Introduction
Welcoming a newborn into the world brings immense joy and excitement to any family, but the birth of a premature baby can be a nerve-wracking experience for new parents. Premature babies, born before 37 weeks of gestation, often face unique challenges as they arrive earlier than expected.1
Among many factors contributing to their healthy development, breastfeeding is massively important to help premature newborn babies grow.2 This article delves into the significance of breastfeeding for premature infants, focusing on the benefits of finding the right breastfeeding position.3
The journey of caring for premature babies can be a daunting one, especially for new parents. However, by embracing the power and the beauty of breastfeeding and learning proper breastfeeding positions, parents can find the journey a rather rewarding one.
This article aims to emphasise the importance of breastfeeding for premature babies, focusing on the positive effect of mastering the proper breastfeeding positions and how that can help parents care for their premature babies.
Importance of breastfeeding for premature babies
Breast milk has been shown to be massively important for the healthy development of newborn infants especially premature ones. Extensive evidence has confirmed that breast milk provides the perfect blend of essential nutrients, vitamins, minerals, and proteins that promote optimal growth and development.4
The composition of breast milk changes over time adapting to the needs of newborn babies and changing according to the different stages of their development. This adaptability is incredibly important for premature babies as their nutritional requirements can vary immensely from full-term infants due to the nature of their rapid growth and development outside the womb.5
Research published in leading journals has highlighted that premature babies fed with breast milk experience better weight gain, improved brain development, and reduced risk of infections when compared to those fed with formula.6 The natural antibodies present in breast milk offer immunity against, shielding these vulnerable infants from various infections, respiratory illnesses, and gastrointestinal disorders, which are more commonly seen in premature infants.7
The number one significant characteristic of breast milk that makes it incomparable is its’ immunological properties, as it contains a variety of immune factors, including secretory immunoglobulin A (IgA), which shields the baby's vulnerable gastrointestinal tract, forming a protective barrier against harmful pathogens.8
This makes breast milk unparalleled when compared to formula as it provides immunity support that is particularly beneficial for premature infants who are more susceptible to infections due to their immature immune systems.9
Various other studies have proved that breast milk not only provides outstanding immunity support against infections and disease for premature babies, but it also provides other everlasting health benefits that will change the trajectory of the baby’s growth and development in the long run.10
Premature babies who are exclusively fed breast milk during their neonatal period have a reduced risk of developing chronic conditions later in life, such as asthma, allergies, and obesity.11 Thus, these immune-boosting properties of breast milk can have life-long benefits on their overall health and well-being providing a strong foundation for a healthy life in the future.
Additionally, breastfeeding also aids in the development of a strong emotional bond with the breastfeeding parent and promotes long-term healthy emotional development. Breastfeeding is an incredible way to foster a profound emotional connection between mother and baby.12
For premature infants, who may spend considerable time in neonatal intensive care units (NICUs), this bond becomes even more critical. Skin-to-skin contact and breastfeeding create a nurturing environment that calms the baby, reduces stress, and regulates their physiological functions such as heart rate and breathing.13
An incredible amount of research has shown that breastfeeding can have massive positive effects on a premature baby's neurodevelopment, leading to improved cognitive and emotional outcomes. The loving touch, warmth, and intimacy experienced during breastfeeding help premature babies feel secure and loved, contributing to their emotional well-being, which has massive implications later on in their lives.14
Benefits of finding the right breastfeeding position
Finding the right breastfeeding position for your newborn baby is incredibly important as it allows for maximising nutrient absorption as well as aiding in digestion. Finding the right breastfeeding position becomes even more crucial when you have a premature newborn, as premature babies often have underdeveloped gastrointestinal systems, which makes it difficult for them to absorb the nutrients from breast milk effectively and efficiently and makes them more prone to digestive issues.15
A wide breadth of studies has shown that proper positioning during breastfeeding can significantly improve nutrient uptake by ensuring a secure latch and proper alignment of the baby's mouth with the mother's breast.16
Upon investigating a wide variety of literature, the cross-cradle and football hold positions have been found to be particularly beneficial for premature infants.17 In the cross-cradle hold, the mother supports the baby's head with one hand and guides the baby's mouth to the nipple with the other.
This position allows for better control and ensures the baby's mouth covers a larger area of the areola, which helps in promoting effective milk transfer.18 On the other hand, the football holder places the baby alongside the mother's body, supporting the baby's head with her hand.18
This position can be advantageous for premature babies with weaker sucking reflexes as it allows better control of the latch and reduces the risk of nipple confusion. More breastfeeding positions and their advantages will be discussed in detail in this article.
However, to fully understand the importance and the benefits of finding the right breastfeeding position, one must first understand the challenges faced by premature newborn babies. One such challenge is feeding fatigue, as preterm babies use more energy during feeding because of their immature suck-swallow-breathe coordination.
An improper breastfeeding position can worsen this issue, leading to not enough weight gain and compromised growth. This article will delve into more issues faced by premature babies when breastfeeding.19
The laid-back breastfeeding position, also known as biological nurturing, is particularly beneficial for premature babies. This position allows the baby to lie on the mother's chest in a semi-reclined position, with the baby's body close to the mother's abdomen.
