Feeding your premature baby at home.
As you have probably noticed,
your preemie can be sleepy during feeding time.
Sleepiness during feeding time is normal for preemie babies
as they do not have the maturity
to eat the way term babies eat.
It is not uncommon for preterm babies
to be referred to as sleepy feeders.
Preemie babies may not be able to cue or show hunger
and this puts them at risk for poor feeding
and poor weight gain at home.
Many preemies are able to give some hunger cues
prior to their discharge.
Your baby is cuing
if they are awake and alert around feeding time,
sucking on their fingers, smacking their lips,
rooting or to turning their head
and opening their mouth for a nipple,
or fussing or crying.
Babies who do not give hunger cues may not eat well
so parents of preemies may need to set alarms
and wake their preemie.
This is especially important for nighttime feedings.
You may have some questions about feeding your baby at home.
What are you feeding your baby?
When do you start breastfeeding?
How often can you breastfeed?
How much should you feed your baby?
Should you feed your baby on a schedule?
And how do you make formula?
The NICU will help you learn to feed your baby.
This will help you get accustomed
to what your baby is eating.
Many moms choose to give breast milk
and other moms choose to give formula.
Although breast milk is preferred,
we are here to support your choice
for what you would like to feed your baby.
A common formula for preterm infants is Similac NeoSure.
This formula is different from term infant formula.
Term infant Similac formula is 19 calories per ounce.
NeoSure is 22 calories per ounce.
This formula gives your preemie optimal nutrition
to support weight gain and bone growth.
NeoSure can be found in most stores that sell formula.
For your convenience,
we also have NeoSure stocked in our outpatient pharmacy.
Some preemies need calories greater than 22
or a different formula than NeoSure.
Some preemies need NeoSure or other formula powder
added to breast milk to boost the calories.
Your NICU team will review what your baby is eating
and what you will need at home prior to discharge.
The NICU dietician is very helpful in preparing you
for what you will be feeding your infant at home.
The dietician will also give you special instructions
or a recipe for how to make higher calorie formula
or breast milk.
If your baby is discharged with a special recipe,
expect to see the dietician office outpatient.
Those families who qualify for WIC
will receive their paperwork
from the NICU dietician prior to discharge.
For more information about WIC,
please see our NICU social workers.
Because you will be feeding your baby in the NICU,
you will be aware of how much your baby is eating,
how much you feed your baby at home will be determined
the day of discharge.
Your baby is working hard learning to eat
and will be at their highest feeding amount
the day they go home.
So how much do you feed your baby?
Start with the amount your baby is taking at discharge.
Increase this amount gradually,
every couple of days,
add more if your baby eats the whole bottle,
they might take more.
And if your baby leaves a little left over,
they are probably satisfied.
Many preemies who leave the NICU are eating a range,
an example of a range would be eating 40 to 60 milliliters
or 30 to 50 milliliters each feeding.
You can always offer the larger amount.
Preemies who eat a range tend to have stronger hunger cues.
There are some things to consider
when determining your preemie's feeding schedule at home.
It is very important to keep your preemie
on a schedule at home.
Feed at least every three hours.
Some preemies may eat more frequently,
feed early when alert and cuing.
Wake up your preemie if they are not up by three hours
and do not allow your preemie
to go longer than three and a half hours
until you talk with the pediatrician.
Here are some reminders when making powdered formula.
Always check the expiration date on the formula can
before purchasing.
Gather your supplies like your measuring cup bottles
and a pan.
Use sterilized water.
Bottled water, distilled water or fluorinated water
are not sterile.
Heat your tap water on a stove in a pan
until boiling for one minute.
Let the water cool for up to 30 minutes
and then use to mix the powder.
Now I'm gonna show you how to mix powdered formula.
Before you begin, you need to clean your surface
and wash your hands
and get like a dish towel, clean dish towel,
lay that down for your workspace.
You're going to need a pan, some measuring cups.
Now, if you do not have a measuring cup,
the NICU can sub apply you with this measuring cup
which can make larger volumes of formula,
your bottles, a spoon for mixing
and a knife for leveling the scooper.
And of course your can of formula
and a clean wet dish rag so that you can wipe off the can.
My baby is going home on NeoSure
so I purchased NeoSure 22 calories.
I also wanna make sure I've checked the expiration date
which is always on the bottom of the can.
