Breastfeeding Premature Babies: Practical Tips and Challenges

By Chinonso Cynthia Ukah, BNSc, RN, RM, RPHN. Freelance Health Writer. Medically reviewed by: Chiamaka Wisdom-Asotah, MBBS.

September 29, 2026

An African mother holding her premature baby next to a breast pump. Click on image to enlarge.

 

Highlights 

• Half of the babies born at or below 32 weeks die in low-income countries every year.

• Breastfeeding can improve the chances of survival for premature babies.

• Premature babies have higher nutritional needs than full-term babies because they are still developing.

• Initiating breastfeeding may be challenging when a baby is too immature to suck and swallow effectively.

• Expressing breast milk early and regularly can help mothers to preterm babies maintain their milk supply.

• Understanding these challenges can help mothers provide breast milk even when direct breastfeeding is not yet possible.

 

Introduction

Breastfeeding a newborn baby is an important part of their survival. Immediately after birth, many babies are placed on their mother's breast, where they not only get nourishment but also comfort and warmth. But what happens when your baby is born too early?

What happens when your baby is taken from you to the special care baby unit (SCBU) or neonatal intensive care unit (NICU) because they are too small or too sick to breastfeed directly? How will your baby get your breast milk? And what happens to you when your breasts are still producing milk, but your baby isn't there to feed?

These are some of the challenges mothers of premature babies may face.

In this article, we'll look at the common challenges mothers may face when breastfeeding a premature baby and, most importantly, what you can do about them.

 

What Is Prematurity?

Prematurity is a term used to describe babies who are born before 37 completed weeks of pregnancy [1]. They are also called preterm babies or preemies, and they can be:

• Extremely premature: Born before 28 weeks
• Very premature: Born from 28 weeks to before 32 weeks
• Moderate to late premature: Born from 32 weeks to before 37 weeks

According to the World Health Organisation, prematurity is the leading cause of death among children aged 5 years and below. And, half of these babies born at or below 32 weeks die in low-income countries like Nigeria, Ghana, etc., due to lack of simple and affordable interventions like breastfeeding, amongst others [1].

Babies can be born premature for two main reasons [1]:

1. Labour began too early (spontaneous preterm labour)
2. Medical indication: When continuing the pregnancy may put the mother or baby at risk. In such cases, the healthcare team may recommend inducing labour or performing a caesarean section, even though the baby has not reached 37 weeks.

In any case, these babies may find it very difficult to breastfeed because their sucking and swallowing skills are not yet fully developed.

 

What Is Breastfeeding?

Breastfeeding simply means feeding a baby with breast milk. It becomes exclusive breastfeeding (EBF) when the baby is fed only breast milk for the first six months, without water or other foods. After six months, other foods are introduced while breastfeeding continues for up to 2 years and beyond.

Preterm babies have unique nutritional and developmental needs. Because they are born before they are fully developed, their nutritional requirements are higher than those of term babies, which is why breastfeeding is very important [2].

 

Why Is Breast Milk Important for Premature Babies?

Breast milk provides premature babies with important nutrients and protective substances that support their growth and help protect them from infections and other complications. Some of the major benefits include [3]:

• Helps with growth and development: Breast milk provides the nutrients a premature baby needs for healthy growth and supports brain development.

• Provides adequate nutrition: It contains important nutrients such as proteins, fats, carbohydrates, vitamins, minerals and water that support the baby's needs. However, breast milk alone may not provide enough of some nutrients to meet the higher nutritional needs of certain premature babies. In such cases, it may be fortified with additional nutrients as recommended by a healthcare professional.

• Protects against infections: Breast milk contains antibodies and other protective substances that help babies fight infections like meningitis and sepsis. 

• Protects the gut: Breast milk supports the development and health of the baby's immature digestive system. It can also reduce the risk of necrotising enterocolitis (NEC), a serious condition in which parts of a premature baby's intestine become inflamed and damaged [3].

• Helps with digestion: Breast milk is easier for a premature baby's developing digestive system to handle making digestion and extraction of nutrients easier.

• Reduces the risk of certain diseases: Feeding premature babies human milk has been associated with a lower risk of chronic health conditions later in life,  like metabolic and cardiovascular diseases [2]. 

