One of the best ways to protect your premature baby is to feed them breast milk, whether through pumping—or, when the time is right—through direct breastfeeding. Breast milk produced by parents of premature babies is tailored to meet their baby’s specific nutritional and immunological needs. Breastfeeding a preemie isn’t without struggles, but the important thing to remember is that “every drop counts” and doing your best is most definitely good enough. Let’s take a look at what to know about the benefits of breastfeeding for preemies, and how to manage common challenges that breastfeeding parents of premature babies face.
How Do Preemies Benefit from Breastfeeding?
Breast milk offers excellent nutrition for all babies, as well as protection from illnesses and diseases. If anything, breast milk is even more important for premature babies, says Barbara Carr, MD, neonatologist and specialty medical officer for neonatology at Pediatrix Medical Group, “The content of milk changes over time and a mother that delivers early has milk that is specially designed for a premature baby,” explains Dr. Carr. Our bodies are pretty amazing!
Nutritional Benefits
Premature babies have different nutritional needs than full-term babies, and the breast milk you produce if you’ve given birth to a premature baby reflects this. Breast milk for preemies is higher in protein, fat, sodium, zinc, and free amino acids. Breast milk for preemies is also higher in fatty acids. Fatty acids found in breast milk help with your baby’s brain development, eyesight, and nervous system, says Lindsey Shipley, RN, IBCLC, and founder of Lactation Link. These fatty acids are not available in formula. It’s important to note that as wonderful a nutrition source breast milk is for preemies, sometimes it needs fortification, especially if your baby is considered very low birthweight (VLBW). “Because the growth needs of a premature baby are different, the breast milk often needs to be fortified, which increases the caloric content and provides extra nutrition, including even more protein for growth and calcium and phosphorus for bone mineralization,” says Dr. Carr.
Immunological Benefits
Breast milk isn’t just a nutritional source: It is full of antibodies and other disease-fighting elements that protect babies. This is especially essential for premature babies, who are more vulnerable to disease than full-term babies. Premature babies who receive breast milk have lower rates of late-onset sepsis, diarrhea, and are less likely to be hospitalized during their first 12 months of life. They are also better able to fight viruses or infections they may pick up after leaving the hospital. “Receiving breast milk also lowers preemies’ risks for urinary, GI, respiratory, and ear infections,” says Shipley. “If they do experience any of these things, breastfed babies usually have a less severe bout with them.” One of the most important protections that breast milk offers premature babies is against necrotizing enterocolitis, a serious and often deadly intestinal illness that preemies are prone to. One study found that babies who received breast milk were six to 10 times less likely to experience a case of necrotizing enterocolitis.
Neurodevelopmental Outcomes
Breast milk is good for your baby’s growth and development. It helps keep their eyesight strong and it offers “good” bacteria for their intestines so that digestion is easier. Moreover, breast milk for preemies is associated with strong neurodevelopmental outcomes. For example, studies have found that premature babies fed breast milk had cognitive and motor advantages even through their toddler years. Other studies have found that premature babies who received breast milk had higher IQ scores through the school-age years.
How Often Should Preemies Breastfeed?
When it comes to breastfeeding premature babies, there is a lot of variation based on the baby’s age, weight, development, and medical vulnerabilities. It takes a lot of strength to come to the breast and feed, and babies don’t develop their mature nutritive sucking abilities until they are about 35 weeks. Some babies can’t even be fed with a bottle at first, and are fed via a feeding tube or an IV. As such, many breastfeeding parents start their preemie breastfeeding journeys by pumping their milk for their babies. Dr. Carr says that breastfeeding parents usually need to pump at least every three hours to keep up their milk supply and to provide enough breast milk for their babies. Depending on the circumstances, premature babies are also fed this pumped milk about every three hours or so, she adds. All premature babies are different, but usually, by about 32 to 34 weeks, your baby may be ready to attempt breastfeeding, says Dr. Carr. These feeds are usually exploratory and non-nutritive, with your baby learning how to coordinate their sucking and swallowing. During this time, your baby will likely still need supplemental feedings, Dr. Carr notes. Once your baby is strong enough to breastfeed directly, Shipley recommends “on-demand” feeding. “Our newborns have no concept of clocks,” Shipley says. “They will want to eat frequently early on.” This may mean eight to 12 times or more in a 24-hour period. There may be special considerations in terms of breastfeeding frequency with newborns, though, as they may not be able to expend as much energy per feeding and may tire easily, Shipley advises. “Depending on the situation, the NICU staff will guide you on the best times and frequency for your preemie,” she says.
Are There Any Precautions I Should Take?
The way that your baby is fed—from the breast, by tube, or by bottle—will depend on several factors. Your baby’s medical team will keep in touch with you about that. If you are pumping, you will need to take care to sterilize your pumping equipment and bottles thoroughly, since your baby will be more at risk of bacterial infections than full-term infants are. You should follow your hospital’s guidelines, but most will recommend that you wash your hands and the pump parts and bottles before each use. You will likely be asked to sterilize the pumping equipment and bottles every 24 hours. Your hospital will give you instructions for how to properly label your bottles, and the best way to store your pumped milk for your baby.
Challenges When Breastfeeding Preemies
Providing breast milk for your baby can help you feel like you are able to do something to help your baby when so much about parenting a preemie can feel out of your control. “Having a baby in the NICU can be a stressful and sometimes frightening experience, leaving parents overwhelmed and uncertain of what to do for their baby,” says Dr. Carr. “Providing milk for your preterm baby is something that only mom can do!” That being said, pumping for a preemie, or attempting to breastfeed them directly, can be a very challenging experience. Fitting in pumping sessions when you are exhausted and depleted can be difficult. If your baby is having trouble transitioning from bottle or tube feeding to direct breastfeeding, you may end up feeling defeated and stressed. It can be helpful to adjust your expectations in terms of what success looks like as you provide breast milk for your preemie. Shipley suggests trying to let go of your picture of “how things should be" and instead focus on doing your best. When pumping, Shipley suggests using a high-quality electric pump or renting a hospital-grade pump. If you can’t be near your baby while you pump, looking at photos or videos of them can help your milk flow more easily, she says. In terms of those first attempts at direct breastfeeding, patience is important. There is a lot of trial and error when your baby is first learning to breastfeed, so it can be helpful to go in expecting that to happen. “One good latch session may be followed by a poor one,” says Shipley. “Try not to get discouraged and remember you are doing a great job!” She also encourages parents to practice a lot of skin-to-skin time with their preemies, which is both helpful for breastfeeding initiation and your baby’s overall health and well-being.
A Word From Verywell
Caring for a premature baby can be a scary and anxiety-producing experience. Although providing breast milk for your baby can be empowering, it doesn’t come without challenges. That’s why support is so important when it comes to the challenges that breastfeeding parents of preemies face. “If possible, enlist family and friend support and ask for a discussion with a social worker at the hospital to understand all the resources and support available to you,” Shipley suggests. Additionally, if you have any questions or concerns about breastfeeding or pumping for your preemie, you shouldn’t hesitate to reach out to your baby’s medical team.
