How to prepare for feeding your NICU baby.

Establishing your milk supply.

Pump your breastmilk 8 times within every 24-hour period or more often if breasts feel full. It is important to establish this consistent pumping routine as soon as possible. Pumping should last for about 15 to 20 minutes and/or until 2 minutes after the milk stops flowing. A good tip is to keep a photo of your baby with your pump. Looking at a picture of your baby may help milk to start flowing.

Skin to skin with your baby.

Benefits of skin to skin (also known as kangaroo care) include parent-infant bonding, improved milk supply, temperature stability and hormonal adjustment. Baby becomes colonized with bacteria on mom or dad's skin (which is good for baby's developing immune system).

Nonnutritive or "dry" breastfeeding.

Dry breastfeeding may begin as early as 30 weeks corrected gestational age, depending on baby's stability. Readiness cues include rooting or restlessness at feeding time, waking with temperature and diaper change and sucking on pacifier or fingers. Dry breastfeeding helps baby practice latch and suck without milk flowing.

General breastfeeding guidelines.

While learning to breastfeed, your baby may be tube fed at the same time, associating sucking with hunger satisfaction. As your baby becomes stronger and has more energy, he or she may be able to take a full feeding at the breast.

The "football" or "cross-cradle" positions usually work best for premature babies. Standard pillows or breastfeeding pillows (such as Boppy or My Brest Friend) are often helpful. Breastfeeding once per day or once per shift for a few minutes at a time is the typical starting point. Babies tend to be more stable during breastfeeding as opposed to bottle feeding when first learning to feed by mouth; they control the flow of milk at the breast. If the baby's suck is not strong, little milk will flow, allowing baby to manage breathing and eating together.

We encourage you to breastfeed your baby at least once daily and continue pumping regularly throughout your infant's NICU stay if you plan to breastfeed at home.

General feeding guidelines.

Premature babies are small, immature and get tired quickly while feeding. Babies are typically fed every three hours until they are able to take all feedings without using the tube. There are several things you can do to help your baby learn to bottle feed:

• Burping
• Pacing
• Positioning: inclined, side-lying (like the cross-cradle breastfeeding position) or upright on your lap usually work best for new feeders
• Recognizing and responding to cues

Swaddling or wrapping your baby snugly may help him or her stay focused while feeding and may help position your baby comfortably. Supporting with your hand rather than cradling your baby in the crook of your elbow helps you feel your baby's breathing pattern and you can reposition as needed.

Nipple choice and burping.

Most babies learning to feed do best with a slower flow (yellow or green rim) nipple. Some babies begin to use a standard (white rim) nipple as they progress. Other premature infants who breathe fast or get tired quickly while they eat feed better with the standard (white rim) nipple. Your baby's nurse or therapist will help you decide which nipple and position to try.

The easiest way to burp is upright or slightly forward on your lap, always supporting baby's head. Gently rub your baby's back or pat to help release air. If this technique doesn't work, try slowly moving your baby forward and back from burping position on your lap.

Pacing your baby.

The coordinated suck/swallow/breathe pattern emerges on average around 36 weeks corrected gestational age. Premature babies will often keep sucking without taking breaks to breathe due to neurologic immaturity.

Until they are able to stop and breathe on their own while feeding, we help them by using a technique called pacing. After the baby sucks a few times, tilt the bottle down to let milk out of the nipple. This helps baby stop and breathe. If the baby continues to suck while the bottle is lowered, removing the bottle completely might help.

Coordination develops with brain maturity and readiness. It is not a "practice makes perfect" skill.