Getting started with breastfeeding can be difficult for a preterm baby can be difficult because they have special challenges.



Often their nervous system is not developed properly, so they find it difficult to coordinate suck swallow breathing. Sometimes they are not allowed to take any feeds by mouth and are fed with a tube till their overall heath stabilizes.  Sometimes they can breastfeed, but not effectively enough to increase and maintain a good milk supply.



In spite of all these challenges, breastmilk is very important for premature babies, because feeding formula increases the risk of a preterm baby getting a very serious infection called necrotizing enterocolitis (NEC) which can be fatal. Breastmilk fed preterm babies are 6 to 10 percent less likely to suffer from NEC than formula fed preterm babies.



There are many things that parents can do to help their preterm babies start breastfeeding, but three things are the most important for eventual exclusive breastfeeding:


  1. Protecting the mother’s milk supply by starting hand expression and pumping early so that her breastmilk can be fed to the baby, rather than formula.  Colostrum, the thick milk present at birth is easier to hand express. Mothers must start hand expression as soon as possible after baby’s birth, within the first hour if possible. As soon as possible, the mother must start pumping with a good quality double electric hospital grade pump. The mother must pump at least 10 to 12 times a day to begin with, to mimic early breastfeeding behaviour.  When a mother has a good milk supply, it is much easier to transition the baby from tube feeding to breastfeeding as the baby’s health improves.


2. Starting kangaroo care.

Kangaroo care, that is placing a baby on the mother’s or father’s bare chest is very beneficial. Kangaroo care can help preterm babies to:

  • Better regulate their temperature, breathing and heart rate
  • Experience less crying and pain
  • Help stimulate mother’s milk supply
  • Promote early attachment and suckling at the breast


3. Getting early help from a lactation specialist. Lactation specialists can help mothers to choose appropriate pumps, show mothers how to do effective hand expression and give tips for pumping, help with positioning and latching and can answer any questions parents may have about breastfeeding.


How do babies progress from being tube fed breastmilk to breastfeeding at the breast? With early kangaroo care, babies learn to associate being near the breasts as a safe and comfortable experience. Slowly, they start latching and sucking. Initially, this sucking is for practice and babies cannot get much nutrition directly breastfeeding. They still depend on pumped milk for most of their nutrition.

As babies grow and become stronger and can better co-ordinate suck, swallow and breathing, they slowly start getting more and more milk at the breast, rather than via a tube. Babies who are born at 32 to 33 weeks may start breastfeeding soon after birth, while babies born earlier than that may need longer because they are often more fragile and need special medical care for longer.


If you have any questions about breastfeeding your premature baby or need help with breastfeeding your premature baby, please email at



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  1. Academy of Breastfeeding Medicine. (2010). Clinical Protocol Number #23: Non-pharmacologic
    management of procedure-related pain in the breastfeeding infant
    . Breastfeeding Medicine 5(6), 1-5. DOI:


  1. Neu, M. & Robinson, J. (2010). Maternal holding of preterm infants during the early weeks after birth and dyad interaction at six months. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 39, 401-414; DOI: 10.111/j.1552-6909.2010.01152.x.


  1. Blacke, J. & Gregson, S. (2011). Kangaroo care in pre-term or low birth weight babies in a postnatal ward. British Journal of Midwifery, 19, 9, 568-577.


  1. Blomqvist, Y. T., Flolund, Nyqvist, K. H., & L., Rubertsson, C. (2012). Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents. Caring Sciences, 27, 345-353.
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