Bottlefeeding and weaning a premature baby.
Having a premature baby - one that is born before 37 weeks of pregnancy - can be an emotional rollercoaster for parents.
Your baby will certainly need special handling, although not necessarily in a special care baby unit (SCBU). Even if she is not in a SCBU, her needs are undoubtedly different to those of a full-term baby. Obviously, one of the most crucial aspects of caring for a premature baby is that of feeding.
A premature baby needs to be fed more frequently than a full-term baby. This is because her stomach is smaller, meaning her feeds need to be smaller but more frequent (about every three hours or more).
Additionally, a lot of premature babies do not have the strength to suck from either a teat or nipple in the beginning. Their intestines may also not be developed enough to properly absorb food. Feeding options for premature babies are as follows:
• Intravenous feeding
Very small or unwell babies may be unable to swallow or digest food for themselves. Instead, they will need to be fed special liquid meals through the means of a tube directed into their veins. At some point the intravenously-fed baby may also be given the antibody-rich colostrum that the mother's body makes in the 72 hours after delivery. An IV-fed baby can progress on to naso-gastric feeding.
• Naso-gastric feeding
If the premature baby is able to digest food but unable to take it in through her mouth, she may be fed through a special fine tube. With this type of feeding, a tube is passed through the baby’s nose into the stomach. The baby does not find this uncomfortable.
When you notice your baby opening and shutting her mouth during her feeding times, you should encourage her sucking reflexes to develop by putting her into a good breastfeeding position so that she can nuzzle your breast. You may be able to express your breast milk which can then be given to your baby via the feeding tube.
• Combination feeding (breast or bottle alongside tube feeding)
Once your baby is a little older and more developed, it will be possible to start feeding her by mouth, even if this has to be topped-up with tube feeding. You could try to express your breast milk for this purpose. The baby's sucking and gag reflexes need to be developed enough to cope with oral feeding. This combination feeding can continue until your baby is sufficiently developed to take just breast or bottle.
Your healthcare practitioner will advise you when the time is right for your baby. Once your baby has entirely stopped tube-feeding, she will progress on to normal breast or bottle-feeding equipment and routines.
Bottle feeding a premature baby with breast milk
It is feasible that your premature baby can be given breast milk via a naso-gastric tube initially. When she is ready and can co-ordinate breathing, sucking and swallowing, she can progress onto a special feeding cup (from 32 weeks of age) or bottle, which you can express your breast milk in to. It should be pointed out that some healthcare practitioners do not recommend using a cup, while others do.
The nutrients in breast milk are invaluable to a newborn, even if you were only to provide her with the antibody-rich colostrum that your body makes in the 72 hours after delivery, and then afterwards switch to bottle-feeding.
Because of their immature digestive systems, breast milk is extremely good for premature babies, helping to protect against the rare but serious condition called necrotizing enterocolitis (NEC), where the intestines become damaged due to infection and a poor blood supply. NEC is more common in bottle fed premature babies. Breast milk also contains protection against allergies and infections, ultimately helping to support the premature immune system.
If you are going to express milk for your premature baby, you can either express by hand or use a specially designed breast pump. Manually or electrically operated options are available.
Babies experiencing difficulties breastfeeding are also often fed breast milk via a bottle. However, they sometimes find it hard to get used to the different sucking style that later breastfeeding requires. These babies may end up being given formula milk from a bottle.
Bottle feeding a premature baby with formula milk
It is possible to bottle feed a premature baby with formula - once she can co-ordinate breathing, sucking and swallowing - although it may be recommended that you try to provide your baby with breast milk, at least for the short term. Giving your premature baby breast milk works to equip her with vital nutrition from the start, which is particularly beneficial to an early baby who needs all the extra help she can get.
If you are going to bottle feed your baby, and she is able to take her food orally, there is specially designed formula milk for premature babies available. Your medical advisors are best placed to recommend the right formula for your baby’s needs.
Your premature baby will probably need to be fed at least every couple of hours, but your midwives will advise you of the individual needs of your baby. One of the initial difficulties of feeding a premature baby is likely to be related to her sleepiness. Often, a premature baby spends most of her time sleeping; and creating interest in feeding, as well as keeping your baby awake long enough to feed properly, can be hard work.
One mum’s experience
Peta Hough, 31, experienced first-hand the challenges of feeding her premature baby, Naomi, who was born at 35 and a half weeks. Naomi was jaundiced, extremely sleepy and needed to be woken up to be fed frequently, although she wasn’t in a special care unit.
“I felt anxious about feeding her because I had to be so very vigilant about getting fluids into her at regular intervals," says Peta. "It was difficult because she was so sleepy and had to keep being woken up.
“I was taught to gently pinch her cheek and talk to her a lot in order to stimulate her awake.”
Equipment
You can start bottle-feeding your premature baby with a specially designed bottle and teat that she can manage in her mouth. This special-sized equipment will be important in establishing your baby’s sucking and swallowing skills, and then in aiding your baby’s ultimate progress on to a normal sized bottle and teat.
Premature baby bottles have a limited capacity of up to 50ml maximum. This is because your baby’s stomach is so small she won’t be able to tolerate much food at any one time. As long as your baby is wetting about six to eight nappies a day, she is receiving enough food.
Weaning a premature baby
The guidelines on when to wean a premature baby are somewhat unclear, so you should look to your GP or health visitor, who understands your individual needs best, for advice. In very general terms, the earlier your baby was born, the later weaning is recommended, some time between six and nine months of age. If your baby was born 12 weeks ago, but was four weeks early, her ‘corrected’ age is actually eight weeks, rather than 12 weeks. Bear this in mind when you are thinking about weaning.
Your premature baby’s gut will take longer to mature and it is important that you don’t try to wean too early, as this could have a detrimental effect on your child’s health. However, each child is individual and it is also vital that you discuss your particular baby’s needs with your healthcare providers.
Generally speaking, it is not recommended that full-term babies are weaned until at least the age of four months (some practitioners say you shouldn’t wean before a year) as the gut is not mature enough to cope with solid food. With this in mind, you should under no circumstances try to wean your premature baby before four months. By around the age of six months, milk alone is usually not sufficient for most babies' needs and your baby will probably give you signs that she is ready to wean (for example, a loss of interest in or complete refusal to breastfeed). If your baby has had stomach surgery or there is a family history of allergies, seek medical advice before weaning.
The information on this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.
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Last Modified: 30/06/2008