Breastfeeding in the NICU (2024)

Babies in the Neonatal Intensive Care Unit (NICU) face many unique challenges based on their condition, but almost all of them share one challenge: feeding. Babies with complex medical conditions may have trouble breastfeeding or bottle feeding because they don’t yet have the skills, or their condition or medical equipment prevents it.

If you have a baby in the NICU, it might take a little longer to get them to feed, and in some cases, babies don’t feed orally. But with the help of NICU lactation consultants and qualified nurses, many babies with complex medical conditions can successfully breastfeed in the NICU.

Breastfeeding in the NICU

The American Academy of Pediatrics and the American Academy of Family Physicians agree that breast milk is the best form of nutrition for infants, especially those with serious illnesses.

We recommend that moms breastfeed their babies if they’re able. But breastfeeding is often difficult for moms with healthy babies, and breastfeeding in the NICU creates additional challenges, but they’re not completely overwhelming.

For many babies in the NICU, the main challenge is simple: they don’t know how to feed orally. Babies born prematurely are more likely to lack the development and instincts to breastfeed. Also, babies who can’t breastfeed in their first few weeks of life due to their medical needs have more challenges learning once they’re physically able to breastfeed. Breastfeeding is a skill that all infants in the NICU have to learn.

Every baby is different and learns at their own pace, but many premature babies start feeding orally at 32 to 34 weeks gestation. Depending on when your baby was born, and how serious their medical condition was, they may or may not be ready for breastfeeding. Lactation consultants and therapists can help guide you at this time.

Skin-to-skin contact

Placing your baby directly on your skin can reduce your baby’s stress, stabilize their breathing, maintain a stable temperature, help you bond and maybe most importantly, help facilitate breastfeeding. Snuggling your baby close can help spark early feeding cues, such as your baby looking for your breast. NICU nurses and lactation consultants can provide one-on-one support during skin-to-skin contact and help encourage feeding cues.

Early breastfeeding in the NICU

If your baby is looking for your breast or showing other feeding cues, they may be ready to breastfeed — if only sparingly. You can pump a little to bring milk to your nipple and help your baby know where to feed. Your baby might just want to nuzzle and not latch on your breast yet, which is fine. If they do latch, they might only feed a little. The goal is to get your baby familiar with the process of locating your breast and see if they can tolerate small amounts of breast milk.

Therapist assistance

In addition to lactation consultants, occupational and speech therapists can help your baby build the skills necessary for breastfeeding: sucking, swallowing and breathing. Many premature babies simply don’t know how to do these things. Therapists might place drops of breast milk on a pacifier, show your positions or use other techniques to encourage feeding.

Follow your baby’s cues

If your baby responds well to early feedings, you can slowly proceed with breastfeeding. Do this with the support of a lactation specialist or nurse who guide you based on how your baby is doing. Premature babies often tire quickly when feeding, which is normal. You can also tell if they’re getting enough breastmilk by how they’re sucking. Short, fast sucking is known as non-nutritive and isn’t giving your baby much breastmilk. Nutritive sucking, on the other hand, is longer, stronger and is more consistent. It’s your baby’s response to your milk flowing. Finally, pay attention to how your baby looks when they’re done feeding. Full babies stop themselves from feeding and have a sleepy, “milk-drunk” look.

Teaching your baby to breastfeed in the NICU can be a slow process, but it helps them feed and grow while there, while also preparing you to go home. Once they can breastfeed on their own, they are one step closer to going home.

Breastfeeding with medical equipment in the NICU

Some medical equipment that helps babies recover in the NICU also makes it difficult for them to learn to breastfeed. Fortunately, our lactation consultants and therapists help babies with complex medical needs learn how to feed and thrive.

Three important pieces of medical equipment often pose challenges to breastfeeding:

Nasogastric tube (NG tube): A small, soft tube fed through a baby’s nose, down their throat and into their stomach to provide nutrition or medication
Gastrostomy tube (g-tube): A small tube that we surgically place in a baby’s stomach to provide nutrition, fluids or medication
Ventilator: A machine that provides breathing support for babies with respiratory issues

If your baby needs this equipment, occupational and speech therapists will work with them to build their oral feeding skills. To help you bond and so your baby can associate you with feeding, hold them while they’re feeding from an NG tube or g-tube. You can also give them a pacifier at this time so they’re building oral feeding skills while being fed.

When babies need a ventilator or similar equipment to help them breathe it’s unsafe for them to try breastfeeding. When your baby can’t breastfeed, you can still give them breastmilk on a swab to help prevent infection and get them used to the taste of breastmilk. Once babies are on small amounts of oxygen through a cannula (a thin plastic tube) in their nose they can begin safely breastfeeding.

While your baby is growing and learning to breastfeed, they can still get breastmilk through a g-tube or NG tube. This allows them to still get the benefits of breastmilk. When your care team says your baby is ready, you can proceed to the breastfeeding tips mentioned above. If your goal is to breastfeed your baby, then work with your lactation consultant and nurse to ensure their first feeding is at the breast, rather than a bottle.

Tongue-tied babies and breastfeeding

A tongue-tie in babies means the tissue (called the lingual frenulum) that connects the bottom of their tongue to the floor of their mouth is short or tight and restricts their tongue movement. A tongue-tie, also called ankyloglossia, can affect how your baby’s tongue functions.

