Tube Feeding Premature Babies: A Guide for Parents

Caring for a premature baby can be overwhelming and it may be worrying how they are going to feed so they can grow and get all the nutrients they need. Tube feeding is often necessary for preemies/these infants/premature babies as it ensures they receive the nutrition they need to grow in the first few weeks or months (ESPGHAN 2022).

Parents may feel anxious about this process and helping to understanding tube feeding can ease these worries. This guide will help to answer some of these questions and explain why tube feeding is used, how long it may be needed, and how you can stay involved in your baby's care.
 

A note about early nutrition

* In some cases, premature babies may receive nutrition through a drip into a vein (called parenteral nutrition) before or alongside tube feeding. This is often needed in the very early days if a baby/preemie is too unwell or too immature to tolerate milk feeds.

Parenteral nutrition provides essential nutrients such as fluids, sugars, proteins, fats, vitamins and minerals directly into the bloodstream to support growth and development. As your baby becomes more stable, milk feeds through a tube are gradually introduced and increased with parenteral nutrition decreased.

(NICE 2020)

Tube feeding is a way to give breast milk or formula to a preemie/premature baby who cannot safely or effectively feed by mouth yet. A small, flexible tube carries milk into the stomach so your baby can get the calories and nutrients needed to grow well.

In the neonatal unit, tube feeding is most commonly done with:

• Nasogastric (NG) tube: A tube placed up and through the nose and into the stomach.
• Orogastric (OG) tube: A tube placed into the mouth and down into the stomach (often used for very small or fragile infants to reduce the nose becoming irritated).

Feeds may be given slowly over time or larger over shorter periods with gaps in between. This will depend on your baby's needs and how well they tolerate their feeds. The specialist staff on the unit will carefully check tube placement before feeding and watch for signs of feeding intolerance which can mean they change the feed or the speed it is given. 

Premature birth occurs when a baby is born before 37 weeks of gestation (WHO 2023). Many premature babies have feeding challenges because their bodies and reflexes are still developing.

Premature babies may need tube feeding because they:

• Have underdeveloped sucking and swallowing reflexes.
• Struggle to coordinate sucking, swallowing, and breathing at the same time.
• Tire quickly and cannot take enough milk by mouth to meet calorie and nutrient needs.
• Have an immature digestive system and may need carefully controlled feeding volumes.
• Have higher nutritional needs to support healthy growth and weight gain and this can’t be met by oral feeding.

Some premature babies may also need tube feeding because they are unwell or receiving treatment for other medical conditions. For example, babies who need breathing support such as a ventilator, have heart conditions, or are recovering from illness may not have the energy to feed safely by mouth.

Although seeing your baby with a feeding tube may feel worrying at first, it is important to remember that tube feeding is not a sign that you or your baby have failed. Instead, it is a safe and supportive way of helping your baby receive the nutrition they need while they grow stronger and develop the skills needed for breastfeeding or bottle feeding. 

There is no single timeline that fits every baby. Some premature babies only need tube feeding for a few days, while others may need it for several weeks or months. This will usually depend on how early they were born, their medical condition and how quickly their feeding skills develop.

Your baby may be ready to gradually reduce tube feeding when they:

• Stay medically stable during feeds, with steady breathing and heart rate.
• Show hunger cues such as rooting, bringing their hands to their mouth or becoming more alert around feeding times.
• Develop stronger oral feeding skills, including coordinating sucking, swallowing and breathing.
• Spend longer feeding at the breast or bottle without becoming overly tired.
• Gain weight steadily with partial or full oral feeds.

Your baby's medical team will regularly review their feeding plan and adjust it to their individual progress. Every baby develops feeding skills at their own pace, and even small steps forward are signs that your baby is moving in the right direction.

Many parents worry that a feeding tube means they can no longer play an active role in feeding or caring for their baby. However, your presence, touch and comfort remain incredibly important. Neonatal staff will encourage you to be involved in your baby's care from the very beginning and will support you in learning how to care for your baby with confidence.

