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Feeding

The decision on how to feed your baby is a very important and personal one and you may not have fully decided how to feed your baby before he or she was born.  This section will give you information about all the different aspects of feeding, from tube feeding to responsive feeding, and help you with your decision.

In the beginning your baby may need to have their milk through a feeding tube to help them grow.   As your baby develops they will begin to show signs that they are ready to take some feeds and the neonatal staff will help you to recognise these important signs.  It will take time for your baby to develop all the skills that they need to take all their feeds themselves, and this is different for every baby.  For further information on feeding your baby try the following website www.bestbeginnings.org.uk

Expressing Milk

When your baby is born, they may not be able to feed straight away so, while your baby is growing and getting stronger, you can pump milk from your breasts.  This is called “expressing” and to get your milk supply off to the best start it is recommended that you start within two hours (or as soon as possible) after your baby is born and staff will explain how to do this. The milk you express in the first few days is called Colostrum and it is thicker and more yellow than the milk produced later on.  It will only be produced in small amounts but every drop is important as it contains many beneficial properties including protecting your baby from infection.

As you continue to express, the quantity of breast milk will increase and you can then combine hand expressing with using a hand or electric pump. Again, staff will show you what to do to ensure that expressing is comfortable and effective.  Staff will also explain to you how to store your milk both at home and on the neonatal unit.

There are certain things you can do to help you to establish your milk supply and a few ideas are listed below:

  • Expressing regularly, around eight to ten times every 24 hours (including during the night) as this is the frequency your baby would feed.  Once your milk supply is established it may be possible to reduce the amount of expressing you do without it affecting your milk supply
  • Expressing next to your baby’s cot or incubator or looking at a photo or video of your baby, as this make you think about your baby
  • Having skin-to-skin contact or Kangaroo care with your baby. This can also help your body to make more antibodies which pass into your milk helping to protect your baby from infection
  • Doing some breast massage before and after expressing
  • Making sure you take care of yourself by eating and drinking regularly
  • Keeping a record of when you express and the amount of milk can encourage you to continue as you see the amounts increasing each day

Sometimes there may be a delay in your milk supply becoming established because of your shortened pregnancy, especially if your baby was born very prematurely, or if you have been unwell so, it may take a bit longer.

For more information visit:  www.bliss.org.uk/breastfeeding

Breast Milk

Breast milk is widely recommended as the best way to feed preterm babies as your milk is unique to your baby and acts like a medicine as well as a food.  You will be encouraged to express your milk in the early days even if it is not your intention to breastfeed in the long term and nursing staff will give you all the support you need.  The benefits of breast milk are:

  • Breast milk provides antibodies that protect your baby against bacteria and viruses
  • It boosts your baby’s immune system and protects against infections
  • It provides nutrients, growth factors and hormones that help your baby grow and develop during the vital early months after birth
  • Breast milk is very easy to digest and is absorbed more easily than formula milks
  • Providing milk for your baby is something only you can do.  It helps develop a close and loving bond with your baby
  • Breastfeeding is good for your health too.  It can help you regain your pre-pregnancy figure as extra fat stored by the body during pregnancy is used to produce breast milk.  There is also some evidence that breastfeeding reduces your risk of breast and ovarian cancer.

Further information

www.nhs.uk/start4life

www.mothersguide.co.uk

www.bliss.org.uk/breastfeeding

Donor Breast Milk

Donor breast milk is breast milk that is donated by healthy breast feeding women who have more milk than their own baby needs.  These donors are carefully screened and the milk is tested and heat treated to ensure it is safe to use.  It is then stored in a Milk Bank which operates to strict nationally regulated guidelines.

Donor milk is most commonly used when the benefits of using human milk for the baby are important and mother’s own milk either cannot be used or there is an insufficient supply.

Donor milk is not used without discussion and consent from the baby’s parents or carers.

Further information        www.ukamb.org

Formula Milk

You may have decided that you wish to feed your baby formula milk and staff will discuss the most appropriate type of milk with you.  They will take into account the prematurity of your baby, how much they weighed and if your baby has any other additional needs.

Formula milk is specially modified cow’s milk which is modified to meet the needs of specific groups of babies.  Formula milks designed for preterm babies have more of the nutrients needed to support growth and development.  It is also possible to use formula milk together with your breast milk if you have milk to use.

On the neonatal unit formula milk is already made up in bottles whereas the milk used at home will be in a powder form.  Some formula milks are also available on prescription.  Nursing staff will ensure you know how to safely prepare your baby’s feeds and sterilise the feeding equipment before you go home.