This natural positioning promotes self-attachment and enables the baby to use their innate instincts to find the breast and feed at their own pace. The laid-back position has been found to not only reduce feeding fatigue but also decrease the risk of respiratory issues as the baby's airway remains unobstructed, and regurgitation is less likely to occur.20
Furthermore, premature newborns are more likely to face medical challenges that can impact their ability to breastfeed effectively and efficiently. Conditions such as gastroesophageal reflux disease (GERD), congenital heart defects, or respiratory issues can further complicate breastfeeding if the right position is not adopted.21
The side-lying position, where the mother and baby lie on their sides facing each other, can be particularly helpful for premature babies with medical challenges. This position allows gravity to help with swallowing and reduces the risk of milk aspiration. Additionally, mothers can adjust their baby's head elevation to accommodate specific medical needs. For example, elevating the baby's upper body slightly can be beneficial for those with GERD as it helps keep stomach contents down.22
The importance and the benefits of finding the right breastfeeding position cannot be overlooked especially for premature newborn babies. The right breastfeeding position will allow for optimal nutrient absorption, assist in proper digestion, prevent digestive issues, prevent feeding fatigue and reduce the risk of respiratory issues.
This article will dive into various breastfeeding positions suitable for premature babies, explaining how each position can address specific challenges, such as latching difficulties and feeding fatigue. By finding the right position, parents can ensure their little ones receive the nourishment they need to thrive. Also, this article will provide practical tips and guidance to help parents create a supportive and nurturing breastfeeding environment for their premature newborn babies.
Challenges of breastfeeding premature babies
Unique considerations and obstacles
Breastfeeding premature newborn babies comes with a list of specific obstacles and requires careful consideration to ensure their optimal growth and development. Premature newborn babies face unique challenges due to their early arrival into the world which makes the breastfeeding journey a slightly more complicated but doable one.
For this reason, several factors come into play that demand special attention and understanding from parents and healthcare providers alike.
Immature suck-swallow-breathe coordination
Premature babies often have an underdeveloped suck-swallow-breathe coordination which makes breastfeeding a difficult activity for them. The ability to coordinate these essential functions is crucial for effective and efficient feeding and preventing aspiration.
Latching difficulties are common, and premature infants may tire easily during feeding due to their limited energy reserves. Navigating this obstacle requires patience, gentle support, and using breastfeeding positions that help with self-attachment.23
Nutritional and caloric needs
Premature babies have higher nutritional requirements than full-term infants because they are born during a critical period of rapid growth. Breast milk is the optimal source of nutrients for them, but its’ composition may differ from that of mothers with full-term babies.
Preterm breast milk often contains higher levels of protein, fat, and certain vitamins to support the baby's growth. Lactation consultants play a crucial role in helping mothers produce adequate milk supply while addressing the baby's specific nutritional needs.24
Neonatal intensive care unit (NICU) stay
Many premature babies require care in the Neonatal intensive care unit (NICU) right after birth. This can complicate breastfeeding, as mothers may face separation from their newborns and experience difficulty in initiating breastfeeding.
The NICU environment may also be overwhelming and stressful for both the mother and baby, affecting the establishment of breastfeeding. In such cases, practising kangaroo care (skin-to-skin contact) when possible and using techniques like pumping and cup feeding can help with the breastfeeding process.25
Risk of infections and medical challenges
Premature infants have weaker immune systems, which increases their vulnerability to infections. Breast milk plays a crucial role in providing essential antibodies and immune factors that protect them from infections and boost their immunity.
However, if the mother has certain infections, breastfeeding may need to be temporarily adjusted or supplemented with pasteurised donor breast milk. Additionally, some preterm babies may face medical challenges like respiratory issues, which makes it important to accommodate positioning adjustments during breastfeeding to aid in breathing and reduce the risk of aspiration.26
Low birth weight and growth concerns
Premature babies often have low birth weight, which increases concerns about their growth trajectory and adequate weight gain. Regular monitoring and growth assessments are essential to track their progress. Healthcare providers may recommend additional supplementation or fortification of breast milk to ensure they receive the necessary calories and nutrients for healthy growth.27
Breastfeeding support and education
Addressing the obstacles of breastfeeding premature babies requires comprehensive support and education for both mothers and caregivers. Lactation consultants, nurses, and healthcare providers all play an important role in providing guidance on breastfeeding techniques, addressing concerns, and offering emotional support.
Mother-to-mother support groups and resources can also be valuable in sharing experiences and coping strategies.28
The role of healthcare professionals in providing guidance
The role of healthcare professionals in providing guidance and support for mothers breastfeeding premature newborn babies is invaluable.
To begin with, healthcare professionals, particularly lactation consultants and neonatal nurses, possess specialised knowledge and training in preterm breastfeeding. They understand the unique needs and challenges faced by premature infants and can offer tailored guidance to mothers.
From addressing latching difficulties to teaching techniques that promote effective feeding, their expertise can significantly enhance the breastfeeding journey for both the mother and the baby.
Healthcare professionals can work closely with mothers to assess their baby's specific needs, nutritional requirements, and growth progress. They can develop personalised care plans catered to the baby’s and mom’s needs that include feeding schedules, pumping routines, and positioning techniques that suit the baby's condition, ensuring optimal growth and development.29
Additionally, healthcare professionals play a crucial role in providing emotional support and encouragement to help mothers cope with the stress and uncertainties that may arise during breastfeeding a premature infant. Their reassurance and empathy create a supportive environment that nurtures the mother-baby bond and this is incredibly beneficial for successful breastfeeding.
Healthcare professionals can also encourage mothers to engage in skin-to-skin contact (kangaroo care) whenever possible, as it helps regulate the baby's body temperature, heart rate, and breathing. This practice enhances breastfeeding initiation and supports the establishment of a strong breastfeeding relationship between the mother and the baby.30
Moreover, healthcare professionals extend their support beyond the mother to involve the entire family. They educate family members about the importance of breastfeeding for premature babies and involve them in the caregiving process. By providing families with knowledge and understanding, healthcare professionals can help create a supportive network that contributes to the overall well-being of the baby.31
Finally, healthcare professionals play an important role in keeping track of the baby's weight gain, intake volume, and breastfeeding outcomes. They create and adjust care plans tailored to the baby’s needs to make sure that the baby is receiving adequate nutrition and thriving as they should.29,32
Recommended breastfeeding positions
Cross-cradle hold
Steps and technique
Find a comfortable position
Sit in a comfortable chair or use pillows to support your back and arms. Ensure that your feet are firmly planted on the floor. You may also use a nursing pillow or rolled-up blanket to bring the baby closer to your breast.
