Overview

Some premature babies can't be fed by mouth right after birth.

If your baby was born before the gestational age of 32 to 34 weeks, he or she can't feed by mouth. The reasons are:

• Poor coordination (or lack) of sucking, swallowing, and gag reflex.
• Weakness of both the oral and stomach muscles.
• Small stomach capacity.

Until your baby is stronger and more mature, tube feeding is used. It can feed milk, formula, or a combination of the two directly into the stomach.

Some premature babies are given intravenous (I.V.) feedings. These include babies whose gastrointestinal tract can't yet digest properly or is affected by necrotizing enterocolitis. The feedings are given through a tube into the umbilical site or into a vein.

When your baby is mature enough to feed from a nipple, you can start oral feedings. Over days or weeks, you can gradually replace more tube or I.V. feedings with oral feedings.

What should you know about breastfeeding?

Oral feedings can begin when your premature baby is mature enough to feed from a nipple. Your baby will probably need to start slowly with breastfeeding. If your baby is getting tube feedings, one or two breastfeedings a day may be enough to start. As your baby gains strength and weight, you can start to feed from the breast more often. When your baby is stronger, try to feed your baby directly at the breast for all feedings. If needed, you can use a syringe, a cup, or some other device to feed breast milk to your baby.

If you aren't sure that you want to breastfeed, think about keeping your options open. You can pump to keep your milk supply going until you've had time to decide. Any amount of breast milk offers your premature baby greater protection from infection than no breast milk at all. Breast milk has proven benefits, especially for the fragile premature baby. Breast milk has benefits over formula. Breast milk provides better immunity to dangerous infections, nutrient absorption, digestive function, and nervous system development.

But keep in mind that anything you put in your body can be passed to your baby in breast milk. If you breastfeed, don't take drugs. And it's best to avoid alcohol. Before you take any kind of medicine, herb, or vitamin, ask your doctor if it's safe.

Premature babies, including those born at 34 to almost 37 weeks, often have trouble with oral feedings. They may need extra help. If you find yourself feeling frustrated or worried about it, get help. Both the nurses and your lactation consultant have years of experience with feeding problems. If at any time you have trouble feeding your baby, talk to your doctor or nurse about it.

In some cases, your health care team may suggest that you use donated breast milk from an accredited milk bank. To find out more about this, including how much it costs, talk with your doctor, nurse, or lactation consultant. If your baby was born before the gestational age of 32 to 34 weeks, your doctor may advise adding a thickening agent to the baby's milk. Talk to your doctor about how this is done, as well as the risks and benefits, before you try it.

How does pumping help with breastfeeding?

Regular pumping keeps up your breast milk production until your premature baby is ready to breastfeed. If your baby is getting tube feedings, you may also need to pump so your baby can be given breast milk. If your baby can't digest milk yet and needs intravenous feedings, your milk will be frozen for future use.

Pumping will get easier with practice. Pump as often as your baby feeds, about every 2 to 3 hours, and at least once at night. Bring your labeled bottles or bags of milk with you to feed your baby or to freeze for later use.

Talk to a lactation consultant about any pumping and breastfeeding questions and problems, both before and after the birth. The consultant can also help you become familiar with the double electric breast pump.

If you aren't sure that you want to breastfeed, pumping can keep your milk supply going until you can decide.