g. Feeding in the NICU

Before your baby was born, you may have thought about what it would be like to hold and feed him. And you may already have decided whether to feed your baby breast milk or formula. But now that your baby is in the NICU, you may need to change your plans. Talk to your baby’s medical team about the best ways to feed your baby.

Tube feeding
Babies who are too sick or weak to breastfeed or drink from a bottle may need to be fed through a thin tube. This tube is called a nasogastric tube (also called NG tube). It is placed through the nose into the baby’s stomach. If the tube is placed through the baby’s mouth it is called an orogastric tube (also called OG tube). Many babies who are tube fed can still practice breastfeeding and bottle feeding.

Breastfeeding
Breast milk is wonderful food for your baby. It has vitamins, nutrients and antibodies (Cells in the body that fight off infection) that can help him get stronger. Some babies will be able to breastfeed in the NICU, while other babies may need to get breast milk from a bottle or feeding tube.

Some babies can benefit from non-nutritive sucking (sucking that a baby does, but not for feeding). This is sucking a baby does, but not for feeding. As soon as your baby can, let him practice sucking at your breast to get ready for breastfeeding. Pump your breast and let your baby touch, taste and lick your breast to get used to what breastfeeding is like.

Many babies in the NICU fall asleep soon after you begin to feed them. This can be very frustrating. Check with your nurse or lactation consultant about how often to feed your baby and how to make sure he is getting enough milk.

Breast milk changes as your baby grows so he gets exactly what he needs at the right time. For the first few days after giving birth, your breasts make a thick, yellowish form of breast milk called colostrum. It has nutrients and antibodies that your baby needs in the first few days of life. Your body will produce a small amount of this before it changes to breast milk in about 3 to 4 days. Every drop counts, so even if you get a few drops it’s OK and can still be used to feed your baby.

Remember, it takes time and practice before you and your baby are comfortable breastfeeding.

Feeding your baby with special needs. Because your baby is in the NICU, you may need extra help to make breastfeeding work. Having a baby born with a birth defect like a cleft lip or palate can also make it hard to feed your baby. Ask the nurse or lactation consultant how to hold and feed your baby.

For babies with special needs, a nipple shield may help your baby latch on and get enough milk. A nipple shield is a piece of soft, thin plastic that fits over the nipple. It has holes in it that let milk flow to your baby.

Using a breast pump
If you are planning to breastfeed and your baby isn’t ready to do that, you may need to pump milk for your baby. Using a breast pump may feel awkward at first. But with practice, pumping becomes easier and more comfortable. It’s a great way to make sure your baby is getting your healthy breast milk.

A breast pump helps you remove milk from your breasts. Your nurse or lactation consultant can show you how to use the pump. It’s best to use a hospital-grade electric pump. It gets the most milk from your breasts in the shortest amount of time. You can use the milk to feed your baby at a later time.

When to pump. You can begin pumping within 2 to 4 hours after your baby is born. Pump every 2 to 3 hours during the day. Be sure to start out at a low setting on your pump so you don’t hurt yourself. It may take a few minutes for your milk to come out, so be patient as you begin to pump. Also, pump right before you go to bed, once in the middle of the night and when you wake up in the morning. You may need to pump more often if you are trying to make more milk.

Keep a record. It’s a good idea to keep a record of when you pump. Write down the date, time and how much milk you pump. By the end of the first week, you want to make at least 16 ounces of milk every 24 hours. If you are feeling frustrated that you are not making a lot of milk, ask your nurse or lactation consultant for help. Some moms find they can build up their milk supply by:

• Getting more rest
• Eating well
• Pumping after or between feedings
• Pumping for the same amount of time each time they pump
• Pumping in a quiet, comfortable place where you can relax

Formula feeding
If you want or need to use formula, talk to your NICU team about which formula is best for your baby. Some formulas can be put into the baby’s bottle without mixing first. Other formulas need to be mixed with water. Practice mixing the formula and feeding your baby with a bottle. Find out how much formula to feed your baby at the hospital and at home.

Feeding multiples
When you have more than one baby, feeding decisions can seem challenging. You may find that one baby feeds better from the breast and another from the bottle. One baby may do better on breast milk, and another on formula. You may choose to pump milk for all your babies, and substitute formula when needed.

Burping
Ask how to hold your baby during burping. Also, ask your baby’s health care provider about how much spit-up is OK and how much is cause for concern.