Feeding Your Premature Baby: A Complete Guide

Feeding a baby born prematurely (before 37 weeks) can feel overwhelming at first. You may be wondering whether your baby is getting enough milk, how they'll learn to feed, or what to expect in the days and weeks ahead.

Because your baby has arrived early, many of their organs and feeding skills are still developing,¹ so feeding may look a little different to that of a full-term baby. 

The good news is that you won't be on this journey alone. Your neonatal team, infant feeding specialists, health visitor and GP are there to support you, and every feeding plan is tailored to your baby's individual needs.⁵

This guide explains why feeding is so important for premature babies, the different feeding methods you may come across, and how feeding is likely to change as your baby grows stronger. 

Feeding is about much more than helping your baby feel full. For babies born prematurely, good nutrition plays an important role in supporting their growth, protecting against infection and helping their brain, bones and other organs continue to develop after birth^{1, 10}.

During the final weeks of pregnancy, babies receive a large amount of nutrients from the placenta. When a baby is born early, they miss part of this important time of growth, so feeding helps provide the extra energy and nutrients they need to continue developing outside the womb¹.

Premature babies have different and higher nutritional needs from babies born at full term because they're growing quickly while many of their organs are still developing. They often need:

• More energy (calories) to support rapid growth, breathing and keeping warm¹
• More protein to help build muscles, organs and other body tissues¹
• Extra calcium and phosphorus to support healthy bone development, as much of this normally happens during the final weeks of pregnancy¹
• Iron and vitamin D, which are important for healthy blood, bone development and growth¹
• Healthy fats such as DHA, which help support brain and eye development¹

Good nutrition supports almost every part of your baby's development. It helps them:

• Gain weight and grow steadily¹
• Support brain and nervous system development during this important stage of life¹
• Build strong bones and muscles¹
• Develop a healthy digestive system¹
• Strengthen their immune system to help protect against infection¹

Although feeding is an important part of helping your baby grow, it's also a special opportunity to bond with your baby. Whether you're expressing milk, bottle feeding, tube feeding or breastfeeding, these quiet moments of closeness, touch and eye contact all help your baby feel safe and secure^{4, 5, 8, 11}

Where possible, breast milk is the recommended first choice for feeding babies born prematurely because it provides important nutrients and protective factors to support growth and development^{1, 2, 6, 11}. If your baby isn't ready to feed at the breast straight away, they can still receive the benefits of your milk through a feeding tube, cup or bottle while they develop their feeding skills.^{2, 6, 11}. Every breastfeeding journey is different, and your neonatal team or infant feeding specialist will support you every step of the way^{4, 5}.

Breast milk can:

• Be gentle on your baby's immature digestive system^{1, 2}
• Provide antibodies and protective factors that help reduce the risk of     infection^{2, 4, 6}
• Support gut health and help protect against serious bowel conditions, such as necrotising enterocolitis (NEC)¹
• Provide healthy fats, including DHA, to support brain and eye development¹
• Change naturally over time to meet your baby's changing nutritional needs²

If your baby is in neonatal care, expressing helps protect your milk supply until your baby can feed orally:

• Start early if you can: ask the team to help you begin expressing as soon as possible after birth¹¹
• Express often: aim for about 8–10 times in 24 hours (including at night) if advised¹¹
• Use the right pump: hospital-grade pumps can help in the early days¹¹
• Skin-to-skin helps holding your baby skin-to-skin (kangaroo care) can support milk production¹¹
• Label and store safely: follow your unit’s rules for dates, times, and storage¹¹

Looking after yourself is important too. Try to eat a balanced diet, make sure you stay hydrated and rest whenever you can. Expressing while your baby is in neonatal care can feel physically and emotionally demanding, so don't be afraid to ask your family or healthcare team for support.³

Most babies can start trying around 32 –24 weeks. This usually happens step by step. Your baby might begin with:

• Non-nutritive sucking (sucking at the breast or finger sucking after a tube feed) to practise
• Short breastfeeds once your baby has developed sucking and feeding techniques. 
• Top-up feeds (expressed milk or formula) if needed while your baby builds strength
• Signs your baby may be ready include being more awake for feeds, rooting (turning towards the nipple), and staying steady with breathing during feeding. A neonatal nurse or infant feeding specialist can guide you²

When you move onto breastfeeding your baby this may be a little difficult at first as preterm babies may⁷:

• Have a weak suck or find it hard to coordinate sucking, swallowing, and breathing⁷
• Fall asleep quickly during feeds – fatigue⁷
• Need extra time to learn how to latch⁷

These challenges are common. They do not mean you are doing anything wrong and can take a little time for both you and your baby to get used to. Lactation consultants and feeding specialists can help to support^{2, 4, 7}.

