The Importance of Initiating Breastfeeding in the NICU

woman sitting on chair and breast pumping for her baby in the nicu

Breast milk is important for all babies, especially those who need to be admitted to a neonatal intensive care unit (NICU) after being born. NICU infants who receive their mothers’ milk have been found to have lower risks of infections, improved digestion, shorter hospital stays, and less long-term problems with their lungs and breathing. Breastfeeding also promotes healthy brain and nerve growth, leading to improved health outcomes and development.

Breast milk contains antibodies, white blood cells, lactoferrin, and many other components which help babies to fight off germs and infections. Premature babies who are breastfed are at a much lower risk of a serious bowel condition called necrotizing enterocolitis (NEC) than babies who are formula fed. NEC causes widespread inflammation and damage to the intestines and is one of the leading causes of death in preemies & NICU patients. Preventing NEC is the reason why most NICUs now supplement babies with donor breast milk from a source or milk bank (instead of baby formula which could be non-nutritive) if their mothers cannot breastfeed or make enough milk during their baby’s NICU stay. Research has proven that a 100% human milk diet protects babies from NEC.

Breast milk is one of the best “gifts” that a mom can give her NICU baby which is why breastfeeding mothers should be encouraged and supported throughout their process. It’s so important for babies in the NICU to get their mothers’ milk that we often refer to it as “liquid gold.” Since many babies in the NICU are too small, immature, preterm, and/or fragile for direct breastfeeding, for the majority of NICU moms, breastfeeding equals breast pumping. Some moms with infants in the NICU will need to pump for days or weeks, while other mothers end up having to pump milk for many months on end to nourish their babies. Because of this, it’s crucial to use a high quality electric pump to produce the amount of breast milk the baby needs. In turn, through bottle feeding they will still receive enough breast milk to maintain good health. This is especially important for preterm infants and premature infants. 

Initiating breastfeeding in the NICU requires dedication and patience, along with having the proper equipment and skills. We know that there is a direct relationship between early and frequent breast stimulation and mothers’ long term breast milk production. Research has shown that moms who start to pump within the first few hours of giving birth have much higher breast milk volumes at 2-4 weeks postpartum. So if a mom is separated from her baby, we recommend that she start to express milk (pump) and colostrum in the first 30-60 minutes after giving birth, if possible. Colostrum is early breast milk that is chock full of antibodies, nutrients, and other important proteins, calciums, and components that strengthen the immune & digestive systems of newborns. This is why early feeding is vital. Every drop of colostrum that a mom pumps can be saved and given to her baby in the NICU via a syringe or feeding tube. It truly is “liquid gold!” 

Tips for Breast Milk Pumping Moms in the NICU

Here are a few tips if you’ll be breast milk pumping for your little one in the NICU:

  • Your first pumping session should occur as soon as possible after birth − ideally within the first hour or so. Early breast milk expression can be accomplished by hand expression, using a manual pump, or a double-electric breast pump. By day 2 or 3 postpartum, you should use a hospital grade breast pump, such as the Medela Symphony, every time you pump to help initiate and increase your milk supply.
  • Pumping multiple times a day improves breast milk supply. It’s recommended for NICU moms to pump 8-10 times per day (every 2-3 hours) for the first few weeks after delivery. Although these early pumping sessions may not yield much milk, they are very important for stimulating the release of hormones that are needed for mature breast milk production.
  • Tracking your breast pumping sessions may also help. We recommend downloading a breastfeeding app onto your phone or tablet for easy, on-the-go tracking of how often you pump and how much milk you are making for your baby.
  • “Kangaroo care,“ which is holding your baby “skin-to-skin” against your bare chest, is a wonderful way to bond with your baby. Kangaroo care also increases the levels of hormones that your body needs for milk production (prolactin & oxytocin) and baby feeds. We recommend spending time bonding with your baby with as much skin-to-skin contact as possible. Even very small and sick babies or preterm babies should be able to have short kangaroo sessions in the NICU with their moms.
  • Don’t give up! Ask for help from your NICU lactation consultants, nurses, pediatrics, and other available breastfeeding resources. Your healthcare providers are here to help. Your partner, friends, and family can also be great sources of breastfeeding support during NICU pumping and along your breastfeeding journey. If needed, there are several breastfeeding support groups to help you along the way.

Breastfeeding is a natural process, but it’s also a learned skill that requires proper initiation and improves with knowledge and practice. Providing breast milk is the most helpful thing you can do for your little one while he or she is in the NICU. Learning the important initiation practice will have a substantial impact on your long-term milk supply and breastfeeding success.

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.


  • Medela. 2022. How to Hand Express Your Breast Milk When Needed. [online] Available at: <> [Accessed 7 September 2022].
  • NEC Society. 2022. What is NEC? - NEC Society. [online] Available at: <> [Accessed 7 September 2022].