Colostrum is the first milk you produce after your baby is born. It is yellow in colour, thick in consistency.
Colostrum is beneficial for many reasons including:
– supporting your baby’s immune system
supporting your baby’s gut development
brain development
improving long term health outcomes
encourages progression with feeding and support’s your milk production
supporting your baby’s pain relief if given as mouth care during procedures
In the first few days it is normal to only get small drops of milk, so expressing by hand means that you are able to catch these small, but precious drops of colostrum for your baby.
Non nutritive sucking (NNS) is when a baby sucks without getting milk on a recently expressed breast or a dummy (Pacifier).
If your baby is less than 32 weeks gestation, they are not likely to have the skills or energy needed to feed by mouth.
Non nutritive sucking allows baby to safely practice breastfeeding whilst not actually getting any milk into their mouth. We should encourage baby’s to practice sucking to
help them learn feeding skills for later on.
Sucking also helps regulate breathing, weight gain and reduces experience of pain, helps baby to self-soothe and to sleep well. Sucking and exploring fingers is a normal part of your baby exploring their environment, and is part of helping your baby develop.
Preterm babies don’t have the same opportunity to have cuddles when they are inside the incubator, so a dummy can be used for comfort. Once breast feeding commences, use of a dummy should be stopped so that baby doesn’t get confused.
Positive oral experiences are an important part of your baby’s feeding journey. We should encourage sucking during tube feeding to help baby enjoy sucking whilst having a full tummy.
If your baby is enjoying sucking on a dummy, this could be dipped in a few drops of expressed breast milk (EBM) for baby to taste while sucking – particularly while having an NG feed; to associate the pleasant taste with the feeling of a full tummy.
Sucking is a pain relief as it releases the happy hormone, so can be helpful during painful procedures or stressful times.
Baby cannot control any of these, however allowing baby to choose to seek out comfort while we carry out tests and procedures that have to happen can help to comfort baby.
Mum and Dad will know your baby best, it is important to learn what stress cues look like so that you can respond to them by giving a dummy.
Benefits of Breastfeeding
Breast milk contains everything baby’s need. This starts with nutrition for growth, but it also contains a lot of other things which help baby’s to grow and develop.
Breast milk also contains hormones, growth factors, and antibodies. These extra special ingredients boost baby’s immune system, protects against infections and help baby’s growth and development.
Breast milk helps the gut to mature, and is absorbed more easily than formula milk. It also has a mild laxative effect, which helps to clear the gut of meconium (the first dark, sticky stool), this can help to prevent Jaundice.
Premature and sick babies are very vulnerable. Even if you did not plan to breastfeed your baby, giving expressed breast milk to your baby whilst they are in the hospital is one of the most important things that you can do. This is because breast milk reduces the risk of illness, necrotising enterocolitis (NEC) and death.
There is lots of information here about breastfeeding, but it should not replace talking to your nursing and medical team. Please ask for support with expressing and with any questions you may have.
https://www.emnodn.nhs.uk/breastfeeding
Breastfeeding benefits to mum
Breastfeeding mothers have been shown to have:
· lower risk of breast cancer
· lower risk of ovarian cancer
· less diabetes
· less hypertension (high blood pressure)
· lower risk of heart disease
· lower risk of osteoporosis
· lower risk of postnatal depression
Benefits for the baby
Breastfed babies have been shown to have:
· Tailored and improved nutrition
· Fewer infections
· Less gastrointestinal infections (diarrhoea and vomiting)
· Less respiratory infections
· Fewer ear infections
· Lower risk of heart disease in adulthood
· Fewer instances of allergies, eczema and asthma
· Lower risk of childhood cancers, including leukaemia and lymphomas
· Lower risk of type 1 and type 2 diabetes
· Lower risk of sudden infant death syndrome (SIDS)
· Improved bone health
· Improved brain development
· Lower blood pressure and cholesterol
· Increase IQ
· Fewer mental health concerns in childhood and adolescence
· Fewer dental concerns in childhood and adolescence
· effecting method of pain relief
· Improved bonding
There are a few things we need to think about before your baby can feed orally.
They need to be breathing for themselves. This means they are able to breath in air or with oxygen through the nose only. So they are not attached to any machines which help breathing.
Your baby needs to have times when they are awake and settled. So if your baby is always sleeping, they are not yet ready to feed orally.
Your baby needs to be able to hold themselves in the midline position. This means that they can keep their arms and legs tucked in. If your baby is not able to do this because their arms and / or legs are too floppy or stiff, then we will ask our physiotherapist and occupational therapist to advise on how we can safely feed your baby. Breast feeding position and attachment.
If your baby is very unwell and needs extra medical support, or is placed nil by mouth, we may need to stop oral feeds.
From 32-34 weeks, your may notice your baby starts to suckle and this is when they may be able to feed orally.
Your baby will also start to show signs that they are hungry, see feeding cues section.
Breast feeding babies usually feed more often then every 3 hours, and don’t always follow a routine. Tube feeding is done at set times of the day to establish a routine which we need to carry out daily cares. As baby moves onto oral feeding, we need to move towards responsive feeding and adjust the tube feeds. We can do this using the UNICEF Breastfeeding toolkit.
