Common feeding challenges of small or sick newborns and how to address them

Feeding can be one of the most frequent challenges with small and/or sick babies, often turning into a “battleground” once the baby comes home.  For these babies, feeding is hard work, requiring them to coordinate sucking, swallowing, and breathing for the extended time needed to get a good feed.

Sometimes, infants who fed adequately in the NICU develop feeding problems at home because the feeding context is vastly different from what they were used to. These issues can lead to “forced” feeding, as parents become concerned about the lack of weight gain, while babies learn that feeding is not a pleasurable activity, potentially contributing to lifelong issues with food, including being overweight. 

With some exceptions (e.g., when an infant has a cleft lip or palate, cerebral palsy, or medical problem), small or sick babies have similar feeding problems as term babies. The approaches and tips provided here can be useful for you.  Feeding challenges may be more prevalent or drastic in small or sick babies, and they may have more difficulty in adjusting to different feeding environments or taking the lead during feedings.   

General tips for feeding small or sick newborns:

  • Experiment with the setting: Adjust the lighting (dim vs. bright) and level of noise (quiet vs. noisy, music, ongoing activities).
  • Follow hungry cues: Unless the baby is very sleepy, feed based on hunger cues.
  • Limit feeding time: Keep feeding sessions to no more than 30 minutes and feed baby every 2-3 hours.
  • Baby-led feeding: Allow the baby to feed on demand and pace the feeding (how much and at what rate).
  • Soften the breast: While breastfeeding, soften the breast to move the hindmilk from the periphery to the nipple. 
  • Night feeds: Provide at least one feed during the night.
  • Consistent nipples: If bottle feeding, use the same nipple as in NICU initially and give the baby control over the flow. 
  • Calm and alert state: Start feeding when the baby is calm and alert. If the baby is stressed (crying, arched back, agitated breathing, pinched and scrunched up face), soothe the baby before trying to start to feed the baby.