Feeding your preterm baby: FAQs, Resources & Expert Recommendations

Sometimes, babies need to get nutrition through an intravenous (IV) line. If your baby is unable to have milk, the NICU team will ensure they get all the nutrition they need by giving them “total parenteral nutrition” (TPN) through an IV. A baby might need TPN if they are getting a small amount of milk that isn't enough to provide all the nutrition they need, or if they are unable to have milk at all for a medical reason. TPN contains all of the nutrition your baby needs. It provides:Water SugarElectrolytes (like salt)Vitamins and mineralsProtein Fat  If your baby is getting TPN, you may see an IV bag that looks like yellow liquid (the vitamins make it yellow), and a syringe with white liquid (lipids–another name for fat). Your baby’s team will decide each day how much TPN your baby needs to get the best nutrition. Ask your team if you have questions about your baby’s TPN.

Colostrum is the early breast milk your body begins producing around the 20th week of pregnancy and continues to make for the first 3–4 days after birth. It is usually thick, sticky, and can range in color from clear to dark yellow. Although produced in small amounts (about 5–15 mL per feeding), it is highly concentrated with nutrients and antibodies that help protect your baby from infection. Colostrum also helps your baby pass their first stool (meconium), which can reduce the risk of jaundice—making it the perfect first food for a newborn’s tiny stomach.For more information visit Prenatal Colostrum Expression | La Leche League Canada

Colostrum is especially important for premature babies because their immune systems and digestive systems are not fully developed. This early milk acts like medicine—providing powerful antibodies that help protect them from infections they are more vulnerable to. It is also gentle and easy to digest, making it ideal for their immature gut.Colostrum helps coat and protect the baby’s intestines, supports healthy gut development, and can lower the risk of serious conditions like infections or feeding complications. It also helps premature babies pass meconium, which can reduce the risk of jaundice. Even in very small amounts, colostrum provides essential nutrition and protection during a critical stage of development.

Water Sugar Electrolytes (like salt)Vitamins and mineralsProtein FatOral Immune Therapy (OIT) is a simple and safe way to use your own breast milk to help protect your baby. A small amount of fresh breast milk (or colostrum) is gently swabbed inside your baby’s mouth—usually every four hours—as part of routine care.Even though it’s not feeding, breast milk acts like medicine, especially for premature or sick babies. It contains protective antibodies that help fight infections, support your baby’s immune system, and promote healthy gut development.OIT can be given to babies who are not yet able to feed by mouth, including those who are premature or receiving tube feeds. Even a few drops of early milk are very beneficial.This practice also supports your baby’s growth, helps them tolerate feeds sooner, and creates a meaningful way for you to be involved in their care and bonding. Nurses can show you how to do it safely.For more information visit Oral immune therapy for your hospitalized baby

Breastmilk is the best nutrition for all babies. When a baby is born premature, mothers make “Premature breastmilk” for their baby. This milk is specifically designed for a baby born prematurely.  Even if a mother had not planned to breastfeed, her breasts begin making breast milk after birth, no matter how early the baby is born.  All mothers of premature babies should consider providing this special milk to their baby for the first 30 days and beyond, even if they are not planning long term breastfeeding. Research shows that premature babies fed their mother’s milk:​Have fewer infectionsHave better digestionHave better visionHave stronger bonesGrow tallerBecome smarter kidsGo home sooner Breastfeeding can also benefit the mother of a premature baby:​hormones that can help mothers cope during this stressful timeincreased connection (bonding) to the babyhealthy breastfeeding advantages for the mother including better weight loss and less risk of breast cancer and weak bones Read more:- benefits of exclusive breastfeeding- providing milk of their own mother to infant at risk- what makes breastmilk so amazing Some of the resources were written by Dr. Paula Meier, director for clinical research and lactation in the neonatal intensive care unit and professor of paediatrics at Rush University Medical Centre in Chicago. There might be some differences from your centre in the resources available.

The first step is to start to stimulate the breast to produce milk. To get your milk supply started and keep it up, you want to pump your breasts as often as your baby would feed, at least 8 times a day. This doesn’t have to be exactly every 3 hours. It may help to plan your pumping times around your daily routine. There may be times when you have to pump after only 2 hours, and others when you go longer. In the morning, your hormone levels are higher, and you will make more milk. Pump more frequently early in the day. Hospitals usually have higher quality breast pumps. Plan to pump more often when you are at the hospital. Take advantage of time with your baby. Any time you have contact with your baby, your body will make more milk. Pump both before and after spending time with your baby, especially skin to skin time. Both mom and dad and any other people who support you can be involved in this journey. The role of support people is very important. They can encourage and praise mom for her efforts, help mom to find the time and space to pump, and help with milk storage and transport to the hospital. Read more:Initiating milk production (PDF)

Most babies born more than a month early don’t yet have the energy and coordination with breathing and swallowing to suck steady and safely on a breast or bottle to get milk. The stomach and gut needs to have milk in order for it to continue to grow and develop. For this reason, milk must be provided through a tube. It is put into the stomach through the mouth or nose. It is referred to as a feeding tube, “gavage” tube, or a orogastric (through mouth) or nasogastric (through nose) tube. At first, most of your baby’s nutrition is given through the intravenous with Total Parenteral Nutrition (TPN).  It contains many essential elements of nutrition, such as protein, fat, sugars, vitamins and minerals, but it is not as healthy as mother’s milk. By giving milk to the baby early, the doctors and nurses can decrease the amount of TPN as soon as possible and get the IV out to decrease the risk of infection.

Many mothers need medicine for their own health. It is important to talk to your own healthcare provider about what you are taking. You can read an info sheet from the International Breastfeeding Centre about medication and breastfeeding here: https://ibconline.ca/information-sheets/breastfeeding-and-medications/ You can also consult the website “MotherToBaby” (https://mothertobaby.org/) for more information.