Support the baby's head and neck
Place your less dominant arm under the baby's head and neck, using your forearm and hand to cradle and support the back of their head. Your fingers should be positioned behind the baby's ears, and your thumb can rest on their upper back.
Position the Baby at Your Breast
Use your more dominant hand to bring the baby close to your breast. Gently touch their lips with your nipple to stimulate the rooting reflex, encouraging the baby to open their mouth wide. Ensure that their mouth is fully open before bringing them to your breast.
Latch-on
As the baby opens their mouth wide, quickly and firmly bring them towards your breast, aiming their lower lip to take in as much of the areola (the dark area around your nipple) as possible. The baby's mouth should cover a large portion of the areola to achieve a deep latch.
Proper alignment
Make sure the baby's head, neck, and body are aligned in a straight line. The baby's nose should be opposite the nipple, and their chin should touch your breast. This alignment allows for a clear airway and minimises the risk of milk aspiration.
Support your breast
If needed, use your free hand to support your breast, gently lifting it from below to provide better access for the baby to latch on deeply.
Observe the baby's cues
As the baby starts feeding, pay attention to their cues. Look for rhythmic sucking and swallowing movements, which is indicative of effective milk transfer. If you notice any signs of distress or hear clicking noises while feeding, it may be a sign that the latch needs adjustment.
Burping
After the feeding session, remember to burp the baby to release any swallowed air and reduce the risk of discomfort from gas.33
Benefits of the cross-cradle hold
Improved control and latch
The cross-cradle hold allows the mother to have better control over the baby's head and neck position during feeding. This positioning facilitates a deeper latch, where the baby takes in more of the areola, ensuring effective milk transfer.
A proper latch is crucial for premature babies, as it ensures they receive enough nutrition and prevents nipple confusion.
Facilitates suck-wwallow-nreathe coordination
Premature babies often struggle with coordinating their suck, swallow, and breathe reflexes during breastfeeding. The cross-cradle hold allows the mother to support the baby's head and neck, making it easier for them to synchronise these movements and feed more comfortably.
Skin-to-skin contact
The cross-cradle hold encourages skin-to-skin contact between the mother and the baby, promoting bonding and emotional connection. This close physical contact is particularly beneficial for premature infants, as it helps regulate their body temperature, heart rate, and breathing.
Enhanced milk transfer
By ensuring a deep latch, the cross-cradle hold helps facilitate better milk transfer from the breast to the baby. This is vital for premature babies, who require more calories and nutrients to support their rapid growth and development.
Support for preterm breastfeeding challenges
Premature babies may have difficulty latching due to their underdeveloped sucking reflexes and small mouth size. The cross-cradle hold allows the mother to guide the baby's mouth to the breast gently, providing the necessary support to overcome these challenges.
Considerations for the cross-cradle hold
Positioning
Correct positioning is critical for successful breastfeeding, especially for premature babies. Mothers should ensure that the baby's entire body, including their head, neck, and body, are in alignment. The baby's nose should be facing the nipple, and their chin should be touching the breast, allowing for a clear airway and effective feeding.
Monitoring baby's cues
Premature babies may tire easily during feeding due to their limited energy reserves. Mothers should pay close attention to the baby's cues and signs of hunger or fullness. If the baby shows signs of distress or fatigue during feeding, it may be necessary to take breaks and offer shorter, more frequent feeding sessions.33
Seek support and guidance
Breastfeeding premature babies can be challenging, and mothers may require additional support and guidance. Lactation consultants and healthcare professionals can offer valuable assistance in perfecting the cross-cradle hold technique and addressing any breastfeeding concerns or difficulties.
Alternate positions
While the cross-cradle hold can be beneficial, not all premature babies may prefer or succeed with this position. It's essential to be open to trying different breastfeeding positions to find the one that works best for both the baby and the mother.34
Football hold
Steps and technique
Positioning
Sit in a comfortable chair with good back support and bring a nursing pillow or regular pillow close to your side. You can also use rolled-up blankets or towels to lift your baby closer to your breast. Ensure that your feet are firmly planted on the floor.
Hold the Baby
Place the baby on the nursing pillow or rolled-up blankets, facing your side with their legs and feet extending towards your back. Support the baby's head and neck with the hand on the same side as the breast you will be using to feed.
Body support
Use your forearm to support the baby's back along their spine. Your hand should gently cradle the baby's neck, with your fingers behind the ears and the thumb resting on their upper back. The baby's body should be fully supported by your arm, and their hips and legs can be flexed and comfortably resting on the pillow.
Positioning the baby at the breast
Bring the baby towards your breast, ensuring that their nose is opposite the nipple. This positioning allows the baby's mouth to open wide, promoting a deep latch and effective milk transfer.
Latching on
As the baby opens their mouth wide, quickly and firmly bring them towards your breast, aiming their lower lip to take in as much of the areola (the dark area around your nipple) as possible. The baby's mouth should cover a large portion of the areola to achieve a deep latch.
Alignment
Make sure the baby's head, neck, and body are aligned in a straight line. The baby's chin should touch your breast, and their nose should be free for breathing. This alignment ensures a clear airway and proper milk transfer.
Support your breast
Use your free hand to support your breast, gently lifting it from below to provide better access for the baby to latch on deeply.
Observe the baby's cues
As the baby starts feeding, pay attention to their cues. Look for rhythmic sucking and swallowing movements, which indicate effective milk transfer. If you notice any signs of distress or hear clicking noises while feeding, it may be a sign that the latch needs adjustment.
