Formula feeds for preterm babies

A Guide to Premature Baby Feeding and Preemie Nutrition

A Guide to Premature Baby Feeding and Preemie Nutrition

When it comes to premature baby feeding, you may have questions. Whether you're breastfeeding or formula feeding, learn more about preemie baby nutrition and your baby's feeding schedule.

Premature baby feeding

• Premature babies need to eat at least every three hours. Tiny babies have tiny tummies. This means they’ll have to eat a lot of small meals for them to gain weight.
• Your baby will eat at their own pace. While they may be eating every three hours, the premature baby feeding process is often slow. You'll soon recognize their pattern of swallowing and breathing. Babies who eat slowly seem to take more milk at each feeding and may be satisfied and sleep longer between feedings.
• Their mouths are often extra-sensitive. If your baby has spent their first few days with tubes and respirators in their mouth, they may assume that anything that goes into their mouth is painful, which could include a breast or a bottle.
• Premature babies are slow to feed. Feeding them too fast by mouth may result in a feeding aversion or spitting up. They are also likely to have more digestive issues than a full-term baby, since their digestive system may not be as mature as a full-term baby's.

Try these premature baby feeding tips

• Each baby is unique. Follow the advice of your baby's doctor.
• Introduce your baby to a nipple. Even if they are still feeding by tube, this will help them adjust to bottle-feeding when they’re ready. You may need to try different nipples at first.
• Stick to breast milk or one type of formula and nipple to help them adjust.
• Keep a record of your baby's feedings.
• Get growth charts, specially designed for premature babies, from your baby's doctor to help monitor their progress.
• Keep your baby on a fairly regular schedule of awake and nap time, to help them eat better.
• Make sure your baby is fully awake before feeding.
• Don't force your baby to eat. If they’re not sucking as fast, sealing their lips or turning away, they may be full.
• Feed them on demand, not a schedule. Studies have shown that premature babies grew at a faster pace when fed on demand.
• When your baby is developmentally ready, slowly introduce solid foods while they are still on formula.
• Enlist the help and support of family and friends, to give yourself a break.

Preemie Nutrition

Most premature babies have low birth weight.

If a baby is too premature to breastfeed, moms are encouraged to pump their milk, as breast milk is considered to be best for the baby. Sometimes, doctors will recommend using a breast milk fortifier, to help give your baby the extra protein, vitamins, calcium and other nutrients they need at this early stage.

If you can't pump or breastfeed, or choose not to, ask your baby’s doctor about the specially designed formulas available for premature or low birth weight babies.

Premature babies may have more digestive issues than full-term babies.

Chances are, your baby’s feeding skills haven't fully developed yet. This means they’ll likely be slow to feed, or they may feed too fast and spit up or develop a feeding aversion. But there are some things you can try to help:

• Introduce your baby to a pacifier. This can help get them used to the feeling of bottle-feeding for when they’re ready to switch over from the tube.
• Record their feedings, so you can keep track of spit ups and how much they’re keeping down.
• Monitor your preemie’s progress with growth charts from the doctor.
• Try to keep them on a sleep schedule.
• Make sure they are fully awake before feeding
• Be aware of indicators, so you know when your little one is full or tired.
• Slowly introduce solids when they are developmentally ready.

Babies who are born premature often undergo developmental testing and programs.

If your baby weighs less than 3.5 lbs. at birth, they will most likely be referred for formal developmental testing around their 1st and 2nd birthdays. If your baby is born prematurely, your doctor may recommend an infant stimulation program. This usually involves working with a physical therapist or specialized healthcare professional to learn gentle exercises, positioning and other ways to interact with your premature baby and help them with physical development. Early intervention programs can help with social and functional skills and provide support for the family.

