Providing breast milk for your premature baby and transitioning to breastfeeding can feel overwhelming, but it’s one of the most effective ways to support your baby’s health and development. With patience and support, you can establish a healthy milk supply and help your baby grow and thrive. Maternal milk is often called "medicine" for premature infants, especially low birth weight infants, because it provides essential nutrients, strengthens the immune system, and supports optimal growth.

The advantages of breastfeeding have a positive impact on your baby’s health outcomes in the first months of life and beyond. This guide offers helpful tips for mothers of preterm infants to establish an abundant milk supply and support the transition to successful breastfeeding once your baby is ready.

How Can I Establish a Strong Milk Supply?

Start Early

Begin to express milk as soon as possible after birth. Hand expressing colostrum within the first hour and pumping within the first 6 hours can help jumpstart your breast milk production.

Pump Frequently

Aim to pump at least 8 times a day with a double electric breast pump, including at least one pumping session during the night. Frequent stimulation signals your body to produce more milk. Using a hospital-grade pump is most effective.

Use Your Hands

Combining pumping with hand expression has been shown to significantly increase your breast milk supply over pumping alone.

Pump to "Empty"

Draining your breasts well at each pumping session helps to maximize your supply and ensures your baby receives the highest-fat and most calorie-dense milk, which is especially valuable for ill infants.

Breast Milk Volume

With consistent, “hands-on” pumping, most mothers can establish a full supply (at least 750 mL/day) by the end of the second week of life. During the immediate postpartum period, your body is hormonally primed to make milk, and this is the ideal time to lay a strong foundation for future production.

What to Expect in the Neonatal Intensive Care Unit (NICU)

Kangaroo Care

As soon as your baby is stable, skin-to-skin care offers many benefits. Direct skin contact helps regulate their body temperature, heart rate, and breathing, while also supporting bonding and encouraging your milk production.

Supplemental Feedings

If your preemie is unable to breastfeed directly, they will likely be fed through a tube (for enteral feeding) or a bottle. Some extremely low birth weight infants may also need parenteral nutrition initially. Providing human milk ensures your baby receives protective antibodies and the benefits of breast milk, supporting growth, immunity, and overall development.

Gradual Transition

Your baby can begin breastfeeding as soon as they are physically ready. Early sessions are “practice” for both of you, improving baby’s mouth coordination, strength, and development of the infant.

 

What Are Some Tips to Start Breastfeeding Successfully?

Experiment with Breastfeeding Positions

Try different holds, like the "football" or "cross-cradle" position to find what works best for you and your baby.

Breast Massage and Compressions

Gentle massage and breast milk expression during feedings can encourage your baby to latch more easily and increase milk flow for your baby.

Consider a Nipple Shield

Sometimes, a nipple shield can help preemies transfer milk more effectively during feedings. Your healthcare team can guide you if this option is right for you.

Get Support

Your baby’s NICU staff, nurse, and lactation consultant play an important role during their NICU stay. They can offer helpful tips and techniques to make these early breastfeeding sessions more successful. 

Be Patient

It’s normal for some infant feedings to go better than others. Some babies may be sleepier than others or have trouble latching. Don’t be discouraged. With time, consistency, and practice, your breastfeeding sessions will become more productive.

Preparing for Discharge

As your baby approaches the end of their hospital stay, the NICU team may conduct test weights to monitor the amount of milk your baby is receiving. Some babies will go home exclusive breastfeeding, while others may continue supplemental feedings. Regular follow-ups are essential to track birth weight and growth progress. Guidance from the Academy of Breastfeeding Medicine (ABM) Clinical Protocols and American Academy of Pediatrics recommendations can help ensure a safe transition from hospital to home.

Helpful Tips for Home

Keep Practicing Skin-to-Skin

This continues to be important for your baby's development and helps you respond more easily to early feeding cues.

Wake Your Baby for Feedings

If your baby isn’t waking on their own, try waking them every 3 hours to ensure they are feeding at least 8 times per day.

Offer Supplements if Needed

Depending on your baby's gestational age and how well they are breastfeeding, continue offering any needed supplementation of expressed breast milk or formula as recommended by your healthcare provider.

Continue Pumping

Keep pumping as needed to maintain your supply until your baby is ready and able to breastfeed more frequently.

Be Patient

Remember that every baby’s journey is unique. With time, practice, and more opportunities for breastfeeding, it will become easier for both you and your baby.

How Do You Know When Your Baby is Ready for More Breastfeeding?

You’ll know your baby is ready to breastfeed more exclusively when:

  • They start waking and showing hunger cues 8–12 times a day.

  • They latch comfortably and effectively.

  • They’re alert and engaged during feedings.

  • They transfer milk well and seem satisfied after feeding.

  • They’re having plenty of wet and dirty diapers.

  • They’re gaining weight consistently with increased breastfeeding and reduced supplementation.

Sometimes, extra reassurance is necessary to make the emotional leap from bottle feeding to more breastfeeding. Weekly weight checks with your baby’s pediatrician, lactation consultant, or breastfeeding support group can help you gauge your baby’s readiness to breastfeed more. Some families choose to rent or buy a baby scale to monitor their baby’s intake at home. You can discuss this option with your healthcare provider and lactation consultant.

Self-Care and Mental Health

Providing breast milk for your preemie and transitioning to breastfeeding from the NICU environment can feel overwhelming at times, but remember, you are not alone on this journey. Caring for yourself is important, so rest when you can, stay hydrated, and don’t hesitate to reach out to your health care providers, lactation consultant, or loved ones for support. With love, patience, and the right guidance, you can achieve your breastfeeding goals and give your baby the best possible start in life.

Disclaimer: Our classes and accompanying materials are intended for general education purposes and should not replace medical advice. For personalized recommendations, please consult your healthcare provider and/or lactation consultant.