This November, we are proud to support National Prematurity Awareness Month, which is an annual event to educate and inform people about premature birth. With over 450,000 premature births in the United States each year, the goal is for Prematurity Awareness Month and World Prematurity Day (November 17th) to raise awareness and help reduce the number of premature births.
Medela is dedicated to supporting all breastfeeding moms with resources to make their breastfeeding journey easier. Families of premature babies have a unique breastfeeding experience which involves providing much-needed breast milk to their infants in the hospital. We asked preemie moms what questions they have about providing breast milk to their premature babies, and teamed up with Hand to Hold to provide their expert guidance to answer the 10 most common questions we received.
Can my diet affect the breast milk I provide to my preemie baby?
While a healthy and nutritious diet is absolutely recommended for breastfeeding moms, breast milk quality is not necessarily affected by an unhealthy diet; however, if a mother does not consume enough calories, her milk supply can suffer. Drugs (such as nicotine, alcohol, and medications) also have proven effects on breast milk and your breastfeeding baby. Click here for more information.
My doctor has prescribed extra vitamins to my preemie, but I thought breast milk had everything a baby needed. Is it possible that my baby isn’t getting enough vitamins?
Breast milk is the foundation of a healthy diet for all babies. It contains the right kinds of fats, sugars, and proteins to support healthy growth and development. It provides your baby antibodies that protect them from getting sick and hormones that help them develop a healthy digestive system. Because of this, feeding your baby breast milk is one of the most important things you can do for them if they are born early or sick. However, while breast milk is best for preemies, it doesn’t meet every one of your baby’s needs.
Babies receive important nutrients from their mom’s body during the last weeks of pregnancy. Because preemie babies are born early, they receive fewer of the vitamins and minerals they need. They are especially vulnerable to three things: anemia, slower growth, and weaker bones. Doctors may prescribe additional vitamins and supplements to help your preemie counteract their deficiencies.
Premature babies may have a harder time than most growing and replacing red blood cells that carry oxygen through their bodies. An iron supplement helps prevent this anemia. That’s why it’s recommended that most exclusively breastfed babies are prescribed a small daily iron supplement. Follow the directions closely and only use the dropper that comes with the vitamins to avoid giving your baby too much. Preemies also need extra calories, vitamin D, and protein for healthy weight gain and brain development. That’s why they need to eat more often and get regular check-ups and developmental screenings. It’s recommended that breastfeeding moms talk to their doctor about how to supplement their own diets and increase the amount of vitamin D in their breast milk. Be sure to ask your baby’s pediatrician about the best way for you and your baby to get enough calcium, phosphorus, and vitamin D for healthy bones.
- Preterm Infants Need Vitamin D and Calcium Supplements – AAP
- Practice Guidelines: AAP Reports on Diagnosis and Prevention of Iron Deficiency Anemia
- Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial – Pediatrics
- FDA Letter to Industry Concerning Liquid Vitamin D Dietary Supplements
- Osteopenia – premature infants – A.D.A.M
- Growth and Body Composition of Human Milk–fed Premature Infants Provided With Extra Energy and Nutrients Early After Hospital Discharge: 1-year Follow-up
My baby seems to want more milk than I can produce. How do I know if she’s getting enough?
Figuring out how much milk your baby needs can be a challenge. If your baby was in the NICU, all of their meals were probably measured and every gram of weight they put on was carefully recorded. When you and your baby go home, things change.
While you may still be keeping a log of your baby’s feeding habits, you don’t have the same reassurance and immediate feedback you got in the NICU. Bottle feedings are easier to measure, but you may wonder, “Does my baby falling asleep at the breast mean they have a full tummy? Or that they were just too tired to finish eating?”
The best answer is this: If your baby is six months or less…
- eating 8 times a day or more
- making at least 6 wet diapers and 3 poopy diapers a day
- growing and gaining weight
…your baby is getting enough!
For an easy way to track your baby’s feedings, diapers, and growth, consider downloading a breastfeeding app.
Does birthing a preemie or needing to pump before establishing nursing affect my ability to produce milk?
Not necessarily. The good news is that no matter how long your pregnancy was, your body had already begun preparing to make milk. While some premature babies will be ready to breastfeed soon after birth (especially if they’re older than 34 weeks gestation), many preemies aren’t ready to nurse right away. That’s ok.
These are the things you can do to help build your breast milk supply for when your baby is ready to get all their nutrition from the breast:
- Pump Early and Often – If you can, start pumping within 6 hours of delivering your baby. Newer research suggests pumping within the first hour of birth is even more beneficial for breastfeeding success. Pump as often as a newborn baby would eat, at least 8 times a day and once at night. This signals your body that you are preparing to feed your baby.
