Breastfeeding a Premature Baby

Archived Q&A and Reviews

Baby born at 35 weeks doesn't want to latch on

Oct 2008

I just had a baby at 35 weeks. He was very small, less than 4 pounds, but doing great. Problem is breastfeeding - he doesnt want to latch on. The lactation people say this is normal, that it is harder for preemies, so I am pumping around the clock. Still have to supplement with formula because he is eating more than I can pump. I just want to know if any people have had success getting their small baby off the bottle and back on to the breast. Any advice on this? Not lovin the pump

Well SURE you can get a baby back on the breast! One of my twins (born at 36 weeks) had a lot of trouble breastfeeding and just didn't seem to have the strength to latch. We continued to breastfeed every feeding and only pumped AFTERWARDS, and that worked well. Try to have your baby breastfeed as often as possible. With our baby, we had to poke her and keep her really cool in order to keep her awake and working hard at it. We were downright PESTS, but after a few days she got the hang of it, and we fed her more by breast, less by bottle. Unless your baby is failing to gain the appropriate amount of weight, it's probably best to ease off on the formula. Yes, babies will eat more than we pump, but we only produce more if the babies are MOTIVATED, and you might fall into a cycle where the baby gets the ''easy'' formula, doesn't work at the breast, and you don't increase your production. We had to have a tolerance for that daughter being a little hungry, giving her the breast absolutely WHENEVER she wanted, and in a couple weeks or so, it worked. Good luck! twins mom

First, congratulations on your baby! My daughter was also born at 35 weeks and also was not able to nurse at the beginning. We went to a wonderful lactation consultant (Bonnie Bruce in Berkeley -- not sure if she still has a practice) who told us that when our baby weighed 7 lbs, she would be able to latch on. The day that our daughter reached that weight, she started nursing. Here was our routine until then: I pumped (and pumped and pumped...), then put the milk in a syringe with a little tube on the end that I taped to my finger, which she sucked. Our lactation consultant (and the NICU nurses) had recommended this over using a bottle to prevent nipple confusion. Although it was a difficult and demanding time (pumping, feeding, sterilizing the equipment, and oh look at that, just about time to pump again!), our daughter soon became an avid nurser (never could get her to take a bottle later, when I really wanted her to!) Courage! Your beautiful baby will nurse and it is well worth the incredible effort you are making now! Alysson

My son was born four weeks early, and he, too, had trouble latching on. We began with a combination of the artificial nipple (it's been eight years, and I've forgotten the term for it) and pumping, and I made several visits to the lactation specialists near where I live (in the South Bay). But he did latch on fully without any devices by the time he was 6 weeks old. I was told that it was unusual for mothers of premature babies to keep at it so long. But I guess I was bound and determined. I nursed my son until he was 14 months old.

One of the best pieces of advice I got from the lactation advisers was to scrunch up my breast to give him what they called--no lie!--a nipple sandwich. It was so he could have something to grasp.

Those early weeks are very hard, and I would just suggest you relax as much as possible about it. But one thing that helps is to begin every feeding with trying your baby on the boob. It really did seem like ''practice made perfect.'' If it doesn't work out, though, the most important thing is that you not stress about it and do what works for your family. The best to you and your new baby! Gwynne

We had a full-term child who was very small, and we had to supplement at first because my milk took so long to come in. Not exactly the same situation, but we followed a regime a friend used who did have a preemie: we always tried latching on first, then would use pumped breast milk and formula. Eventually, the baby began to latch on, and I could pump much less. Our concern, since formula is ''easier'' to eat, was that the baby would prefer it. She didn't. We just did the (truly a pain) routine for the first month or so, and she eventually didn't ned any formula. The hardest part was believing that I could eventually just breast feed. anon

Hang in there! I was in the same boat w/ our daughter who was born at 36 wks and had trouble latching on. We supplemented w/ formula until my supply was adequate (used Fenugreek, Mother's Milk, skin to skin contact, and frequent attempts at nursing). For weeks I pumped every 2-3 hours around the clock and fed baby w/ pumped breastmilk and formula. It was very frustrating and tiring, but I'm SO GLAD I stuck with it. At about 1 mo baby all of sudden was able to latch properly and started nursing normally. I've heard that this happens w/ premies...they have trouble, then at some point they suddenly get the hang of nursing. I highly recommend seeing Janaki Costello, a fantastic lactation consultant, to help you through this tough time. Try to keep your milk supply up with supplements and lots of skin to skin time. Hope this helps. Good luck Amanda

My daughter was also born at 35 weeks, and like you, I was not thrilled with pumping. In my case, because I was discharged from the hospital three weeks before my child, I had to pump and deliver it to the hospital so the nurses would have breast milk for the feedings I was not there for. As you know, bottles allow a steady and easily extracted flow that is much easier on the preemies since they are so small and not (initially) strong enough to sustain the effort required to get enough milk, each feeding, from the breast. When she came home, I could nurse her entirely for the first few feedings of the day, when she was most rested. But as the day wore on, with playing, outings, and just being awake, she got too tired to nurse for the full feeding and I had to use a bottle to supplement so she'd get enough nourishment. For the late-in-the-day nursings, I tried to gradually increase the amount of time she would nurse but she had her own ideas. After about five weeks, my daughter completely rejected the breast and no matter what I tried, she would only take a bottle. I was disappointed, and to be honest, I shed a few tears - I was sad. However, the most important thing was for her to thrive, not my feelings about whether or not I wanted to pump. Good luck! Jen

