After a few months, breast or bottle feeding is gradually supplemented with solid foods. For a premature baby, this transition may differ from that of a baby born at 40 weeks of pregnancy. The information below provides an overview of this process.
Feeding
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Breastfeeding up to six months
The World Health Organization (WHO) recommends exclusive breastfeeding during the first six months (corrected age), followed by the gradual introduction of complementary foods. Throughout the breastfeeding period, the composition of breast milk adapts to the baby’s growth, immune system, and individual needs.
Providing exclusive breastfeeding for six months offers significant health benefits for premature infants. It reduces the risk of infections—such as middle‑ear infections and respiratory infections—as well as the risk of developing type 2 diabetes, asthma, eczema, and other conditions.
Long‑term breastfeeding also provides benefits for mothers, including a reduced risk of type 2 diabetes, breast cancer, and ovarian cancer.
Formula feeding
If the baby receives formula, a transition is made to follow‑on formula or second‑stage milk from a corrected age of six months (when solid foods are introduced). This type of milk is adapted to the changing nutritional needs of an older infant.
Between 12 and 18 months, the transition is made to whole milk or growth milk, depending on parental preference and the advice of healthcare professionals.
Solid foods
Only limited research is available on the introduction of solid foods in premature infants. The skills required for swallowing solid foods and eating from a spoon generally develop between a corrected age of four to six months. It is, however, essential to consider each child individually.
Children typically show their own signs when they are ready to start solid foods. These signals include: the ability to sit upright with sufficient stability, interest in the mouth and the spoon, reaching for food, making chewing motions with the mouth and more. In premature infants, these signs may appear somewhat later.
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Feeding difficulties
Premature infants and babies who have received long‑term tube feeding often experience many unpleasant sensations in the mouth area during their hospital stay—such as the placement of a feeding tube, suctioning of secretions, and other procedures. These experiences can affect the baby’s oral motor skills, which may later cause difficulties with drinking or eating. This may present as: difficulty latching onto the breast or bottle, restless or shallow drinking, frequent choking or gagging, refusal of the nipple or food, and challenges during the transition to solid foods (e.g., gagging on small pieces).
TIPS
Parents can support their baby in developing positive oral experiences. Small, gentle actions can make a significant difference.
- Create positive experiences around the mouth
Allow the baby to become familiar with touch around the mouth in a playful way. This can be done by letting the baby explore their face with their hands or by gently stroking the mouth and cheeks. These experiences help the baby learn that touch around the mouth can also be pleasant.
- Respect the baby's signals
A baby should never be forced to eat. Turning the head away, gagging, or showing signs of stress indicate the need to slow down. The EFS method can be used to recognize the baby’s cues and adapt the feeding process accordingly. Trust and a sense of safety are essential for healthy feeding development.
- Create a calm environment
A calm environment with minimal stimulation helps the baby focus on drinking or eating. Allowing adequate time to offer the feed also contributes to a positive feeding experience. A calm caregiver helps the baby feel secure.
- Seek help in time
Support is available. When feeding or drinking appears difficult or uncertain, professional help should be sought. Early guidance from a healthcare provider, such as a speech therapist, can prevent or reduce many feeding problems.