- Ask for Support – Lactation Consultants (IBCLCs), Feeding Therapists (SLPs), peer breastfeeding counselors, friends, and family can all play a role in supporting your pumping and breastfeeding goals. These services are covered under most health insurance plans, including Medicaid. Click here for more information on finding lactation support near you.
- Find the Right Breast Pump – Take time to find the pump, settings, and flange size that works best for you. Most moms of preemies say that they have had the most success using a hospital-grade breast pump. If that’s what you need, ask your lactation consultant or your baby’s doctors to write a prescription to get this equipment. You have a right to proper breastfeeding support and to have your insurance cover it. Click here to search for a pump to rent or buy.
- Learn to Hand Express – Many moms are able to get more milk when they learn to hand express their milk from their breasts while pumping. Hand expression can also be combined with using the breast pump for better effect. Ask a lactation consultant to teach you how. Click here for more information on hand expression.
- Hold Your Baby Skin-to-Skin – Not only is skin-to-skin (also known as kangaroo care) relaxing and enjoyable for you and your baby, it increases your levels of oxytocin and prolactin, making it easier for you to make more milk.
- Practice Pre-Feeding Skills Together – Babies are born with wonderful feeding instincts. While you and your baby are skin-to-skin, let them smell your skin, find your nipples, and taste your breast milk. These are important steps in your feeding journey.
- Stick to a Schedule – Remember, the more often you pump, the better your milk supply will be. Breast milk production works on a supply-and-demand basis, and by emptying your breasts you are signaling to your body to make more breast milk. If you have to choose between how long you pump and how often you pump, pump less milk more often.
- Take Care of Yourself – You and your baby will need time, patience, and practice to figure out the feeding routine that works best for you. If you are going to take good care of your baby, you need to take good care of yourself. Eat well, rest often, and let people help you.
- Celebrate Your Successes –Don’t get too discouraged when things don’t go as planned. Every feeding is an opportunity to bond with and enjoy your baby. Any amount of breast milk you can provide your baby is a success worth celebrating!
- The Supporting Premature Infant Nutrition (SPIN) program
- Factors associated with feeding progression in extremely preterm infants
- From gavage to oral feedings: just a matter of time
- Oral Feeding and the Late Preterm Infant
Are there special rules for handling breast milk with a preemie baby?
Yes, breast milk storage and handling guidelines are slightly different for premature infants than for term babies. Because preemies are more at risk for infection, it’s important to handle and store their breast milk with extra care. If you have questions about storing milk for your baby, reach out to your baby’s healthcare provider. Here are some guidelines to follow on how to handle your breast milk and how long it can be stored:
- Freshly expressed milk can stay out at room temperature for up to 4 hours.
- Freshly expressed milk is good for up to 48 hours in the refrigerator.
- Previously frozen but completely thawed breast milk (or fortified breast milk) is good for 24 hours in the refrigerator.
- Breast milk can remain frozen for up to 3 months, or up to 12 months in a detached deep freezer.
- When traveling, breast milk can be kept in an insulated cooler, with ice packs, for up to 24 hours.
- Keep breast milk towards the back of your refrigerator or freezer
- Thaw milk overnight in the refrigerator or in a bowl of warm water
- Gently stir breast milk prior to feeding
- Dispose of unused milk after feeding
- Wash your hands and pump parts with gentle soap
- Keep breast milk in the door of the refrigerator or freezer
- Microwave breast milk – microwaves do not heat evenly, and it can create hot spots that can burn your baby’s mouth
- Shake breast milk
- Refreeze thawed breast milk
Why do some babies get jaundice?
Most breastfed babies will show some signs of jaundice. It is very common during the first two weeks of a baby’s life, and for longer if they were born preterm. In most cases, jaundice is a mild, temporary condition that can be easily managed. In very few cases, it can result in a more serious condition called kernicterus that carries risk of brain damage. So it is good to know what to watch for. Click here to learn more about jaundice in newborn babies.
You can recognize jaundice by the yellow color it gives your baby’s skin or the whites of their eyes. Jaundice happens when a protein called bilirubin builds up in baby’s blood. Bilirubin forms naturally as our body recycles red blood cells (the cells in our blood stream that carry oxygen). But, a newborn baby’s liver doesn’t filter bilirubin out of their blood stream as well as it will when they are older.
Your baby’s doctors will treat your baby with specific therapies for jaundice, which may involve repeated, brief exposures to a blue phototherapy light. Ask them for more details about the treatment and what is involved for your baby’s specific needs.
- NICU Health Problems – Jaundice
- Infant Jaundice
- Hyperbilirubinemia in the premature infant (less than 35 weeks gestation)
- Increased risk for kernicterus –
- Bilirubin Neurotoxicity in Preterm Infants: Risk and Prevention
What can I do to help my constipated preemie baby?