• Reduces the risk of death: Because breast milk can help protect against serious infections and complications, breastfeeding is associated with better survival among infants.

 

How Premature Babies Are Fed Before They Can Breastfeed

Before breastfeeding, premature babies are often given expressed breast milk (EBM). EBM is breast milk that has been removed from the breast by hand or with a breast pump and given to the baby using a suitable feeding method. 

Image showing four ways expressed breast milk may be given to a preterm baby when direct breastfeeding is not yet possible. Click on image to enlarge.

 

Depending on the baby's maturity and ability to suck and swallow, EBM may be given through the following means:

• Tube feeding

A thin tube is passed through the baby's nose or mouth into the stomach. Expressed breast milk can then be given through the tube, especially when the baby is not yet able to suck and swallow effectively.

• Cup feeding

The baby is given expressed breast milk from a small cup. This may be used when the baby is able to take milk by mouth but is not yet ready to breastfeed directly.

• Cup and spoon

Small amounts of expressed breast milk may be given using a cup and spoon. This is another way of providing milk while the baby develops the skills needed for direct breastfeeding.

• Bottle feeding

Expressed breast milk may sometimes be given through a bottle. However, certain authors say it can be a risk factor to stopping breastfeeding early [4].

 

How Breastfeeding a Premature Baby Differs From a Normal Term Baby

Unlike a baby born at term (38-40 weeks), premature babies may need to move between tube feeding, cup and spoon before finally feeding at the breasts due to the following reasons;

• Uncoordinated sucking, swallowing and breathing: Sucking and swallowing reflexes usually develop while the baby is still in the womb, and is further developed when a baby is born to include breathing [5]. Many babies born prematurely have difficulties feeding through the mouth and this may be an early warning sign of brain damage and future health problems [4, 6].

• Inefficient milk transfer: Milk transfer refers to the amount of milk a baby is able to remove from the breasts during a feed. A newborn needs to generate enough expression pressure, suction pressure, and endurance to maintain a latch and effectively remove milk from the breast, which some premature babies may lack [5]. Preterm babies may also have weaker sucking and less organised sucking patterns compared with term babies.

• Length and pattern of breastfeeding: A premature baby may not breastfeed for as long or in the same pattern as a term baby. They may suck for shorter periods, take more pauses and become tired more quickly during a feed. This is because premature babies have less feeding endurance, with studies showing weaker sucking, more resting and less endurance compared with term babies at similar developmental ages [7].

• Breastfeeding directly: A term baby is usually more prepared to breastfeed directly from the breast because the skills needed for effective sucking, swallowing and breathing are more mature at birth. A premature baby, on the other hand, may take more time to develop these skills and become able to breastfeed effectively. How soon this happens varies depending on how early the baby was born, their health and their feeding maturity.

 

Practical Tips for Breastfeeding a Premature Baby

If you have a premature baby and want to continue giving them breast milk, here are some practical tips you can follow [8]:

• Start expressing your breast milk early

A mother in a hospital bed expressing breast milk with a breast pump. Click on image to enlarge. 

 

If you are separated from your premature baby after birth, start expressing your breast milk as soon as you are able to. If you are medically stable and strong enough, try to begin within the first 1–3 hours after giving birth. This helps you start building your milk supply while your baby may not yet be able to breastfeed directly.

• Express regularly 

An African mother sitting at a table with a breast pump and breast milk collection bottles beside her. Click on image to enlarge.

 

Some mothers may not be able to express large amounts of milk especially in the first week of birth. This shouldn't discourage you from expressing. The more you express, the more milk you can produce with time. It is often recommended that you express up to 8 to 12 times per day in the first few weeks to aid milk supply.

• Attend antenatal care

Pregnant women attending an antenatal class as a healthcare worker provides health education. Click on image to enlarge.

 

It is important that you attend your antenatal classes. Here, your healthcare provider can teach you strategies for expressing your breast milk more effectively, such as how to massage your breasts, how to use skin-to-skin contact, how often you should express and the best timing for expressing your milk.

• Practise Kangaroo Mother Care

Mother holding her premature baby skin-to-skin against her chest at home. Click on image to enlarge.

