Gaining and Growing: Assuring Nutritional Care of Preterm Infants in the Community

Some Common Feeding Problems for Low Birth Weight Infants

My baby falls asleep when I feed her. She doesn't seem to have the energy for feeding.

This is a fairly common problem in the first weeks at home for some babies. It will take some patience to get through this period. The solution will depend on the reason for the problem. Here are some possible reasons and potential solutions for a baby's lack of energy for feeding.

My baby gets really upset when I try to feed her. Feeding doesn't seem to bring her any pleasure, and she fights it.

This is a problem that needs to be attended to immediately because some fairly serious causes should be ruled out. There are several possibilities to consider here.

My baby coughs and gags when I feed her. Sometimes this even leads to spitting up.

The key here is to establish the cause of the coughing and gagging and to rule out serious consequences of these behaviors. Coughing and gagging that result in apnea or color changes are serious events and should be evaluated promptly. Please see section on aspiration. Other causes and solutions for coughing and gagging follow:

My baby gets really frustrated when I put her to my breast. She really seems to prefer the bottle.

Babies have different responses to starting out life with bottle feedings and then switching to the breast. Some babies go back and forth from breast to bottle easily, others develop strong preferences. For a mother who really wants to breastfeed at the breast this can be a very hard problem to work through. No one intervention will work with all babies, and some very low birth weight babies never seem to want to go to the breast despite the best efforts of their mothers.

The infant may be frustrated if the mother has a limited milk supply. Mother's milk supply should be assessed and interventions to increase supply such as more frequent nursing or more frequent use of the breast pump may be helpful.

An infant may also experience difficulty "latching on." This may be due to fullness of the mother's breast, neurological problems of the infant, or characteristics of the maternal breast such as flat or inverted nipples. A lactation specialist referral will be helpful in this case.

It is important to remember that, especially when they first come home, most low birth weight infants are nutritionally vulnerable. They have limited reserves of fat, protein, and other nutrients. They are easily tired. They need to be adequately nourished in order to recover from the problems caused by being born early and small. Despite the importance of breastfeeding for these babies, it is more important to make sure that they remain as well-nourished as possible. Breastfeeding at the breast only may not offer the child optimal nourishment if the baby isn't capable of getting adequate energy and nutrients. Please see section on breastfeeding for information on supplementing breastmilk.

Some solutions that have worked for some mother/infant dyads include:

I try to follow the schedule set up in the hospital of feeding my baby every 3 to 4 hours, but I can't seem to get her to take the amount of formula or breast milk that she took in the hospital.

Many babies change their feeding style after they come home. There are several possible reasons for this, but the most important thing is to find a feeding pattern that will work for both baby and family. In this case, it is probably a good idea to try smaller, more frequent feedings.

This baby may be sleeping longer than 3 to 4 hours at night. In this case, something needs to be done to make up the missed night feeding. The question of waking a preterm baby up for regular feedings at night is open to several interpretations and should be approached on an individual level. A sleepy baby may not be in an appropriate state for feeding, and families are likely to be in great need of nighttime sleep to cope with the challenges of the baby during the day. On the other hand some infants will not ingest enough breastmilk or formula to grow if they are allowed to sleep for much longer than 4 hours. Sometimes it is helpful to try a modified demand schedule where the caregiver regulates the timing of the feeding and the infant continues to regulate the volume at each feeding. Increasing the frequency of feedings during the day may allow the infant to sleep a little longer during the night and still have an adequate intake.

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Page reviewed: March 24, 2015