Breastfeeding a Preemie - Gibsonia,PA

Updated on February 18, 2010
C.R. asks from Gibsonia, PA
17 answers

My son was born 9 weeks early and was tube and bottle fed in the NICU. I was able to nurse him at the hospital and the LC said that he was a natural (yay!) and had no trouble latching on. We brought him home after 5+ weeks in the hospital and are trying to breastfeed him at home. He still latches on fine but suckles for a few minutes then falls asleep. I wake him up, he latches on, suckles for a minute and falls asleep. And repeat... This continues for about two hours and we have been at this for almost three weeks - it's more frustrating for me than it is for him. I've been supplementing with breast milk in a bottle. His due date is still a couple of weeks away. Is this something that will get better or should I just pump and bottle feed him? Are there any other tricks I can try to make nursing successful for both of us?

More info: We have plenty of wet and dirty diapers, so I think he's getting enough to eat. I guess my main concern is if he will always be this inefficient at nursing, or will he become a better eater as he gets bigger. Is the falling asleep just his style or is it because he's young and small. Is there really even a way to know?

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So What Happened?

I talked to a lactation consultant today to basically told me to continue doing what I'm doing and that he will get the hang of it. She said it sounds like he's almost there, just needs a bit of extra encouragement - and a lot of persistance with keeping him awake. She also said that preemies are really good at being inconsistent with nursing. Since I posted my question, I thought he was making a lot of improvement, but today has been pretty trying. Hopefully the end of the frustration is near.

But, thanks to everyone for the great suggestions, advice and support. It was reassuring to hear that I'm not the only one who is (or has) gone through this and it's nice to know that I was already on the right path to getting him to nurse properly. Keep your fingers crossed that I can keep my little guy awake for more than a few minutes at a time.

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answers from Pittsburgh on

HUGS!!!! My son was 10wks early and did the same thing for about 2mos (nod off/eat a few, nod off/ eat a few). I had other BF issues, but this way of eating didn't do well with my supply, so you may want to look into pumping/expressing until he's better at it.

Good luck!!!!

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answers from Dallas on

How often are you feeding? My girls were 10wks early and came home after 5wks in NICU. After a few weeks at home, they would not wake for their feedings or remain awake during them so I moved their feedings to every 4hrs and this helped. They were only nursing for about 10-15min then I had to give them their high calorie formula which was about an ounce. Also, I used nipple shields-made by Medela-I had one that had trouble latching on so they gave them to me in the hospital and they made nursing less tiring for the girls.



answers from Philadelphia on

My son is a former 24 weeker, weighed 1 lb 9oz and always feel asleep when eating. It's a preemie thing. The nurses used to say imagine trying to suck a really thick shake through a straw and how hard and tiring it is for adults. That's what happens with preemies.

I will say, my son who is 11 months old actual, 7 months old corrected can eat his whole bottle and stay awake and then be awake for many hours after that. So just stick with it... Keep waking your baby to eat as much as he can.

Our baby was an on demand feeder, so whenever he wanted to eat he ate. There was no putting him on a schedule. So if he needed to eat every hour, then so be it. But he will grow out of it.



answers from Pittsburgh on

I have twin girls born at 33 weeks. Until their due date (even a little bit past that) we had the same trouble feeding. It seemed like it took so long to nurse that each feeding just ran together! As long as he is gaining weight and has a good diaper count, I wouldn't worry. It will get better, it just takes some time. Keep working with the LC - they can provide invaluable tips along the way and will reassure you that things are going OK. Hang in there!



answers from Sharon on

My first son wasn't a premie but did the same. If the diapers are wet and dirty and he is gaining weight at his visits then hes just fine and I'm sure he will grow out of it. It really doesn't take much to fill his stomach and 1-2 oz a feeding is all he needs. As his appetite gets bigger and he gets older he will be more alert in general. All my babies sleep almost constantly for the first 6-8 weeks. After that they start to be more alert in general. If you son is a premie this stage may just last longer but it will get better!



answers from Erie on

Our twins were born at 28 weeks, and spent 8 weeks in the NICU before coming home with us. It's exhausting for everyone, but soon this will be a distant memory.... Based on what you've written, it sounds like he does OK when drinking from a bottle? If that's the case, I whole-heartedly second the shield suggestion. We used nipple shields for quite a while before weaning off them and onto my bare breast. They really seeemed to help one of our guys a lot. Just make sure that you have the right size, since we ran into problems with that. Regardless of what you decide to do, please try to remember that he's growing and learning every day. Just do your best not to get frustrated (or at least to get over it quickly when you do) and enjoy your special little angel ;)