Burping
After the feeding session, remember to burp the baby to release any swallowed air and reduce the risk of discomfort from gas.33
Benefits of the Football Hold
Improved control and support
The football hold allows the mother to have better control over the baby's head and neck position during feeding. This positioning provides extra support for the baby's body, which can be especially beneficial for premature infants who may have weaker muscle tone and coordination.
Gentle on incision sites
For mothers who underwent a caesarean section, the football hold can be more comfortable as it keeps the baby away from the incision site. This positioning also reduces pressure on the mother's abdomen, promoting a more pleasant breastfeeding experience.
Better visibility and access
The football hold allows the mother to have a clear view of the baby's latch and feeding, which is advantageous for both premature babies and mothers. The mother can easily adjust the baby's latch and ensure they are effectively transferring milk.
Reduces pressure on baby's abdomen
Premature babies may have a more sensitive abdomen due to their underdeveloped digestive system. The football hold positions the baby at the mother's side, reducing pressure on the baby's tummy, and potentially minimising discomfort.
Supports preterm breastfeeding challenges
Premature babies may have difficulty latching due to their underdeveloped sucking reflexes and small mouth size. The football hold allows the mother to guide the baby's mouth to the breast gently, providing the necessary support to overcome these challenges.33
Considerations for the football hold
Correct positioning
Proper positioning is crucial for successful breastfeeding, especially for premature babies. The baby's head, neck, and body should be aligned in a straight line. The baby's nose should be facing the nipple, and the chin should be touching the breast to ensure a clear airway and proper latch.
Support for baby's neck
Since the baby's neck is supported by the mother's forearm, it's essential to ensure that the baby's head is stable and comfortable. The mother's hand should gently cradle the baby's neck, with fingers behind the ears and the thumb on the upper back, providing adequate support.
Baby's comfort
The baby's comfort during feeding is vital, particularly for premature babies who may tire easily. Mothers should be attentive to the baby's cues and signs of hunger or fullness. If the baby shows signs of distress or fatigue during feeding, it may be necessary to take breaks and offer shorter, more frequent feeding sessions.33
Side-lying position
Steps and technique
Set up the bed
Start by arranging the bed for safe and comfortable side-lying breastfeeding. Use a firm mattress with a fitted sheet and position pillows behind your back for support. Ensure that the bed is free from any potential hazards or objects that could pose a risk to the baby.
Lie on your side
Lie down on your side facing the baby, with your head on a pillow and your body aligned in a straight line. You can place a pillow between your knees for added comfort and stability.
Position the baby
Gently place the baby on their side, facing you, with their head near your breast. Their nose should be opposite the nipple, and their mouth should be at breast level.
Support the baby's neck
Use your lower arm to support the baby's head and neck. Your forearm should be under the baby's head, with your hand gently cradling the back of their neck. This provides stability and ensures the baby's head is properly aligned with the body.
Latch-on
As the baby's mouth opens wide, bring them towards your breast and guide their lower lip to take in as much of the areola (the dark area around your nipple) as possible. The baby's mouth should cover a large portion of the areola to achieve a deep latch.34
Benefits of the side-lying position
Comfort and relaxation
The side-lying position allows both the mother and the baby to rest comfortably during breastfeeding. For mothers recovering from childbirth, especially caesarean sections, this position reduces strain on the body and promotes relaxation during feeding sessions.
Skin-to-skin contact
The side-lying position facilitates skin-to-skin contact between the mother and the baby. This close physical contact not only promotes bonding, but also helps regulate the baby's body temperature, heart rate, and breathing.
Improved milk transfer
In the side-lying position, the baby's head and body are in alignment with the mother's breast, which aids in achieving a proper latch. A deep latch ensures effective milk transfer, which is vital for the nutrition and growth of premature babies.
Reduced risk of aspiration
Side-lying breastfeeding reduces the risk of milk aspiration, as gravity helps keep milk flowing downward and away from the baby's airway. This can be particularly beneficial for premature infants who may have weaker sucking and swallowing reflexes.
Flexibility and convenience
The side-lying position allows mothers to breastfeed without having to sit up, offering flexibility and convenience during nighttime feedings or when the mother needs to rest.34
Considerations for the side-lying position
Safety
Safety is of utmost importance when using the side-lying position for breastfeeding. Ensure that the bed is firm, with no gaps or loose bedding that could pose suffocation hazards for the baby. It's essential to maintain close supervision during side-lying breastfeeding to prevent accidental rolling.
Proper latch
Achieving a proper latch is crucial for successful breastfeeding. In the side-lying position, ensure that the baby's mouth covers a significant portion of the areola, and their chin touches the breast. This positioning allows for effective milk transfer and prevents nipple soreness.
Switching sides
To stimulate both breasts and maintain a balanced milk supply, remember to switch sides for each feeding session. Supporting the baby's head with a pillow can help keep them at the appropriate level for nursing on either breast.
Burping
After the feeding session, remember to burp the baby to release any swallowed air and reduce the risk of discomfort from gas.34
Laid-back/reclined position
Steps and technique
Find a comfortable surface
Choose a comfortable and supportive surface, such as a reclining chair, bed, or sofa, where you can recline at a comfortable angle. Make sure you have pillows or rolled-up blankets to support your back and neck.
Semi-recline
Position yourself in a semi-reclined position, leaning back at around a 45-degree angle. This reclined position helps take the weight off your arms and shoulders, making it easier to support the baby during feeding.
Place the baby on your chest
Place the baby directly on your chest, skin-to-skin, with their body facing yours. The baby's head should be near your breast, and its body should be nestled against your abdomen.