Constipation refers to the quality, not the quantity, of your baby’s poops. Babies can have several poopy diapers a day and yet still be constipated.
Generally, babies become constipated when their body removes too much water from their poop. This can result in dry, hard, bloody, black and difficult to pass poops. Preemies are more likely to get constipated than other babies because they have lower overall muscle tone and less mature digestive systems. Be sure to consult your baby’s doctor if you think he or she might be constipated.
Some helpful things you can do to treat constipation are:
- Keeping your baby hydrated by feeding them often.
- Giving them a warm bath.
- Doing gentle abdominal massage.
- Slowly circling their legs as if they were peddling a bicycle.
- Asking your baby’s doctor for suggestions. In some case, changes or additions to a baby’s diet can help relieve
Where and how can I donate breast milk for moms and babies in need?
Moms of preemie babies know firsthand just how important breast milk is for sick and fragile babies. Breast milk is more than nutrition; it is medicine. So it’s no surprise that many former NICU moms donate their extra breast milk. There are things you need to know to make an informed decision about donating or receiving breast milk:
- The Human Milk Banking Association of North American (HMBANA) is a professional association of non-profit milk banks that follow a strict code of ethics and rigorous guidelines for the collection and distribution of breast milk. Donated breast milk is dispensed based on healthcare provider order and medical need, not ability to pay. Hospitals are charged a small fee to cover the costs of recruiting and screening donors as well as processing milk so that it is safe for fragile and vulnerable babies. Click here to find a HMBANA location near you.
- For-profit milk banks collect breast milk through a private network of milk banks and websites. Then they sell it to hospitals or directly to consumers. Donors are screened and the breast milk that is collected is tested and processed to make it safe for fragile babies. Sometimes breast milk is used to make fortifiers or other products that sick and preterm infants need to grow and thrive. Other times milk is sold straight to consumers. Moms may be offered the option to be paid for their milk.
- Informal, casual milk sharing is not condoned by the medical community. There is no organized system in place to screen donors. The quality or safety of casually shared breast milk is not regulated and is not controlled.
- HMBANA Position Paper on Donor Milk Banking: The Value of Human Milk
- HMBANA Position Paper on For Profit Milk Banking- Donor Human Milk: Ensuring Safety and Ethical Allocation
- LLLI policy regarding the donation of human milk
Will feeding my preemie with a bottle at first make it harder to transition to breast later?
Not necessarily! In fact, the skills babies learn while using a pacifier or bottle nipple can actually support breastfeeding success.
The truth is that babies are very adaptable, and bottle feeding and breastfeeding are not mutually exclusive – most moms use a combination of the two. Every baby is different, but whether they are feeding at the breast, from a bottle, or using a pacifier, they are:
- Practicing feeding and pre-feeding skills.
- Building their endurance so that they can finish their feedings more quickly and burn fewer calories while they’re eating.
- Finding comfort and learning ways to soothe themselves.
- Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants
- Bottlefeeding the Breastfed Infant in the Neonatal Intensive Care Unit
Are preemies more prone to latching problems? How can I help?
Preemie feeding problems can stem from a medical condition or persistent developmental issue, or be a learned behavior left over from the NICU. Babies who have been intubated or who have required supplemental tube feedings in the NICU may have difficulty latching. Most NICU clinicians will help your baby start the breastfeeding process long before 34 weeks, or have them “practice” on mom in order to help them develop the skills they will need for successful breastfeeding later.
You can help your baby develop proper latching techniques with:
- Non-nutritive sucking – putting baby to breast for practice and valuable bonding
- Nipple shields – thin, silicone shields that help the baby latch and also help slow the flow of milk for very small infants
- Pacifiers – Another type of non-nutritive sucking, pacifiers are greatly encouraged in the NICU to help NICU babies with oral development and stamina
- Hand to Hold – NICU to Home: A Perspective on Feeding Difficulties
- Hand to Hold – What Does a Lactation Consultant Do?
- Latching The Baby Onto The Breast from Medela
- Breastfeeding Your Premature Baby Using a Nipple Shield from Medela
About Hand to Hold: Hand to Hold is a community-based, national support program for parents of preemies, babies born with a special health care need and those who have experienced loss due to these or other complications. The nonprofit organization’s vision is to enable a network of families to offer support, comfort and understanding to one another, and to provide them with knowledge, information and resources to ensure the best outcome for their children and family. For more information, visit Hand to Hold’s website or follow them on Facebook.
Useful resources for parents of preemies:
- Preemie Babies 101 Blog
- Life After NICU Facebook community
- Supporting Premature Infant Nutrition (SPIN) from UC San Diego
- A Parent’s Guide to the NICU – Moving Toward Breastfeeding from Rockford Health System
Are you a parent of a preemie baby? Share your experience with providing breast milk to your preemie in a comment below.