Yes! Don't give up on breastfeeding! My 27 weeker (born at 1.25 lbs) and now a healthy ten year old took roughly 5 months to breast feed competently w/o supplementation. Your baby is likely to be able to handle it much sooner. My routine once my daughter came home was to ''practice nurse'' on demand for at least 15 minutes, then pump and bottlefeed. If someone else can bottlefeed while you pump, that's helpful, and it was worth it to me to use the hands-free pump attachments to be able to do a little desk work while pumping. It was helpful to me to keep a log of how much milk I expressed and how much she drank, and while there were lags, my supply did increase as her sucking strengthened.

I did not persist with a supplemental tube system to allow the baby to get expressed milk while sucking, but wish I had. I did drink special teas and milkshakes to increase my milk supply as well. The lactation consultant was an important support for me.

I encourage you to hang in there, and gather support for yourself for doing it. Please feel free to stay in touch. Carol

Sucking from a nipple often takes a lot more effort than sucking from a bottle. My preemie just didn't have the power to breastfeed until much later and by then it worked out better for everyone to bottle feed. I continued to pump at regular intervals and got a good amount of sleep because anyone (not just me) could feed the baby anytime.

If you really want to breastfeed, set the breast pump to the lowest setting - this setting is probably most like the power your baby has.

Also, I found that milk flowed much more freely from one breast than the other (and in greater quantities). You could feed on that side and gently pump the other until he gains the strength to get milk from both sides - shouldn't take too long.

Good luck! Preemie mom too

I had my daughter at 35 weeks, she was 4 1/2 lbs. and we had an incredibly hard time breastfeeding, but stuck with it and now she's almost 2 and still nursing. Hang in there, it will get better.

We found a good lactation consultant and pediatrician who helped us a lot. We didn't have a problem with latching, but my daughter wasn't able to generate enough force with her mouth to get as much milk as she needed from my breasts. So, we came up with a plan that might work for you. Every time your baby needs to eat, start with the breast (we'd try to do 15 minutes each side, but that might be hard at first if you are having latching problems), and then shift to bottle. At first the bottles were mainly formula, but I was able to very gradually get enough from pumping to use breast milk. You probably know this, but it's easier for babies to get milk from a bottle, so they will often start to prefer this. Be sure you are getting newborn nipples for the bottles as well. I ended up pumping a few times a day, 5-10 minutes per time, for 5-6 months to supplement her and keep up with a diminished milk supply, but I made it sort of a nice time (ha!) by putting the baby down for a nap or handing her off to my husband, and then watching tv or listening to my iPod while I pumped.

I got a lot out of reading ''The Nursing Mother's Companion.'' I know that you can purchase feeding systems that let the baby get milk from a tube as they nurse from you. We didn't have to do that, but considered it.

Anyway, best of luck to you, and it's awesome that you are trying to nurse your preemie -- your milk has such great stuff in it that is actually different for a preemie than it would be for a full-term infant. Somehow your body knows and adjusts. Sympathetic Mommy

I had great success using the Medela Contact Nipple Shield, its available for about $6 at Target & BabysRus. My son was born at 35 weeks & 3 days and weighed 5.6 lbs, dropped down to 4.13 before we left the hospital. He was having trouble latching, these sheilds gave him more to grab onto and also would fill with milk so it was flowing more regularly. I was able to stop using them when he was about 8 weeks old. I would try him without it every now and then, until he finally didn't need it anymore. He's a breastfeeding champ now! Good luck. Evelyn

I had a 4.5 pound premie, and it took awhile to get the breast feeding going. I did use a lactation consultant. When the baby was about 6 pounds at 6 weeks, I spent a couple of days just breast feeding to stop using the pump so much. At that point, I switched to pumping just a couple of times a day to get milk for when I wasn't home. Later, after she was about 3 months it started working much better, and the lactation consultant told me, ''Yes, it takes until they are 8 pounds for their mouths to be big enough to nurse efficiently.'' I'm glad I continued nursing, but those first few months were incredibly hard. My main advice is to find a decent lactation consultant who has had experience helping mothers of premies, and hang in there. The good side is that once you get going, it actually is quite straightforward to nurse. Also, you are helping your baby get the extra nutrients they need to finish developing. My child is doing well, and after age 2, there were no apparent differences between her and the term babies. anon

I had a full term, low birth weight baby (under 5 lbs) who had trouble latching and nursing at the beginning. I was pumping around the clock and supplementing at first as well. The transition to nursing took a little work, but he did eventually get the hang of it. I couldn't have done it without the help of Janaki Costello, a lactation consultant in Albany off of San Pablo. Prior to her, I had seen a couple consultants who were not helpful. She's incredibly patient, open minded, and just plain knows her stuff. Her number is 510-525-1155. Good luck! Anon