My baby's on NeoSure
so I know I'm gonna follow the recipe on the can.
I want to make a larger amount of formula
for the rest of my day.
So I'm gonna start with the eight fluid ounces
mixed with four scoops.
So now that I figured out how much water I'm gonna need,
I'm gonna go ahead and from my tap,
I'm going to add water to my pan,
and I'm going to boil that on the stove
for at least one minute.
Once this is boiled, I'm going to take the lid off
and let that cool for 30 minutes.
I'm gonna use the bigger measuring cup
that I got from the NICU.
And now that my water is cooled,
I'm gonna go ahead and pour eight ounces of water
to make my eight ounce recipe.
This is a fresh can of formula.
So I definitely wanna wipe off the top of this container
and that foil before I open the can.
Remember too to go ahead and wash your hands again.
Now, when you're measuring your scoops,
you want to get a big scoop,
and then you want to level that,
you don't wanna pack your formula.
So you just get a big heaping scoop 1, 2, 3, 4, 5,
to ensure that you get all the little air pockets out.
Measure that off and go ahead
and put that into your eight ounces of water.
Now I'm gonna do that three more times.
1, 2, 3, 4, 5,
and there we go.
Heaping scoop, 1, 2, 3, 4, 5.
We'll level that off.
So that's the third scoop and the last scoop, 1, 2, 3, 4, 5.
Perfect.
And I would leave this outside of your can
to keep your powdered formula as clean as you can.
So we'll go ahead and put the lid on that
and set at that aside,
and you can wash this and reuse it.
So now I have my powder mixed with my water
and you can see that it's clumpy.
So now I'm going to take my spoon
and I'm gonna go ahead and mix it up
until it's smooth and there are no clumps in it.
You can also get a little container
to store your formula in the refrigerator.
This is a Mason jar that I actually have a lid for it.
I can put the lid on it and shake it up a little bit
and that will help get all the lumpiness
out of your formula.
My baby is taking two ounces of formula or 60 milliliters.
So I'm gonna challenge my baby.
I'm gonna go ahead and I'm gonna give my baby
a little bit more than two ounces.
Now, before you've feed your baby,
always check the temperature of the formula
because we let it cool on the stove,
but we wanna make sure that it's cooled down enough
to safely feed your baby with,
so a great place to always check a temperature of formula
or even bath water is on your inner forearm.
So I've just now tested the temperature
and it feels just a little lukewarm,
and it's fine if it's room temperature.
Now that I have this big batch of formula,
the storage of this formula is gonna be extremely important.
This formula is good for 24 hours in the refrigerator.
If I don't put this formula in the refrigerator,
it's only good sitting out for two hours.
Once my baby eats off the bottle
and doesn't eat the whole thing,
I'm gonna need to discard that amount within an hour.
After your can of formula is opened,
it is good for 30 days or from the expiration date,
whichever comes first.
Breastfeeding a preemie can be challenging.
The sleepy feeder can be even sleepier at the breast.
Preemies are particularly comfy
and cozy up against their mommy's bare skin.
Attempting a latch can be more difficult
than a hard nipple on a bottle.
So it is important to establish a latch early
when oral feedings are started.
Do not wait until discharge to attempt breastfeeding.
Here are some tips for successful breastfeeding at home.
Discuss your plans for breastfeeding with the NICU team
prior to your infant feeding.
Get help from our lactation nurses.
Attempt breastfeeding at least once a day
prior to discharge.
Watch for breast changes
and softening with breastfeeding
and seek support after discharge.
Our lactation team can help you establish
an effective latch at the breast.
Some moms may need a shield,
this is an effective tool,
especially for preemies who have had many bottles
prior to attempting breastfeeding.
Your nipple looks very different
than the nipple on the bottle.
The shield will give your baby a firm nipple
to latch onto and allow for effective breastfeeding.
Your baby is getting enough to eat at the breast.
If you are able to hear or see swallowing,
your breast is softening after feeding,
your baby continues to have wet and poopy diapers,
and your baby is gaining weight.
Here are some tips for making more milk.
Breastfeed and/or pump at least eight times per day.
Try power pumping, 10 minutes, rest 10 minutes,
pump 10 minutes.
Do this for one hour.
Drink plenty of water, 128 ounces or 16 cups a day.