Allow skin-to-skin contact
Skin-to-skin contact is essential for promoting bonding and regulating the baby's body temperature, heart rate, and breathing. Ensure that the baby's bare chest is in direct contact with your skin.
Follow the baby's cues
In the laid-back position, allow the baby to lead the way. Premature babies have strong instincts and will naturally move towards the breast. Follow their cues and allow them to find the breast and latch on at their own pace.35
Benefits of the laid-back/reclined position
Enhanced skin-to-skin contact
The laid-back position promotes skin-to-skin contact between the mother and the premature baby. This physical closeness helps regulate the baby's body temperature, heart rate, and breathing, creating a nurturing environment that mimics the womb.
Natural latch-on
In the laid-back position, babies are encouraged to use their natural instincts to find the breast and latch on. This often leads to a deeper latch, ensuring effective milk transfer and reducing the risk of nipple soreness for the mother.
Improved milk transfer
With a proper latch and a more relaxed feeding environment, premature babies may be more effective at extracting milk during breastfeeding. This can be especially beneficial for their growth and development during a critical period.
Reduced reflux and spitting up
The laid-back position allows gravity to work in the baby's favor, reducing the likelihood of reflux and excessive spitting up during and after feedings.
Comfort for mother and baby
The semi-reclined position provides comfort for both the mother and the baby during feeding. The mother's back and arms are supported, reducing strain, while the baby can nestle against the mother's body for security.
Enhanced bonding
The laid-back position fosters a sense of security and closeness between the mother and the premature baby, promoting bonding and emotional connection35.
Considerations for the laid-back/reclined position
Safety
Safety is of utmost importance during the laid-back position. Ensure that the mother is in a stable and comfortable position, with proper support for her back and neck. Use pillows or rolled-up blankets to achieve the right angle for semi-recline.
Prematurity-related challenges
Premature babies may have weaker muscle tone and coordination, which can affect their ability to latch effectively in the laid-back position. It's essential to be patient and provide support as the baby learns to find the breast.
Latching assistance
While the laid-back position encourages babies to self-latch, some premature infants may require gentle guidance to achieve a proper latch. Mothers can use their hands to support the baby's head and guide them towards the breast.
Feeding cues and breaks
Premature babies may tire more quickly during feedings. Pay close attention to their feeding cues and take breaks as needed to ensure they are comfortable and can effectively transfer milk36.
Tips for successful breastfeeding
Responding to baby’s cues
It is incredibly important to be attuned to a baby’s needs and cues when breastfeeding and that becomes even more important when you have a premature infant. Premature infants have unique needs and challenges when it comes to breastfeeding, which makes it especially important for their breastfeeding mothers to be focused and responsive.
Premature babies may display subtle hunger cues, such as rooting (turning their head toward anything that touches their cheek), licking their lips, or making sucking motions. It's crucial for the mother to be observant and recognise these cues as signs that the baby is ready to feed.37
It is very important to follow the baby’s cues and to feed them when they show signs of hunger even when it is not their feeding time. Additionally, it is of vital importance that mothers of premature infants understand the importance of skin-to-skin contact as it is highly beneficial for premature infants.38
Before and during breastfeeding, ensure that the baby is placed against the mother's bare chest to promote bonding and emotional connection, regulate the baby's body temperature, and encourage feeding readiness. Furthermore, premature babies may have difficulty latching due to their small mouth size or underdeveloped sucking reflexes.39
Mothers can support latching by gently guiding the baby's mouth to the breast and ensuring a deep latch for effective milk transfer. Finally, mothers of premature infants must pay attention to the baby's cues that indicate they are full or satisfied.
Premature babies may show signs of contentment, such as slowing down their sucking, releasing the breast, or turning their head away.39 Further considerations include realising that premature babies may swallow more air during feeding, leading to discomfort from gas.
Hence, new mothers should take breaks during feeding to burp the baby and release any trapped air, promoting more comfortable and less fussy feedings. Moreover, a new mother of a premature infant should be keeping track of the baby's weight gain and feeding patterns with the help of healthcare professionals.
Regular weight checks can help ensure that the baby is getting enough nutrition and growing at an appropriate rate.40
Utilising lactation consultants and support groups
The use of lactation consultants and support groups can be immensely beneficial for mothers of newborn premature infants. Lactation consultants are trained professionals with expertise in breastfeeding and supporting mothers and babies.
They can provide individualised guidance and solutions tailored to the specific needs of premature infants. These licensed professionals can help mothers in establishing a breastfeeding schedule that works for them and the baby, they can also help new mothers with latching issues and teach mothers techniques to increase milk supply if needed.
Additionally, mothers of premature infants may choose lactation consultants with previous experience with premature infants as they might understand the specific challenges that may arise, such as weak sucking reflexes, low muscle tone, and difficulties latching and could offer targeted strategies to overcome these challenges and help mothers of premature infants establish a healthy breastfeeding routine.
Moreover, lactation consultants can provide emotional support, reassurance, and encouragement, helping new mothers of premature infants build confidence in their ability to breastfeed and care for their premature babies. It is, hence, essential to be in touch with a lactation consultant while breastfeeding your premature infant, especially because lactation consultants stay informed about the latest research and best practices in breastfeeding premature babies.
They can provide evidence-based information and help mothers make informed decisions regarding their baby's nutrition and care.41
Another way new mothers of premature infants can find support is by joining support groups for mothers of premature infants to create a sense of community and understanding. Interacting with other mothers who are going through similar experiences can be immensely comforting and reassuring.
It allows mothers to share their challenges, exchange tips, and celebrate each other's successes. This gives new mothers of premature infants the platform to listen to other mothers’ stories, problems and successes, which helps new mothers find hope and inspiration to help in their own journeys.
