Breastfeeding A Premature Infant Help

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Breastfeeding your prem baby

When can I start?

The earliest a baby can take milk directly from the breast is around 28 weeks, when he may lick drops of expressed milk from the nipple. By 30:32 weeks he may be able to swallow expressed, let-down or leaking milk that drips or flows while some of the areola (the dark area around your nipple) is in his mouth. Eventually, perhaps between 32 and 34 weeks, he'll gradually start learning to suck and 'milk' the breast himself.

Encouraging your baby to breastfeed

Knowing what to expect can make it easier to meet the challenge of getting enough milk into a small, immature baby. Your baby may:

• Be quickly tired by breastfeeding

• Feed better if you don't distract him by talking or stroking

• Be sleepy much of the time

• Fall asleep soon after starting a feed

• Refuse to carry on feeding before the milk has started to flow

• Refuse to carry on feeding when the milk starts to flow

• Not make his hunger known (for example, by restlessness or crying - what some call 'demanding' a feed) until 40 weeks post-conception.

It's clearly easier to breastfeed if you're with your baby as much as possible, so you can put him to the breast in the short periods of time when he's awake and alert. It's best to catch these natural 'islands of wakefulness' when you can, rather than wake him artificially for a feed, because he'll grow better if he sleeps a lot. However, if your baby doesn't wake often enough, you will need to wake him gently.


Breastfeeding a baby who's still cup-fed and/or tube-fed

Wash your hands before putting your baby to the breast, wrap him up if you like, make yourself comfy, and hold him so he's facing your chest without twisting his neck. The nurses can help you position him so your breast doesn't get in the way of his nose, so he doesn't drag on the nipple, and so he can take the breast ('latch on') if and when he wants.

At 28 weeks post conception
Try putting him to the breast perhaps a couple of times a day to see if he's interested in licking drops of milk expressed from the nipple. He can have a tube-feed at the same time. If your breast is full or hard, express a little milk first to take the pressure off, otherwise the flow might make him choke. Softening the breast also means that more of the areola will fit in his mouth if he sucks.

Remember, he can't breastfeed yet. All he'll do is practise being at the breast, learn to enjoy being there, taste the milk and perhaps hold the nipple and areola in his mouth. If he sucks at all, he'll probably do little bursts of three to five rapid, practice, 'non-nutritive' sucks which don't draw any milk out. After several sporadic bursts of this he'll stop, tired out.

At 30:32 weeks post conception
As above, but also try expressing a few drops of milk directly into his mouth before or during a tube-feed or before a cup-feed.

At 32:34 weeks post conception
When he shows an interest, encourage him to open his mouth wide and take the breast further in. He'll still do plenty of practice sucks, but at some stage he'll gradually start learning to breastfeed effectively by sucking and by 'milking' -- removing milk from the reservoirs beneath the areola by massaging the breast with his tongue and jaw. As he grows older and stronger, he'll get more able to co-ordinate breathing, sucking and swallowing, so he'll gradually take more and more milk.

A few babies this age occasionally take one or more full feeds from the breast in 24 hours -- each of the same amount they would have had in a tube-feed. But it's still very early days, and knowing your baby is getting what he needs from a cup (and possibly a tube as well) means there's no pressure on you or him to perform. Many full-term babies take several months to become effective breastfeeders, and yours needs to catch up on the time he missed in the womb.

Eventually, your baby will take so much milk from the breast that you can discard the cup and/or tube.

Using a supplementer

A supplementer consists of a small polythene bag which you fill with breast milk and pin on your clothing high above the breast. It has two fine tubes coming from the bag and going to each nipple. Each tube is taped to the breast so one end protrudes very slightly beyond the nipple and enters your baby's mouth when he breastfeeds.

Although your baby isn't mature or strong enough to get all the milk he needs directly from the breast, taking breast milk from the supplementer at the same time means he becomes used to the idea of filling his tummy at the breast. And at the same time he stimulates your breasts -- and therefore your milk supply.

As he becomes stronger, bigger and more mature, he'll gradually suck and 'milk' your breasts more efficiently until the naso-gastric tube can eventually go, and one day the supplementer, too.

How often?

If your baby is mature and strong enough to take all his feeds directly from the breast, use his 'islands of wakefulness' to fit in at least eight feeds in 24 hours, and as many more as he wants. Many feed 10 times in 24 hours and some as often as 14 times a day, though with napping and practice-sucking it's hard to tell when a 'feed' is over. Babies need particularly frequent feeds when they have a growth spurt.

If you can't manage even eight feeds, make up the difference with sessions of expressing or pumping. The more often you feed, the more milk you'll make and the quicker your baby will become good at breastfeeding -- as long as he gets enough sleep and doesn't get overtired.

Night feeds of breast milk are important to your baby, and for you -- to encourage your milk supply. If you don't want to wake more than once, the staff can cup-feed your baby with your expressed milk.

How to tell when he's had enough

It can be difficult to know when a learner breastfeeder has had enough because:

• He's too young as yet to breastfeed for long and may keep dropping off to sleep. This doesn't matter if you have the time and patience. If you get bored, you may find it helps to watch TV.

• Much (or all, in a very immature baby) of his sucking is non-nutritive, practice sucking.

• The rate of milk flow can vary from 1ml (just a few drops) a minute to as much as 13ml (nearly a tablespoonful) a minute in some women as their milk lets down.

Some experts recommend weighing a low-birthweight learner breastfeeder before and after a feed so as to work out how much milk he's taken; if he hasn't had enough, he can then have a top-up of expressed milk by tube or cup.

Getting help

Most breastfeeding women experience challenges of one sort or another. Among the most frequent are sore nipples and a blocked duct. It pays to have ready access to information. You can get this from nurses and midwives skilled at breastfeeding help, or from a breastfeeding helper trained by the National Childbirth Trust or La Leche League.

Coping with Your Premature Baby by Dr Penny Stanway is published by Orion and costs £4.99. Dr Penny Stanway is an experienced doctor, medical author, journalist and broadcaster. She is author of several other books, including Breast is Best and The New Guide to Pregnancy and Babycare.