 

Kangaroo Mother Care involves a combination of prolonged skin-to-skin contact between you and your baby, breastfeeding and bonding. This strategy has been recommended by the World Health Organisation to increase the rate of breastfeeding among premature babies and also babies with low birth weight.

• Avoid bottle-feeding your preterm baby

A mother gently feeding her premature baby with a cup while holding the baby close to her chest. Click on image to enlarge.

 

Most preterm babies are still learning to breastfeed and may need an alternative feeding method while they develop the ability to suck, swallow and breathe effectively. Cups or spoons are often preferred to feeding bottles and teats for preterm babies who need alternative feeding. This is because bottle-feeding has been linked to early stoppage of breastfeeding compared to expressing breastmilk and feeding it to your baby [4]. 

• Practise exclusive breastfeeding 

A mother breastfeeding her premature baby in a hospital room. Click on image to enlarge.

 

Once your baby is able to breastfeed effectively and there is no medical reason for additional feeds, aim to practise exclusive breastfeeding for the first six months. This means giving your baby only breast milk, without water or other foods and drinks [9]. 

 

Challenges of Breastfeeding a Premature Baby 

Some of the challenges you may encounter as an African mother with a preterm infant include the following [10, 11].

1. Separation

Your baby may be separated from you in the first hours of life because they need to be stabilised. They may need immediate breathing support or other urgent medical care, making early initiation of breastfeeding almost impossible.

2. Latching Difficulties

When your preemie becomes stable enough to breastfeed, you may also have challenges putting them to breast as; 

• Their mouth may be too small
• They may not attach properly, stay attached or suck effectively
• They may be positioned wrongly especially if you are a first-time mother 
• Flat or inverted nipples may not allow the baby to latch properly 

3. Lethargy

Premature babies get tired quite easily and tend to sleep a lot. Even when they are able to latch and suck, they may not have enough strength or stamina to breastfeed for long [7].

4. Not Being Able to Express Effectively 

Some mothers may experience difficulties when trying to express breast milk for their premature babies. This may be due to a lack of knowledge about how to express effectively, difficulty using a breast pump, or other personal reasons. This is why learning about breast milk expression during antenatal care and seeking help from healthcare providers when needed is important.

5. Breast Engorgement

This usually happens on the 3rd to 5th day after you have had your baby. Your breasts become fuller, firmer and painful. Breast engorgement can become worse when:

• Your baby is premature and cannot remove enough breast milk from the breast
• You don't express breast milk as often as recommended 
• You can't express effectively because it is painful, especially when you have sore or cracked nipples
• You express too much milk while engorged, as this can encourage your breasts to produce even more milk

6. Low Milk Supply

Some mothers may struggle with low breast milk supply after giving birth prematurely. Preterm birth is a risk factor for delayed lactogenesis stage II, the stage when milk production increases and becomes more abundant [4]. This can make it difficult to produce enough milk for your premature baby, especially in the early days after birth.

 

Conclusion

Breastfeeding a premature baby can come with challenges, especially when your baby needs to stay in the NICU or SCBU, cannot breastfeed directly, or you are struggling with milk expression. However, these challenges do not mean that you cannot provide breast milk for your baby. Starting milk expression early, expressing regularly, practising skin-to-skin contact and getting support from your healthcare provider can help you establish and maintain your milk supply while your baby develops the skills needed to breastfeed directly. Be patient with yourself and your baby, and remember that you do not have to figure it all out alone.

 

Common Questions Parents Ask

• What can I do if my premature baby is struggling to feed?

Give your baby time to develop the ability to coordinate sucking, swallowing and breathing. You can continue expressing your breast milk and giving it to your baby using the feeding method recommended for them until they are ready to breastfeed directly. You may also benefit from the support of your healthcare provider.

• How do I know if my premature baby is getting enough milk?

Your baby's weight gain, growth and feeding pattern are some of the best ways to know if they are getting enough milk. As they grow, regular wet and soiled diapers can also be a useful sign that they are feeding well.

• How often should I breastfeed my premature baby?

This depends on your baby's gestational age, weight, health and ability to breastfeed. Some premature babies may need to feed more frequently or take longer breaks during feeds. Follow the feeding schedule given for your baby and watch for their feeding cues.

• How much milk should a premature baby drink?

