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Feeding a Premature Baby

When your baby is born premature, it goes without saying that it can be a scary time. How many weeks along they are when they’re born can have an impact on their ability to do many things that full-term babies can do, such as bottle or breastfeeding. As a parent, you have dozens of questions about your preemie baby’s abilities, health issues, and what’s going to happen in the next few weeks and months – and making sure your little one gets the nutrients they need to grow.

In honor of Prematurity Awareness Month this November, we’ve put together information about the different ways your preemie baby may feed, the role parents play in their feeding, and the path to helping your baby learn to feed.

Feeding Facts for Preemies

When we talk about a full-term baby, we are referring to a child born between 37 and 40 weeks. They have time to fully develop in utero, so they arrive with a more developed suck, swallow, breathe coordination – which means they can usually breastfeed or bottle feed with minor difficulty.

Premature babies, those born before 37 weeks, do not have the time in the womb to fully develop this coordination. Their stomachs are also not ready to take in the same amount of food as a full-term baby. Thus, they need help feeding.

When confronted with the knowledge that your role in feeding you baby is going to look drastically different than you thought, parents can face an onslaught of different emotions. It’s deep in our nature, this need and urge to feed our young, so it can feel as if you are failing as a parent when you are unable to do that. Just remember: It is completely normal for a premature baby to have feeding difficulties. They are not supposed to have the skills yet – but with time, patience, and your steady presence, baby will get there. Let’s talk about the ways a premature baby feeds and your role in that process.

Types of Feeding for Premature Infants

Depending on how many weeks baby is when born, there are several different feeding techniques. When they are born will also determine when they’re able to go home from the Neonatal Intensive Care Unit (NICU) and what follow-up you might need.

Intravenous (IV) Feeding and Digestive Development

The smallest of preemie babies cannot yet stomach breast milk or formula. Their gastrointestinal tract has not yet fully developed, which means they also cannot immediately process large amounts of nutrition in their stomach. This is where intravenous (IV) feeding comes in.

It works like this: Baby will have an IV that very slowly places nutrients directly in their body. Typically, when baby’s belly starts making noises and they successfully pass stool, your doctor may begin introducing milk through a process called tube feeding.

Parents’ Role in IV Feeding

It’s so difficult not experiencing the joy of bringing baby home from the hospital quickly and it can feel as if you are helpless to do anything, but the opposite is true. The most beneficial thing you can do for your little one is to just be there. If your doctor deems it safe, providing skin-to-skin contact, also called Kangaroo care, has untold benefits to baby’s health, well-being, and growth.

Simply put, your role in feeding baby at this time is to fill them up with love. Let the IV provide nutrients while you provide bonding and try to learn their cues, for a successful graduation to the next stage of feeding.

Tube Feeding and Oral Development

Preemie babies, especially those younger than 34 weeks, can have a tough time coordinating the suck, swallow, breathe process they need to successfully breast or bottle feed – but may have more developed tummies. In this case, they may need a feeding tube to provide nutrition once the IV is removed.

A feeding tube is simply a small, flexible tube placed in the nostril or mouth that is passed into baby’s stomach. At first, tiny amounts of breastmilk or formula are given through the tube typically by means of an electronic pump. As baby grows, so, too, does the amount of milk at each feeding.

Parents’ Role in Tube Feeding

While baby is still in the NICU and tube feeding, your baby’s feeding team will work with you on pre-feeding skills to help support improved positive feeding experiences. These positive feeding experiences include kangaroo care, or skin-to-skin care. This means holding baby while they are being fed via the tube, possibly using a pacifier to help them associate feeding with sucking. It’s important to be there as much as possible during feeding times, as research shows that baby better thrives and improves in their parents’ arms.

While tube feeding, hospitals and parents will work with preemie babies to begin learning how to orally feed, as well, either by breast or bottle feeding. When they reach full-term, if baby is still struggling with full oral feeding, they may go home with the tube still in place – though this isn’t common.

