Breastfeeding Your Premature Infant in the NICU

Breastfeeding Your Infant in the NICU

Photograph of a mother breastfeeding baby.

For a time, your baby will be cared for in the NICU (neonatal intensive care unit). But you don’t need to wait until your baby is home to start breastfeeding. Breast milk is the best food for your baby. It gives your baby the best nutrition, and it contains immune factors (substances that help the baby fight off infection). In fact, the milk you produce after a premature birth is tailored to the needs of a preemie. Breastfeeding can help you bond with your baby. It allows you to be more involved in your baby’s care. You may not be able to supply all of your baby’s food. But any amount of breast milk is better than none. Even if your baby is too small to breastfeed, pumped breast milk can be fed to your baby or frozen for future use. Your baby may also be fed breast milk with special supplements added. Before you breastfeed, tell your doctor or nurse about any medications you are taking.

How Do I Start and Maintain My Milk Supply?

Normally, breastfeeding stimulates the breasts to produce more milk. If your baby is not yet able to suckle, you can use a breast pump to start your milk supply and keep it going. The milk you collect can be given to your baby. Pumping will also help later when you begin breastfeeding. Pumping enough to keep your milk supply going takes work and commitment. You’ll need to start soon after the birth. If you don’t, it can be difficult or impossible to get a milk supply going later. Starting to pump right away gives you more options for feeding your baby.

Guidelines for Pumping

  • Begin as soon as possible after birth.

  • Pump 8–10 times per each 24 -hour period.

  • Empty the breasts with each pumping.

  • Try not to go more than 6 hours without pumping.

  • Wash your hands thoroughly before handling the breast pump or collection kit.

  • Be sure to rest and get plenty of fluids. This will help maintain your milk supply.

  • Unless told otherwise, use a hospital-grade electric pump. These can be rented for use at home.

  • To pump from both breasts at the same time (double pump), use a double milk-collection kit that attaches to the breast pump. Double pumping increases prolactin, the hormone that stimulates your breasts to produce milk. It also saves time.

  • Massage the breasts before pumping and again during the final minutes of pumping. This helps stimulate “let-down” of the milk.

  • Start with a low pump setting and increase it as you get used to the feel of pumping. 

Storing Breast Milk

It’s best for your baby to be given fresh breast milk that has just been pumped. But sometimes this isn’t practical. If so, frozen breast milk is the next best thing. To store breast milk:

  • Use sterile containers. An NICU nurse can provide these or tell you where to get them.

  • Label each bottle as instructed by the nurse. Unless told otherwise, you should write the baby’s name, the date and time the milk was pumped, whether the milk was fresh or frozen. Also list any medications you are taking.

  • Don’t mix milk from different pumping sessions unless told to do so.

  • Keep storage times in mind. Hospitals may have their own process for storing human breast milk for hospitalized infants. In general, the following storage times are recommended for NICU patients:

 Room temperature

 77°F  to 79°F

 25°C  to 27°C

 Use within 4 hours


 35°F  to 40°F

 1°C  to 4°C

 Use between 4 and 48 hours is ideal,

 but storing up to 96 hours is acceptable


 0°F  to 4°F

 -18°C  to -20°C

 Use between 48 hours and 3 months

Getting Started with Breastfeeding

Before your baby is ready to breastfeed, you may start with non-nutritive (practice) breastfeeding. This means putting the baby to the breast to suckle, without expecting the baby to feed. This can help the baby learn to suckle. It helps your baby’s digestion. It can also help you bond with your baby. And it may help prevent or overcome the baby’s “oral aversion”—a dislike of having things put in the mouth. (Some babies develop an oral aversion due to having tubes in their mouths to provide food or air.) Your baby should eventually start to take in some milk at each feeding. This amount should increase as your baby grows stronger. Before discharge from the NICU, nurses will check how much milk your baby is taking in during each feeding or will check your baby’s weight gain.

Tips for Holding Your Baby While Breastfeeding

  • For good support, hold the baby’s head with your hand, and support the body with your wrist and arm.

  • Keep the baby’s body in a straight line with the head and neck.

  • Sit in a comfortable position, so that you’re not leaning forward over the baby. Bring the baby to the breast, not the breast to the baby.

  • Use pillows or other props to help support your back and arms while you hold your baby.

Breastfeeding Positions

Preemies need to feed in positions that provide extra support for the neck and head. These are the safest positions for nursing preemies:

The “football hold.” Place a pillow at your side next to the breast you’re going to use. Lay the baby on the pillow at breast height. Place the back of the baby’s head in the palm of your hand. Use your forearm to support the shoulders and spine. Tuck the baby’s legs between your arm and body. If you’re nursing twins, you may be able to use this hold to nurse both babies at once.

The “cross-cradle hold.” Put a pillow in your lap, and lay your baby across your lap at breast height. Support the baby’s head and neck with the hand and arm opposite the breast you’re using. Hold the baby’s head just below the ears, at the nape of the neck. Use your other hand to support your breast.