When babies are born prematurely (before 37 weeks of pregnancy), they may have special feeding and nutritional needs. Preemies often need extra support to grow and continue developing, and parents may have questions about breastfeeding, bottles or feeding schedules.
Kikelomo Babata, M.D., a neonatologist at Children's Health℠ and Assistant Professor at UT Southwestern, answers these questions and shares advice for feeding your premature baby.
What are common feeding problems in premature infants?
Premature babies may face different feeding problems depending on their age and development. "Post-conceptual age is more important than chronological age for a baby's development," explains Dr. Babata. "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."
Some premature babies have difficulty breastfeeding or bottle-feeding for the first few weeks of their lives. This is because infants, both full-term and premature, continue developing their ability to suck, swallow and breathe after birth. This is a skill they need to feed, so they can coordinate how to suck, swallow then breathe through their nose. Additionally, premature babies may be sleepy and get tired during their feeds.
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)
If your baby experiences these feeding problems, they may need to be fed through a feeding tube. This tube is placed through the nose and down into the esophagus. If your baby has a feeding tube, they'll stay in the hospital until it is removed.
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 speech therapist for more support.
Can I breastfeed my premature baby?
Yes, you can breastfeed a premature baby. Your breastfeeding experience may depend on your baby's development and nutritional needs.
Breastmilk offers many benefits for premature babies, such as:
- Boosting digestion
- Helping baby’s immune system fight infection
- Promoting eye and brain development
- Providing bonding opportunities
"Breastmilk is linked to a lower risk of necrotizing enterocolitis, an illness that can be devastating for preterm infants," says Dr. Babata. Necrotizing enterocolitis is inflammation that can seriously damage or destroy intestinal tissue in babies. It can increase their risk of death or neurodevelopmental problems.
Breastfed infants also have a lower risk of ear infections, respiratory infections like respiratory syncytial virus (RSV) and bronchiolitis, rashes and gastroenteritis. Breastfeeding can have long-lasting benefits as well – lowering your child's risk for chronic illnesses in the future.
Advice for breastfeeding a premature baby
It's important to know that breastfeeding a premature infant 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 breastmilk in a bottle. See tips for increasing your milk supply while pumping and how to safely store your breast milk.
If your premature baby can breastfeed, they still might need bottles of supplemental formula. Often, premature babies cannot exclusively breastfeed because they have higher caloric needs to support growth. Special high-calorie formula or human milk fortifiers can help your child grow while still getting the benefits of breastmilk.
If your premature baby is on a feeding tube, talk to your care team to learn what you can do and whether you should pump your breastmilk.
What type of bottle and formula is best for my premature infant?
Whether you give breastmilk or formula in a bottle, you should use a slow flow bottle nipple designed 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. Depending on your baby's diet, they can also advise if any other nutritional supplements are needed, such as vitamin D or iron.
How much should I feed my premature baby and how often?
How much your baby needs to eat will change as they grow. Premature babies need 150 to 160 milliliters per kilogram of body weight each day. Your lactation consultant or pediatrician can help you determine how much this is for your baby.
No matter how much they eat per feeding, preemies need to eat at least every 3 to 4 hours.
When can my premature baby eat solids?
A premature baby can start eating solid foods when their adjusted or conceptual age is 4 to 6 months. A conceptual or adjusted age means that instead of counting your baby’s age from their date of birth, it's calculated from their due date. For instance, if your baby is born 10 weeks before their due date, their age at 10 weeks past their due date is 10 weeks (even though they were born 20 weeks ago).
Around the adjusted age of 4 to 6 months, premature babies should be able to support their head and have lost their tongue-thrust reflex. This reflex causes them to spit out anything put in their mouth that's not milk or formula. This is a good time to introduce solids.
Taking care of a baby is a challenging job. While these special feeding needs can add extra stress to those early days of your child's life, parents should remember that patience is key.
"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."
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.