How to Bottle Feed a Preemie

Female nurse feeding newborn African baby next to incubator

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Bottle feeding a preemie in the NICU can be one of a parent’s biggest joys and concerns. Snuggling your baby is, of course, a pleasure. But while feeding, you may be worried about whether or not your baby is getting enough milk. Being able to feed well at the breast or by the bottle is one of the milestones that a NICU baby must meet before discharge, so it's natural to feel anxious about reaching it.

Even if you plan to breastfeed, you may need to bottle feed your preemie at times in the NICU. Bottle feeding allows NICU staff to know exactly how much milk a premature baby is taking in, and it allows nurses to fortify breast milk by adding extra calories.

Tips for Encouraging Good Bottle Feeding

Bottle feeding a preemie is very different from feeding a term infant. Unlike a baby born at term, a premature baby may be very sleepy at feeding times, may not be strong enough to drink enough milk to sustain growth, and may have a hard time swallowing and breathing at the same time. NICU nurses will help you learn how to bottle feed your preemie, using some time-tested tricks.

  • Sit your baby up: In the NICU, you’ll notice that premature babies are bottle-fed sitting up, not cradled in the arms. To help your baby stay awake and to promote good positioning, sit your baby on your lap, supporting their head and shoulders in your non-dominant hand (meaning your left hand if you are right-handed, your right hand if you are left-handed).
  • Or try an inclined side-lying position: Place your baby on their side, with ear, shoulder, and hip aligned. Then raise their head slightly, supporting it with your non-dominant hand. Hold the bottle parallel to the floor with your dominant hand. In both of these positions (sitting up and side-lying), your baby has more control over the flow of milk. If you cradle your baby and hold the bottle pointing down into their mouth, milk drips out of the nipple due to gravity, so the baby can't control it and may choke.
  • Use chin and cheek support: With your baby supported by your non-dominant hand, your dominant hand is free to hold the bottle and support her chin and cheeks. It takes practice, but NICU staff can show you how to provide gentle chin and cheek support to help your baby get a good seal on the nipple.
  • Do your exercises: Ask NICU nurses or physical therapists to show you a series of mouth exercises you can perform on your baby to help prepare her for feeding. Exercises, like circling the lips with your fingers, stroking the chin, and gently squeezing the cheeks together, can help your baby to eat better.
  • Practice pacing: Premature babies may have trouble coordinating bottle feeding with breathing, and may experience apnea or bradycardia during a feed. Watch your baby for signs of trouble, and pause the feeding if your baby has trouble breathing, gags, goes limp, or has a drop in heart rate or oxygen saturation (indicated by the monitors).
  • Discuss the feeding tube: NG tubes are important for premature babies who aren’t able to take in enough calories by bottle or breast to grow well. Discuss with your baby's healthcare team (doctors and nurses) whether you can try a feeding without the NG tube in place.
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Article Sources
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  1. Arquilla K. Correctly bottle-feeding your baby and why it's important. Bumblebaby. Updated September 19, 2019.

Additional Reading
  • Sears W. The Premature Baby Book: Everything You Need to Know About Your Premature Baby from Birth to Age One. Little, Brown and Co., 2004.