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Breastfeeding your premature or ill baby

Breast milk is more than food for your premature or ill baby. Babies who are fed breast milk generally spend less time in the hospital.

Breast milk:

  • is gentle on your baby's tiny tummy and easy to digest
  • protects your baby from infections - especially life-threatening gut infections that can affect premature babies
  • improves the brain development and vision of premature babies
  • provides antibodies to build your baby’s immune system

The first milk you produce is called colostrum. It is full of nutrients and antibodies for your premature baby. Every drop of colostrum makes a difference to your baby.

Breastfeeding also helps you to bond with your baby.

Expressing breast milk

You may not be able to feed your baby at your breast if your baby is:

  • very premature
  • unwell
  • separated from you

But you can express your breast milk for your baby. Your midwife will talk to you about expressing milk.

Read about expressing breast milk for a premature or ill baby

Getting ready to breastfeed

Before your baby is ready to feed by mouth, they may get feeds through a feeding tube. But you can give them expressed breast milk through the tube.

Skin-to-skin contact with your baby will help them get ready for feeding by mouth. Skin-to-skin contact is also called kangaroo care.

When your baby has skin-to-skin contact at your breast, they can begin to lick and feel your nipple. This is called non-nutritive sucking (NNS).

NNS means sucking without getting milk. It is the first step to breastfeeding and will help your milk supply grow. NNS helps your baby associate your breast with feeding.

If your baby is very premature, express your breast milk before putting your baby to your breast.

As your baby grows and learns how to coordinate sucking, swallowing and breathing, they may show signs they are ready to feed by mouth.

The staff caring for your baby will help you to recognise these signs. They will help and support you with the first feeds. You may notice an increase in your milk supply.

At the start, your baby may only feed for a few minutes. It will take time for them to feed for longer. Express your milk after each feed. This will empty your breasts and protect your supply.

Read more about touching and holding your premature baby

Starting to breastfeed

  1. Before they are due to feed, hold your baby skin-to-skin.
  2. Massage your breasts and express a little milk onto your nipples.
  3. Support your baby in a position that will help them attach to your breast.
  4. Make sure your baby is attached to your breast and feeding well.

If you can feel sucking and hear swallowing, they are actively feeding. Let your baby feed for as long as they are actively feeding.

At the start, your baby may only take small drops of milk. They may only feed for a few minutes before they get tired. Feeds will get longer as your baby gets stronger.

If your baby does not feed fully at your breast, offer extra expressed milk after the feed. Express your milk after the feeds to protect your supply.

As your baby feeds more at the breast, you can gradually reduce the amount of expressed milk. It may take patience and many weeks before all their feeds are at your breast. Your baby may not be fully feeding at your breast when you leave the hospital.

Some premature or sick babies learn the skill of breastfeeding quickly. Other babies take longer but persistence and support will help.

Breastfeeding positions

There are many breastfeeding positions. Your nurse or midwife will help you find a comfortable position that works for you and your baby. There are very few rules about how to hold your baby when breastfeeding.

Positioning and attachment

Try to relax and get comfortable before a feed.

  1. When your baby seems ready to feed, hold them near your breast in a comfortable position.
  2. Hold your nipple near your baby’s upper lip and nose. This helps them feel the nipple and smell the breast milk.
  3. Your baby then tilts their head back, opens their mouth widely and attaches onto your breast.

The deeper the attachment, the more comfort for you and the better your baby feeds. The better your baby feeds, the more milk you make.

When you hold your baby close, they should be able to:

  • reach your breast without having to twist their head
  • tilt their head back easily

Support your baby’s neck, shoulders and back. Some babies also like to have their feet supported.

Signs your baby is attached and feeding well

When they are attached well, your baby’s:

  • mouth is open wide
  • cheeks appear ‘full’ and rounded
  • chin is tucked closely into your breast and they can breathe easily

The sucking pattern changes to long deep sucks and swallows with pauses in between. You hear slow and rhythmic sucking and swallowing sounds. There are no smacking or clicking sounds.

