Premature and Fragile Babies and Breastfeeding

by T. Berry Brazelton, M.D., author of Feeding: The Brazelton Way

Many of these babies will encounter difficulties in feeding. Difficulty in swallowing—due to neurological damage or developmental delays impairing swallowing mechanics, gastroesophageal reflux after feedings, hypersensitivity of the intestinal system leading to colic and irritability, hypersensitivity of the nervous system to auditory, tactile, visual, and kinesthetic stimuli—all require special handling at feeding times. All of these need to be understood by new, frightened parents before discharge. The opportunity to soothe and heal these fragile babies' disorganized nervous systems can be enormous if parents can model on nurses, doctors, and others trained to handle these babies with the special care they need. It is a parent's right to ask for such help.

Patience and careful observation of the baby's behavior will be a great help. A premature or otherwise fragile baby must reorganize slowly. Many different systems—circulatory and respiratory systems, nervous system and sensory apparatus, and gastrointestinal tract—will be entwined in this recovery. These will need to become integrated in order for the baby to begin to thrive.

This process will demand patience and understanding from parents. They must be ready to reduce stimulation (such as noise, lights, even handling) for the baby. Yet their hunger for her to recover and to "catch up" is likely to press them to push her to eat, eat, eat. This will very likely work the wrong way, for example, by overloading a sensitive GI tract, resulting in regurgitation or diarrhea.

Premature and low-birth-weight babies face a double challenge. On the one hand, they need far more nutrients relative to their weight than full-term babies do. On the other, their digestive systems are often not yet well developed enough to handle these amounts.

Formulas

Special formulas are available for premature infants, and specialized dietitians in the hospital will help decide which formula to use, whether it needs to be diluted, and how much and how often it can be given. Sometimes premature infants must be fed with feeding tubes or with intravenous fluids containing the nutrients they need until they can suck on their own and their digestive systems are mature enough to handle formula.

Breastfeeding

It is certainly possible, though a challenge, to give premature infants breast milk. They may initially be too weak to suckle at the breast, so a mother who wants to breastfeed will need to express milk—while at the NICU or when at home. A mother's milk, even when the pregnancy has ended too soon, contains an ideal balance of proteins as well as antibodies to help protect the baby from infections. A specialized dietitian can mix the mother's milk with the extra nutrients that a premature infant requires.

The mother of a premature infant needs and deserves extra support—from family, NICU staff, and a lactation consultant if she wants one. Carrying a baby skin-to-skin, between the mother's breasts or in a sling on her chest, is called "kangaroo care." It stimulates the mother's milk supply and helps her to feel close to her baby. It's good for the baby too.

Parents will need to observe and to adapt to their baby's individual situation. For example, their baby may tolerate feedings only every 3 hours rather than every 4 hours. A slower feeding in a quiet, darkened room may be necessary at first. Later, parents can gradually add stimulation, watching for signs that the baby has had enough—spitting up, hiccups, or a bowel movement. Her face may darken, as her body arches away and her color changes, which are all signals that she is overwhelmed. If she is overstimulated, she's likely to vomit up all the food she's managed to get down. She needs protection from too many sights and sounds and motion if her progress is to continue, although this can be difficult in a busy household.

Parents who have been through a difficult adjustment to a premature or fragile baby are very likely to hover over the baby. They find it difficult to allow her to go through the normal, inevitable "touchpoints" as she gets older without tremendous anxiety. At touchpoints when backslides in the area of feeding might be expected, parents are bound to worry and press the child to eat. This may hold her back from learning to feed herself when she is able to. Such parents may have trouble accepting her defiance, especially when food is involved. They are bound to stifle such bids for independence, urging, "Just try this, darling!" A baby, especially a once fragile baby, needs many chances to feel successful, to be able to say to herself, "I did it myself!" The child will always win in a struggle over food, and this is the wrong place for parents to set up a conflict. I urge parents of a fragile baby not to hover, but instead to encourage the child toward self-sufficiency and to seek help if you aren't sure how to proceed. Don't push food on your child, for you can only lose.

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