In hospital Feeding

The aim of nutritional support for a preterm baby is to achieve a similar growth rate compared to the fetus at the same age. In order to reach the optimal development experts, recommend to start feeding as soon as possible after birth. However, it may not always be possible to start full feeding immediately after birth.

Enteral nutrition

This means feeding the baby by using a nasogastric (via nose to stomach) or orogastric (via mouth to stomach) tube. It can be initiated as soon as the gastrointestinal tract is mature. This solution is recommended by most guidelines for preterm infants as long as they cannot coordinate to drink, suck, swallow and breathe. The ability for suck-feeding usually develops around 35 weeks of gestational age, so that infants born before 35 weeks will most likely require temporary tube feeding. During the first days of life, only very small amounts of milk are administered until the intestines get used to it.

The first steps towards breastfeeding can be initiated as soon as the condition of the preterm baby has stabilized. The learning process takes time and needs a lot of patience. The first step towards breastfeeding is kangaroo care which may already be commenced soon after birth. Health care professionals together with parents will decide if the preterm baby is stable enough for kangaroo care. Skin-to-skin contact will help the baby to develop the feeding abilities and also stimulates the milk production.

Around the age of 24 weeks, babies are able to do their first sucking movements but cannot coordinate sucking and swallowing yet.

Between 26 and 30 weeks the development progresses and babies will have a gag reflex, which helps to prevent choking. At this stage, some babies are already able to lick some drops of breast milk.

In the next two weeks, kangarooed infants will already start to turn their head towards the breast and may lick some drops of milk directly from the breast. But most feeds will still need to be through the nasogastric tube.

The ability to coordinate sucking, swallowing and breathing will be developed around the age of 35 weeks. But most infants at that age are still weak and may get tired easily. Hence, tube feeding is still needed in many cases.

The preterm infant will now get more active every day until even full breastfeeding is possible. Some hospitals work with so-called ‘early feeding scales’ for the assessment of feeding abilities or nutrition specialists check whether a preterm baby is ready to start oral feeding.

Babies may also need temporary support such as nipple shields, finger feeding, cup feeding or bottle feeding. There are numerous techniques for feeding a preterm baby with breast milk. Healthcare professionals or lactation specialists can help parents to find the optimal solution for them and their baby.