answers from York on

My son was born on time, but did the exact same thing. If you're anything like me, you are probably falling asleep during this whole process too! It was soooo difficult to keep him awake and me awake too.
Now, with a clearer mind, I wonder if he had to keep restarting my letdown process after each time he nodded off. I like the advice that someone else gave about pumping first, just to get things started for him. I know that my letdown took a really long time when I was sleepy. He might have a more quality nursing session if things are ready to go when he starts.
The LC I worked with told me to stop nursing after 20 minutes per side because after that point the baby was just pacyfying himself. Not sure if that advice would be the same for a preemie. I do know that without a cut off point, my son would have nursed 24/7 as drowsy as he was. Things slowly got better, and we developed a routine of sleep, wake, and immediately eat that works well for us. I think my son was about six weeks old when he started to be much more alert during his awake periods. Prior to that there was almost no line between awake and asleep!
I visited the LC's at the hospital probably a half dozen times during the first two months. It took a long time for my son to figure out nursing (he was NOT a natural) and to gain weight. Don't hesitate to go back to your LC, even if it's just to gain confidence. Hang in there! All too soon the sleepiness will pass, and you'll be on here asking for advice on how to get him to nap better!



answers from Allentown on

It sounds like he is getting enough but you want to make sure he is getting it without supplementing. I would stop all bottles and attach a device you fill with milk and attach to your nipple, this will make him get all his milk from nursing, and slowly decrease the amount you put in the supplemental feeder which you can buy at the hospital. My daughter was a preemie too and had trouble nursing and I did this as well as got a warm washcloth and vigorously rubbed the top of her head whenever she would start sleeping when nursing, also undressed her to her diaper, to keep her more awake, and pumped and used the supplemental device, i have to say it was so worth it, because when she finally got enough from me alone, it was so easy to feed her. Keep at it, it will get better soon.



answers from Philadelphia on

Both my daughters for the first couple months of life had a tendency to fall asleep while nursing. First, be sure to nurse when the baby wakes, not later when he's ready for another nap. Second, don't be afraid to make him a little uncomfortable to keep him awake! Tickling my younger daughter's feet worked quite well for keeping her awake. Personally, I feel that "on demand" nursing when babies are little is best. It takes a HUGE bit of time for you, but it's healthy, and it will help your milk production so that you won't need to supplement at all. Small infants really need many small meals, since their little stomachs are so tiny. As long as you can tolerate it, you can just put him down and let him have those short drinks some of the time. When he gets hungry, he'll stay awake long enough to get more!



answers from Allentown on

First of all, congratulations on already making it this far!!! Breastfeeding, especially for a preemie, is essential! So good for you!!!

This sounds pretty normal, really. Although I'm a bit concerned that he's developing nipple confusion. Nursing takes a LOT more effort than drinking from a bottle (which functions by gravity & a tiny bit of tongue pressure alone).

If it were me, I'd cut out bottles & all artificial nipples all together for the next few weeks. This will give him time to learn how to nurse more efficiently. Baby-wearing, especially in a sling, would be ideal. Skin-to-skin as much as possible especially. (So as not to self-promote too much, suffice it to say that in the marketplace area on this site, there's a local company that gives Mamasource members a 15% discount on some awesome slings! lol)

I'd also contact your local LLL Leader asap for additional tips & tricks. If you're near Lehigh Valley, I know that one of the Leaders had a VERY small & early preemie, so she has tons of tips & tricks. (Her name is Samina).

Keep up the good work though! Sounds like you're both doing really well!



answers from Gainesville on

My son was 8 weeks premature and spent 6 weeks in the NICU and had no idea how to breastfeed when he got home. We only had a couple of opportunities to try in the hospital. He eventually learned how after 6 weeks of work at home. You guys are ahead of the game! Rather than spending 2 hours trying to nurse him take a step back and try this-nurse him when he gives you the cues, time him, if he falls asleep try gently stroking his cheek to see if he gets going again (my second always fell asleep nursing and would wake to this to finish). Once he stops again, burp him, and try putting him back on. If he's too sleepy, let him be and then see how long it is before he's ready to eat again. My daughter and son were both power nursers. My daughter would literally be done in 10-15 mins! And that was using both sides! And she was my sleepy little monkey. But she got the job done in short order even though I had to coax her a bit initially. Try the above and see how long he seems satisfied, if he has wet diapers, etc. Remember, breastfed babies eat every 1 1/2-3 hours from the start of a feeding.



answers from Philadelphia on

I'm not sure if you think he isn't getting enough, or you are frustrated by the frequency of his nursing small amounts? I'm thinking that since he is still so small, that he just needs small frequent meals. If you are truly concerned about his amount of intake I would call the pediatrician and take him for a weight check today and then go from there. Is he wetting diapers? Are the soft spot on his head level with the rest of his head? Does he have tears when he cries? These are all good indications that he is getting enough!



answers from Cincinnati on

Sucking, swallowing and breathing (SSB) are complex processes, even when considered separately. When an infant is fed, these processes must work together smoothly and efficiently with highly accurate timing and coordination to result in safe and efficient feeding. If he is only drinking 2 minutes and then sleeping it is a sign that he is exerting too much effort thus having a hard time with the SSB process. He needs to build up his endurance.

