Sleepy, Preterm, or Small Babies
Sleepy, Preterm, or Small Babies
Meeting Your Baby’s Needs
Babies who are early (35–37+6 weeks) or small (<6 lbs) are often very sleepy, have poor stamina for breastfeeding effectively, and usually do not have the strength to adequately stimulate your breasts for optimal milk production.
Graphic by Jody Segrave-Daly, RN, IBCLC
The three most important things are to (a) feed them enough to manage their increased risk for complications such as low blood sugar and jaundice, (b) to give them the energy they need to feed well, and (c) to empty your breasts frequently and thoroughly; this buys you time for your baby to learn to breastfeed effectively, which may take until their expected due date.
In terms of how much milk your baby needs, the general rule is 2.5 oz per pound of body weight. Here is a useful milk calculator. Every baby’s individual 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.
Ensuring Good Breast Stimulation
Your breasts need strong stimulation 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 extracted all the milk you are able to, until only little drops are coming out). Because your baby does not have the energy and stamina to provide this stimulation, pumping will have to be part of your plan if exclusive breastfeeding is your goal.
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.* Having an extra kit to cut down on washing frequency also helps. Some feedings can be pump/bottle only to save you time.
*Note that mothers who are pumping while others bottle feed the baby sometimes feel isolated and disconnected from their baby—it can feel like your only role is to be a milk provider while everyone else gets the fun and bonding. Make sure you get time to snuggle and you can also bottle-feed when you wish. Time with you is more important to your baby than the number of ounces of milk you produce.
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 or partner bottle-feeds baby
(3) Mother pumps her breasts about 15 minutes.
*Please feel free to customize this to meet your own needs, and take a look at a modified version that prioritizes your sleep.
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.
Transitioning to Exclusive Breastfeeding
Your baby will need practice at the breast in order to learn to transfer milk effectively, and you will need practice positioning 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.
Your baby’s transition to exclusive breastfeeding needs to be customized based on how well your baby can transfer milk. It is necessary to evaluate that in person with a scale that can measure milk intake during breastfeeding; the scale must be accurate to 2 g or 0.1 oz, which I usually have available for rent, or can refer you to another rental station. 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.