Feeding premature babies: milk and food
An early start - the needs of your premature baby
If your baby is born prematurely, you’ll likely experience a wide range of emotions. Shock, anxiety and concerns for the future being just a few. That’s why it’s important to know that you’re not alone, and that with the right support, you can help your baby get the very best, albeit early, start.
Here you can explore the best way to feed a premature baby, how much milk they need and how to start the weaning journey.
Caring for a premature baby
Babies are considered premature or preterm if they’re born before 37 weeks of pregnancy1.
Depending on how early your baby arrives into the world, they may need extra care in the neonatal unit of the hospital. When their respiratory and other systems are strong enough, your doctor may decide that they’re ready to transfer to the postnatal or transitional care ward, or to go home.
Instead of a cot, your baby might be nursed in an incubator which is better equipped to keep them warm as they continue to strengthen and develop2.
What’s the best way to feed a premature baby?
Breast milk is the best form of nourishment for your baby whatever their age. That’s because it provides the perfect combination of essential nutrients your baby needs and is easily digested. It also delivers important immunity-boosting benefits, helping their immune system to mature, and protect them against infection.5
However, it might be that your baby isn’t yet mature enough to coordinate the breathing, sucking and swallowing actions that breastfeeding or bottle feeding requires3, as these usually develop between weeks 34 and 36 of pregnancy4
Depending on how prematurely your baby has been born, they may need to be fed directly through a vein, called parenteral nutrition, or via a feeding tube4.
Tube feeding your premature baby
If your baby is born earlier than 34 weeks of pregnancy, they may be fed milk via a feeding tube until they’re ready to learn to breast or bottle feed independently. The feeding tube goes through your baby’s nose, or their mouth, directly into their stomach5.
Whilst this may sound daunting, the staff on the neonatal unit will show you exactly how this is done and once you feel comfortable doing so, you’ll be able to tube feed your baby yourself.
Expressing your breastmilk
If your baby is being tube fed, you can feed them your expressed breast milk. Expressing your milk allows your baby to receive all the benefits of breast milk via their feeding tube, whilst building up and maintaining your supply.
Just like breastfeeding, expressing your breast milk can take practice, so you need to give yourself time to learn. Be patient, and don’t worry or feel guilty if you’re not expressing a lot of milk at the beginning6 as every little bit will benefit your baby.
Remember you can always ask your midwife or feeding specialist on the neonatal unit for support if you need it.
Your body will only make a small amount of milk at first. With time, and regular expressing, your milk supply will increase.
There are some simple things you can do to try and stimulate your milk supply. If you’re able to do so, having skin to skin contact with your baby as soon as possible is a great way to bond with, feel close to your baby, and increase the amount of milk you make. It can also help to establish breastfeeding, support your baby’s heart rate and breathing, and can reduce the chances of you developing postnatal depression5.
You may find that a warm bath or gentle self-massage helps too.
If you’re using a breast pump to express, it’s worth experimenting with different pumps. Everybody’s different. And whilst a particular breast pump may work for one woman, it might not be the best one for you.
Hospitals often have them available for mums to borrow, or you may be able to hire different models from a local breastfeeding organisation. Your midwife or healthcare professional should be able to provide you with the information you need about your options1.
Formula feeding your premature baby
If you decide not to breastfeed or express your milk, your baby might be prescribed a preterm formula by your doctor which is especially designed to help meet the nutritional needs of your baby.
It’s important that you always discuss what type of formula is best for your baby with your doctor and midwife. You can also ask for guidance from the staff working on the neonatal unit on how to make up a bottle safely before going home with your baby.
Combination feeding your baby involves offering your baby expressed breastmilk or formula milk in a bottle, alongside breastfeeding. There are a number of reasons why some women choose to combination feed. For example if they’re unable to produce enough breastmilk or they’re finding it very difficult to breastfeed8.
If this is something you’re considering, be sure to discuss this with your GP or midwife before making your decision. It’s so important that you feel supported and happy with the way you’re feeding your baby, and not becoming stressed or anxious. Seeking the right support is vital.
How much milk will my premature baby need?
You might be surprised by how often newborn babies need to be fed, and premature babies are no exception. However, the volume of milk that a new baby’s stomach can tolerate is very small, and the exact amount will depend on a number of different factors. For example how much they weigh, how early they arrived, and their overall health.
That’s why if your baby was born prematurely, it’s up to the medical professionals overseeing their care to advise on the amount of milk they’ll need, how often they’ll need to be fed and the rate of change as your baby gets bigger.
