Feeding a Premature Baby: Breast Milk, Fortifiers, and Nutrition Tips

Feeding a premature baby can feel challenging, but with the right approach and guidance, it becomes a rewarding journey. Here’s everything parents need to know about breast milk, fortifiers, and nutrition tips for preterm babies to help them grow strong and healthy.

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Unlike full-term babies, premature babies have distinct nutritional needs. Their growth continues outside the womb, and their organs, digestive system, and immune response are still developing. Therefore, providing proper nutrition is crucial to bridge this developmental gap.
Proper feeding supports:
  • Healthy weight gain
  • Brain and organ development
  • Strong immunity
  • Better long-term growth outcomes
Feeding a preterm baby is a journey that requires patience, close monitoring, and sometimes medical guidance. As a parent, your role is crucial in this process.

Breast Milk: The Best Nutrition for Premature Babies

Breast milk, often considered the gold standard for all babies, is particularly crucial for premature infants due to its unique nutritional composition. It provides:
  • Readily digestible proteins and fats
  • Antibodies that boost immunity
  • Essential fatty acids for brain growth
  • Natural enzymes that protect the gut
Mothers of preterm babies produce milk that naturally contains more protein, fat, and antibodies suited to their baby’s needs. Even if the baby cannot nurse directly, expressed breast milk can be given through a feeding tube or bottle until they are ready to latch.

How to Feed a Premature Baby Breast Milk

  • Express frequently: Pump every 2 to 3 hours to maintain milk supply. Hospital lactation consultants can guide mothers on expressing techniques.
  • Store Safely: Use sterilised containers and refrigerate immediately. Label each container with the date and time of expression.
  • Feeding in the NICU: Nurses may use small feeding tubes to deliver expressed milk until the baby can suck on their own.
  • Gradual Transition: As the baby’s sucking and swallowing reflexes mature, feeding shifts from a tube to a bottle or to direct breastfeeding.
  • Kangaroo Mother Care: Skin-to-skin contact improves milk flow and helps preemies feed better.

When Breast Milk Alone Is Not Enough

Some premature babies, especially those born before 32 weeks, need extra nutrition that breast milk alone may not provide. It is where human milk fortifiers come in.

Understanding Milk Fortifiers for Preterm Babies

Fortifiers are special supplements added to expressed breast milk to increase its calories, protein, and minerals, such as calcium, iron, and zinc. They help:
  • Support faster weight gain
  • Strengthen bones and muscles
  • Improve overall growth and immunity
Fortifiers are recommended by neonatologists when a baby’s growth needs are higher than what milk alone can provide. They are safe when prescribed and monitored correctly. Parents should never add any supplement on their own without medical advice.

Feeding Methods for Premature Babies

Depending on their gestational age and strength, premature babies may be fed in different ways:
  • Tube Feeding: If the baby is too small to suck or swallow, milk is delivered directly to the stomach using a soft feeding tube.
  • Cup or Spoon Feeding: For babies ready to start oral feeding but not yet able to breastfeed fully. It helps them learn to coordinate sucking and swallowing.
  • Bottle Feeding: Some babies adapt better to bottles initially. Use small, slow-flow nipples designed for preemies.
  • Direct Breastfeeding: Once the baby is strong enough, direct breastfeeding becomes the best method for bonding and nutrition.
Each baby transitions at their own pace. The neonatologist or lactation specialist guides the process.

Feeding Frequency and Volume

  • Premature babies have tiny stomachs and need small, frequent feeds.
  • Feed every 2 to 3 hours or as advised by your doctor
  • Start with small volumes, gradually increasing as your baby gains weight
  • Monitor signs of hunger like lip movements, restlessness, or crying
  • Avoid overfeeding, as their digestion is delicate
  • Consistent feeding helps regulate body temperature, sugar levels, and growth.

Signs Your Baby Is Feeding Well

You can tell your baby is getting enough milk when:
  • Weight increases steadily
  • The baby seems active and alert after feeding
  • Urination and stool frequency are regular (at least six wet diapers a day)
  • Sleep becomes more settled
If your baby seems too sleepy, refuses feeds, or vomits frequently, consult your doctor immediately.

Common Feeding Challenges and Solutions

Challenge Possible Reason Solution
Baby Tires EasilyWeak Sucking ReflexFeed smaller amounts more frequently
Spitting up MilkOverfeeding or Air IntakeKeep the baby upright for 20 minutes after feeding
Low Milk SupplyStress or FatigueExpress regularly, stay hydrated, rest well
Difficulty LatchingPrematurity or Small MouthSeek help from a lactation consultant

Every preemie learns at their own pace. Remember, patience, practice, and the love you pour into their feeding journey make the most significant difference. Your emotional support is as crucial as the medical care they receive. Trust in the process and your baby's resilience.

Nutrition Tips for Parents

  • Stay Hydrated and Eat Well: A mother’s diet directly affects milk quality. Include high-protein foods, fruits, vegetables, and iron-rich meals.
  • Keep Feeding Records: Track feeding times, milk volumes, and weight gain. It helps doctors evaluate progress.
  • Avoid Rushing Solids: Even if your baby seems ready, wait until the corrected age of 6 months before introducing solids.
  • Watch for Allergies or Intolerance: If your baby becomes unusually fussy, develops rashes, or vomits, consult a paediatrician.
Feeding challenges can be stressful. It's okay to feel overwhelmed at times. Remember, you're not alone. Talk to lactation counsellors or support groups for guidance and reassurance. Your emotional well-being is as important as your baby's physical health.

Long-Term Outlook

With proper nutrition and medical care, most premature babies catch up in growth within their first year. Regular follow-ups ensure your baby’s feeding, digestion, and weight gain stay on track. Stay hopeful and keep up the good work.

Whether you’re pregnant, a new mom, or navigating postpartum, you don’t have to do it alone. Join our support group to connect, share, and support one another.

FAQs on Feeding a Premature Baby: Breast Milk, Fortifiers, and Nutrition Tips

  1. Can all premature babies drink breast milk?
    Yes. Even if babies can’t suck directly, expressed breast milk can be given through a tube or spoon. It’s the safest and most nutritious option.
  2. Why are fortifiers added to breast milk?
    Fortifiers are added to breast milk to significantly increase its protein and calorie content, meeting the high energy needs of premature babies.
  3. How often should I feed my premature baby?
    While a general guideline is to feed every 2 to 3 hours, it's crucial to follow your doctor’s guidance, which will be based on your baby’s unique condition and needs.
  4. When can I stop fortifiers?
    Once your baby reaches an appropriate weight and growth rate, your doctor may advise discontinuing fortifiers.
  5. What if my baby vomits after feeding?
    Keep your baby upright after feeding and ensure small, frequent meals. Persistent vomiting requires medical evaluation.
Disclaimer: Dr. N Sapna Lulla, Lead Consultant - Obstetrics & Gynaecology, Aster CMI Hospital, Bangalore