Further information        www.nhs.uk/bottlefeeding 

Tube Feeding   

When babies are born prematurely they may be unable to take enough milk to grow adequately, this might be for a number of reasons.  These include:

  • Baby has been born too early for the sucking reflex to be fully developed
  • Baby may be unable to take enough milk by breast or bottle as they tire easily
  • There may be a medical reason which makes feeding more difficult

In these situations milk can be given through a feeding tube and feeding in this was will help your baby receive enough nutrition to grow and develop.  There are two types of tube feeding used:

  • Nasogastric tube feeding - this is when a baby is fed through a small soft tube, which is placed in the nose and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach
  • Orogastric tube feeding - this is when a baby is fed through a small soft tube, which is placed in the mouth and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach

There are many feeding experiences you can provide for your baby while they are having tube feeds including smelling milk during skin to skin, tasting milk during mouth care, practising sucking and tasting at the breast or the use of a dummy.  As your baby develops they will begin to show signs that they are ready to take some feeds themselves and staff will help you recognise these.  Signs may include waking at feed times, attempts  to suck or lick during skin to skin, mouthing their hands or rooting during tube feeds.

Further information

www.bliss.org.uk/tube-feeding

www.bliss.org.uk/skin-to-skin-and-kangaroo-care

Breast Feeding

When a baby feeds they have to coordinate sucking, swallowing and breathing, when babies are born prematurely, this skill takes time to develop. As your baby’s feeding skills develop they will start to try and latch onto your breast and begin sucking. Premature babies tire easily so this will be a gradual progress and every baby is different.

You may notice that during skin to skin your baby starts to lick or nuzzle your skin or try to move towards your breast  so staff will help support you to position your baby at your breast.  Your baby may not attach to your breast or suck to begin with, but they will enjoy being close and the smell of your milk. This is a good time to practice holding you baby and positioning your baby at the breast and finding a position that is comfortable for you both.

Your baby will still be having milk feeds through their feeding tube to continue to support their growth, and as your baby feeds more from the breast they will need less tube feeds.  Staff will help you manage your expressing during this time, and support you and your baby make the transition from tube feeding to breast feeding.  Good positioning and attachment are important for feeding to be effective and staff will help you to understand and recognise these signs, and to recognise your baby’s feeding cues and how to respond to them.

Breast feeding is a skill that takes time and practice so spending as much time with your baby as you can and giving them as many opportunities to breast feed will help.

Further information

www.bliss.org.uk/breastfeeding

 www.nhs.uk/start4life

www.mothersguide.co.uk

Bottle Feeding

If you are planning to feed your baby by bottle,  once your baby starts showing signs that they are ready to take some of their feed themselves there are some things you can do to help them.  Give your baby eye contact during feeds and they may look back at you.  It is also important that you watch your baby so you can tell when they are getting tired and have had enough.  You can also have skin to skin while you are bottle feeding, and this will help you and your partner build a close and loving relationship with your baby.

When a baby feeds they have to coordinate sucking, swallowing and breathing which is a skill that takes time for premature babies to develop.  Different teats might help with this and staff will help you to choose the best one for your baby.  They will also help you to recognise when baby is ready to move on.

When your baby is feeding it is important that you hold them in a way that gives you both as much support as possible so that your baby can concentrate on learning the new skill of feeding and you are comfortable and can watch your baby.  Staff will help you find the right position for you and your baby and they will also support you to learn about sterilising feeding equipment and preparing formula feeds.

Further information        www.nhs.uk/bottlefeeding

Weaning

Weaning is the introduction of solid foods and is an important stage in your baby’s development. Weaning your baby onto solids is a gradual process that can take time as all babies are different and some take longer than others.

When milk can no longer provide all the nutrition your baby needs the introduction of solids will continue to support your baby’s growth.  Weaning also helps to support your baby’s development by giving them the opportunity to practice lip, tongue and jaw movements and experience a range of different tastes and textures so that their diet is well balanced.

Most healthy preterm babies are ready to start weaning between five to eight months from the date they were born but, to ensure they have the necessary skills and head control needed, they also need to be at least three months corrected age.

Signs that your baby may be ready to start weaning include

  • Can your baby be easily supported in a sitting position?
  • Can your baby hold their head in a stable position?
  • Is your baby showing interest in you and your family eating?
  • Is your baby alert and looking ready to move on to a new type of feeding?
  • Is breast or bottle feeding going well?
  • Can your baby bring their hands to their mouth and are putting other things in their mouth?
  • Are they making any “munching” movements with their mouth when putting things into their mouth?

You can discuss whether or not your baby is ready for solid food  with your Health Visitor or other health care professional who may be supporting you at home.

Further information        www.Bliss.org.uk/weaning-your-premature-baby

N.B. The information above varies from current government guidelines for weaning which do not include preterm babies