Bonding with your premature baby
No matter how early your baby was born, they’ll still be able to recognise your smell and your voice. So if you’re not able to hold or breastfeed your premature baby just yet, talking to them and sitting close by will help you to bond and build a connection. If you're allowed to stroke your baby, this contact can be a great source of comfort for both of you.
Visiting your premature baby can be an emotional experience, and there may be times when you experience feelings of helplessness and anxiety. Be sure to get plenty of rest, and eat well to keep your energy levels boosted.
A healthy breastfeeding diet will help your body produce the rich source of nourishment your baby needs.
Your premature baby’s development
If your baby is born prematurely, it might be that they don’t follow the usual developmental milestones of a baby born at full term. How they grow and develop will depend on a number of factors, including how early they arrived.
However, whilst your baby might have some challenges to overcome in the early weeks and months, that’s not to say that being preterm will necessarily affect their ongoing development. With love and encouragement, they’ll reach the milestones they need to, all in their own good time.
Weaning premature babies
Just when you’ve wrapped your head around your premature baby’s milk intake, it’s time to think about weaning. The thought of introducing solid foods to your premature baby’s diet may feel a little daunting, but whilst things may take a little longer for preterm babies, their weaning journey will follow the same principles.
Most babies are ready to start weaning at around 6 months. However, for premature babies it’s especially important to wait until they can develop enough head control before introducing solid foods. This tends to happen when they’re at least three months corrected age7.
Some babies (not many) are ready to wean at 5 months, whilst others won’t start eating their first solids until they’re older. It’s important to remember that every baby is different when it comes to weaning. That’s why it’s so important to let your baby lead the way and wait until they show signs that they’re ready for weaning.
Remember to always consult with your health visitor if you think your baby is ready to start weaning, as the advice for weaning premature babies is different to the advice around weaning babies born at full term.
When can I introduce cow’s milk to a premature baby?
Cow’s milk shouldn’t be introduced into your baby’s diet as their main milk drink until they’re around 15-18 months of age6. This is a little later than for full term babies, who can be offered cow’s milk into their diet after 12 months.
If you have any questions or concerns about introducing cow’s milk to your premature baby, or weaning them in general, ask your doctor or health visitor for advice and guidance.
You can find more support, advice, and further information about premature babies at bliss.org.uk.
Oriana Hernandez Carrion
Oriana has a BSc (Hons) in Nutrition and Food Science (1st class) from University Iberoamericana in Mexico, the country where she completed an internship in a Children’s Public Hospital (HIMFG) and later on worked in a private nutrition clinic.
- National Health Service (NHS). Premature labour and birth [Online]. 2019. Available at https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/premature-labour-and-birth/. [Accessed May 2021]
- National Health Service (NHS). Special care: ill or premature babies [online] 2021. Available at https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/special-care-ill-or-premature-babies/. Accessed May 2021.
- BLISS. Tube feeding [Online]. Available at: http://www.bliss.org.uk/tube-feeding [Accessed May 2021]
- BLISS. Nutrition for your baby [online] Available at: https://www.bliss.org.uk/parents/about-your-baby/feeding/nutrition-for-your-baby [Accessed May 2021]
- National Health Service (NHS). Breastfeeding your premature baby [Online]. 2019. Available at https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/premature-baby/#:~:text=Expressing%20milk%20if%20your%20baby,supporter%20can%20show%20you%20how. [Accessed May 2021]
- White, R. Breastfeed Med, 2017;12(7)398-400.
- National Health Service (NHS). Breastfeeding your premature baby [online] 2019. Available at https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/premature-baby/#:~:text=Babies%20do%20not%20normally%20learn,or%20mouth%20into%20their%20stomach. [Accessed May 2021].
- BLISS. Expressing [Online]. Available at: http://www.bliss.org.uk/expressing [Accessed May 2021]
- National Health Service (NHS). How to combine breast and bottle feeding [online] 2019. Available at:
- https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/combine-breast-and-bottle/[Accessed May 2021]
- BLISS. Weaning your premature baby [Online] 2014. Available at: https://mft.nhs.uk/app/uploads/sites/4/2018/04/Bliss-Weaning_2014.pdf. [Accessed May 2021]
- 8 National Health Service (NHS). How to combine breast and bottle feeding [online] 2019. Available at: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/combine-breast-and-bottle/[Accessed May 2021]
Last reviewed: 09th June 2021
Reviewed by Oriana Hernandez Carrion
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