The Unique Challenges of Breastfeeding a Preterm Baby

Trish ~ Labor Nurse Mama
April 29, 2019

Breastfeeding a preterm baby can play a huge role in a more positive outcome. If you are faced with preterm birth or in the middle of a NICU stay, then read why breastfeeding a preterm baby is optimal.

Breastmilk in itself is a perfect food which has incredible superpowers. 

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Why I am here and who I am:

Hey mama, I am Trish— AKA Labor Nurse Mama. I am a labor and delivery nurse with over 15 years of high-risk OB experience. I am also a mama to 7 kids and have given birth to 6. This means I am quite familiar with the postpartum period and how to navigate it. I am the online birth class educator for Calm Labor Confident Birth and The VBAC Lab birth classes and the mama expert inside our Calm Mama Society, a pregnancy & postpartum membership community! I am passionate about your birth and motherhood journey! You can find me over on IG teaching over 230k mamas daily. I am passionate about your birth and motherhood journey!

We make a small commission from some of the links (you don’t pay any more for using our links); however some of the recommendations, we do not earn anything; we love ’em and want you to know about them. Click here for our full disclosure. Thank you!

What is a preterm baby?

A preterm baby is a baby who is less than 36 weeks and six days of gestational age. Preterm is even further broken down into early preterm and late preterm.

Early preterm: less than 33 weeks six days. 

Late preterm: 34 weeks through 36 and six days. 

A late preterm infant can be confusing for the parents (and for us nurses). These little guys often are the same size as a term baby. But there are some hidden differences that parents sometimes are unaware of. Late preterm babies are less mature than term babies both physiologically and metabolically. Both of which can present in poor feeding behaviors. 

Preterm Baby Problems

Preterm baby's face a lot of hurdles and challenges. I've listed some below so you can see how this little fighter has to have every possible tool to fight.

Feeding issues



Weight loss (a lot)

Respiratory Distress


Necrotizing Enterocolitis

Not able to maintain body temp 


Slow to gain weight

Bonding Issues

Lung diseases

Preterm Baby Breastfeeding problems (for mom)

A massive problem with many preterm baby’s is that they are preterm because momma had some sort of issue during pregnancy. Whether it’s diabetes or preeclampsia doesn’t matter. Many of these underlying problems which cause the preterm birth may also cause breastfeeding issues. 

Here is the kicker…..Preterm babies need breastmilk more term babies need it (this doesn’t mean our term babies don’t need the booby milk!).  

We have talked many times how breast is best but check out these reasons a preterm baby needs breastmilk.

Improves Host Defenses

 Host defenses are the bodies way of blocking out the bad stuff. Think skin, mucous membranes, and secretions. Our preterm baby needs these defenses to be active as they are desperately trying to survive. 

Improves GI function

Not only does breastmilk improve the function of the go system but it also aids in developing the system. 

Helps with Digestion and absorption 

A preterm baby is going to struggle with weight issues. They may be slow to gain weight, or they may also lose weight. Either one is no bueno for a pre-termer. Breastfeeding a preterm baby improves digestion and absorption of nutrients. Both of which are vital to weight gain. 

Exclusively breastfed preterm babies may gain slower but according to this article, studies have shown that they will score higher on developmental tests later down the road.

Improves Neurodevelopmental wins

This is a no brainer. (insert wink emoji) If breastfeeding a preterm baby improves the neuro-developmental outcomes than I say DO IT! These babies are doing to fight for every milestone. Breastmilk gives them a boost in the right direction!

Offers protection from infection

Preterm infants are fighting to survive. Breastfeeding a preterm baby gives this baby a boost in the infection-fighting department. A small infection in a preterm baby can be life-threatening. Breastmilk is the perfect solution. 

Skin to Skin 

Another essential reason for breastfeeding a preterm baby is the skin to skin factor.

Skin to skin is vital whether or not you’re able to latch them onto your breast or feed breastmilk through a supplemental system. 

Guess what? Skin to skin contact when breastfeeding a preterm baby also means higher milk volume. Another win in your game plan!

Kangaroo Care is a term used (especially in the NICU) for a method of skin to skin contact for your baby. Basically what it means is to strip baby down to the diaper and hold the baby skin to skin between your breasts. If dad does it, it merely is baby to bare chest. It is crucial to cover the baby with a blanket as babies are not able to maintain body heat. Our labor gowns are fantastic for skin to skin, as you can simply slip the baby down the gown, yet keep baby covered and remain modestly covered yourself. 

Skin to Skin contact exposes the preterm baby to mom’s normal flora on her skin, prompting the baby’s immune system. 

If you read my post on the golden hour, then you would also know that skin to skin regulates baby’s oxygenation, heart rate, and temperature. All of these things are important in a term infant but even more vital in a preterm baby. 

Challenges When Breastfeeding a Preterm Baby

Immature suck-swallow reflex

The best breastfeeding success is accomplished when at the breast. However, breastfeeding a preterm baby presents several challenges that a term baby doesn’t face. Preterm baby’s many times have very immature suck and swallow reflexes. 

Often, they must be fed through an orogastric or nasogastric feeding tube. The preterm baby has to learn to coordinate sucking, to swallow, and breathing. 

Being at the breast in any way possible is absolutely the best thing for your preterm baby. The baby can smell you, touch you, hear you and bond with you. The skills they need for breastfeeding will gradually come along. 

Despite their developmental delays, a preterm baby has a much easier time suckling from your breast than a nipple on a bottle. Your beast is much softer and more pliable for the baby. 

Momma is Anxious

I know. Your brain and maybe others around you are telling you that you don’t have enough milk to breastfeed your preterm baby. Girl, it’s ok. Whether or not you do is not the entire issue here. Read back over the reasons skin to skin is best. Get your baby to your breast. Let nature do its will. 

Your little tiny preterm baby will be stubborn. PERSEVERE! Breastfeeding is hard. I know sticking a bottle in the baby’s mouth is so much easier. But you weren’t made for easy. WOMEN ARE FIGHTERS! We sacrifice for our family, and sticking with a breastfeeding plan when faced with preterm birth is a HUGE sacrifice. 

Be sure to check out the many class options offered online, Birth Boot Camp Childbirth Classes Online or Live Classes Available, as this may be something you could do to fill the time. You will be sitting and waiting a lot when you have a baby in the NICU.

We are all proud of you!!

Set the mood

Ok, listen, my husband has a brain injury, so I know all about over-stimulation. You have to set the mood for your preterm baby to breastfeed. (do this for skin to skin as well)

Think guard dog!

Dim the lights (use a nursing cover).

Hush the people around you.

Whisper to your Preterm Baby.

Touch your baby Gently.

You are in a battle to get breastmilk into your preterm baby. Breastfeeding a preterm baby is the best thing you can do for your baby. Human milk for a human baby is incredibly powerful in promoting growth and development. 

If you are amid a preterm birth, ask for a member of the lactation team to see you NOW! They can teach you to hand express and to spoon feed colostrum. 

Again, it truly depends on the gestational age of your preterm baby, but getting breastmilk to your baby is optimal.

Good luck and remember you are not alone. 

Comment with your experiences with preterm birth and breastfeeding challenges! We love to hear your unique stories! 

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Just a little Disclaimer: As always, I am just writing my thoughts and what I’ve learned along the way. Although I am in fact a labor and delivery RN, This is not medical advice. You should always seek and follow the advice of your care provider.

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