Preemies – Transitioning to the Breast

By Krista Gray, IBCLC. Last updated February 11, 2013.

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Baby breastfeedingSo you have your milk supply established through either hand expression or pumping and now it’s time to transition away from exclusive pumping because your baby is transitioning to the breast.  How can you know if your baby is ready and how can you best go about this?

First, if you have any colostrum or milk from the very first week, these are both incredibly beneficial for your preterm baby and you should give this milk first.  Then your freshly expressed milk, or milk at your breast, should be given next.  Any other milk you have expressed can be safely frozen for use later.  Or, if your milk supply is established and you have an abundance of pumped milk, you may want to consider donating to a human milk bank.

In order to effectively nurse at the breast, a baby must be able to suck, swallow, and breathe at the same time.  This is actually an advanced skill and requires the development of 31 muscles, 6 cranial nerves, and at least 3 cervical nerves to function properly! 1  Typically, this skill is developed between 32-35 weeks gestation.  However, current research shows that preterm babies held in Kangaroo Mother Care develop this skill earlier than their counterparts in incubators. 2  Babies held in KMC may root for the nipple or lick drops of milk from a mother’s breast; these are positive things and should always be encouraged.

Once a baby is ready to begin to transition to the breast there are a variety of ways to do this.  One of the most common ways in the past (and continues in many NICUs today) is simply to choose a feeding to replace at the breast.  Feedings are usually scheduled every three hours in the NICU and one or two of these are replaced with breastfeeding.  While this method can be effective and has helped many babies transition from bottle (or gavage feeding) to the breast, it may not be the best method.  With current knowledge of Kangaroo Mother Care and all its many health benefits to preterm babies, it has also been shown these babies breastfeed earlier and for a longer duration. Babies in KMC have access to their mother’s breast all throughout the day and tasting of drops of milk on the breast or even attempts at suckling are always encouraged, no matter how young the preterm baby.  Rather than prescribing one or two feeds to be at the breast and the rest from a bottle, babies in KMC are able to “practice” breastfeeding from a much earlier age.  They are able to suckle when they are awake, alert, and/or hungry…whenever they are ready and as often as they wish. Preterm babies cared for in KMC typically breastfeed earlier than those transitioned to the breast using other methods. 3

If your preterm baby is ready for oral feeds but, for whatever reason, is unable to nurse at the breast, feeding via cup, syringe, or bottle are all options.  Worldwide, cup feeding is the most common.  It is easy to clean, affordable, and doesn’t teach a different method of sucking than what a baby would use at the breast.  Though sometimes spillage can be high, studies show babies are able to transition from cup to breast easier than bottle to breast.  In fact, when comparing infant responses to cup or bottle, babies have a significant fall in skin temperature and more difficulty breathing while bottle feeding than cup feeding. 4  Syringe feeding is a similar option to cup feeding, although it tends to be easier to control spillage.  Ultimately, though, even if you giving oral feedings via one of these routes, make sure to continue lots of skin-to-skin time and offer your breast, even for non-nutritive sucking, whenever your baby is willing.

Show 4 footnotes

  1. Hazelbaker, Alison K. (2010). Tongue-Tie: morphogenesis, impact, assessment, and treatment. Aidean and Eva Press, Colombus, Ohio 67.
  2. Barlow SM. (2009) Oral and respiratory control for preterm feeding. Current Opinion in Otolaryngology & Head and Neck Surgery. 17(3):179-86
  3. Nyqvist KH, Sjoden PO, Ewald U. (1999) The development of preterm infants’ breastfeeding behavior Early Human Development 55(3):247-64
  4. Marinelli KA, Burke GS, Dodd VL. (2001) A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed Journal of Perinatology 21(6):350-5
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