Providing breast milk for your premature baby and transitioning to breastfeeding can feel overwhelming at times, but it’s one of the best ways to give your baby a strong start in life. With patience and the right support, you can establish a healthy milk supply and help your baby grow and thrive. Breast milk is often called “medicine” for preemies, as it provides essential nutrients, strengthens their immune system, and supports healthy growth and development, all while protecting them from infections.1 This guide offers helpful tips for building your milk supply and transitioning to breastfeeding when your baby is ready.

Establishing Milk Supply^1,2

• Start Early: Begin expressing milk as soon as possible after birth. Hand expressing colostrum within the first hour and initiating pumping within the first 6 hours after your baby’s birth can help jumpstart your milk production.
• Pump Frequently: Aim to pump at least 8 times a day, including at least one pumping session during the night. This frequent stimulation signals your body to produce more milk. Hospital-grade pumps are the most effective.
• Use Your Hands: Combining pumping with hand expression will remove more milk. Research shows this combination can significantly increase your milk supply.
• Pump to Empty: Make sure to pump long enough to empty your breasts. This helps maximize your milk production and ensures your baby gets the highest-fat, calorie-rich milk, supporting their growth and development.
• Breast Milk Volume: With consistent, “hands-on” pumping, most mothers can establish a full milk supply (at least 750mL/day) by the end of their baby’s 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 your milk supply.

What to Expect in the NICU

• Kangaroo Care: As soon as your baby is stable, holding them skin-to-skin offers many benefits. It helps regulate their body temperature, heart rate, and breathing, while also supporting bonding and encouraging milk production.³
• Supplemental Feedings: If your preemie is unable to nurse, they will likely be fed breast milk through a tube or bottle. Providing expressed breast milk for your baby will help them grow strong and stay healthy.⁴
• Gradual Transition: Your baby can usually begin breastfeeding as soon as they are physically ready to feed by mouth. In the beginning, think of these sessions as “practice” for both of you. As your baby grows stronger, their feeding skills will improve, making breastfeeding easier.

Helpful Tips for Beginning to Breastfeed:

• Experiment with Breastfeeding Positions: Try different holds, like the “football” or “cross-cradle” position, to find what works best for you and your baby.⁵
• Express Milk onto the Nipple: This can encourage your baby to latch more easily. Gentle breast massage and hand expression can also help milk flow for your baby.
• Get Support: Your baby’s NICU nurse or a lactation consultant can offer helpful tips and techniques to make these early breastfeeding sessions more successful. 
• 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.⁶
• Be Patient: It’s normal for some feedings to go better than others. Some babies may be sleepier 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 gets closer to going home, the NICU team will assess how well they’re breastfeeding. Test weights may be offered so you can see how much milk your baby is getting during breastfeeding sessions. Depending on your baby’s progress, some may go home breastfeeding exclusively, while others may breastfeed only a few times per day. Regular follow-ups with your baby’s pediatrician will help monitor their weight gain as you gradually increase breastfeeding at 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 Supplemental Milk: Continue offering supplemental expressed breast milk or formula based on your feeding plan and how well your baby is breastfeeding.
• Continue Pumping: Keep pumping as needed to maintain your milk supply until your baby is ready and able to breastfeed more frequently.⁷
• 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.

When to Transition to 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 feedings.
• They’re having plenty of wet and dirty diapers.
• They’re gaining weight consistently with increased breastfeeding and reduced supplementation.

Additional Steps

What If I Have Questions?

If you are interested in learning more, these Aeroflow classes expand on some of the topics discussed above:

• Pumping 101
• Ultimate Breastfeeding Prep

Want More Info?

For a directory of Aeroflow’s other Care Guides offering information on pregnancy, baby care, and more, browse our comprehensive list of titles:

References