Breastfeeding Late Premature Babies

Premature baby sleeping

Late premature babies, also called “late preemies,” are born between 34 to 36 weeks. One in 10 babies born in the U.S. each year are premature (premature birth before 37 weeks or their due date), and 70% of babies who born prematurely are “late preemies.”  

Late Premature Babies

Babies can arrive early for many different reasons with risk factors including maternal high blood pressure during pregnancy, pre-eclampsia, gestational diabetes, cervical incompetence, fetal growth restriction, and infections during pregnancy. Most twins are also delivered at/around 36 weeks

Many late preemies need to spend time in the neonatal intensive care unit (NICU) before leaving the hospital especially if they are at higher risk of health problems. Although babies born between 34 to 36 weeks of pregnancy often look like full-term babies (only smaller) there are major physiologic differences. One example is that the brains of late preterm infants are only 2/3 of the size of those of full-term infants.  

As a result of immature brain and nervous system development, late premature infants have an increased risk of low birth weight, feeding difficulties, and breathing struggles. In some cases, they may require a temporary feeding tube due to not being able to coordinate sucking, swallowing, and breathing at the same time.

Other Problems Encountered by Late Preemies:

  • Pauses in breathing (apnea)
  • Abnormal heart rate drops (bradycardia)
  • Respiratory distress (due to premature lungs)
  • Temperature instability
  • Jaundice
  • Infections
  • Low blood sugar levels
  • Excessive weight loss
  • Slow weight gain
Breastfeeding momBreastfeeding mom

Common Breastfeeding Challenges for Mothers of Late Preemies

  • Delayed lactogenesis II (mother’s milk “coming in”)
  • Being sleepy at the breast and falling asleep during feeds
  • Difficulty latching on
  • Having a shallow latch
  • Pain with breastfeeding
  • Logistics associated with breastfeeding multiples (twins or triplets)

Delayed lactogenesis II can result from multiple factors, including health problems, pregnancy complications, delivery by c-section, maternal-infant separation due to a NICU admission, and/or ineffective latch in the early postpartum period. Many of these breastfeeding challenges can be overcome with intense inpatient and outpatient lactation support with an IBCLC (lactation consultant), health care provider or other trained breastfeeding professional. 

Pumping, nipple shields, supplemental nursing systems, and galactagogues are all commonly used “tools” in establishing successful breastfeeding and milk supply with a late premature infant. Some late preemies will require special care and supplementation with donor breast milk or formula, if there is too long of a delay in their mothers’ breast milk coming in, to prevent excessive weight loss and other problems like low blood sugar levels.

FAQs about Breastfeeding Late Premature Infants

1. How can I wake up a newborn baby who is too sleepy to feed?  

Tips for waking a sleepy baby to feed include undressing baby prior to feeding, feeding in a room with a lot of natural light, compressing your breasts during feeding to increase milk flow, having long periods of uninterrupted skin-to-skin contact, switching sides/positions while nursing, and gently stroking or rubbing your baby’s back, hands, or feet before and during feeding sessions.

2. Are herbal galactagogues safe to take while breastfeeding a late preemie? 

Yes, all commonly used herbal galactagogues, including fenugreek, can be used while breastfeeding preemies.

3. Can I use any type of breast pump, or are there certain ones to use for a late premature infant? 

If you are pumping for a preemie, it’s recommended to use a high quality, double electric breast pump, with properly sized flanges. 

4. Can I keep breastfeeding if I develop mastitis? 

Healthy late preterm babies can continue to breastfeed while their mothers have mastitis. If there is any concern that your newborn might have a compromised immune system, the decision as the whether to feed from the affected breast should be made in consultation with a breastfeeding medicine specialist.

5. The doctors say I need to add a special human milk fortifier powder to the bottles of pumped milk. Is this necessary?   

 Most late preemies who are breastfeeding do not need human milk fortifier supplements. But if your baby was born small for their gestational age, has had problems gaining weight, and/or low levels of minerals needed for bone growth, such as calcium and phosphorous, they may need temporary fortification. The decision as to when to start or stop fortification of breast milk should ideally be made in consultation with your baby’s pediatrician and a pediatric nutritionist (dietician). 

FLEXIBILITY is key when breastfeeding babies who are late preemies. Breastfeeding preterm newborns often requires supplemental feedings, needing to pump early and often in the postpartum period and often, and using special equipment, such as nipple shields and supplemental nursing systems.  

Each mother who is breastfeeding a late preemie will benefit from working with a lactation consultant, both in the hospital and outpatient setting. If you deliver prematurely, it’s very important to make sure that you have a lot of help and support lined up for after you come home. Your “village” can consist of your partner, family members, friends, neighbors, doulas, night nurses, lactation consultants, and other newborn care specialists.  You can never have too much help in the early weeks of breastfeeding any newborn, especially late preemies!

About the Author

Jessica Madden, MD, is the Medical Director at Aeroflow BreastpumpsDr. Madden has been a board-certified pediatrician and neonatologist for over 15 years. She's currently on staff in the neonatal intensive care unit (NICU) at Rainbow Babies and Children’s Hospital in Cleveland, OH. She previously worked in the Boston and Cleveland Clinic Children’s Hospitals. In 2018 she started Primrose Newborn Care to provide in-home newborn medicine and lactation support. She also enjoys traveling, yoga, reading, and spending time with her children.

Information provided in blogs should not be used as a substitute for medical care or consultation.


American Academy of Pediatrics Clinical Report: Rate of Late Preterm Births Rise Nationally After Years of Decline. Published online 10/21/2019. 

“Late-Preterm” Infants: A Population at Risk. AAP Committee on the Fetus and Newborn. Published 12/7/2007.

ABM Clinical Protocol #10: Breastfeeding the Late Preterm (34-36 6/7 Weeks of Gestation) and Early Term Infants (37-38 6/7 Weeks of Gestation), Second Revision 2016. Breastfeeding Medicine, Volume 11, Number 10, 2016.

March of Dimes. Feeding Your Baby in the NICU. Last reviewed April 2019.