Breast-Feeding: Late Preterm Baby

Babies born between 35 and 37 weeks gestation may not feed well. They are also at risk for low blood sugar, jaundice, breathing problems, and infections. These babies are sleepy, and often have problems latching on and sucking properly. Two things that help are to keep your baby in close physical contact, and to give your baby extra milk.

Where do I start?

• If your baby is stable, keep him on your chest to help regulate his heart rate, breathing, and temperature.
• Make sure your baby is close to your breasts. Any time your baby wants something in his mouth, it should be your breast.
• When your baby makes little sounds, moves his arms and legs, moves his mouth and tongue, brings his hands to his mouth, or turns his head, he is showing you that he is ready to feed.
• For the first day, it’s a good idea to hand express some colostrum (the first milk) after feedings. This lets you give your baby extra milk. Give 1 to 2 tablespoons of expressed milk or formula after feedings in the first day. Give 2 tablespoons to 1 ounce each feeding the second day.
• Some babies are very sleepy, so you may need to wake your baby for feedings. He should feed at least 8 times in 24 hours.

What if my baby does not latch on and nurse?

The hospital staff or a lactation consultant can help you learn and practice what you need to know.

• Hold your baby skin to skin while you massage and hand express your colostrum. You can express it into a spoon, cup or special syringe and feed it to your baby. It is best not to use bottles at this stage. Using bottles can cause problems with breastfeeding for some babies.
• If your baby is dehydrated or has lost too much weight, you may need to supplement with formula if you cannot express enough milk.
• If supplementing, you should pump or express your milk regularly every 2 to 3 hours during the day and every 4 hours during the night. It is best to use a hospital grade electric pump.
• Sometimes, the use of a nipple shield (a soft silicone nipple cover) will help the baby suckle better. However, this may cause problems with milk supply and your baby’s ability to get enough milk. Work closely with a lactation consultant when you are using a nipple shield.

What happens when we go home?

• Keep feeding as you have been doing in the hospital. If you are supplementing with expressed milk or formula, continue doing that. Your baby’s healthcare provider or a lactation consultant will check to make sure that your baby is getting enough milk. You may decide to use a bottle for the supplement rather than spoon, cup or syringe.
• Your baby should be seen by his healthcare provider within 48 hours after leaving the hospital. The provider will check your baby’s weight, how well your baby is feeding, and make sure there is no jaundice.

How do I know my baby is getting enough?

• Your baby should wake to feed every 2 to 3 hours and suckle at the breast for up to 30 minutes each time.
• Your baby will act satisfied after feedings and usually go to sleep until he wakes for the next feeding.
• Your baby should urinate 6 times per day and have 4 bowel movements a day by 5 days of age.
• If your baby is hard to wake up, or falls asleep at the breast, express your milk and feed it to your baby.
• If you are not sure that your baby is getting enough milk, call your healthcare provider or lactation consultant. Weight gain is the most reliable way to know your baby is nursing well. Ask about weighing your baby.

Questions to ask your healthcare provider

• How often should I bring my baby in for examination?
• When should my baby have a blood test for jaundice?
• How many times should I feed my baby each day?
• How long should my baby go without eating?
• What problems should I watch out for?
• How will I know if I should call you and how do I reach you?