Feb 01

Helping Baby Learn To Breastfeed

Breastfeeding a baby who was born sick or premature is a reward for all your hard work and such a benefit for baby.

It will take time for your baby to learn to breastfeed, especially if they have been sick, or had a lot of tubes in their mouth to trust feeding to be a good experience.

Seek out other mothers who have been successful and a pediatrician who can help you after you go home.

There are special breastfeeding clinics to help moms and babies get breastfeeding working after you take baby home.

How Do I Know When My Baby Is Ready To Breastfeed?

‘Feeding readiness cues’ may signal that your baby is ready to start learning how to breastfeed.

You may notice your baby showing interest in feeding by:

  • Rocking their head back and forth.
  • Sucking or sticking out their tongue.
  • Smacking or licking their lips.
  • Putting their hands to their mouth.

Before learning how to breastfeed, your baby must be able to:

  • Tolerate being held in a side-lying position.
  • Have the strength and coordination to latch on to the breast.
  • Coordinate their breathing with sucking and swallowing, which can be a lot of work for your baby.

As you prepare for this stage, here are some great videos featuring women around the world facing the same issues.

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Click here to watch UC San Diego Health SPIN program videos.

Non-Nutritive Breastfeeding

Early breastfeeding — where the baby starts to latch and suck but does not drink any milk — is called ‘non-nutritive breastfeeding’.

As your baby gets closer to you, they will begin to smell your milk and may move toward your breast.

Position your baby in a ‘cross-cradle’ side-lying position and allow them to explore the breast.

If baby opens their mouth, bring them to your breast and allow them to suck.

Try to pump first to empty your breasts so baby can start learning without getting overwhelmed by milk.

If your baby seems ready to start learning to breastfeed or you need guidance, ask a nurse to make an appointment with a lactation consultant to visit you during a feeding.

Nutritive Breastfeeding

When babies are learning to breastfeed, it can be difficult to tell the difference between when they are tired and when they are full.

While feeding, look for signs that your baby is drinking or ‘transferring’ milk.

As your baby becomes stronger, it will be easier to tell if they are tired or full.

Don’t worry too much about how much milk your baby drinks.

Transferring milk from the breast is more complicated than sucking and it will improve in time.

In the beginning, it’s important to practice and help your baby have a positive experience at the breast.

What Are The Signs That My Baby Is Drinking Milk?

  • You have a good, comfortable latch.
  • You can see and hear your baby swallowing while feeding.
  • Baby’s jaw is moving.
  • Milk is visible in your baby’s mouth or in the nipple shield.
  • Your baby refuses a bottle after breastfeeding.
  • Baby is calm and relaxed after the feeding.
  • Your baby sleeps for an hour or more after the feeding.

  • Your breasts feel softer after the feeding.
  • You pump less milk than usual after the feeding.
  • Your baby’s weight is higher after the feeding. Weighing a baby before and after a feeding and then subtracting the difference between those weights gives you an idea of how many grams of milk your baby drank.

Can A Nipple Shield Help My Baby Transfer Milk?

Nipple shields encourage a wider open-mouth position and help keep the nipple in your baby’s mouth, even without much suction.

They help maintain suction, which helps draw milk out of the breast.

Nipple shields prevent babies from pushing the nipple out of their mouths with their tongues.

They help babies attach to a flat or inverted nipple, which may be a challenge for a small or preterm baby.

How Many Times A Day Should I Breastfeed My Baby?

For most premature babies, once or twice a day is best when they are learning.

Many NICUs will encourage baby to nurse more frequently as they start to transfer more milk and wean off the nasogastric (NG) tube.

Bigger or full-term babies in the NICU should be able to nurse more depending on their stamina.

If your baby is feeding well at the breast and not tiring, you can gradually increase the feeding time.

As you continue to practice each day, you will see that your baby will start to help you by getting into position more easily.

There will be days when your baby is interested in breastfeeding and days when your baby is not.

This will improve in time.

Can I Breastfeed My Baby When I Visit The Hospital?

Call every morning before you go to the hospital and let them know that you plan to breastfeed when you come in.

This way, you can coordinate your visit with your baby’s feeding time.

The more often you can visit and care for your baby before they go home, the easier the transition to breastfeeding will be.

Most preemies are breastfeeding a few times a day by the time they are ready to go home, but every baby is different.

Keep pumping! When your baby is learning to breastfeed, they will probably not be able to empty the breast right away.

Until they can, continue to pump in order to maintain your milk supply.

Your baby will find breastfeeding easier if you have a good milk supply and the milk comes easily.

After you go home, you will be able to gradually taper off your pumping.

Taking Your Baby Home

Before you leave the hospital, a lactation consultant or feeding specialist will meet with you.

Every baby who goes home breastfeeding should have an individualized nutrition and feeding plan.

Most premature babies — and many full-term babies — who have been sick are not able to fully breastfeed by the time they are ready to go home, but they will learn with you at home.

The lactation staff at your hospital will work with you to decide on a discharge plan that is appropriate for you and your baby.

The plan will help guide you on how and when to advance breastfeeding. Your plan will depend on several factors, including:

  • Your baby’s age and growth pattern.
  • Your baby’s energy level and ability to breastfeed.
  • Your breastfeeding goals and comfort level.
  • Your milk volume.

If your baby needs extra protein and minerals for brain and body growth, a fortifier for your milk may be recommended.

Be sure your NICU team knows your milk supply and breastfeeding goals so they can help you and your baby meet those goals.

What If I Have Questions After Discharge?

If you have any medical concerns about your health, call your obstetrician.

For your baby’s health, talk to your pediatrician.

If you need more help with breastfeeding, call a lactation specialist, attend a support group, La Leche League, and seek out other mothers who have been successful.


Lisa Stellwagen MD, FAAP Professor of Clinical Pediatrics at UC San Diego Health