m. Feeding your baby at home

We talked about breastfeeding, formula feeding and tube feeding in the NICU earlier. Now, we’d like to talk about feeding your baby at home. In the NICU, you may not have been able to feed your baby the way you wanted to. At home, you can find a quiet, comfortable place to feed your baby.

Young babies like to eat a lot. Many babies eat eight to twelve times over 24 hours. But each baby is different. Some babies are hungrier in the mornings, and other babies are hungrier at night. Over time, you will get to know your baby’s eating habits.

If you are not sure about how much milk or formula your baby needs, ask your health care provider.

How do you know when your baby’s ready to eat?

Look for her feeding cues. Feeding cues are ways that your baby tells you that she’s hungry. Examples are:

  • Rooting (turning her head toward anything that touches her cheek or mouth)
  • Sucking movements or sounds
  • Putting her hand to her mouth
  • Crying — this is a late feeding cue. Try to breastfeed your baby before she starts to cry. 

Breastfeeding

Breastfeeding a baby who has been in the NICU can be hard. But most babies, including those who were born early or have birth defects, can learn to breastfeed. Take time to get comfortable breastfeeding. Ask your lactation consultant for help. You also can get help from a breastfeeding peer counselor (a mom who has training to help women breastfeed, but not as much as a lactation consultant) or a support group.

Breastfeeding mothers often worry that their baby isn’t getting enough to eat. That’s because they can’t see exactly how much their baby is eating. Your baby is probably getting enough milk if she: 

  • Is making six to eight wet diapers and two to five dirty diapers in 24 hours
  • Is gaining weight

Getting Started: 5 steps to help you breastfeed

  1. Find a comfortable place to sit or lay with your baby.
  2. Gently guide your baby so that his nose is close to your nipple. With one hand, support his head. With the other hand, hold your breast and tickle his lip with your nipple.
  3. When your baby opens his mouth, bring him to your breast. Bring him to you — don’t lean into him. Your baby should have a good mouthful of your areola, the area around your nipple. This is called latching on. When your baby has a good latch, you feel his tongue pull your breast deep into his mouth. If you feel his tongue at the tip of your nipple, it’s not a good latch. Latching on is important for your comfort and to help your baby get enough milk.
  4. When your baby stops feeding, burp him. Sit him on your lap. Support his chest and head with one hand and pat his back with your other hand.
  5. After he burps, offer him the other breast. It’s OK if he doesn’t want it.

If you need to stop nursing, don’t try to pull your baby off your breast. Instead, put your pinky finger in the side of his mouth to release the latch. Breastfeeding may be uncomfortable at first, but should become less so as time goes on. If it doesn’t, talk to your provider or lactation consultant. You probably just need a little help getting started. Don’t feel badly about asking for help. 

How do you hold your baby when you breastfeed?

There are different ways to hold your baby when you breastfeed. Try them all to find out which one you and your baby like best. You may want to use a pillow to help support the baby. The cross-cradle and football holds let you have the best control of your breast and your baby’s head. These are the easiest holds for breastfeeding when you’re just starting out. The football hold is also called the clutch hold.

Pumping

You may already have used a breast pump in the NICU. Many women find it helpful to use a breast pump when they are going back to work or school or just want a break from feedings. Also pumping your breast milk lets your partner feed and bond with the baby. 

If you need to store breast milk, you’ll just need a few supplies to keep your breast milk safe. 

  • Bottles or bags — These are made just to store pumped breast milk. The bags are plastic, and the bottles are plastic or glass. You can buy them at most grocery or drug stores. 
  • Cooler — You may need a small cooler to keep your pumped milk cold until you get it home. After you pump, put your pumped breast milk in bottles or bags and store them in the refrigerator or freezer. Put just the amount of milk your baby needs for each feeding in each bottle or bag. Breast milk doesn’t last forever, so write the date on the bottle or bag before you store it. Refer to the chart to the left for how long you can store breast milk.

Here’s how long you can store breastmilk:
WHERE HOW LONG
Refrigerator (temperature must be 32F to 39F) 5 to 8 days
Freezer inside a refrigerator 2 weeks
Freezer that has its own door (not inside refrigerator) 3 to 6 months
Separate freezer 6 to 12 months

 

Formula-feeding

Your baby’s health care provider will tell you what kind of and how much formula to feed your baby. Some babies leave the hospital on regular infant formula. Other babies need a special formula that has more calories or certain nutrients. Be sure to follow your provider’s feeding plan to make sure that your baby is gaining enough weight. If your baby sleeps for long periods of time, you may need to wake him up every few hours to eat. Ask your baby’s health care provider for help if you need to wake up your baby for feedings.

Be sure to prepare the formula according to the package directions or your baby’s health care provider.

There are three kinds of formula:

  1. Ready-to-use liquid formula — Just put the formula in the baby’s bottle, warm the bottle if needed and feed to your baby.
  2. Liquid formula that is concentrated — You must add water to this formula before giving to your baby.
  3. Dry or powdered formula — You must add water to the powder before giving to your baby.

Use the scoop that comes with the formula to measure the right amount of powder. Make sure you put the water in the bottle first, then the formula and shake well to mix.

If your baby doesn’t drink all the formula in his bottle within 1 hour, throw it away. Give him a new bottle of fresh formula at the next feeding. 

Nipples and bottles

If your baby has done well with the nipples and bottles used in the hospital, ask to take some home. Also ask where you can buy them. If the nipples and bottles used in the hospital didn’t work well, you will need to try different ones to find out what your baby likes best. Clean and store the bottles and nipples according to the package directions.  You don’t have to sterilize them unless your baby’s health care provider says you need to.

The best way to warm your baby’s bottle is to put it in a cup of warm water. Test the milk on your wrist to make sure it isn’t too hot — it should be lukewarm. Never microwave your baby’s bottle. The milk can heat unevenly and burn your baby’s mouth.

Reflux and spitting up

Reflux happens when food in the stomach comes back up during or after a feeding. All babies spit up once in a while, but some do it a lot. It often happens to babies who were born early. Reflux cam happen whether your baby is breastfed or bottlefed or whether they get breast milk or formula. Most of the time babies outgrow the condition in a few months. And most babies don’t seem to be upset by reflux.

These tips can help lower the chances of your baby spitting up:

  • Hold your baby upright during feeding.
  • Try feeding your baby more often and in smaller amounts.
  • Burp your baby often, especially if you are feeding him with a bottle.
  • Try a different nipple on your baby’s bottle so he swallows less air.
  • Do not put your baby in a car seat or infant seat after feeding.
  • Keep baby still after feeding.

Keep some cloth diapers or burp cloths nearby. Use them to protect your clothes, your baby’s clothes and your furniture. 

Call your baby’s provider if:

  • The spit up is bright yellow or green
  • There is a large amount of spit up
  • Your baby’s vomit seems to come out forcefully, also called projectile vomiting
  • Your baby arches her back or cries when feeding

These may be signs that your baby has problems digesting food. Ask your baby’s health care provider what to do.