Preterm babies have a harder time maintaining the proper water balance in their bodies. These babies can become dehydrated or over-hydrated. This is especially true for very premature infants. Keep the following preemie nutrition facts in mind as you navigate feeding your baby:

• Premature babies may experience more water loss through the skin or respiratory tract than babies born at full term.
• The kidneys in premature babies have not grown enough to control water levels in the body.
• The NICU team keeps track of how much premature babies urinate (by weighing their diapers) to make sure that their fluid intake and urine output are balanced.
• Human milk from the baby's own mother is the best for babies born early and at very low birth weight.
• Human milk can help babies avoid infections and sudden infant death syndrome (SIDS) as well as necrotizing enterocolitis (NEC).
• Many NICUs will give donor milk from a milk bank to high-risk babies who are not able to get adequate amounts of milk from their own mother.
• Special preemie formulas can also be used. These formulas have more added calcium and protein to meet the special growth needs of premature babies.
• Older premature babies (34 to 36 weeks gestation) may be switched to regular formula or a transitional formula.
• Babies who are given breast milk may need a supplement called human milk fortifier mixed into their feedings. This gives them extra protein, calories, iron, calcium, and vitamins. Babies fed formula may need to take supplements of certain nutrients, such as vitamins A, C, and D, and folic acid.
• Some infants will need to continue taking nutritional supplements after they leave the hospital. For breastfeeding infants, this may mean a bottle or two of fortified breast milk per day as well as iron and vitamin D supplements. Some babies will need more supplementation than others. This may include babies who are not able to consume adequate amounts of milk through breastfeeding to get the calories they need to grow well.
• After each feeding, babies should seem satisfied. They should have 8 to 10 feedings and at least 6 to 8 wet diapers each day. Watery or bloody stools or regular vomiting could indicate an issue and you should discuss them with your doctor.

Preemie Weight Gain

Weight gain is monitored closely for all babies. Research suggests developmental delays could be associated with premature babies who experience slow growth.

• In the NICU, babies are weighed every day.
• It is normal for babies to lose weight in the first few days of life. Most of this loss is water weight.
• Most premature infants should start gaining weight within a few days of birth.
• The desired weight gain depends on the baby's size and gestational age. Sicker babies may need to be given more calories to grow at the desired rate.
• It might be as little as 5 grams a day for a tiny baby at 24 weeks, or 20 to 30 grams a day for a larger baby at 33 or more weeks.
• In general, a baby should gain about a quarter of an ounce each day for every pound (about 1/2 kilogram) they weigh. (This is equal to 15 grams per kilogram per day. It is the average rate at which a fetus grows during the third trimester).

If you are experiencing difficulty affording specialty premature formulas for your baby, financial assistance is available.

Enfamil has developed a program called Helping Hand for Special Kids, to help families who need specialty formulas for their premature baby but have difficulty affording them. Depending on your needs, the Helping Hand program provides either long-term assistance or a free, one-time shipment of products. To us, all babies deserve the very best start in life. Ask your doctor if you qualify for this program.

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How to Feed Preemie Babies

Feeding Your Premature Baby

Whether you choose to breastfeed or formula feed, meal time is an important opportunity for bonding with your baby. Here are a few tips to help you both have a successful experience.

If you choose to formula feed, ask your baby's doctor which formula is appropriate for your baby.

If you choose to breastfeed, ask your baby's doctor if supplements and vitamins are appropriate for your baby.

In This Article

About Formula | Preparing Bottles | Feeding Your Baby | How to Tell if Your Baby's Getting Enough to Eat | What You Can Learn From Her Diaper

About Formula

Ready-to-use and Concentrated Liquid infant formulas are commercially sterile in the sealed container.

Powdered infant formulas are not sterile and should not be fed to premature infants or infants who might have immune problems, unless directed and supervised by your baby's doctor.

Remember that improper hygiene, preparation, dilution, use or storage may result in severe harm.

Ask your baby's doctor which formula is appropriate for your baby.

