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Updated November 25, 2014.

Bottle feeding a preemie in the NICU can be one of a parent’s biggest joys and concerns. Snuggling your baby in your arms is, of course, a pleasure. But, while feeding, you may also be worried about whether or not your baby is getting enough milk. Being able to feed well at the breast or by bottle is one of the milestones that a NICU baby must meet before discharge, so it's natural to feel anxious about reaching it.


Even if you plan to breastfeed, you may need to bottle feed your preemie at times in the NICU. Bottle feeding allows NICU staff to know exactly how much milk a premature baby is taking in, and it allows nurses to fortify breast milk by adding extra calories.

Tips for Encouraging Good Bottle Feeding

Bottle feeding a preemie is very different from feeding a term infant. Unlike a baby born at term, a premature baby may be very sleepy at feeding times, may not be strong enough to drink enough milk to sustain growth, and may have a hard time swallowing and breathing at the same time. NICU nurses will help you learn how to bottle feed your preemie, using some time-tested tricks.

• Sit your baby up: In the NICU, you’ll notice that premature babies are bottle fed sitting up, not cradled in the arms. To help your baby stay awake and to promote good positioning, sit your baby on your lap, supporting his or her head and shoulders in your non-dominant hand.
• Use chin and cheek support: With your baby sitting up, supported by your non-dominant hand, your dominant hand is free to hold the bottle and support her chin and cheeks. It takes practice, but NICU staff can show you how to provide gentle chin and cheek support to help your baby get a good seal on the nipple.

• Do your exercises: Ask NICU nurses or physical therapists to show you a series of mouth exercises you can perform on your baby to help prepare her for feeding. Exercises like circling the lips with your fingers, stroking the chin, and gently squeezing the cheeks together can help your baby to feed better.
• Practice pacing: Premature babies may have trouble coordinating bottle feeding with breathing, and may experience apnea or bradycardia during a feed. Watch your baby for signs of trouble, and pause the feeding if your baby has trouble breathing, gags, goes limp, or has a drop in heart rate or oxygen saturation (indicated by the monitors).
• Encourage nurses to take out the tube: Although NG tubes are important for premature babies who aren’t able to take in enough calories by bottle or breast to grow well, many babies bottle feed better with no tube in place. As your baby starts taking more milk by bottle, ask to try a few feedings without the tube.

<sub>Sources:

Daley, Helen RN, MSN, Kennedy, Christine RN, PhD. “Meta Analysis: Effects of Interventions on Premature Infants Feeding.” The Journal of Perinatal and Neonatal Nursing December 2000, 14; 62-77.

Sears MD, William, Sears MD, Robert, Sears MD, James, Sears RN, Martha. The Premature Baby Book: Everything You Need to Know About Your Premature Baby from Birth to Age One. Little, Brown and Co., New York, 2004.</sub>