Handling specific feeding issues for premature or sick babies

Prematurely born babies, or babies born before 37 weeks of gestation, can have some of the feeding difficulties:

• Difficulty latching to the nipple of the breast or gagging when taking the bottle
• Difficulty sucking (i.e., weak suck), coordinating sucking, swallowing, and breathing; and difficulty swallowing (coughing, choking or gasping)
• Frequent vomiting and spitting up
• Falling asleep during feedings
• Easily overwhelmed by changes in the environment
• Sensitive around the mouth or face due to past medical procedures
• Fussy and irritable
• Poor weight gain and growth

Tips for feeding a premature baby:

• Provide more frequent and shorter paced feedings. Allow the baby time to rest and breathe and wake the baby for feeding at night.
• Use the same bottle nipple as in the NICU.
• Hold the baby in an almost upright position but hold the bottle in a neutral/horizontal position, not pointing down, to allow for baby-controlled flow.
• Do not force the baby to eat. Feed in a quiet place with limited stimulation. Stroke and stimulate the lips to encourage sucking and calm the baby before every feed.

Baby who frequently spits up (Gastroesophageal reflux - GER) 

Common feeding difficulties:

• Uncontrollable vomiting and spitting up, after each meal and even between feedings
• Fussiness and irritability during feeding, but refusing the breast or bottle even when hungry

Tips for feeding a baby who frequently spits up:

• Offer smaller feeds more frequently.
• Pace meals.
• With bottles, use a slow-flow nipple.
• Feed the baby in upright position or 30-45 degree angle, not lying down.
• Keep the baby upright for 15-45 minutes after feeding.
• Use pacifiers before and after feeding to help baby control reflux and reduce spit-ups.
• Do not diaper or move the baby a lot after a feeding.

Baby with cleft lip or palate

Common feeding difficulties:

• Swallows too much air during feed
• Can’t close lips around the nipple, difficulty latching on to breast
• Liquids run out of the mouth
• Choking, coughing, vomiting, spiting up
• Frequent ear infections, ear drainage and poor weight gain

Tips for feeding a baby with cleft lip or palate:

• Feed the baby more frequently, at a slow rate, so liquid does not run out of the mouth or nose
• Pace meals to reduce choking
• For bottles, use a wider, slow flow nipple or a specialty bottle, and point the nipple down and away from the cleft
• Feed in an upright, sitting position to keep milk from flowing back into the nose 
• Burp the baby gently more often because they take in more air
• Keep the baby upright for 15-45 minutes after feeding