Bottle feeding plays an important role for many premature babies. Some babies receive expressed breast milk by bottle, while others receive infant formula or a combination of both. For many families, bottle feeding can be an important step as babies develop the feeding skills needed to grow and thrive. Premature babies often need extra time to learn how to coordinate sucking, swallowing and breathing, so feeding may look a little different compared with full-term babies.^{5, 8, 10}.

Your baby's neonatal team may recommend a particular bottle or teat based on your baby's gestational age, feeding skills and individual needs.

When choosing a bottle for a premature baby:

• Ask your neonatal team which bottle and teat they recommend.
• Consider a slow-flow teat if advised, as this can help your baby manage the flow of milk more comfortably.
• Choose a teat that allows your baby to feed steadily without becoming overwhelmed by a fast flow of milk.
• If your baby has feeding difficulties, reflux or ongoing medical needs, a feeding specialist may recommend specialised feeding equipment.^{5, 8, 10}

Bottle feeding may be used in a variety of situations, including:

• When a mother expresses breast milk and feeds it to her baby by bottle.
• When partners and other caregivers help with feeding, allowing them to take an active role in caring for and bonding with the baby.
• When healthcare professionals need to monitor how much milk a baby is taking.
• When a baby is receiving a specialised formula designed for premature infants.
• When a baby receives a combination of breast milk and formula.
• While a baby is learning the skills needed for direct breastfeeding.^{5, 8, 10}

Many premature babies benefit from paced bottle feeding. This technique slows the flow of milk, giving your baby time to coordinate sucking, swallowing and breathing while reducing the risk of becoming tired or overwhelmed during feeds.

To use paced bottle feeding:

• Hold your baby in a semi-upright position with good head and neck support.
• Gently tickle the teat on your baby's top lip and wait for them to open their mouth wide.
• Hold the bottle fairly horizontal so the milk flows more slowly.
• Allow your baby to suck for a few moments, then lower the bottle slightly to give them a short pause to breathe.
• Watch your baby's feeding cues and take extra breaks if they become sleepy, cough, splutter or show signs of stress.
• Always sterilise bottles and teats according to current guidance.^{5, 8, 10}

Babies born prematurely have much higher nutritional needs than babies born at full term. While breast milk is the recommended first choice where possible, some babies need extra nutrients to support their rapid growth and development¹.

Preterm formula is specially designed for babies born early. Compared with standard infant formula, it contains higher levels of energy, protein, vitamins and minerals to help support growth and development.

There are different types of preterm formula, including:

• Hospital preterm formula used while your baby is receiving neonatal care.
• Post-discharge formula, which may be recommended for some babies after they go home to help support catch-up growth.

Your neonatal team will decide if and when preterm formula is needed¹⁰.

A human milk fortifier is added to expressed breast milk to provide extra protein, energy, vitamins and minerals. This allows your baby to continue receiving the protective benefits of breast milk while helping meet the increased nutritional needs^{1, 10}.

Never change formula type or mix strength without guidance from your neonatal team, GP, or dietitian.

Every baby is different, and the type of feeding support they need will depend on their individual circumstances. Your baby's neonatal team, paediatrician, GP or dietitian will recommend the most appropriate feeding plan based on your baby's growth, medical needs and nutritional requirements.

Specialised formula may be recommended in a number of situations, including:

• When a mother is unable to produce enough breast milk, even after receiving breastfeeding support and guidance.
• When a baby has a specific medical condition that requires a specialised formula, such as cow's milk allergy, multiple food allergies, digestive conditions or certain metabolic disorders.
• When families choose formula feeding for personal, practical or medical reasons.
• When a combination of breast milk and formula feeding is used. Many families use mixed feeding, which can help ensure nutritional needs are met while providing greater flexibility.
• To reduce pressure on parents and support family wellbeing. Feeding a premature baby can be challenging, and a feeding plan should work for both the baby and family.
• When ongoing nutritional support is needed after discharge from hospital. Some premature babies continue on nutrient-enriched or post-discharge formulas at home to help support catch-up growth and meet their increased nutritional needs.

It is important to remember that feeding recommendations can change as your baby grows. Regular monitoring by your healthcare team helps ensure your baby is receiving the right nutrition at the right time. Always seek advice from your neonatal team, GP, paediatrician or dietitian before making any changes to your baby's feeding regimen¹⁰.

Every premature baby is different, so there isn't a single feeding schedule or amount that's right for every baby. How often your baby feeds will depend on their gestational age, weight, medical needs and how well they're growing¹.

Your baby's feeding schedule will be based on their individual needs and may change as they become stronger and grow.

While in the Neonatal Intensive Care Unit (NICU) or neonatal unit, feeds are carefully planned and monitored by the healthcare team. Some babies may initially receive nutrition through a feeding tube if they are not yet strong enough to feed by breast or bottle. As your baby develops, they will gradually learn to coordinate sucking, swallowing and breathing, allowing them to take more feeds by mouth.