Your baby feeds calmly. They do not fuss or come on and off the breast. Your baby finishes feeding and seems satisfied.

You do not feel pain when your baby is attached well.

Attachment is key to successful breastfeeding

The laid-back position

Woman lying down with a baby on top breastfeeding

You may find it relaxing and comfortable to feed your baby lying back, supported by pillows or cushions.

Your body supports your baby. You have a free hand to stroke and help your baby.

Using the laid-back position:

  1. Lay your baby on top of you with their tummy down and their cheek resting near your breast.
  2. Let your baby attach to your breast themselves. You can also guide or help your baby to attach.
  3. Use your arms as guard rails to support your baby.
The cross-cradle position

A woman breastfeeding a premature baby on her left arm

The cross-cradle position can work well for a premature or sick baby. It's a good position to start with. It gives you good control of your baby’s body.

Using the cross-cradle position:

  1. Face your baby towards your breast.
  2. Rest your baby’s body along your forearm and bring them close to your body.
  3. Support your baby’s neck with your hand but do not hold or cover their head. They need space to tilt their head back.
  4. Let your baby attach to your breast themselves. You can also guide or help your baby to attach.
The football or underarm hold position

Woman holding her premature baby while breastfeeding. The baby's legs are under the arm and around the woman's back.

The football or underarm hold can be a helpful position for a premature baby. It's also a good position for feeding twins together.

You can rest your baby on a pillow or cushion.

Using the football or underarm hold position:

  1. Tuck your baby under your arm on the side you want to feed from. Your baby’s legs go under your arm and along your back.
  2. Hold your baby close to your side. Support their back, shoulders and neck with your hand.
  3. Bring your baby to the breast so your baby's nose is at your nipple.
  4. Let your baby attach to your breast themselves. You can also guide or help your baby to attach.

Breastfeeding premature twins and other multiples

Twins, triplets or more may need care from a neonatal unit. This is because these babies are more likely to arrive early.

If your babies are being cared for in a neonatal unit, skin-to-skin contact is important as soon as each baby is well enough.

Skin-to-skin contact helps you feel close to your babies. It gives them the best chance to grow and recover if they have had a difficult start. You can hold one baby at a time. Or you can hold your babies together, but you will need some help.

Try to get your breast milk supply going soon after birth and feed your babies at the breast. If your babies cannot feed at your breast yet, you can express milk for them until they are ready.

At the start, it might be easier to feed one baby at a time. You can learn how to position and attach each baby.

When you are confident with breastfeeding each baby, you can try to feed both babies together. When the first baby is feeding well, ask for help to attach the second baby.

Breastfeeding and giving breast milk to twins or other multiples can be difficult. But it is very important for keeping your babies healthy.

Read more about breastfeeding twins or triplets

Bringing your premature baby home

Bringing your baby home from the hospital can feel exciting and daunting. Hospital staff will assess your baby and they will be confident that your baby is ready to go home.

They are there to answer any questions you have before you take your baby home. They can help you build your confidence in caring for your baby.

When you are at home, continue to have regular skin-to-skin contact with your baby. It's nice to enjoy cuddles in your own home.

Read more about coming home from a neonatal or special care unit

Read more about feeding your premature baby when they come home

Information and support

Staff at the hospital will give you information and support on breastfeeding. You can also contact a local support group before you leave the hospital.

When you get home, your public health nurse (PHN) and GP can provide support and information. Many babies will have follow-up appointments with the hospital.

Support groups

Breastfeeding support groups are a great place to get advice on breastfeeding and meet other mothers.

Breastfeeding support groups are run by:

Related topic

Where to get support with feeding your baby

Find a breastfeeding support group

Read more about breastfeeding

Page last reviewed: 18 February 2021
Next review due: 18 February 2024

This project has received funding from the Government of Ireland’s Sláintecare Integration Fund 2019 under Grant Agreement Number 123.