Ongoing care: feeding and nutrition

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Read about ongoing care for a premature baby in terms of feeding and nutrition. Learn about what is normal, and what may be a concern.

Key points

  • Although baby growth is predictable within a certain range, most babies will go through periods when they eat more and periods when they eat less, making it difficult for some parents to know if this is normal feeding behaviour.
  • In general, you will know that your baby is getting enough milk in the first two weeks if they pass three to four substantial bowel movements and wets six or more diapers per day.
  • Premature babies may require more nutritional supplements to either breast milk or formula than do full-term babies, such as iron and vitamins.
  • If your baby suffered from anaemia in the NICU, watch for signs of recurrence once they are home.

It can be difficult to tell when a baby is showing normal feeding behaviour and whether they're getting enough nutrition. Staff at the follow-up clinic can help parents deal with any potential feeding and nutrition issues.

Normal feeding issues

Most babies vomit at some point. Most babies get constipation at some point. Although baby growth is predictable within a certain range, most babies will go through periods when they eat more and periods when they eat less. All these factors can make it difficult for parents of premature babies to know whether their baby is displaying normal feeding behaviour and if the baby is getting everything they need in terms of nutrition.

As a rule, parents should ask the staff at the follow-up clinic for advice on these and other nutritional matters.

Vomiting

In particular, parents will have to learn the difference between vomiting, which, on occasion is normal, and gastroesophageal reflux (GER), which can be more serious. GER is a normal phenomenon of newborns and premature babies. Many babies reflux happily and grow normally. However, if signs of gastroesophageal reflux including apnea, wheezing, and respiratory distress, or persist to the point that there is poor weight gain or pain, the baby should be seen at a follow-up clinic.

Reflux usually resolves itself after six months. After that time, the baby has grown, is eating solid food, and spends more time in an upright position, which together help to reduce reflux.

Constipation

Constipation is also frequently an issue with all babies at some point. Although it can be alarming for a parent, it is not particularly unusual for a baby to go several days without a bowel movement. If a premature baby had problems with any aspect of their digestive system or had other troubles feeding, it is possible that constipation may be more of an issue. If the constipation is prolonged and frequent, you should speak to your paediatrician or follow-up staff if you have a concern.

Knowing when your baby is getting enough milk

At some point, all parents wonder if their baby is getting enough milk. You will know that your baby is getting enough milk in the first two weeks if they pass three to four substantial bowel movements and wets six or more diapers per day. They will also seem full after each feeding. By the end of the first two weeks, their bowel movements may be less frequent. Make sure to bring your baby to their two week check-up, to make sure that they are gaining weight properly and is otherwise remaining healthy.

If, as the parent of a premature baby, you have additional concerns, you should bring them up with the staff at the follow-up clinic.

Additional vitamins and iron supplementation

Breast milk provides all the vitamins and minerals your baby needs, except for vitamin D and fluoride. All breastfed babies need an additional supplement of vitamin D. From six months onward, your baby will also need fluoride to prevent tooth decay. Premature babies may require more nutritional supplements to either breast milk or formula than do full-term babies. Generally, these supplements include iron and vitamins. Iron supplementation is usually recommended for about year. Iron should not be given with milk.

Anaemia due to deficiency of iron in the body can recur. If your baby suffered from anemia in the Neonatal Intensive Care Unit (NICU), you should familiarize yourself with the signs of anaemia. These signs include:

  • pale skin
  • excessive sleepiness
  • frequently tiring when feeding
  • a fast heart rate and breathing rate when resting

Please note these signs are generic and non-specific in the sense that they can also be an indication of other problems.

Avoid supplementing with formula

The first four to six weeks after birth are the most important in terms of establishing your milk supply. Therefore, try not to offer your baby any supplemental bottles during that time. Although difficult, breastfeeding can often be started days or weeks after your premature baby was born. If your baby is not gaining weight properly, ask your doctor or lactation consultant for additional help. After the first six weeks of breastfeeding, when your milk supply is well-established, you may try giving your baby some expressed breast milk or formula to get them used to the bottle, if you wish.

Formulas can be labelled differently. You should check with your paediatrician whether the formula you have chosen is appropriate for your premature baby.

More information

Last updated: October 31st 2009