FEEDING PREMATURE AND UNDERWEIGHT BABIES: IT’S NOT CHILD’S PLAY!

Breast feeding by the mother is a natural process among mammals and human beings are no exception.  Among normal babies born at full term, there is no doubt that exclusive breast feeding is the best diet for an infant in the first six months of life. But babies born prematurely and underweight are a special situation. The brainsof such premature babies are not fully developed, so theymay find it difficult to express hunger and thirst and to feed directly from the breast. To ensure adequate nutritional intake, we have to modify some of the feeding methods. These modifications are particularly important for babies born before 8 months of gestation or with a birth weight of less than 2 kg.  We have tried to answer some Frequently Asked Questions (FAQ’s) by mothers- related to the feeding of premature and underweight babies.

1. How often should I breast-feed my premature, underweight baby?

You should feed a premature or underweight baby every three hours by the clock. This includes night time feeding. This is in contrast to a full term normal weight baby who can be fed on demand. This is because a preterm baby may not be able to express his/her hunger and thirst in an effective way.

2. What feed should I give my baby?

Mother’s milk is the preferred feed even for the smallest of newborns. As these babies may not have the energy to suck out milk directly from the breast, you will have to express your milk- eitherby hand or using breast pumps- into a clean steel cup (katori) each time. You must take care to ensure that your hands are washed thoroughly with soap and water before you express the milk by hand. Breast pumps are of two kinds- mechanical and electrical. It is extremely important to ensure that the breast pump is correctly sterilised- as per the manufacturer’s instructions- otherwise the baby may suffer from diarrhoea or other infectious diseases. Hence, unless you can ensure 100% sterility, it is simpler to express by hand.

3. How should I feed my baby?

In an Indian setting, cup and spoon feeding is the safest method to feed such small babies. In our experience, mothers easily acquire the skill of spoon-feeding a baby. The spoon must be small in size (around 2-3 ml) and its edges must be smooth and rounded to avoid injury to the baby’s mouth. It is easy to wash and boil a steel spoon and cup. This makes cup and spoon feeding much safer than using a feeding bottle.You must never forcefully spoon-feed your baby, especially if s/he is sleeping, because this may result in choking.

4. Why is it risky to bottle-feed a premature baby?

Feeding bottles have many parts and are difficult to clean, thus putting them at a higher risk of contamination. The levels of bacterial contamination and heat and humidity in our environment are much higher than in developed countries, hence the major worry with bottle-feeding is the higher chance of infections. Premature babies have underdeveloped immunity and are especially prone to infections.Compared to spoon feeding, bottle-feeding also requires a greater coordination of sucking and swallowing, something which a very premature baby may find difficult.

5. In what position should I hold my baby while feeding?

Always ensure that you hold your baby in a relatively upright position (45° or above) while feeding. You must support your baby’s head and back adequately. Take care not to bend your baby’s neck forward or backwards, as it will make it difficult for him/her to breath and feed.

6. How do I know whether my baby is getting enough amount of milk?

The most objective way is to weigh your baby on a baby weighing scale once a week. If your baby is gaining about 100-150 g every week, the milk intake is adequate. Remember that an adult weighing scale does not have the required accuracy for weighing babies. So, you will have to take the baby to a local dispensary for weighing. A well-fed baby will be playful and happy after each feed; will spend the next 2-3 hours calmly sleeping and will pass urine about 8-12 times per day. Modern-day commercially available diapers are highly absorbent and it may be difficult to judge the exact number of times the baby has passed urine.

7. Is breast milk enough for my premature baby?

Although your breast milk is the ideal diet for your premature baby, it needs to be supplemented after the first 3-4 weeks of life. Premature babies have a higher requirement of proteins, minerals and vitamins, which mother’s milk may not be able to meet after the first few weeks of life. You will have to consult your child specialist, who will prescribe vitamin and mineral supplements.

8. I think my baby is not gaining weight adequately. What should I do?

In case your baby fails to gain weight adequately, consult your child specialist. Your doctor may suggest some additional measures. These include increasing the feed volume, more frequent feeding, feeding hind-milk (the later part of a breast-milk feed, which is richer in calories), adding a fortifier, and so on. There are many reasons why a premature baby may not gain weight adequately- insufficient milk intake is not the only reason. Do not make the mistake of introducing animal milk or formula milk without consulting your child specialist. You may end up doing more harm than good to your baby.

9. When should I start feeding my premature baby directly from the breast?

Once your baby reaches a weight of 1.8 kg, generally speaking, you would be able to feed your baby directly from the breast. Some babies may take a longer time depending upon their level of maturity and the illnesses that they have had. Switching over from spoon-feeding to direct breast-feeding is not a sudden process. It may take several days to gradually move to direct breast-feeding. Weeks before you start feeding directly from the breast, it would help to empty the breast by manually expressing out all the milk and suckling your baby on the empty breast. This is called “non-nutritive sucking” and it will help both you and your baby get accustomed to the process of breast-feeding.

 

Dr Binesh Balachandran and

Prof Sourabh Dutta

Newborn Unit,

Department of Pediatrics,

PGIMER