Ways many parents can help include:

• Skin to skin contact (kangaroo care): Holding your baby skin-to-skin can be a wonderful way to bond during their neonatal stay. It can help your baby feel calm and secure while supporting temperature regulation, breathing and digestion.
• Non-nutritive sucking: Sucking on a dummy, finger (or at the breast without actively feeding) can build oral skills and comfort your baby. Many families use non nutritive sucking for premature babies with feeding tube as a bridge toward oral feeding - (Demir Barbak et al 2025)
• Participating in care: Everyday activities such as changing nappies, taking part in care, comforting your baby and being present during feeds can help you build confidence and strengthen your bond.
• Learning from neonatal nursing: Your neonatal team can show you how feeds are given, explain how your baby is monitored and answer any questions you may have.
• Comfort and interaction: Talking, reading, singing or simply sitting quietly with your baby during feeds can help them become familiar with your voice and provide comfort during their time in the neonatal unit.

If you're expressing breast milk, your team can also help with pumping schedules, storage, and fortification (where extra energy and nutrients are added to your babies feeds to meet their needs. 

Transitioning from tube feeding to oral feeding can feel like a major milestone, but it is usually a gradual process rather than a sudden change. Every baby develops feeding skills at their own pace, and it is completely normal for progress to take time.

As your baby grows and becomes stronger, you may start to notice signs that they are becoming ready for oral feeds. These can include:

• Becoming more alert around feeding times.
• Rooting (turning towards a touch on their cheek or mouth).
• Bringing their hands to their mouth.
• Sucking on their fingers or a dummy.
• Maintaining stable breathing during feeds.
• Having the stamina to stay awake and alert for longer periods.

Many babies begin with short breastfeeds or bottle feeds before receiving the remainder of their feed through their tube. This gradual approach allows them to practise feeding skills while continuing to receive the nutrition they need for growth and development.

You may also be supported by a wider feeding team, including lactation consultants, speech and language therapists (SLTs) and occupational therapists (OTs). These professionals can help develop oral feeding skills, support breastfeeding and provide ways to make feeding as safe and comfortable as possible.

It's important to remember that feeding is a skill your baby is learning over time. Celebrating the small milestones along the way, whether that's showing more interest in feeding, staying awake for longer during feeds or taking a little more milk, can help you recognise just how far your baby has come. 

Some babies go home still using a feeding tube alongside oral feeds and your hospital team will provide training, so you feel prepared and supported before discharge.

At home, your routine will usually include:

• Hygiene and routine: Keep your hands and feeding equipment clean and follow the schedule provided by your neonatal team.
• Tube and skin checks: Watch for signs of irritation and follow instructions for checking tube position before feeding.
• Recognising feeding intolerance: Look out for symptoms such as vomiting, significant belly swelling, diarrhoea, or unusual irritability. You should contact your medical team if they occur.
• Follow-up care: Attending regular appointments to track your babies growth, nutrition, and feeding development.

If you are struggling with feeding your baby, ask your care team about resources and support.

Tube feeding is common in neonatal care. The medical team will ensure that the tube is placed correctly and monitor your baby's tolerance and comfort during feeds. Your baby's plan will be adjusted as it needs to be.

Tube feeding does not prevent bonding. Parents and carers can still build closeness through skin-to-skin contact, gentle touch, talking or singing to their baby, and being involved in care routines. Many families find that learning the feeding routine helps them feel more connected and confident.

Many premature babies/preemies go on to feed by mouth. Feeding skills develop over time as reflexes mature and stamina with oral feeding improves. Some babies need extra support during the transition, and your care team can guide you on techniques and therapies if needed.

In many cases, yes. Holding your baby (including skin-to-skin contact) is often encouraged when your baby is stable. Always check with your baby's care team about the safest way to hold them during or around feeds.

Tube feeding might feel overwhelming at first. With support from your healthcare team, you'll learn a routine that suits you and your baby, understand your baby's cues, and see steady progress over time. If anything feels unclear, ask your healthcare team to walk you through the next step-no question is too small.