It is very common for a mother’s milk supply to decrease when they have been pumping for many weeks. It is important to not get upset about it.  There are a few key elements to keeping up your supply. The first is a good pump. Generally a full sized electric breast pump is going to be the most reliable. The more often you pump, the more milk you will produce at each pumping session. Pump until the milk flow stops, and then just a bit longer. If you massage your breasts before pumping and express by hand for 5 minutes after pumping, you can also boost your supply. Review your milk volumes every day, and keep track of how often and how long you are pumping. If you are finding that the milk stops flowing sooner, keep the pump on for a longer time. Find ways to fit extra pumping times into your day and night. As you recover from the birth, it may get easier to get up at night to pump. You can try “power pumping” once a day. It takes one hour. Pump for 20 minutes, rest for 10 minutes, pump for 10 minutes, rest for 10 minutes and finally pump for 10 minutes. There are some herbal and prescription medicines that can help increase milk supply. They are not magic. If you had a full supply and then it dropped off, you are more likely to respond to them. These other methods may bring back your supply without any other medicine. Talk to your nurse, doctor, nurse practitioner, midwife or lactation consultant about them before you start them.

Your baby starts the journey to breastfeeding when you do. Babies each have their own rate of progress and development and it is important to work with your team to help them reach their goals. You can expect your baby to follow a pattern similar to the one outlined below: Tube feeding with mom’s milk. Having positive contact with mom whenever possible. Small tastes of mom’s milk are often given during this stage. Learning to suck. This starts with a soother given during tube feedings so that baby associated sucking with a full stomach. Have regular skin to skin time with mom and introduce baby to the breast to lick and gently suck. This is called a “non-nutritive suck” because baby is often too small or weak to get much milk out of the breast. It is important to make this a positive experience for both you and your baby. Short breastfeeding practice sessions. These are often only 5-10 minutes long to make sure that baby doesn’t get too tired. There are optimal ways to support your baby at the breast that your baby’s nurse, a lactation consultant or an occupational therapist can teach you. The focus is on the quality of sucking not on the milk volume that baby takes. Building up breastfeeding stamina and mom’s confidence. Follow baby’s cues for what they can handle and don’t push them too hard. It is very important to keep the sessions positive for both yourself and your baby. If your baby shows any signs of stress, stop the breastfeeding session and consider just holding your baby in skin to skin until they are calm. You can try again next time. Hospitals have different protocols for helping a premature baby transition to full breastfeeding. Talk with your baby’s nurse about theirs. Full breastfeeding. Some premature babies achieve this before going home, while others continue to work towards this at home. Your team will help you determine the best way for you and your baby. Talk to them about the people who will support you in your community. It is more difficult to do this on your own, so don’t be afraid to call for help and advice. If you and your baby never achieve full breastfeeding remember, you are still a winner! The important thing is that you are doing the best you can for your baby. Many of the doctors and Nurses who work in the NICU have extra education to help you with breastfeeding. There are also health professionals called Lactation Consultants who can help you specifically with breastfeeding in many cities and hospitals. If you don’t have those resources in your community, there are online resources to help you. Below are some links you may want to try: International Breastfeeding Centre (based in Toronto ON): https://ibconline.ca/About Kids Health Breastfeeding Learning Hub  https://www.aboutkidshealth.ca/breastfeeding

Many premature infants need extra nutrients added to their mother’s milk to achieve the best growth and development. Premature babies often need extra protein, calcium, phosphorus, and even salt, to build strong bones and healthy organs. The doctors, nurses and dietitians keep track of your baby’s growth and blood test results, in order to see what your baby specifically needs. These extra nutrients are added to the milk before it is fed to your baby. There are two types of human milk fortifiers available. One is made from cow’s milk and the other is made from human milk. Doctor’s don’t add more volume, just more calories and protein for the tiny babies to get the added nutrition they need.  If only extra calories are needed, sometimes using more hindmilk (which is breastmilk obtained at the end of the feeding or pumping, which has a higher fat content) can improve growth.​Since many commonly used fortifiers are made from cow’s milk proteins (like regular formulas), some babies may have difficulty initially when the fortifier is added. They may have delayed emptying from the stomach, abdominal distention or even gas. The stools may change somewhat in color. If that happens, the doctor may remove the fortifier and try again at a later time. ​It is important to remember that your baby needs these extra nutrients because of the prematurity or illness – not because there is a problem with your milk. As most premature babies are discharged home a few weeks before they were due to be born, some infants may require fortification for a time after being discharged home.

If you are unable to pump enough milk to meet your baby’s needs, then it will be supplemented by either special formula that is designed for premature babies, or by donor milk, if your hospital has a donor milk program.  Donor milk comes from mothers who have donated their milk to a milk bank. The mothers are screened and tested, and the milk is tested and pasteurized. It is also pooled, so that the batches come from multiple donors. This helps to standardize the nutritional content of the milk. Donor milk is easier for premature babies to digest than formula. Although the heating process of pasteurization decreases some of the nutrition in the milk, most of it is still present. Many of the immunity properties of the milk, which are not present in formula, are present in donor milk. It is considered safe and for very premature babies it is considered an essential option. Donor human milk information (PDF) Human Milk Banks in Canada: Rogers Hixon Ontario Human Milk Bank https://www.milkbankontario.caBC Women's Provincial Milk Bank http://www.bcwomens.ca/our-services/labour-birth-post-birth-care/milk-bankNorthern Star Milk Bank http://northernstarmilkbank.caHema Quebec Public Mothers' Milk Bank https://www.hema-quebec.qc.ca/lait-maternel/donneuses-lait/banque-publique-lait-maternel.en.html