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Breastfeeding Preterm, Sleepy, and Small Babies

Updated: Apr 28

You can breastfeed successfully, but these babies have special needs.

Meeting Your Baby’s Needs

Babies who are early (35–37+6 weeks) or small (<6 lbs):

  1. are usually very sleepy

  2. often don't have the energy to breastfeed well

  3. usually have a weaker suck

than an average-weight or full-term baby. These babies can forget to eat, and when they do eat, they may not eat enough. In this case, your body may not get a strong enough message to make more milk.

  1. feed baby enough to reduce the risks of low blood sugar and excessive jaundice or weight loss

  2. be patient with your baby's breastfeeding skills

  3. empty your breasts frequently and thoroughly

Doing these three things buys you time for your baby to learn to breastfeed well, which may take a few weeks.​

In terms of how much milk your baby needs, the general rule is 2.5 oz per pound of body weight per day. Here is a useful milk calculator. You can look at this page for how to encourage your baby to get a lot of milk while breastfeeding, and how to give them extra milk (supplementation). Every baby’s needs are slightly different, but this is a good starting point. Do not worry about overfeeding—underfeeding is much more of a concern with early, small, or sleepy babies.

Many preterm/small babies, or those who have a weak suck, benefit from the use of a nipple shield:

Applying a nipple shield

Baby is latched on properly to the nipple shield

Be sure to use a size that fits your nipple and is easy for your baby to get their mouth around (lips should be at the base of the shield; see above picture).

Good Breast Stimulation

Your breasts need a strong signal in order to know how much milk to make. The way they figure that out is by how frequently and thoroughly they are emptied (the breasts are never truly empty, but for our purposes, consider them empty when you have gotten out all the milk you are able to, until only little drops are coming out). If your goal is a full milk supply, pumping will likely have to be part of your plan.

Making more milk is easiest for your body to accomplish in the first week.

It would be best to make sure your breasts are emptied about 7–8 times/day. This is a lot of work, so please get help if you can; your support person can wash pump parts and feed your baby while you pump. (Be sure to get some low-stress baby snuggle time too.) Having an extra kit (bottles, flanges, etc.) to cut down on washing frequency also helps. Some feedings can be pump/bottle only to save you time.

Feeding plan for sleepy babies

Every 3* hours: (1) Wake baby and (if you are both up to it) practice breastfeeding for about 15 minutes. (2) Father of baby/partner/support person bottle-feeds baby (3) Mother pumps her breasts about 15 minutes. Please feel free to customize this to meet your own needs, for example, if you need to sleep longer, see this plan.

Feeding in this way is called “triple feeding,” because you are doing three things—breast, bottle, and pumping. It is a typical plan for babies who are not breastfeeding well, and/or mothers who have a low milk supply. I suggest trying this plan for 3–4 days, and if it is not working for you, get more individualized advice by scheduling an appointment with a board-certified lactation consultant (IBCLC).

Transitioning to Exclusive Breastfeeding

Your baby will need practice at the breast in order to learn to get milk effectively, and you will need practice holding and latching your baby. You can do this whenever you and your baby are awake and have the energy, but I recommend limiting the time to about 15 minutes for time-management purposes. It is not necessary to practice breastfeeding at every single feeding; for example at night, most families find it most efficient to bottle feed and pump only and then get back to sleep.

Before your baby can exclusively breastfeed, it's important to know they can do the job of getting enough milk at the breast. This should be evaluated with a scale that can measure how much baby eats while breastfeeding; the scale must be accurate to 2 g or 0.1 oz, which lactation consultants carry and you can usually rent. If you cannot do this, you can start by breastfeeding only at the first morning feeding (no pumping, no bottles), and see whether your baby is satisfied until the next feeding. Your breasts should feel softer after baby eats. It is important to get your baby’s weight checked weekly or as recommended by your pediatrician, as you are transitioning from feeding and pumping to exclusively breastfeeding. Through all of this, please be kind to yourself and do not put your own needs last. You are recovering from childbirth, which is one of the most physically grueling experiences a person can go through. You physically need sleep, rest, and enough food and drink.

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