If baby is going home with the tube in place, you may be instructed to do the following to help them towards oral feeding:

  • Practice “normal” feeding routines, like ensuring tube feeding lasts 20 – 30 minutes.
  • Hold baby and provide a pacifier for sucking.
  • Place liquid on their lips prior to feeding to further encourage positive oral feeding experiences.
  • Generally engage with baby as you would during breastfeeding or bottle feeding, such as hand holding, stroking, and eye contact.

There are a few common care techniques for maintaining baby’s feeding tube. This includes ensuring baby isn’t pulling at the tube, as well as specific cleaning and changing instruction for your baby’s particular type of tube. Your specialist team, including your case manager and medical supply equipment team will show you everything you need to care for the tube and make baby comfortable.

Use of a Pacifier During Tube Feeding

While tube feeding, baby may be given a pacifier to encourage oral development, even if mom is breastfeeding. Dr. Brown’s Medical offers two pacifier sizes for preemies babies, the HappyPaci and the Preemie Pacifier, both featuring a cut-out shield that accommodates feeding and oxygen tubes. These one-piece pacifiers have the same shape as the Dr. Brown’s™ nipple, giving baby the consistency they need. The Preemie Pacifier is about 20 percent smaller than the Stage 1 HappyPaci and is specifically made for preemie infants in the NICU who are less than 34 weeks.

Another benefit to using a pacifier is for self-soothing and pain management. Research has shown that when preemie babies have to endure potentially painful and uncomfortable procedures, providing them a pacifier during the experience helps lessen the pain and offers comfort.

When your feeding team decides baby is ready, parents can incorporate the next level of feeding with breast or bottle!

Bottle Feeding with Dr. Brown’s™ Ultra Preemie™ and Preemie Bottles

When baby had reached a certain milestone, they will begin feeding via breast or bottle. At this point in baby’s journey, how much they eat is not the most important thing. What matters the most is helping them practice and develop positive oral skills – so don’t worry if they aren’t taking in a lot of milk. They will get there!

What sets Dr. Brown’s™ baby bottles apart from other brands is the internal vent system – what many parents call “the bottle with the straw in it.” This internal vent system creates a completely vacuum-free bottle feeding experience, which means your preemie baby doesn’t have to fight against pressure build-up common in other bottles.

Dr. Brown’s offers two different slow-flow nipple levels for preemie babies:

  • Ultra-Preemie Nipple: This nipple features a 35% slower flow rate than Dr. Brown’s current Preemie nipple and is usually offered to preemie babies who are still trying to work out the suck, swallow, breathe coordination. It is our slowest-flow nipple, touted by hospitals to help baby reach full oral feedings in less time than with a faster flow nipple. Your NICU feeding team will help determine if this is the best flow rate for your baby.
  • Preemie Nipple: This nipple is the first choice for many preemie babies who may still be on the feeding tube but show signs of readiness for oral feedings. The Preemie Nipple might also work well for preemie and full-term breastfed babies who occasionally need to supplement with a bottle.

An important aspect of breast or bottle feeding with preemie babies is consistency. Really, it’s everything. It may be a challenge for preemie babies to learn how to feed from the breast or bottle, so having a different experience each time can make it that much harder. Not only is the Dr. Brown’s bottle system reliable and consistent, our quality control ensures that each same-level nipple you buy offers the same flow that baby can trust. That reliability, along with the internal vent system, is exactly why 98 percent of the country’s top children’s hospitals are using Dr. Brown’s bottles. If you’re interested in the Dr. Brown’s bottle and Ultra-Preemie and Preemie nipples, ask your NICU medical team about our feeding system. The Dr. Brown’s Medical division is glad to work alongside you and your healthcare professionals to begin your baby’s journey to successful oral feeding.

Remember, you and your preemie baby can get through this difficult time together. There is a lot to know and learn about your special bundle of joy, and it can be a stressful, worry-filled experience. But with your medical team by your side, you and baby can reach your feeding goals confidently. Feel free to get in touch with any questions about the Dr. Brown’s feeding systems designed just for your preemie baby. For more information about life after the NICU, nipple guidelines, where to buy, and more, visit the Dr. Brown’s Medical website now.

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