The amount depends on your baby's weight, gestational age, health and nutritional needs. Premature babies are usually given a specific amount of milk based on their body weight. So, don't compare the amount your baby takes with what another baby takes.

• How do I feed a premature baby at home?

Before leaving the hospital, your healthcare provider will show you how to breastfeed, express your milk and give expressed milk if your baby is not yet breastfeeding effectively. If your baby still needs an alternative feeding method, continue using the method recommended for them until they can breastfeed directly.

• When should I start solid foods for my premature baby?

Most babies start complementary foods at around 6 months while breastfeeding continues. For premature babies, however, the timing may depend on their corrected age and developmental readiness. Look for signs that your baby is ready rather than relying on age alone.

 

References:

1. World Health Organization. Preterm birth [Internet]. Geneva: World Health Organization; 2023 May 10 [Cited 2026 Sep 12]. Available from here.

2. Tongo OO, Olwala MA, Talbert AW, Nabwera HM, Akindolire AE, Otieno W, et al. Enteral feeding practices for very preterm and very low birth weight infants in Nigeria and Kenya. Front Pediatr. 2022;10:892209. doi:10.3389/fped.2022.892209. Available from here.

3. Degaga GT, Sendo EG, Tesfaye T. Prevalence of exclusive breast milk feeding at discharge and associated factors among preterm neonates admitted to a neonatal intensive care unit in public hospitals, Addis Ababa, Ethiopia: a cross-sectional study. Pediatr Health Med Ther. 2020;11:21-28. doi:10.2147/PHMT.S215295. Available from here.

4. Kinoshita M, White MJ, Doolan A. Clinical assessment of breastfeeding in preterm infants. Eur J Clin Nutr. 2024;78(10):825-829. doi:10.1038/s41430-024-01471-3. Available from here.

5. Shandley S, Capilouto G, Tamilia E, Riley DM, Johnson YR, Papadelis C. Abnormal nutritive sucking as an indicator of neonatal brain injury. Front Pediatr. 2021;8:599633. doi:10.3389/fped.2020.599633. Available from here.

6. Scherman A, Wiedrick J, Lang WC, Rdesinski RE, Lapidus J, McEvoy C, et al. Quantification of nutritive sucking among preterm and full-term infants. Res Rep Neonatol. 2018;8:53-63. doi:10.2147/RRN.S165421. Available from here.

7. McLeish J, Aloysius A, Gale C, Quigley MA, Kurinczuk JJ, Alderdice F. What supports mothers of very preterm babies to start and continue breast milk feeding in neonatal units? A qualitative COM-B analysis of mothers’ experiences. BMC Pregnancy Childbirth. 2024. doi:10.1186/s12884-024-06910-4. PMID: 39506695. Available from here.

8. Cunha CMC, Lima EFA, Galvão DMPG, Brito APA, Fonseca LMM, Primo CC. Breastfeeding assistance for preterm and low birth weight infants: best practices implementation project. Rev Esc Enferm USP. 2024;58:e20230380. doi:10.1590/1980-220X-reeusp-2023-0380en. PMID: 38949512. Available from here.

9. World Health Organization. Early Essential Newborn Care [Internet]. Geneva: World Health Organization; 2022 Jul 22 [cited 2026 Sep 12]. Available from here.

10. Breastfeeding experience, barriers, and facilitators among mothers of vulnerable low birth weight infants in Amhara region, Ethiopia: a qualitative exploratory study. Int Breastfeed J. 2025;20:51. Available from here.

11. Russell JA, King R. The challenges of breastfeeding a late preterm or early term infant: Women's and clinician's perceptions of provision of antenatal information when considering early planned birth. Midwifery. 2025;143:104314. doi:10.1016/j.midw.2025.104314 Available from here.

 

 

Related:

7 Barriers to Exclusive Breastfeeding in Africa

14 Breastfeeding Challenges African Nursing Mothers Need To Know

10 Common Myths and Misinformation about Breastfeeding in Africa

6 Breastfeeding Tips for New African Moms

Make up, Nail Polish, Hair Dyes Can Be Harmful During Pregnancy and Breastfeeding

Breast Hygiene and Care During Breastfeeding: A Guide for African Women

 

 

Published: September 29, 2026

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