Additionally, lactation consultants and support groups can offer problem-solving skills and strategies to address issues such as low milk supply, nipple pain, or difficulties with pumping and storing breast milk.42
It is important to remember that breastfeeding support is not limited to the early postpartum days. Lactation consultants and support groups can offer ongoing assistance, helping mothers navigate the transition from hospital to home and supporting them as their premature infants grow and develop.
Implementing a breastfeeding schedule
Implementing a breastfeeding schedule for mothers of premature infants requires careful consideration of the baby's unique needs and challenges. Premature babies may have smaller stomachs, weaker sucking reflexes, and lower energy reserves which makes it important to create a feeding plan that supports their growth and development.
Here are some guidelines for establishing a breastfeeding schedule for mothers of premature infants:43
Work with healthcare professionals
Collaborate with the neonatal healthcare team, including neonatologists, nurses, and lactation consultants. They can provide valuable insights into the baby's condition, feeding readiness, and nutritional requirements.
Initiate skin-to-skin contact
Begin skin-to-skin contact as soon as possible after birth. This practice, also known as kangaroo care, helps to stabilise the baby's vital signs, regulate body temperature, and promotes bonding.
Follow baby's cues
In the early days, follow the baby's hunger cues for feeding. Premature babies may have smaller, more frequent feeds compared to full-term infants. Watch for rooting, licking lips, or sucking motions, indicating that the baby is ready to feed.
Demand feeding
Consider adopting an on-demand feeding approach, allowing the baby to feed whenever it shows signs of hunger. This may mean feeding every 1.5 to 3 hours during the day and potentially at longer intervals during the night, depending on the baby's weight and health.
Gentle wake-up techniques
Premature babies may be sleepy and have weaker sucking reflexes. To encourage feeding, gently wake the baby if they show little interest in latching or are not feeding effectively.
Use breast pump
For mothers whose premature babies are not yet latching or are not feeding well at the breast, a breast pump can be helpful in expressing breast milk. This helps maintain milk supply and provides milk for the baby, even if they cannot feed directly from the breast initially.
Gradual increase in feeding volume
In the early days, the baby's stomach is tiny and may not tolerate large feeds. Gradually increase the volume of breast milk offered as the baby grows and tolerates more significant volumes.
Monitor weight gain
Regular weight checks help assess the baby's growth and the effectiveness of breastfeeding. Weight gain is an essential indicator of whether the baby is receiving adequate nutrition.
Proper latch and positioning techniques
Proper latch and positioning techniques are crucial when breastfeeding premature infants to ensure effective milk transfer, prevent nipple pain, and promote a positive feeding experience. Utilising the laid-back or reclined position, also known as biological nurturing, can be very helpful when breastfeeding premature infants as it helps in promoting skin-to-skin contact and a more relaxed feeding environment, and it allows the baby to use their instincts to find the breast and latch on naturally.
Another trick to help with latching is through positioning the baby's nose opposite the nipple, ensuring that the head is slightly tilted back to open its mouth wide. This alignment helps the baby take in a larger portion of the areola, facilitating a deeper latch.
Additionally, ensuring the baby's chin is touching the breast during latching helps the baby maintain a secure latch and prevents nipple soreness. You should also wait for the baby to open its mouth wide before bringing them to the breast.
This helps them latch deeply, promoting efficient milk transfer and reducing the risk of nipple damage.44
Troubleshooting common challenges
Low milk supply
A lot of new mothers face the issue of low milk supply which can be particularly stressful when you have a premature infant that you are eager to feed to promote optimal growth. However, troubleshooting low milk supply when breastfeeding a premature infant requires you to remain proactive and patient.
One thing you can do is to ensure that you are providing frequent and effective nursing or pumping sessions to stimulate milk production. Feed the baby on demand, including overnight, and consider using a hospital-grade pump to express milk between feedings.
You can also increase skin-to-skin contact with the baby, as this can boost milk supply and foster a strong breastfeeding bond. Moreover, it is also of vital importance to stay well-hydrated and consume a balanced diet with enough calories to support breastfeeding.45
Nipple confusion
Nipple confusion may be a frustrating problem for new mothers of premature infants, however, there are ways to deal with this issue. Mothers could delay introducing artificial nipples, such as pacifiers or bottles until breastfeeding is well-established.
Mothers could also prioritise direct breastfeeding whenever possible, as this encourages proper latch and feeding techniques. If supplementation is necessary, new mothers use slow-flow nipples on bottles to mimic breastfeeding flow.
Additionally, breastfeeding mothers could consider finger feeding or using a supplemental nursing system (SNS) to avoid artificial nipple use.46
Poor latch or difficulty latching
To troubleshoot poor latch or difficulty latching, the breastfeeding mother should ensure that the baby is in a comfortable and supported position, with their nose aligned with the nipple. Using the laid-back or reclined position could also be helpful to encourage a more natural latch.
The breastfeeding mother could also offer gentle guidance to help the baby open their mouth wide for a deep latch. However, it is important to remember that persistence and patience are key as premature babies may require more time to establish a successful latch.47
Summary
This article emphasised the significance of breastfeeding for premature babies and the benefits of finding the right breastfeeding position. Breast milk provides essential nutrients and immunological properties that support the healthy development of premature infants, promoting weight gain, improved brain development, and reduced infection risk. Breastfeeding also fosters emotional bonding and positively impacts neurodevelopment in premature babies.
Finding the right breastfeeding position is crucial for premature infants, as it aids nutrient absorption and digestion. The cross-cradle and football hold positions have been found particularly beneficial. The laid-back position supports self-attachment and reduces feeding fatigue and respiratory issues. Premature babies with medical challenges can benefit from the side-lying position.