Have you tried :
1) to support his chin and cheeks (so he has to work less)?
2) providing with this increased body support (so he doesn’t have to work on his trunk support while feeding)
3) pumping prior to feeding in order to stimulate milk production?

Also it is okay to be in a quiet alert state, but he should be re-alerted when he becomes drowsy. Alertness is critical to an infant's ability to communicate with the feeder regarding loss of suck-swallow-breathe coordination. Infants can be alerted by using a burping maneuver, such as patting or rubbing the back. Unswaddling a blanket (or removing blanket that is covering him for a few minutes lets "fresh air in." Before resuming feeding, rub the infant's head, take its t-shirt off and put it back on, and if you are swaddling him - reswaddle him.(
** Avoid prodding him. When you breastfeed, avoid twisting or turning the nipple, moving it up and down, moving it in and out of the infant's mouth, or jiggling it. While the intent is to help him, it may lead to safety issues. These techniques result in fluid passively entering the mouth without the infant's active participation. The risk of aspiration significantly increases because the fluid may overfill the oral cavity and move toward the airway. Until the infant actively swallows, which occurs only after active sucking, the airway is open and in jeopardy. Thus if you do this and he falls asleep he maybe sleeping with fluid in his mouth putting him at risk for coking. (

Does he do the same thing with the bottle? (drink for a couple of minutes and then fall asleep)? Have you had a lactation consultant assist you in the beginning (if not you may want to see one). Another option is seeing a therapist who specializes in breast feeding (some NOT ALL occupational therapists or speech therapists work with assisting parents with breast feeding - are you near CHOP? they may have therapists who specialize in breast feeding). If you decide to see a therapist make sure when you schedule an evaluation that you ask for someone with experience in breastfeeding and premature infants - some therapists who work on feeding have not worked on breastfeeding.

hope that helps! Good luck!



answers from Philadelphia on

Are you sure I didn't type your entry?! Our experiences are
SO exactly similar, I seriously could have written it!
My son, once at home always would fall asleep too. I pumped
And supplemented, but I hate to say in my experience,
Since he wasn't nursing enough my milk supply eventually
Dried up. Our bodies don't produce enough milk w/ pumping
As it does w/ the baby actually latching on and nursing. It was
A hard decision for me to make because I really wanted to nurse
But it came down to the fact that he simply wasn't getting
Enough food. So I ended doing formula and pumping breastmilk into
Bottles until I completely had no more breast milk. Then went to
All formula. Another issue you have to think about when you
Breast feed and supplement is the baby can get nipple
Confusion and then latching on or sucking the bottle becomes
A big task for such a tiny baby. My son didn't really start putting on
Weight until I got him to formula - not sure why, but my guy was
Pretty little - took 6 weeks just to get back to birth weight. Another good thing
For you to keep in mind is that the most important part of
Breastfeeding is the colostrum we pass to them which is all
During the first 6 weeks, which you seem to have gotten through!
My son may have struggled in the beginning, however the months following
And even today you would never know he was a preemie! He is VERY healthy
And thriving and I'm very confident you'll be saying the same
Thing as the months and years go by!! Much Luck! I will keep you in my thoughts & prayers!


answers from Allentown on

Hi, C.:
Contact your local La Leche League breast feeding consultant at

Good luck. D.



answers from Boston on

I had twins 7 weeks early, plus 3 other full termers, and your son sounds normal. It is frustrating and tiring but remember he's still really small. Eating is exhausting for him. Hang in there, keep on trying to offer the breast. See if you can't find a lactation consultant to come to the house to help with tips on position etc. But don't give up! Having him near you for extended periods of time will help keep up your supply too -- as does frequent pumping, but it's not as good and not as nice. Good luck, and don't worry this won't last forever, and it will get a little better all the time...

Update: Here's another thought, have you tried nursing him when you are both lying on your sides facing each other? He (and you) may fall asleep a lot, but that way you get rest and are right there for him when he wakes up. Put a beach towel or two under you both since you may leak all over. I slept with all my kids this way (even the twins, swapping them around) and it's one way to actually sleep 7-8 hours a night with a newborn. If you have a large bed, you can set up a changing station right there (with purell) and not get out of bed all night. You'll be amazed at how you can score a basket with the dirty diapers all the way across the room to the trash can in the dark...


answers from Pittsburgh on

AJ C had an EXCELLENT answer and advice; I can't say it any better than that ( I am a four and a half year bfing veteran of three).

All I do have to say is that with two of mine we had problems in the beginning (one of them was my little sleeping princess) and I will reassure that it WILL get better. They become more efficient with practice.Think of it his way...if babies weren't built to become little nursing machines, our species wouldn't exist! That's why I must say when I hear women claim "I didn't produce enough milk" (which I kinda believe is code for "I gave up on nursing and went to formula", not to be mean to those women but I think that' s what it is), I think well thank God this wasn't a thousand years ago, 'cause back then they couldn't go to the corner-cave and grab some Similac! ;)

You are doing a GREAT job and I'm proud of you.....and thanks for posting such a good question!

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