When babies are born prematurely (before 37 weeks), they may have special feeding and nutritional needs. Preemies often need extra support to grow and continue developing.
Kikelomo Babata, M.D., a neonatologist at Children's Health℠ and Assistant Professor at UT Southwestern, answers some common questions about breastfeeding, bottles and feeding schedules for premature babies.
Premature baby feeding methods
Premature babies may face different feeding problems depending on their age and when they were born. “A 4-week-old infant born at 32 weeks may not be as developmentally ready to feed as a 2-week-old infant born at 35 weeks. And every baby is different," explains Dr. Babata.
IV feeding
Some premature babies receive their first nutrients through an IV method called total parenteral nutrition (TPN). This method helps deliver the nutrition they need directly into their bloodstream, bypassing their digestive system that still needs a little time to mature.
Even if your baby cannot yet digest breast milk, you can still start pumping and storing milk – if you plan to breastfeed. That way, you'll have plenty of breast milk when your baby is ready for it.
Gavage feeding
Gavage feeding is another method of delivering nutrition to a premature baby. In this method, your baby gets the nutrition they need delivered into their stomach from a feeding tube that goes through their nose or mouth.
Pumped breast milk, fortified breast milk and formula specifically designed for preemies can be delivered through the tube every few hours. The good news? You can help feed your baby this way and enjoy the benefits of kangaroo care.
Breastfeeding and bottle feeding
Some preterm babies are ready for breast or bottle feeding as early as 30 or 32 weeks. Others may need to wait until 36 weeks. Your doctors can help you know when your little one is ready.
What are common feeding problems in premature infants?
Some premature babies have difficulty breastfeeding or bottle-feeding for the first few weeks of their lives. It all depends on when they're able to develop the coordination they need to suck, swallow and breathe – in the right order. Additionally, premature babies may be sleepy and get tired while feeding.
Premature infants might also have underdeveloped lungs. They might need to be on oxygen, which can make it difficult for them to eat.
Other common feeding problems in premature babies can include:
- Apnea (episodes where they stop breathing)
- Episodes of bradycardia (slow heartbeat that can cause oxygen levels to drop)
- Immature feeding pattern (sucking, swallowing and breathing incorrectly or out of order)
- Oral aversion (not taking a bottle or breast)
- Risk of aspiration (breathing in milk or formula)
Once your baby goes home, your pediatrician can offer tips on feeding your baby and the importance of good nutrition. If needed, they can refer you to a speech therapist for more support.
Can I breastfeed my premature baby?
Yes, you can breastfeed a premature baby. But it might look different than breastfeeding a full-term infant. Breastfeeding may take more coordination for a preemie than bottle feeding, and depending on how premature your baby is, they may have difficulty latching. You may need to use bottles for a few weeks if your baby is having difficulty nursing. You can still choose to pump and provide breast milk in a bottle. See tips for increasing your milk supply while pumping and how to safely store your breast milk.
What type of bottle and formula is best for my premature infant?
Whether you give breast milk or formula in a bottle, you should use a slow flow bottle nipple designed especially for premature infants. These bottle nipples help prevent your baby from getting more liquid than they can handle at once.
Most premature babies will use a special formula designed for preterm babies. Your pediatrician or neonatologist can recommend the right formula for your baby's needs. They can also advise if your baby may need other nutritional supplements like vitamin D or iron.
How much should I feed my premature baby and how often?
A good guideline is to feed your premature baby at least every 3 to 4 hours. How much they need at each feeding will change as they grow. In general, premature babies need 150 to 160 milliliters per kilogram of body weight each day. Your lactation consultant or pediatrician can help you know how much this is for your baby.
Premature baby formula feeding chart
If you're using formula to feed your premature baby, here's a rough guide of how many ounces to give them and how often.
These are just rough guidelines. Ask your pediatrician, neonatologist or lactation consultant for more specific guidelines.
Premature baby breast milk feeding chart
If you're using breast milk to feed your premature baby, here's a rough guide of how many ounces to give them and how often.
These are just rough guidelines. The most important thing is to make sure your baby continues to gain weight. Your pediatrician, neonatologist or lactation consultant can provide you with more specific guidelines for your baby.
Can I overfeed my premature baby?
Yes, it is possible to overfeed your premature baby. If you try to feed them too much it can make them spit up or cause gas, bloating and discomfort. This is because their immature digestive systems are not able to handle large amounts of milk or formula yet. Overfeeding can also put extra pressure on a baby's lungs and make it harder to breathe.
If you're worried about overfeeding, talk to your baby's doctors. They can help you monitor your baby's growth and development and make sure they're getting enough at their feeding – but not too much.
When can my premature baby eat solids?
A premature baby can start eating solid foods when their adjusted or conceptual age (your baby's chronological age minus the number of weeks or months early they were born) is 4 to 6 months.
Around the adjusted age of 4 to 6 months, most babies can support their head and no longer have the tongue-thrust reflex that causes them to spit out anything put in their mouth that's not milk or formula. This is a good time to patiently begin to introduce solids.
"Most babies will eventually learn to feed orally," says Dr. Babata. "Just take it one step at a time and be sure to notice and enjoy progress as it occurs."
Learn more
With the only nationally ranked Level IV NICU in North Texas, Children's Health provides expert multidisciplinary care for a wide variety of complex neonatal conditions. Learn more about our top-ranking Neonatology program.
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