I hear your frustration. My twins were born at 35 weeks and both had difficulty latching. I pumped and bottle fed for 3 months before they were able to latch consistently. It was brutal and though I managed to breast feed them in one manner or another for the first year, it really took some of the enjoyment out of the first few months to have to pump so often, especially at night. I would just keep trying to have them latch and please don't be too hard on yourself and enjoy your baby! Natalie

My daughter was also a preemie just over 4 pounds and in the NICU for 15 days. I also pumped like crazy because she was too weak to nurse. But everyone said keep trying. So every time it was time for her to eat, I would first try to get her to nurse, then would follow up with breastmilk in a bottle, then immediately go and pump. The best advice I got was from the pediatrician. He said that something happens when they turn 8 to 8.5 pounds, and all of a sudden they get it, nursing that is. And he was right. Suddenly around 8 pounds she started getting the hang of it and we never turned back. One day after that she refused the bottle and never drank from one again. I nursed her exclusively until she went onto solids and until she was almost 3 years old. So don't give up. There is hope. been there

My baby was born at 29 weeks and was two pounds at birth. She stayed in the hospital until her due date but I was able to get her breastfeeding by the time she left the hospital. Mostly I did it by being at the hospital for every feeding I could possibly be around for (the nurses had to bottle feed overnight when I went home). I got a lot of help from the NICU nurses and lactation people at the hospital who helped with positioning. The My Breast Friend pillow made a huge difference bc my baby was so small her whole body fit on top of it comfortably. It was a challenge, and took a lot of patience, but was well worth it to not have to spend time pumping on top of everything else. My advice is to keep trying as long as you can because it definitely can be done. At some point though you'll know if it's just not going to happen. I met a friend at the NICU who did everything I did but her baby just couldn't get the hang of it. At that point she wisely recognized the situation for what it was and stopped putting massive effort into something that wasn't to be. Good luck! preemie mom

That is so wonderful for your baby that you are trying so hard to breastfeed. I completely feel what you are going through. My little guy will be full term tomorrow (was born at 34 weeks) and we have been going through something similar. He did not get his sucking reflex in until about 37+ weeks (later then typical), so was being fed through an ng tube with breast until then. He would latch, but not really suck.

I resisted the bottle as long as I could, but at the end of the day they would not release him from the NICU without a bottle after each feed and 3 weeks was long enough. Now after getting the bottle, he is confused about what to do with my breast, chews often, and does not open his mouth wide enough. I switched him to the breast with a nipple shield after he got a healthy check-up with his pediatrician (last Tuesday), but we are still having some problems as his feeding schedule is very irregular (making pumping challenging) and his weight gain is borderline acceptable. I get him weighed often and will go back to the bottle if needed.

The good news is that even after a bottle, the breast is completely possible with a nipple shield and maybe without (and it just might take time- my son could only breastfeed with the shield as of 38 1/2 weeks).

We are still trying, but my little one still has an uncoordinated suck, according to lactation, which causes him to pull off frequently (even on the nipple shield, although no frustration with that). As of now we are trying the breast at every feed until he gets frustrated and then we switch to breast with the nipple shield. It is a waiting game and I am hoping he gets it eventually. I am still pumping after every feed for 15 minutes (well I skip 1-2 feeds a day).

Wishing you luck and feel free to contact me. We have gone through so much with feeding, but we are committed. You are doing a great thing for your baby and keep trying. With your hard work he will get it. Blessings, sam

Hi there, I breastfed twins, who were both preemies. It was very hard for them to get milk out at first because they were premature and small, although neither was under 4 pounds. It was very difficult for me, probably one of the hardest things I've ever done, but they did get much better as time went by.

What I did was offered them the breast at every single feeding and tried to get them to nurse as much as possible. Only after that did I offer them bottles and pump. As I recall, I continued this for about 3 - 4 weeks (pumping after feeding), and they were then nursing all on their own. I slowly started eliminating the pumpings after each feeding, one at a time (starting at night).

I also made use of lactation consultants, and would highly recommend that. I did not have much luck with pediatricians, who don't seem to know nearly as much about breastfeeding as they should (because it is not just about the infant, but about the mother's body too and they aren't as knowledgeable about women's health).

Persistence paid off for me, so I would just keep trying. The more you try to breastfeed him the better he will get. Good luck. Daria

I didn't see your original post, but I did see all the answers. I wanted to offer you another perspective. My second daughter was born at 33 weeks and spent 6 weeks in the NICU. I had breastfed my first and really wanted to do it again with my second. I wanted it so badly that I pretty much made myself and my family miserable - pumping 8 times a day - getting extremely frustrated when my baby wouldn't nurse and taking on a lot of emotional guilt about keeping up with all of it in order to give my premie the best start possible. I finally stopped the insanity about week 14. Some kids nurse, some don't. And here's the the kicker, my non-nurser has hardly ever been sick (she's 5) - her big sister had 9 ear infections her first 18 months of life.

So give it your best shot, if it works, great, if it doesn't - move on and don't worry yourself over it. Your baby will be just fine. another perspective