After going home, many premature babies continue to feed every 2 to 3 hours, including overnight. Some babies may still need frequent feeds to support growth and meet their higher nutritional requirements^{1, 7, 10}.

As your baby grows and their feeding skills develop, they will usually begin taking larger feeds less often. Your neonatal team, health visitor, GP or dietitian will monitor your baby's growth and advise if any changes to their feeding schedule or milk are needed.

Remember that every premature baby is different, and feeding patterns can vary. It is important to follow the guidance provided by your healthcare team and attend follow-up appointments to ensure your baby is growing and developing well.

Hunger cues in the early days can be a little difficult to notice, especially in preterm babies. Look for:

• Stirring, opening eyes, or making small noises
• Rooting (turning head side to side)
• Bringing hands to mouth
• Smacking lips or sucking movements

Crying is a late sign of hunger. If your baby is already upset, they may struggle to feed and tire quickly.

Monitoring your babies weight gain, wet and dirty nappies, and whether they seem settled after feeds can all help to understand if they are getting enough^{5, 7, 10}.

It's quite common for babies born prematurely to bring small amounts of milk back up after feeds. This is known as reflux and happens because the valve between the stomach and food pipe (oesophagus) is still developing. In many babies, reflux improves as they grow.

There are a few things that may help, including keeping your baby upright during and after feeds, offering smaller, more frequent feeds if advised, using paced bottle feeding and winding your baby regularly⁷.

When to seek advice

Speak to your healthcare professional if:

• Your baby seems uncomfortable or distressed during or after feeds.
• Your baby keeps vomiting during or after feeds.
• Your baby regularly coughs, chokes or splutters while feeding.
• Your baby is feeding poorly or refusing feeds.
• Your baby is not gaining weight as expected or is losing weight.
• Reflux symptoms are not improving or you are concerned about your baby's feeding⁷.

Seek urgent medical advice if your baby:

• Has green or yellow vomit.
• Has blood in their vomit or stool.
• Vomits forcefully (projectile vomiting).
• Has a swollen or tender tummy.
• Shows signs of dehydration¹².

Babies born prematurely are monitored closely to make sure they're growing well. If your baby's weight gain is slower than expected, your healthcare team may review how they're feeding, recommend fortified breast milk or a higher-calorie feeding plan, and arrange more frequent weight checks. Never change the amount of formula powder or the way you prepare feeds without advice from your neonatal team¹.

Feeding takes a lot of energy for a premature baby, so it's common for them to become sleepy or tired before they've finished a feed. Feeding when your baby is alert, taking gentle pauses for burping and keeping the environment calm can all help. If you're concerned that your baby is becoming tired at every feed, speak to your healthcare team, who can review their feeding plan^{6, 7}.

Some babies move easily between the breast and bottle, while others need a little more time to adjust, as feeding skills continue to mature over time.

If you are finding feeding challenging, or if your baby is struggling to feed effectively, speak to your neonatal team, health visitor, or lactation consultant. They can provide practical advice and support tailored to your baby's individual needs⁷.

Bringing your baby home is an exciting milestone, but it's completely normal to feel a little nervous about feeding without your neonatal team nearby.

Before you leave hospital, your neonatal team will make sure you feel confident with your baby's feeding plan. This may include guidance on:

• How much and how often your baby should feed.
• Recognising your baby's hunger and fullness cues.
• Breastfeeding, expressing and/or bottle-feeding techniques.
• Preparing, storing and handling breast milk or formula safely.
• Using any prescribed fortifiers, supplements or specialised formulas.
• Monitoring your baby's growth and knowing what to expect.
• Who to contact if you have any feeding concerns once you are home.

You may also be given details of follow-up appointments with your neonatal team, paediatrician, GP, public health nurse or dietitian. These appointments help ensure your baby is growing well and receiving the nutrition they need¹³.

Remember that it can take time to adjust to feeding at home. Every premature baby is different, and it is normal for feeding routines to continue evolving as your baby grows and develops. If you have any concerns about feeding, growth or milk intake, contact your healthcare team for advice^{5, 10, 13}.

Once you're home, it can take a little time to settle into a routine. In the first few weeks, some parents find it helpful to keep a simple record of feeds and wet nappies, particularly while they're getting to know their baby's feeding patterns.

Trust your instincts. If you're worried about your baby's feeding or feel something isn't quite right, it's always worth asking for advice.

Some things to look out for include if your baby:

• Has fewer wet nappies than expected.
• Is difficult to wake for feeds.
• Is not gaining weight as expected.
• Coughs, chokes or struggles to breathe during feeds.^{7, 10,13}