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Preparing Bottles

• Wash everything—bottles, nipples, and caps—in hot, soapy water before using.
• Check with your baby's doctor about the need to use cooled, boiled water for mixing and the need to boil clean utensils, bottles, and nipples in water before use.
• To prepare your baby's formula, make sure you follow the label directions.
• Once prepared, infant formula can spoil quickly.
  • After opening, containers of liquid formula need to be fed immediately or covered and refrigerated and used within 48 hours.
  • Formula prepared from powder needs to be fed immediately or covered and refrigerated and used within 24 hours (check product label for specific guidelines).
• Most babies don't seem to mind whether their bottle is warmed or straight out of the refrigerator. Some may prefer a consistent temperature from one feeding to the next.
• If you want to warm a bottle that has been in the refrigerator, run warm tap water over the bottle or place the bottle in a pan of hot (not boiling) water. Take care that the cap and nipple do not get wet.
• Shake the bottle occasionally while warming. The warming time should be less than 15 minutes.
• Test the formula temperature before feeding; it should not feel warm or cold when dropped on your hand—neutral is close to body temperature (about 100°F). Warmed formula should be discarded within one hour.
• Discard formula remaining in the bottle within one hour after feeding begins.

WARNING: Never warm formula in a microwave. Serious burns can result.

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Feeding Your Baby

Whether you're breastfeeding or bottle-feeding your baby, use these guidelines as you learn more about your baby's feeding schedule:

• Support your baby's head during feedings, keeping it higher than her stomach. This aids in digestion and helps avoid ear infections.
• Your baby will eat at her own pace. You'll soon recognize her pattern of swallowing and breathing. Babies who eat slowly seem to take more milk at each feeding and may be satisfied and sleep longer between feedings.
• If your baby ever seems to have trouble catching her breath while eating, or is coughing, choking, or sputtering, sit her up until she seems ready to eat again.
• Keep feedings relaxed, with as few interruptions as possible.
• Keep your baby from swallowing air by keeping the bottle nipple full of formula. She shouldn't suck on an empty bottle or drain the bottle.
• When your baby is finished eating, the nipple will fall out of her mouth and her whole body will become relaxed. Your baby will probably need about 20 to 30 minutes to finish her bottle.
• If she seems finished after only 15 or 20 minutes, you may want to wake her and try to get her to eat for a little longer. If possible, you want her to feel full enough to be satisfied for another few hours.

Feeding Tips

• It's important to hold the bottle at a 45-degree angle so your baby can get the right suction.
• Your baby may need to eat on demand—or may feed well on a newborn schedule. A breastfed baby usually has 8 to 12 feedings in 24 hours, while a bottle-fed baby may have 8 to 10 feedings during that time. Whatever feeding method you choose, your baby will need small, frequent feedings around the clock.
• You may need to wake your baby every three hours or so if she's sleeping through a feeding. Wake your baby gently by removing her blanket or stroking her arms and legs. Don't rush her or she may be too upset to eat.
• Once she's wide awake, hold her, and touch your nipple, or the bottle nipple, to her cheek or lip. She'll be encouraged to open her mouth and turn toward it to eat.
• If your baby takes less than 15 minutes to eat, you may want to use a nipple with a smaller hole. If she takes longer than normal and doesn't seem to be sucking actively, make sure the nipple hole isn't clogged.

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How To Tell If Your Baby's Getting Enough To Eat

• The best way to tell if your baby's getting enough to eat is to check her growth. She should be gaining about an ounce a day during the first few weeks home from the hospital.
• During the first few months, her doctor will carefully watch her weight gain to make sure it's increasing steadily. Also, if your baby has six or more wet diapers a day and seems happy between feedings, she's probably getting plenty to eat.
• Your baby may give you signs when she's had enough to eat. She may fall asleep or close her mouth and turn away from her bottle. She may also bite or play with the bottle nipple, or even fuss if you keep trying to feed her. Follow your baby's lead.

If you're worried that your baby isn't eating like she should, talk with the pediatrician. If you notice any of these signs, take your baby to the doctor:

• Constant or inconsolable crying
• You cannot wake your baby
• Consistent feeding refusals
• Persistent coughing, choking, or breathing problems
• Noticeably fewer wet or soiled diapers

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What You Can Learn From Her Diaper

Breastfed babies usually have softer, yellow stools. Formula-fed babies usually have yellow, brown, or green stools. Occasional changes in the color and consistency of stools are normal.

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