Even for a full-term baby, it takes work learning how to eat – the suck-swallow-breathe action can be complex. It’s even more challenging for a baby born early.

“Feedings can be even more difficult for preemies since they do not suck well, if at all, and have underdeveloped intestines and lungs,” said Jill Martin, BSN, RN, Geisinger Lactation Consultant.

Although preemies need a little extra time and care with feeding than full-term babies, with practice, patience and determination, you can feed your preemie and ensure he or she gets vital nutrients they need.

The first thing you need to know is that, as the mother of a preemie, your breast milk is a bit different than milk for a term baby.

“When a baby is born early, your body produces milk that has a higher amount of protein, iron, fat and other important nutrients than it would if your baby was born full-term,” Martin said.

Additionally, breastmilk has shown to enhance baby’s brain development, is easier to digest, and contains antibodies and other substances from the mother’s body to help a newborn build his or her immune system – this is an especially important aspect of breast milk for preemies since they’re more susceptible to infections.

“Preemies are uniquely at risk of a severe intestinal infection called necrotizing enterocolitis, in addition to ear infections, urinary tract infections and lower respiratory infections like pneumonia or croup,” Martin said.

How you feed your baby and whether they’re ready for breastmilk all depends on how prematurely your baby was born.

“Babies typically aren’t able to coordinate sucking and swallowing before 34 weeks of gestation,” Martin said. “If your baby is born before 28 weeks or is very ill, he will likely receive nutrients through an IV.”

Feeding through an IV bypasses the need for the suck-swallow-breathe action and allows nutrients to go straight into the baby’s bloodstream, skipping their underdeveloped digestive system. The IV may initially contain water, glucose and electrolytes. Eventually, a blend of fat, protein, sugar, vitamins, minerals and fluids will be introduced into their feedings.

“If your preemie is feeding through an IV, he or she won’t be able to receive feedings by mouth yet,” Martin said. “However, if your plan is to breastfeed, you’ll need to start pumping and storing your breastmilk as soon as possible so you are ready when he or she is.”

Pumping and storing your breastmilk allows you to build up your milk supply so your body produces all your baby needs when he or she is ready to breastfeed. You should begin expressing milk as soon after delivery as possible and pump every 2-3 hours. You can refrigerate or freeze your milk in special storage containers.

"Despite not being able to directly breastfeed in the beginning, our NICU staff encourages mother to bond with her baby through skin-to-skin cuddling, which is also known as kangaroo care," Martin said. “Kangaroo care can help premature babies: regulate their heart rate, breathing and temperature, improve growth and weight gain, experience less pain, less crying, better sleep patterns and a shorter hospital stay."

If your preemie is born between 28 and 34 weeks of gestation and doesn’t need IV feedings or has graduated to tolerate milk feedings, they may have gavage or tube feedings.

“During tube feedings, a thin, flexible tube is inserted into your baby’s mouth or nose and down into their stomach,” Martin explained. “They will receive the milk you have been storing, at times your milk may be fortified to give your little one extra calories or fats preemies need. Preemies usually get fed through the tube every couple of hours.”

Unlike IV feedings, you can get involved in tube feedings. Your baby’s nurse or doctor will encourage you to do skin-to-skin cuddling during these feedings.

It’s a huge milestone when your preemie is ready for oral feedings. Some preemies are ready at 30 to 32 weeks, while others may not be ready until 36 weeks – it can vary from baby to baby, watch for signs that your baby appears eager to feed.

“When your baby is ready for oral feedings, try offering the breast first,” Martin said. Studies show that babies with a low birthweight tend to take the breast more easily than a bottle.

At first, oral feedings can be tiring for your preemie and you may only be able to breastfeed him one or two times a day with tube feedings in between.

“The more you practice breastfeeding with your preemie, the more improved his ability to feed will become,” Martin said.