Common Feeding Problems In The NICU

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There are many reasons why your baby may need to be admitted to the Neonatal Intensive Care Unit (NICU). Premature birth or having been born before completing 37 weeks in the womb is the most common amongst them. Some babies stay in the NICU for a day while others may need to stay for longer. Having a baby in the NICU is stressful for the parents as feeding NICU babies can be a challenge.

Why Is Breastfeeding Difficult?

Breastfeeding a premature baby is particularly difficult in the NICU and the reasons for this can be categorized as:

Physiological Issues

Premature babies are not born with the skills needed to suck milk from a breast or bottle. They also find it difficult to swallow the milk. In addition to this, they cannot coordinate muscle movement between drinking milk and breathing. Thus, they may start drinking but suddenly remember that they need to breathe and thus choke or gag on the milk. The inability to breathe may also make the baby tire himself/herself out faster during feeding.

Challenges For The Mother

Breastmilk production is related to the stage of pregnancy. Thus, when a mother delivers her baby prematurely, her breasts may not be able to develop sufficient milk. The experience of giving birth may also trigger physiological and emotional issues that affect their ability to breastfeed.

Separating the baby from the mother to take him/her to the NICU may increase the risk of complications and cause feeding problems. For example, when the infant is kept away from the mother, she may need help initiating and maintaining sufficient milk supply. This is often the case when babies need to be kept in the NICU for extended periods of time but the mother is discharged. Thus, mothers often need to rely on breast pumps or pasteurized donor milk.

In some cases, it may not be safe for mothers to breastfeed their babies in the NICU. For example, the mother may be prescribed certain medications to aid with her recovery, which may be transferred to the breastmilk and thus be unsafe for the baby. Mother’s milk may also need to be pasteurized before the baby can drink it.

Underlying Health Issues of babies

Other underlying health issues that may cause feeding problems for the babies include low muscle tone (hypotonia), gastrointestinal and neurological immaturity, chronic respiratory disease and gastro-oesophageal reflux. Birth defects such as a cleft palate or cleft lip can make it hard for babies to create and maintain the vacuum around the nipple to suck milk and thus limit the process further.

Winning The Challenge

When it comes to feeding NICU babies, the principle aim is to help the baby develop the skills required for natural feeding through exclusive breastfeeding and provide human milk to the baby at all times.

In case of premature babies born before 27 weeks, the baby may need to be fed through a nasogastric tube or orogastric tube. Most babies can transition from tube feeding to breastfeeding by 32 or 34 weeks gestational age. However, there is no definite time period for this transition.

If the mother cannot be present for every feeding, she will need to express the milk with the help of a breast pump. A special feeder may be used to deliver this milk to babies with physiological defects such as a cleft lip.

When it is possible to breastfeed, the experience should be made as comfortable for the baby and mother. Do not force-feed the baby. Respect the baby’s natural cues and stop feeding if the baby appears fatigued or upset. It is important to remember that force-feeding the baby can increase the baby’s chances of developing an oral aversion. Turn off all distractions and make the environment dark and quiet.

If the mother cannot produce sufficient milk, suitable alternatives may be needed such as pasteurized donor milk. Donor milk refers to the milk donated by other healthy lactating mothers which is rich in all the nutrients required by infants and can be easily digested.


Having your baby admitted to the NICU is stressful enough and being unable to feed your baby can aggravate this stress further. However, these challenges are usually short lived and can be overcome by the combined efforts of parents and healthcare professionals. In many cases, using pasteurized donor milk or human milk-derived products is the ideal solution until the baby can be breastfed naturally.



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