Formula Feed a Premature Baby

Premature babies require special care. You must be extra careful with how you feed your baby. Physicians will determine whether your baby needs tube feeding and when your baby can switch to oral feeding. Once your child can feed normally, breastfeeding and formula feeding are both options.

Steps

Caring For Your Baby in Hospital

1. Bond with your baby. When your baby is being fed with tubes, you might find it difficult to connect with her. Talk to your nurses about doing kangaroo care, which helps you bond with your baby. With this technique, you hold your unclothed baby (wearing a diaper) against your naked chest. One option is to wear a baggy button down shirt. You then button the shirt up to the child’s upper back so that the baby is inside your shirt and the heat is locked in. Alternatively, you can place a blanket on your baby's back so that the heat is trapped.
   • Fathers and mothers should both do kangaroo care.
   • Kangaroo care can stabilize your baby’s heart rate, breathing, and oxygen saturation levels. The care also works to reduce crying and help your baby gain weight.
2. Choose whether to express your milk. Premature babies often have difficulty sucking, swallowing, and breathing correctly. This makes breastfeeding and bottle feeding complicated. You can, however, choose to pump your milk and have the doctors feed it to your baby via tubes.
   • If you choose not to breastfeed, the hospital might, with your permission, use a donor’s milk. There also are formulas available that are designed for premature babies. They have extra fat and protein to help preemies grow. There are also supplements that can be added to pumped breastmilk called human milk fortifier. Most babies born at 34 – 36 weeks gestation can use regular formula or a transitional formula.
3. Learn how to do tube feedings. Some babies need to be fed through IVs. Others have a tube placed in their mouth or nose that goes to their stomachs. For the latter, some hospitals will allow you to participate in this process.
   • The nurses will show you how to put the tube inside the baby and make sure the position is correct. They will instruct how to get your child to suck, which can benefit later breastfeeding or bottle feeding. They also will help you learn how to handle vomit.
   • Babies born at 34 weeks or later gestation often can breastfeed or drink from a bottle. Oftentimes, breastfeeding is easier than bottle feeding for premature babies. Preemies can have difficulty stopping the milk flow from a bottle, which can lead to choking or breathing problems.
4. Bottle feed your baby. While your baby is still receiving tube feedings, doctors will encourage you to try bottle feedings when your baby is ready. You will start once a day and gradually increase the number of bottle feedings. Your baby needs to learn how to feed and breathe simultaneously. To bottle feed your baby, do the following:
   • Hold the baby in your arms. Cradle him in the crook of your right or left arm so that you are supporting his head. He should almost be sitting, not laying down. You do not want him to choke.
   • Position his head so it is leaning forwards and in front of his body. It should not be twisted to the side.
   • Keep his arms and hands forward and near the bottle.
   • Place the bottle in his mouth. Try to help him suck the nipple. Do not force the bottle down his throat and never leave him propped up with the bottle alone.
   • Pull the bottle out after every few sucks. This will reduce the chance of your baby becoming too tired. If his lips turn blue and his heart rate is too low, he is over-exerting himself.
   • Do not rush your baby. Preemies need more time to feed as they are learning a new process at a younger than normal age.

Planning to Feed Your Baby at Home

1. Ask your doctor when your baby can switch to formula. While in the hospital, many babies receive either your or a donor’s breastmilk or formula via tubes. Upon discharge, the doctor might prescribe a special formula called “post-discharge milk.” This formula has more nutrients than ordinary, store-bought formula. Your baby should use this formula until your doctor directs otherwise.
   • Larger premature babies often can use normal baby formula that is iron fortified. Your baby should use this formula until she is at least four to six months old.
   • Normal formulas are available for purchase at grocery stores, drugstores, and superstores like Target.
   • Do not change your formula without consulting your physician.
2. Ask the doctor about how much to feed your baby. Generally, newborns should receive 2.5 oz. (75 ml) of formula per pound (450 g) of body weight each day. Premature babies can have different needs, though. Thus, it is best to have open dialogue with your medical team about feeding amounts. Oftentimes, premature babies drink 2 – 3 oz (60-90 mL) of formula per feeding once home.
3. Create a feeding schedule. Speak with your doctor about how often you should feed your baby once home. If your baby is receiving bottles, how many should he have per day? Many premature babies feed every three to four hours once they are home. They also feed upon wakening.
4. Determine whether your baby needs supplements. Preemies who receive formula in the hospital often receive vitamins A, C, and D plus folic acid supplements. When feeding your formula to your baby at home, she likely will need to continue supplements. You can also add the supplements to the formula itself.
   • Speak with your doctor about your baby’s nutritional needs. Do not implement changes without her approval.
   • Your doctor might recommend fortifiers. These give formula or breastmilk added minerals, vitamins, and protein. They help your baby’s bone growth.
   • Babies taking breastmilk are often prescribed iron supplements also.
   • Your doctor also might recommend probiotics to prevent gut infections in your preemie. These nutritional supplements consist of yeast and bacteria.

Feeding Your Baby Formula

1. Learn how to prepare formulas. There are many different types of formulas. Which type you choose depends largely on what your doctor recommends. Some come in a ready-to-go liquid form. Others are powders that you must mix with water. Still others are concentrated liquids that you must add water to. In every case, follow the instructions on the packaging. Once you have prepared a formula, you should refrigerate it until use and use it within 24 hours.
   • It is advisable to make a day’s batch all at one time. This will reduce the time you need to spend mixing the formula.
   • Wash your hands and any utensils or bottles you use thoroughly. Let bottles dry in the air.
   • Keep your formula cool before use but heat it up prior to use. To do so, place it in a container with warm water for five minutes.
   • Avoid heating formula in the microwave.
2. Sit in a quiet location. To coax your premature baby to eat, sit in a calm, quiet, and peaceful environment. Avoid harsh sunlight or artificial lighting. Choose a cushioned, supportive chair in which you too will feel comfortable.
3. Feed your baby. Using the instructions you learned at hospital, hold your baby in his correct position and attempt to feed. Help your baby want to feed by giving your child oral stimulation. To do so, use your finger to gently touch your baby’s cheeks, mouth, tongue, and gums. Complete this action before and after you feed. After this process, put the bottle in your baby’s mouth.
   • Remember that just like in the hospital, feeding can take a longer time with a premature baby. Consider watching a movie (nothing with too loud of sounds) or reading a book.
4. Burp your baby. Halfway through the feeding, place the baby upright and over your shoulder. Gently pat her back for one to three minutes. Continue feeding after she has burped. Then at the end of the feeding, burp her again.
5. Watch for signs of poor feeding. Premature babies’ digestive systems are particularly sensitive. If your baby’s stool forms and patterns change for more than two or three days, call your doctor. Your child might need a different formula or you might need to feed more or less often. He also could be developmentally unable to bottle feed regularly.
   • Signs of discomfort include hiccups, coughing, gagging, excessive spit up, crying, biting, head turning, turning blue, and fanning of the fingers. If your child exhibits these symptoms, stop feeding immediately. Also, consult your doctor.
6. Clean your baby’s mouth. Even though she might not have teeth, you want to protect her gums. After feeding, wipe her gums with a clean, moistened cloth. You also can purchase an infant toothbrush and use it with warm (not hot or too cold) water.

Related Articles

• Observe Premature Infant Behavior
• Breast Feed a Premature Baby
• Bond With Your Premature Baby in the NICU
• Take Care of a 32 Week Premature Baby

Sources and Citations

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