Breastfeeding: Helping your preemie stay awake to nurse

My baby is two weeks old and in a neonatal ICU with respiratory problems. When I came in for a visit, I was told he was well enough to begin breastfeeding. Right now he only seems to latch on well when he is crying and I push him onto my breast. He sucks in short bursts and tires easily. However, I do notice he breathes much more easily while sucking. He only gets one to one and one-half ounces each 30 minute feeding. He soon falls asleep or falls off the breast and has to be reattached. What can I do to help him stay awake and interested in feeding?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

It's wonderful that you are nursing your baby! The first thing I would recommend is to begin working with the hospital's IBCLC, or one who is in private practice. Beginning to breastfeed your premature baby can be challenging -- it sounds as if you could really use some one-on-one help.

You are correct in observing that your baby is able to breathe more easily while breastfeeding. Researchers have found that breastfeeding is less stressful than bottle feeding to preemies, and helps them to better maintain their oxygenation, heart rate and body temperature (Meier, 1988).

When getting ready to nurse, find a place where you can be comfortable. Have pillows handy to help support yourself comfortably while breastfeeding. Begin nursing on the side it is easiest for you to manage -- if you have a preference. If you decide to start feeding from your left breast, support that breast with your left hand, thumb above and back from the areola, and other fingers cupping under the breast. You might want to try expressing a bit of your milk onto your nipple to entice your baby. Supporting your baby's body with your right arm, and his neck with that hand, bring him toward your (left) breast, stroking his lip with your nipple. This should encourage him to open his mouth and latch-on to your breast. He may need a bit of assistance in the beginning. A helper can gently pull down on his chin, as you say "open." You and your little one should be chest to chest, and his body should be in alignment as he nurses. Use pillows, as needed, for comfort and support. His nose and chin should be gently resting on your breast. Your little one may need some assistance in the beginning, with increased support to maintain attachment as he feeds.

Newborns need to be nursed at least 8 to 12 times a day. Until your baby is feeding well at your breast it is important to continue expressing your milk if your baby misses a feed or has an incomplete feed. If your baby is very small, he may only be able to nurse at one breast per feed. It would be wise in the early weeks, as your milk supply is becoming established, to express your milk from the other breast. Use a hospital-grade electric breastpump with a double pump kit.

Was the 1.5 ounce consumption figure per 30 minute feed determined by test weighing or by the amount of milk you typically express? In your situation, it is quite common for a mother to express more milk than her baby is able to take in. This can be due to his inability to sustain a sucking pattern. When learning to nurse, many preemies consume less at breast than they would if fed by gavage or bottle. It can take a while for their sucking and swallowing pattern to get in sync, with less pauses in between sucking bursts. This will happen with maturity, and can be at a different time for each baby.

Your little one will stay awake at the breast more easily as he matures. In the meantime, undress him, use a blanket to cover both of you, skin-to-skin, as he feeds. Skin-to-skin contact is very stimulating for newborns. You may also find it helpful to use breast compression, massaging your breast, as your baby's sucking and swallowing begins to slow during a feed. And as he gets older, and tires less during a feed, switching breasts several times during a feed. This can stimulate the milk ejection reflex, helping to keep your baby more interested in feeding. Very best wishes in mothering!

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