Breastfeeding premature babies comes with unique challenges, including immature suck-swallow-breathe coordination, higher nutritional needs, NICU stay, and medical concerns. Healthcare professionals, such as lactation consultants and neonatal nurses, play a vital role in guiding and supporting mothers through these challenges. They offer specialised knowledge, personalised care plans, emotional support, and family involvement to ensure successful breastfeeding.
Overall, breastfeeding and proper positioning play a crucial role in the healthy development of premature babies, offering lifelong benefits and strengthening the bond between parents and their infants. Healthcare professionals' support and guidance are instrumental in overcoming obstacles and fostering a nurturing environment for these vulnerable babies.
References
- Bakewell-Sachs S, Gennaro S. Parenting the post-NICU premature infant. MCN Am J Matern Child Nurs. 2004;29(6):398–403.
- Moreira-Monteagudo M, Leirós-Rodríguez R, Marqués-Sánchez P. Effects of formula milk feeding in premature infants: a systematic review. Children (Basel). 2022 Jan 24;9(2):150.
- Obeidat HM, Bond EA, Callister LC. The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ [Internet]. 2009 [cited 2023 Jul 31];18(3):23–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730907/
- Shamir R. The benefits of breast feeding. Nestle Nutr Inst Workshop Ser. 2016;86:67–76.
- Martin CR, Ling PR, Blackburn GL. Review of infant feeding: key features of breast milk and infant formula. Nutrients [Internet]. 2016 May 11 [cited 2023 Jul 31];8(5):279. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882692/
- Juharji H, Albalawi K, Aldwaighri M, Almalki A, Alshiti H, Kattan W, et al. Impact of breastfeeding on low birthweight infants, weight disorders in infants, and child development. Cureus [Internet]. [cited 2023 Jul 31];14(12):e32894. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9870598/
- Goldman AS, Chheda S, Keeney SE, Schmalstieg FC. Immunology of human milk and host immunity. Fetal and Neonatal Physiology [Internet]. 2011 [cited 2023 Jul 31];1690–701. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310932/
- Lawrence RM. Host-resistance factors and immunologic significance of human milk. Breastfeeding [Internet]. 2011 [cited 2023 Jul 31];153–95. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158292/
- Collins A, Weitkamp JH, Wynn JL. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed [Internet]. 2018 Jul [cited 2023 Jul 31];103(4):F391–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013388/
- Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin North Am [Internet]. 2013 Feb [cited 2023 Jul 31];60(1):31–48. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508512/
- Lyons KE, Ryan CA, Dempsey EM, Ross RP, Stanton C. Breast milk, a source of beneficial microbes and associated benefits for infant health. Nutrients [Internet]. 2020 Apr 9 [cited 2023 Jul 31];12(4):1039. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231147/
- Krol KM, Grossmann T. Psychological effects of breastfeeding on children and mothers. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz [Internet]. 2018 [cited 2023 Jul 31];61(8):977–85. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096620/
- Altimier L, Phillips R. The neonatal integrative developmental care model: advanced clinical applications of the seven core measures for neuroprotective family-centered developmental care. Newborn and Infant Nursing Reviews [Internet]. 2016 Dec 1 [cited 2023 Jul 31];16(4):230–44. Available from: https://www.sciencedirect.com/science/article/pii/S1527336916301118
- Belfort MB. The science of breastfeeding and brain development. Breastfeed Med [Internet]. 2017 Oct 1 [cited 2023 Jul 31];12(8):459–61. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651963/
- Indrio F, Neu J, Pettoello-Mantovani M, Marchese F, Martini S, Salatto A, et al. Development of the gastrointestinal tract in newborns as a challenge for an appropriate nutrition: a narrative review. Nutrients [Internet]. 2022 Mar 28 [cited 2023 Jul 31];14(7):1405. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9002905/
- Joshi H, Magon P, Raina S. Effect of mother–infant pair’s latch-on position on child’s health: A lesson for nursing care. J Family Med Prim Care [Internet]. 2016 [cited 2023 Jul 31];5(2):309–13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084553/
- Ezeukwu OA, Ojukwu CP, Okemuo AJ, Anih CF, Ikele IT, Chukwu SC. Biomechanical analysis of the three recommended breastfeeding positions. Work. 2020;66(1):183–91.
- Pehlivan N, Demirel Bozkurt O. Comparison of cradle hold versus football hold breastfeeding positions after cesarean section in primiparous mothers. Breastfeed Med. 2021 Nov;16(11):904–8.
- Kamity R, Kapavarapu PK, Chandel A. Feeding problems and long-term outcomes in preterm infants—a systematic approach to evaluation and management. Children (Basel) [Internet]. 2021 Dec 8 [cited 2023 Jul 31];8(12):1158. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700416/
- Wang Z, Liu Q, Min L, Mao X. The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis. BMC Pregnancy Childbirth. 2021 Mar 24;21(1):248.
