A premature baby is usually not able to drink directly from the breast or bottle right away and therefore often requires feeding support. With the help of healthcare professionals, parents learn to recognize and interpret the baby’s cues. Feeding is introduced gradually, often using a combination of intravenous nutrition, tube feeding, and breastfeeding or bottle‑feeding.
Feeding
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Feeding preterm infants
For babies born prematurely, the initiation of feeding is often challenging. The pattern of sucking, swallowing, and coordinating these actions with breathing is still developing. Feeding skills typically mature between 32 and 37 weeks of gestation. As a result, premature babies often struggle to feed independently at the breast or from a bottle. The immaturity of these skills, combined with limited energy reserves, makes it difficult to take in sufficient nutrition. Therefore, it may be necessary to provide nutrition partially or entirely through an intravenous line (TPN) and/or a feeding tube, using either breast milk or formula.
Methods of feeding
Parenteral nutrition
If the baby is not yet able to digest nutrition fully or partially through the stomach and intestines, nutrients may be administered intravenously in the form of TPN (total parenteral nutrition). This is not “milk,” but a mixture of sugars, proteins, fats, vitamins, and minerals delivered directly into the bloodstream.
Tube feeding
When the baby’s stomach and intestines are ready to process nutrition but the coordination of sucking, swallowing, and breathing is still insufficient, feeding is provided through a feeding tube. This thin tube is inserted through the nose or mouth into the stomach. Breast milk or formula is given through the tube. By offering small amounts of milk through the tube, the stomach and intestines can gradually become accustomed to digesting nutrition. Tube feeding is slowly increased while the intravenous line is reduced. As feeding at the breast or bottle improves, tube feeding is gradually phased out. A feeding tube therefore gives the baby time to learn to drink effectively from the breast or bottle.
Breastfeeding
Breast milk is highly valuable for supporting growth and development, as its composition adapts to the needs of the premature baby. It also contains antibodies, white blood cells, hormones, growth factors, and more. When the baby receives breast milk, direct breastfeeding is introduced as soon as the baby is developmentally ready. For this, the coordination of sucking, swallowing, and breathing must be sufficiently mature. The initiation of breastfeeding in premature infants follows the baby’s own pace. Often, they first latch and suckle without actively drinking. This non‑nutritive sucking is an important part of the learning process, helping the baby explore the breast and prepare for active feeding. Practice is key, the more opportunities the baby has to practice, the more smoothly breastfeeding can progress.
Bottle feeding
If breastfeeding is not possible or not desired, bottle feeding can be provided. Premature babies receive special formula that contains more calories, proteins, vitamins, and minerals than standard infant formula. This type of formula is specifically designed to support the growth and development of preterm infants. In addition to formula, the baby may also receive expressed breast milk in a bottle. This can be offered when parents choose this option or when the mother is not present. Additional nutrients (milk fortifiers), such as extra calories, proteins, fats, vitamins, minerals, and electrolytes, can be added to expressed breast milk to meet the premature baby’s increased nutritional needs.
Alternative feeding methods
In addition to parenteral nutrition and tube feeding, there are alternative methods for providing nutrition when a premature baby is not yet able to drink effectively at the breast or from a bottle. These methods include cup feeding (offering milk via a small cup) and finger feeding (a thin tube placed alongside a finger in the baby’s mouth, allowing the baby to practice sucking movements). These approaches support the transition to breastfeeding and help further develop the sucking reflex.
Breast milk offers significant benefits for the health and development of a premature baby. It provides essential nutrients and protects against infections. However, in some situations it may not be possible to provide breast milk (e.g., due to the mother’s medical condition), or parents may choose formula feeding. Click on the preferred option for more information.
Breast milk
Formula feeding
Support in the neonatal unit
In the neonatal unit, several healthcare professionals can provide specialized support with the baby’s feeding.
Lactation Consultant
Lactation consultants are healthcare professionals with additional training in breastfeeding and are therefore experts in breastfeeding support. Breastfeeding premature babies and expressing milk do not always go smoothly. Parents can turn to lactation consultants for information and questions related to breastfeeding. They also offer support in addressing breastfeeding challenges and work together with parents to find appropriate solutions.
Lactation consultants can also provide support with formula feeding. Their guidance may include advice on selecting an appropriate bottle and nipple, teaching a safe and comfortable feeding position, and techniques such as paced feeding to help make bottle-feeding calmer and less stressful.
Midwife/nurse
Midwives and nurses play an important role in feeding, both breastfeeding and bottle-feeding. They guide the baby’s feeding after birth and offer practical advice and support.
Speech therapist
Some babies experience feeding difficulties from an early stage. In such cases, the department’s speech therapist can be involved. A speech therapist focuses on assessing sucking and swallowing difficulties and supports parents in teaching an effective feeding technique.