Feeding Premature Babies in the NICU

Feeding a premature baby is one of the biggest challenges that families must face before they can take their precious little ones home from the hospital. Preemies are immature at birth, and may not have enough strength or coordination to breastfeed or bottle feed well enough to grow. A preemie may look strong and healthy enough to go home, but may still not be feeding well.

Why is Feeding Premature Babies So Difficult?

Although it comes easily to term babies, learning to eat is a challenge for preemies. Whether bottle feeding or breastfeeding, babies need to develop three major skills in order to be able to eat effectively:

• A mature suck: Premature babies aren't born with mature sucking skills. In order to drink milk from the breast or a bottle, babies need to have a suck that is both coordinated and strong.
• A mature swallow: Swallowing large volumes of milk takes a lot of strength, and babies need to develop the muscles in their tongue and jaw to swallow well.
• Coordination of sucking, swallowing, and breathing: The most challenging of the feeding skills, it can take babies a while to learn how to coordinate breathing with drinking milk.

Feeding premature babies who haven't developed these three skills can be frustrating for parents, nurses, and the babies themselves.

A preemie without a mature suck and swallow will quickly become exhausted during a feeding -- each feeding session is quite a workout! Babies who don't coordinate sucking, swallowing, and breathing well are scary to feed. They start off well, sucking and swallowing with gusto. Suddenly, though, they may realize that it's time to breathe, and they aren't quite sure how.

They may choke and gag on their milk, or stop breathing entirely until the feeding is paused.

When Will My Baby Learn to Breastfeed or Bottle Feed?

Unfortunately, there is no definite time period in which all babies learn to breastfeed or bottle feed. Some babies catch on quickly while others take longer.

• 32 to 34 Weeks: By 32 to 34 weeks gestational age, most preemies have a mature suck and are able to begin the transition from tube feeding to bottle feeding or breastfeeding.
• 35 to 38 1/2 Weeks: By about a week and a half before your original due date, your baby should be able to suck, swallow, and coordinate eating with breathing. By this time he or she should be taking all feedings by mouth.

Most babies will learn to eat within these time frames, but some babies will take longer. If your baby was born before 27 weeks, was on a ventilator for a long time, wasn't able to eat for a while due to NEC or another illness, or has chronic respiratory problems, it may take longer for your baby to learn to eat. In some cases, doctors may place a g-tube to allow you to tube feed your baby at home while he or she regains strength.

It can be very difficult to have a baby in the NICU who isn't eating well enough to go home.

Parents may feel like NICU staff is trying to overfeed their babies or that they're just not hungry enough to drink all that milk. Try to remember that preemies have higher nutritional needs than term babies. Not only do they need to grow, but they also need to have good catch-up growth to support their brains and their bodies.

How Can I Help My Preemie Learn to Bottle Feed or Breastfeed?

As your baby is learning to eat, it's important for you and your baby's caregivers to allow your baby to learn at his or her own pace.

• Respect cues: Offer the breast or bottle when your baby is awake, sucking on his fist or a pacifier, or rooting for a feeding. Stop the feeding if your baby seems upset or fatigued.

• Don't force a feeding: Feeding premature babies should be a positive experience. Forcing a feeding can increase the chances that your baby will develop an oral aversion, a condition where babies don't like anything -- including a bottle -- in their mouths. Even if there are only a few milliliters left in a bottle, let your baby rest if she needs it.
• Make sure the environment is feeding-friendly: A quiet, darkened environment is the best place to learn to breastfeed or bottle feed. Turn off the radio or TV, and focus on your baby. Feeding takes all of your baby's attention, and too much noise is a distraction.

Sources:

_{Amaizu, N, Shulman, RJ, & Lau, C. "Maturation of Oral Feeding Skills in Preterm Infants." Acta Paediatrics January 2008: 97, 61-67.}

_{Lau, C. "Oral Feeding in the Preterm Infant." NeoReviews January 2006: 7, c19-c26.}