Responsive feeding involves getting to know your baby by watching their behaviour, so you know when they are hungry. Try to spend as much time as possible with your baby as the better you know them, the more you will learn know their feeding cues (see above section).
Have a look at the section on ‘feeding cues’ and ‘stress cues’ to help you understand signs that your baby is ready to feed.
Bottle feeding
If you are not able to breast feed or have decided to bottle feed your baby with either expressed breast milk or formula.
If your baby was born early, they will need some extra support when they first start bottle feeding.
Your baby will need to learn how to suck, swallow and breath during a feed. We usually call this feeding coordination.
Elevated side lying mimics the breastfeeding position and is the best way to hold your premature baby whilst they are feeding from a bottle.
Your babies heart rate and breathing will be more stable in this position. It also allows your baby to be more in control of the pace they drink, and is safer for preterm babies as it helps the milk to go down the right way without choking, and it may reduce reflux.
If your baby was born at term, they will usually learn how to coordinate feeding and breathing quickly because they are more developed. Term babies can be fed feed whilst being held when cradled in your arms, in a semi-upright position.
Paced feeding
Paced feeding is way of giving your baby more control over feeds.
Babies usually take small amounts of milk and stop for a rest, and then take more. You can help them to “pace” their feeds so that it mimics the way they would breastfeed.
To do this:
- Start by touching the teat on your baby’s top lip, inviting your baby to draw the teat into their mouth.
- Keep the bottle almost horizontal – just very slightly tipped to prevent the milk flowing too fast.
- Watch your baby for signs that they are finished or need a break, as this gives them time to feel full and avoid overfeeding.
- Your baby might become upset when you take the teat away from their mouth. If this happens, try tilting the bottle down with the teat still in their mouth – this will slow down the milk flow, but still feel comforting to your baby.
Never force your baby to finish a feed as this will be distressing and can mean your baby is overfed.
Pacing feeds
You may need to externally pace your babies feed if they are not pausing by themselves to breathe, in between sucks and swallows.
The Speech and Language Therapist may recommend that the bottle is lowered or removed after every few sucks, as identified during assessment, to allow your baby to pause to breathe in between sucking bursts.
Responsive feeding
Offering the bottle in response to feeding cues, gently inviting the baby to take the teat, pacing the feeds and avoiding forcing the baby to finish the feed can all help to make the experience as acceptable and stress-free for the baby as possible, as well as reducing the risk of overfeeding. Supporting you as parents to give most of the feeds yourselves (particularly in the early days and weeks), will help you to build a close and loving relationship with your baby and help your baby to feel safe and secure.
Equipment
You will need a pillow and footstool we can provide these for you during your neonatal stay.
Feeding is a skill and your baby will need to learn how to feed. Baby’s start to develop their sucking skills after 34 weeks gestation. So baby’s who have been early will need to wait until they are developmentally ready to start their oral feeding journey.
Breastfeeding takes time for mum and baby to learn and the more often we practice, the quicker you will be able to establish breastfeeding.
In the early days, a positive experience is what matters most. Feeding should be enjoyable for you and baby.
If your baby is in hospital and you are not able to breastfeed straight away then it is important to start expressing milk as soon as possible after your baby is born (ideally within 2 hours of birth). The nurse or midwife looking after you and your baby will be able to support you with expressing.
Even though your baby will be having small volumes, for good long term milk supply, we aim to produce around 750ml of breast milk in 24 hours in the first 10 to 14 days.
Breast milk is produced on a demand, the more often you express, the more milk you should produce.
To keep a good supply, try to express 8-10 times a day, leaving no more than 5-6 hours between each pump including overnight. The timings can vary depending on your routine, and you may choose to express every hour for a few hours, or every couple of hours.
Preparing to express breast milk
When expressing milk it is a good idea to give yourself time and make sure you have everything you need before you start.
Wash your hands thoroughly before you begin.
Things you may need:
- 1 or 2 expressing kits (for single or double pumping).
- Pump and tubing, funnels and valves.
- Bottles and lids for bottles.
- Labels for bottles and a pen to write on them.
- A large bottle to drink from
- A table to put the bottle on whilst you disconnect from the tubing.
- Something to record when, how long for and how much you have expressed.
- A pumping bra can also be useful to free up your hands whilst you express.
Things you may need if you are expressing
Clothing
Try to wear comfortable clothing, that you are able to pump whilst wearing them. You can buy special feeding tops, or make sure they are loose fitting and easily accessed with buttons / poppers. If you also want to wear a bra, you can use a pumping bra, or nursing bra can also be worn.
If you want to cover yourself whilst you’re feeding on the unit. We can provide a feeding cover for you on the unit or you may prefer to purchase something.
Caring for your body
Nipple cream
Breast pads
Snacks
Water bottle
Pumping
Pump for home
Extra pump parts
Transporting your milk
Cool bag
Bottles or bags – take these from hospital?
Steriliser – in hospital/ at home
Fridge and freezer space at home
Elevated side- lying
Elevated side-lying positioning (ESL) is a strategy that has been shown to improve oral feeding in preterm infants by supporting their stability, measured by heart rate and oxygen saturations during feeding.
ESL should therefore be considered for all preterm infants when oral feeding is being introduced and established. It is also likely to be beneficial for term infants where physiological stability is affected during feeding e.g. infants with a cardiac condition.