- Gulati IK, Jadcherla SR. GERD in the NICU Infant: Who needs to be treated and what approach is beneficial? Pediatr Clin North Am [Internet]. 2019 Apr [cited 2023 Jul 31];66(2):461–73. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400306/
- Raczyńska A, Gulczyńska E, Talar T. Advantages of side-lying position. A comparative study of positioning during bottle-feeding in preterm infants(≤34 weeks ga). J Mother Child [Internet]. 2022 Jun 9 [cited 2023 Jul 31];25(4):269–76. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9444194/
- Barlow SM. Oral and respiratory control for preterm feeding. Curr Opin Otolaryngol Head Neck Surg [Internet]. 2009 Jun [cited 2023 Jul 31];17(3):179–86. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724868/
- Boquien CY. Human milk: an ideal food for nutrition of preterm newborn. Front Pediatr [Internet]. 2018 Oct 16 [cited 2023 Jul 31];6:295. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198081/
- Lau C. Breastfeeding challenges and the preterm mother-infant dyad: a conceptual model. Breastfeed Med [Internet]. 2018 Jan 1 [cited 2023 Jul 31];13(1):8–17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770126/
- Camacho-Morales A, Caba M, García-Juárez M, Caba-Flores MD, Viveros-Contreras R, Martínez-Valenzuela C. Breastfeeding contributes to physiological immune programming in the newborn. Front Pediatr [Internet]. 2021 Oct 21 [cited 2023 Jul 31];9:744104. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567139/
- Thoene M, Anderson-Berry A. Early enteral feeding in preterm infants: a narrative review of the nutritional, metabolic, and developmental benefits. Nutrients [Internet]. 2021 Jul 1 [cited 2023 Jul 31];13(7):2289. Available from: https://www.mdpi.com/2072-6643/13/7/2289
- Torres JMC. Families, markets, and medicalization: the role of paid support for childbirth and breastfeeding. Qual Health Res [Internet]. 2015 Jul [cited 2023 Jul 31];25(7):899–911. Available from: http://journals.sagepub.com/doi/10.1177/1049732314553991
- Shattnawi KK. Healthcare professionals’ attitudes and practices in supporting and promoting the breastfeeding of preterm infants in nicus. Adv Neonatal Care. 2017 Oct;17(5):390–9.
- Dietrich Leurer M, Misskey E. The psychosocial and emotional experience of breastfeeding. Glob Qual Nurs Res [Internet]. 2015 Oct 23 [cited 2023 Jul 31];2:2333393615611654. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342287/
- Pound CM, Unger SL. The baby-friendly initiative: protecting, promoting and supporting breastfeeding. Paediatr Child Health [Internet]. 2012 [cited 2023 Jul 31];17(6):317–21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380749/
- The importance of infant and young child feeding and recommended practices [Internet]. World Health Organization; 2009 [cited 2023 Jul 31]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148967/
- Ojukwu CP, Okpoko CG, Ikele IT, Ilo IJ, Ede SS, Anekwu NE, et al. Neck muscles’ responses to cradle, cross-cradle and football breastfeeding hold positions in nursing mothers: a preliminary study. Niger J Clin Pract. 2022 May;25(5):563–8.
- Puapornpong P, Raungrongmorakot K, Laosooksathit W, Hanprasertpong T, Ketsuwan S. Comparison of breastfeeding outcomes between using the laid-back and side-lying breastfeeding positions in mothers delivering by cesarean section: a randomized controlled trial. Breastfeed Med. 2017 May;12:233–7.
- Trust) N (National C. NCT (National Childbirth Trust). 2022 [cited 2023 Jul 31]. Laid-back breastfeeding: benefits and uses | Baby & toddler, Feeding articles & support | NCT. Available from: https://www.nct.org.uk/baby-toddler/feeding/early-days/laid-back-breastfeeding-benefits-and-uses
- Wang Z, Liu Q, Min L, Mao X. The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis. BMC Pregnancy and Childbirth [Internet]. 2021 Mar 24 [cited 2023 Jul 31];21(1):248. Available from: https://doi.org/10.1186/s12884-021-03714-8
- Crump EP, Gore PM, Horton CP. The sucking behavior in premature infants. Hum Biol. 1958 May;30(2):128–41.
- Sanford Health News [Internet]. 2023 [cited 2023 Jul 31]. The importance of skin-to-skin with baby after delivery. Available from: https://news.sanfordhealth.org/childrens/the-importance-of-skin-to-skin-after-delivery-you-should-know/
- Lau C. Development of infant oral feeding skills: what do we know?123. Am J Clin Nutr [Internet]. 2016 Feb [cited 2023 Jul 31];103(2):616S-621S. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733254/
- Thoene M, Anderson-Berry A. Early enteral feeding in preterm infants: a narrative review of the nutritional, metabolic, and developmental benefits. Nutrients. 2021 Jul 1;13(7):2289.
- Fox R, McMullen S, Newburn M. UK women’s experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services. BMC Pregnancy Childbirth [Internet]. 2015 Jul 7 [cited 2023 Jul 31];15:147. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494694/
- Brett J, Staniszewska S, Newburn M, Jones N, Taylor L. A systematic mapping review of effective interventions for communicating with, supporting and providing information to parents of preterm infants. BMJ Open [Internet]. 2011 Jan 1 [cited 2023 Jul 31];1(1):e000023. Available from: https://bmjopen.bmj.com/content/1/1/e000023
- Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frandsen A, et al. Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates. PLoS One [Internet]. 2014 Sep 24 [cited 2023 Jul 31];9(9):e108208. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177123/
- Bashiri A, Amiri-Farahani L, Salehiniya H, Pezaro S. Comparing the effects of breastfeeding in the laid-back and cradle position upon the experiences of primiparous women: a parallel randomized clinical trial. Trials [Internet]. 2023 Feb 13 [cited 2023 Jul 31];24(1):109. Available from: https://doi.org/10.1186/s13063-023-07143-0
- Asztalos EV. Supporting mothers of very preterm infants and breast milk production: a review of the role of galactogogues. Nutrients [Internet]. 2018 May 12 [cited 2023 Jul 31];10(5):600. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986480/
- Huang YY, Huang CM. [Nipple confusion and breastfeeding: a literature review]. Hu Li Za Zhi. 2006 Apr;53(2):73–9.
- Goyal RC, Banginwar AS, Ziyo F, Toweir AA. Breastfeeding practices: Positioning, attachment (Latch-on) and effective suckling – A hospital-based study in Libya. J Family Community Med [Internet]. 2011 [cited 2023 Jul 31];18(2):74–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159232/
Get our health newsletter