Often, tongue-tie is harmless and will go away or stretch out on its own. But sometimes, tongue-tied babies have trouble breastfeeding. If your baby has tongue-tie, they might:

What research shows about tongue-tie

Tongue-tie surgery has increased in recent years, but we don’t have many good studies on tongue-tie and breastfeeding. Research also hasn’t clearly proven that surgery consistently helps improve results for families.

But research has shown that:

Less than 50% of all infants with physical signs of tongue-tie have trouble nursing.
115 babies in a U.S. study were referred for tongue-tie surgery, but 63% did not need the procedure to solve nursing issues.
A muscle found under the baby’s tongue can stretch and lengthen with continued feeding, possibly solving nursing issues.
Healthy nursing might also depend on movements in the middle of a baby’s tongue, making the tip of the tongue less important and surgery less effective.

Breastfeeding when you go home from the NICU

When your baby feeds from a breast or bottle independently and consistently, and is gaining weight, you’re ready to leave the NICU. You’ve probably worked hard with lactation specialists and nurses so far. When you go home, focus on maintaining your baby’s good habits and taking care of yourself.

Maintaining your breast milk supply

Making sure you have enough breast milk to help your baby grow can be challenging, especially when you’ve been in the NICU and your baby may have ongoing medical needs. Stress and other medical complications from a high-risk pregnancy can reduce your breast milk supply.

Remember: Take care of yourself so you can care for your baby. Here’s how to help maintain a healthy breast milk supply:

Rest: It’s hard as a new parent because your baby might not cooperate but try to get enough sleep. Nap when your baby naps if you can and accept offers from friends and family to help.
Drink plenty of fluids: “Drink to thirst” is a good rule of thumb. Drink enough nonalcoholic fluids so you’re not thirsty, and don’t go overboard with caffeine (2 to 3 cups of coffee a day is typically fine). Remember to have water every time you feed, pump or eat a meal.
Eat a balanced diet: Nutrition is always important, but even more so when you’re sharing it with your baby. Eat fruits, vegetables, lean protein and whole grains. You typically want to add about 500 calories to your normal daily intake.
Pump your breast milk: Pumping between feedings can help stimulate your breast milk production. You can freeze breast milk you can’t use right away and use it later. Not every mom produces enough breast milk to have excess, so don’t get discouraged if this is the case for you.

Go easy on yourself. Every mom is different, and if breastfeeding doesn’t work for you and your baby, that doesn’t mean you’ve done something wrong. Some moms don’t produce a lot of breast milk, and sometimes it doesn’t work with your schedule or causes too much stress.

You can supplement with donated breast milk or formula. What matters is that your baby is growing and healthy.

If you have questions about breastfeeding once you’re home, you can always contact our Breastfeeding Management Clinic or our 24/7 ParentSmart Healthline at 720-777-0123.

Feeding with medical equipment at home

If your baby can’t get all the nutrition they need from feeding, they might go home with an NG tube or g-tube to supplement their nutrition. They can still breastfeed whenever they are hungry, but you can give them extra breast milk through their tube after they are done breastfeeding or through the night.

When your baby gets better at breastfeeding and you can stop using their g-tube or NG tube if your pediatrician says it’s safe. In rare occasions, it might be unsafe for a baby to breastfeed if they cannot safely swallow milk. These babies will only get breast milk through a g-tube or NG tube until your doctor says they can swallow safely. If this is the case for your baby, hold them while you’re feeding them and allow them to suck on a pacifier. This can help you both feel more connected at feeding time.

Try to make eating something your family does together. Have your baby around during meals, so they can smell food and see other people eating. Hold your baby while they’re feeding through a tube, talk to them and consider providing a pacifier.

These tips will help your baby associate you with feeding and transition to breastfeeding more easily. And if your baby uses a feeding tube, they’ll likely receive ongoing care from therapists, so you can always ask them questions.

Bottle-feeding in the NICU

You might choose to bottle-feed their baby breast milk or formula in the NICU for several reasons:

Some babies have trouble latching on a breast and drinking breast milk, so you might choose to pump breast milk and bottle-feed.
Some mothers are not comfortable with having their baby latch on to their breast.
Sometimes the stress of a high-risk pregnancy and stay in the NICU or other factors contribute to inadequate breast milk supply. We can supply donor breast milk, formula or a hybrid approach to complement the important health benefits your available breast milk is providing.
Some preterm babies need more calcium and phosphorous to help with bone formation than breast milk alone can supply. In this case, we might provide fortified breast milk.
If babies have an allergy to dairy protein, they might need formula that doesn’t have cow’s milk protein. Moms can also choose a dairy-free diet in this case.

NICU nurses and feeding specialists will tend to your baby’s individual needs and help you learn how to best feed your baby. Here’s some general advice:

Position your baby in an upright, cradle position and hold them close. This helps with digestion and bonding.
Develop a feeding schedule with your care team based on your baby’s weight and nutritional needs. You will likely feed them every 2 to 4 hours and increase the amount as they grow.
Burp your baby after every 1 to 2 ounces they consume.
Find a bottle and nipple that work for your baby. There’s no “right” bottle that works for every baby.

Maintaining a pumping routine and milk supply is challenging. You may be pumping 8 to 10 times a day in addition to feeding your baby, so try creating a routine to make feeding more efficient. If you’re producing more milk than your baby can consume, freezing it can save you time later. You can save freshly pumped breast milk for about 6 months.

Above all, maintain your personal well-being. If pumping and feeding is wearing you down, talk to your care team about supplementing with formula or receiving donated breast milk.

Parenting a newborn with complex medical needs is tough. Accept help and remember what your baby needs most: a healthy you.