Eat high fiber foods like oat, beans, and leafy greens.
Try to relax with music or video apps
to decrease your stress and pump near your baby.
You will need to clean your pump kit.
In the hospital you need to clean it after each use
and take all pieces apart.
Wash in hot soapy water with a brush,
always wash your valves by hand.
At home, handwash or use the top rack of the dishwasher.
You can also sterilize your pump parts
by boiling them on the stove for a few minutes.
Always allow your parts to air dry, do not wash your tubing.
Tubing will get some condensation.
Shake your tubing and allow it to air dry.
If it gets black specs, this could be mold, throw it out.
We are here for you.
Here are the important numbers you will need
for Fairview Hospital.
Hillcrest Hospital.
Main campus.
Feeding a preemie can be very different
from feeding a term infant
due to being early preemies can sometimes have problems
with the three important skills
for successful feeding, sucking, swallowing, and breathing.
You will work with the NICU team
to learn how to feed your preemie.
You will learn how to position and pace your infant
during the feeding.
Many preemies eat in an inclined sideline position.
This position allows for the feeding
to pull into the cheek and not in the back of the throat
thus allowing for a better pacing.
You may be feeding your preemie
in this sideline position in the NICU and at home.
The NICU team will help you learn
how to feed your baby in an inclined sideline position.
Sideline feeding position allows for close observation
of your baby sucking and swallowing and breathing.
When feeding in an inclined sideline position,
make sure that your baby's ears
are in line with the shoulders.
This will help your baby breathe easier
during the feeding.
Swaddling your infant can help keep your baby's ears
in line with the shoulders.
This allows for the hands to be brought to the face,
encouraging rooting.
As your baby becomes a stronger feeder,
you can try a true upright feeding.
The more you feed your baby at the NICU
the more comfortable you will be feeding at home.
Even term infants can have mild choking events
at home during feeds.
Avoid distractions while you feed your preemie,
watch for sucking, swallowing, and breathing,
and watch the color of the lips.
Your baby may need to be paced.
Tipping the bottle down prevents flow from the nipple
and allows your baby to take a breath.
During a mild choking event, stop the feeding,
sit the baby up,
and gently pat the back.
Your baby may need suction
so have a bulb syringe or suction device on hand.
If the choking becomes severe,
begin back slaps and chest thrusts
as reviewed in your infant CPR class and call 911.
We'll now talk about the home bottle.
Please bring in bottles you have purchased for your baby.
The NICU will start using them in preparation for home.
Home bottles are very different than hospital bottles
and we wanna make sure that the bottle you purchased
is a good fit for your baby.
If you have not purchased bottles,
your NICU team can help you choose the best option
for your baby.
Most babies leaving the NICU will go home
on a vitamin D supplement.
Vitamin D is important for calcium absorption,
which is necessary for bone growth.
Some preemies also need iron.
It is not recommended to give vitamins
directly into your preemie's mouth.
Many preemies do not like the taste
and may hold their breath.
The safest way to give vitamins to preemies
is to add the vitamins in about 10 to 15 milliliters
of the feeding.
Vitamins in any other medication
for your baby will be sent electronically
to our outpatient pharmacy.
We will let you know when you can pick it up
or we can have have our Med to Bed bring it to you.
It is important that your baby's nurse verify
that you've purchased the correct medication
and show you how to drop the dose.
Vitamins and other medications will have refills
and you can get them refilled at your pharmacy.
Purchasing an infant scale will help you
monitor your preemie's weight gain at home.
A basic infant scale is all you would need.
Most basic infant scales can range from 35 to $40.
You can find infant scales at many stores or online sites.
Infant scales are especially useful for breastfeeding moms
or those families whose preemie
is seeing a dietician after discharge.
Your baby's pediatrician
may want to monitor the weight closely
and may require frequent weight check visits in the office.
Let your pediatrician know you have an infant scale at home.
This may limit some of the extra appointments.
Let me show you an example
of weighing your baby on an infant scale.
First, undress your baby.
Turn on the scale, take off the diaper,
and go ahead and lay your baby on the scale
until you get the reading.
Soon enough your preemie will grow and mature
into a vigorous, hungry, and demanding little feeder.
Keep your preemie feeding
and you will keep your preemie growing.
Growth is so important for your baby's brain and body
and lays the foundation for your child's overall health
and wellness for the future.