Feeding Your Premature Baby: Special Considerations

Feeding a premature baby is different from feeding a full-term infant. Preemies have unique nutritional needs, less developed feeding abilities, and often start their feeding journey in the NICU. Understanding these differences helps you feel more confident and prepared as you nourish your premature baby.

The good news: with the right support and approach, most preemies go on to feed successfully. Here's what you need to know.

Why Premature Babies Have Different Feeding Needs AAP

Understanding the challenges helps you know what to expect.

Physical differences:

• Smaller stomachs
• Less developed sucking reflex
• Difficulty coordinating suck-swallow-breathe
• Lower muscle tone
• Get tired more easily during feeding
• May have digestive immaturity

Nutritional differences:

• Higher calorie needs per pound than full-term babies
• Need more protein for catch-up growth
• May need fortified breast milk or special formula
• Miss last trimester nutrient transfer
• Higher iron needs

When feeding can begin:

• Very early preemies may start with IV nutrition
• Gradually transition to tube feeding
• Oral feeding typically possible around 32-34 weeks gestational age
• Every baby's timeline is different

Feeding in the NICU AAP

The NICU team will guide your baby's feeding journey.

Stages of feeding:
1. IV nutrition (TPN): For very early preemies, nutrients through IV
2. Tube feeding: Breast milk or formula through tube to stomach
3. Transitional: Learning to oral feed while still getting tube feeds
4. Full oral feeding: All feeds by breast or bottle

Your role in NICU feeding:

• Provide breast milk if possible (pumping)
• Participate in skin-to-skin (kangaroo care)
• Learn feeding cues and techniques from staff
• Be present for feedings when possible
• Ask questions and stay informed

Breast milk for preemies:

• Especially beneficial for premature babies
• Reduces risk of serious intestinal problems (NEC)
• Easier to digest than formula
• Contains antibodies and immune factors
• Often fortified to meet higher calorie needs

Pumping for Your Premature Baby AAP

If your baby can't breastfeed initially, pumping provides breast milk.

Getting started:

• Begin pumping as soon as possible after birth (within 6 hours if possible)
• Pump 8-10 times per day to establish supply
• Even drops of colostrum are valuable
• Hospital-grade pumps work best

Maintaining supply:

• Continue frequent pumping
• Pump at night (important for supply)
• Skin-to-skin contact helps milk production
• Don't be discouraged if amounts are small initially
• Supply often increases over time

Using pumped milk:

• NICU will store and use your milk
• Breast milk may be fortified for preemies
• Every drop helps—don't discard small amounts
• Fresh milk is ideal; frozen is excellent too

If supply is limited:

• Any amount of breast milk helps
• Donor milk may be available
• Formula is a healthy alternative
• Don't feel guilty—you're doing your best

Transitioning to Oral Feeding AAP

This happens gradually as baby develops.

Signs baby is ready:

• Around 32-34 weeks gestational age (varies)
• Shows sucking motions
• Can coordinate suck-swallow-breathe
• Alerts for feedings
• Maintains temperature during feeding attempts

How transition happens:

• Practice feedings at breast (non-nutritive sucking first)
• Very short bottle or breast attempts
• Gradually increasing amounts orally
• Tube feeds continue for remaining needs
• Timeline varies widely between babies

Your involvement:

• Be patient—this takes time
• Participate in practice feeds
• Learn your baby's cues
• Celebrate small progress
• Trust the NICU team's guidance

Breastfeeding Your Premature Baby AAP

Direct breastfeeding is often possible, with patience.

Getting started:

• Begin with skin-to-skin
• Non-nutritive sucking at breast (before milk comes in strongly)
• Short feeding attempts
• May use nipple shield if helpful
• Pump after practice feeds to maintain supply

Challenges:

• Baby may tire quickly
• Latching may be difficult
• May need supplementation even with nursing
• Transition takes longer than with full-term babies

Support:

• Lactation consultants experienced with preemies
• Continued pumping to maintain supply
• Patience with the process
• Combo feeding is very common and okay

Success factors:

• Early and frequent skin-to-skin
• Consistent pumping
• Patient practice
• Professional lactation support
• Realistic expectations

Bottle Feeding Your Premature Baby AAP

Whether formula or breast milk, bottle feeding preemies has specific considerations.

Special techniques:

• Use slow-flow preemie nipples
• Pace feeding (frequent breaks)
• Side-lying or upright position
• Watch for stress cues
• Keep feedings calm and not rushed

Signs baby needs a break:

• Color changes
• Breathing changes
• Turning away
• Falling asleep
• Eyebrows raised
• Fingers splayed

After NICU discharge:

• Continue paced feeding at home
• Use recommended nipple flow
• Follow feeding schedule from NICU
• Watch for adequate intake (diapers, weight)

Nutritional Needs After NICU Discharge AAP

Preemies often have higher needs even after going home.

Higher calorie needs:

• May need fortified breast milk
• Or higher-calorie formula
• Supports catch-up growth
• Continue per pediatrician's guidance

Special formulas:

• Premature infant formula (higher calories)
• Transitional formula after discharge
• Follow medical team's recommendations
• Don't switch without guidance

Monitoring growth:

• More frequent weight checks initially
• Using corrected age for milestones
• Pediatrician tracks growth closely
• Adjustments made as needed

Introducing Solids AAP

Timing is based on corrected age and readiness.

When to start:

• Use corrected age (age from due date, not birth date)
• Around 4-6 months corrected age
• When baby shows readiness signs
• Discuss with pediatrician

Readiness signs:

• Good head control
• Sitting with support
• Interest in food
• Loss of tongue-thrust reflex
• Able to move food to back of mouth

Approach:

• Same general guidelines as full-term babies
• May progress more slowly
• Watch for feeding difficulties
• Address any ongoing oral motor issues

Common Challenges AAP

Preemies may face some feeding hurdles.

Reflux:

• Common in premature babies
• May require positioning changes
• Sometimes medication helps
• Usually improves with time

Oral aversion:

• Some preemies develop aversion to oral feeding
• Often from NICU tubes and interventions
• Occupational therapy can help
• Patient, positive feeding experiences important

Slow weight gain:

• Monitor closely
• May need calorie fortification
• Address any feeding difficulties
• Work with medical team

When to get help:

• Refusing to feed
• Vomiting frequently
• Not gaining weight
• Choking or gagging often
• Feeding taking longer than 30-45 minutes
• You're concerned

Growth and Development Expectations AAP

Preemies follow their own curve.

Corrected age:

• Use due date, not birth date, for milestones
• A baby born 2 months early is developmentally 2 months younger
• Growth charts should be interpreted with this in mind
• Most catch up by age 2-3

Catch-up growth:

• Most preemies catch up significantly
• Happens at different rates
• Nutrition plays a key role
• Patience is important

Long-term outlook:

• Most preemies go on to eat normally
• Feeding issues typically resolve
• Close follow-up ensures good outcomes
• Every baby's journey is different

The Bottom Line

Feeding a premature baby requires patience, flexibility, and close partnership with your medical team. Whether you're pumping in the NICU, learning to breastfeed a tiny baby, or mastering paced bottle feeding, you're giving your baby exactly what they need. AAP

Remember:

• Preemies have unique nutritional needs
• Breast milk is especially beneficial (but formula works too)
• Feeding skills develop over time
• Use corrected age for milestones
• Close follow-up ensures good outcomes

Clara is here when you have questions about feeding your premature baby.