to be able to use a nipple for all his/her feedings. Some signs that suggest your baby may begin ready to feed include being alert for a feeding, able to maintain a stable temperature and having a stable breathing pattern.
Around 32 to 34 weeks gestation is when feedings using a nipple are first introduced to most infants. The feeding experiences at this time are ONLY to encourage bonding time between you and your infant. For the most part your baby will get very little of the milk he/she requires for growth and will continue to need tube feedings. That is okay and even expected. Don’t focus on how much food your baby may or may not be eating; the main focus should be on ensuring that your baby is having a positive bonding experience.
Around 34-36 weeks your baby will develop a stronger and more coordinated sucking pattern. Even though their strength and coordination are improving most infants will still require feeding support with an NG tube in addition to bottle or breastfeeding. As always, the main focus of each feeding should be ensuring that your baby is having a positive feeding experience. A positive experience encourages the development of healthy feeding skills. If your baby is vigorous and takes a large feeding, great! If your baby feeds a small amount before falling asleep, that’s great too. This is the time to learn your baby’s different feeding cues.
Somewhere between 36 and 38 weeks feeding skills improve rapidly. Many babies, but not all, master feeding sometime during this period. A few babies will master this sooner and still more infants will take longer. This variation in time is normal. Your baby will need to nipple all his/her feedings and be without a tube feeding for 48 -72 hours before being considered ready for home. In addition he/she must show that he/she can eat enough to gain weight.
Premature infants have special nutritional needs compared to term infants. Many premature infants who are breastfed will require bottles of supplemented breast milk to assure they receive enough calories to grow. This will be mixed with your breast milk and fed to your baby from a bottle. The number of supplemented feedings your baby requires will depend on his/her nutritional needs. Most of the time your baby will be able to transition to full breast feedings over several months if growth is appropriate. When to introduce a bottle to breastfed infants depends on several factors. Our usual recommendation is to wait until breastfeeding is established. This is usually around 35-37 weeks. Letting your doctors and nurses know what your feeding goals for your baby are is one way you can help formulate a feeding plan that works for you and your baby.
Formula fed babies will need infant formulas specially designed for premature infants. These are readily available and will give your baby complete nutrition.
Remember, your baby’s feedings WILL get stronger with time. Unfortunately, predicting when your baby will be able to eat all their feedings is impossible and there is no way to speed this process up. Keeping your baby’s feeding experiences positive is the best way to allow his/her own feeding skills to develop.
A SVH Occupational Therapist will be consulted at times to assess feeding as part of the NICU team.
If you have questions or concerns about your babies feeding please ask your doctor.
In general, we know your baby is ready to go home when:
- Baby is taking all feedings at the breast or by bottle and is gaining weight
- Baby is stable on a small amount of oxygen (or doesn't require additional oxygen)
- Baby is maintaining proper body temperature in a crib
- You are comfortable taking care of your baby
- If your baby was born prematurely, he or she will most likely be ready to go home by his or her due date and often babies go home before then.