Feeding your baby in the NICU

What does your baby eat in the NICU?

Breast milk is the best food for your baby, even if she’s in the newborn intensive care unit (also called NICU). Breast milk has antibodies that help keep your baby from getting sick. It also contains nutrients that help your baby grow and develop. And breast milk changes as your baby grows so she gets exactly what she needs at the right time. This is true even if your baby was born prematurely. Premature birth is birth that happens before 37 weeks of pregnancy.

For the first few days after giving birth, your breasts make a thick, yellowish breast milk called colostrum. It has nutrients and antibodies that your baby needs. Even if you make only a few drops of colostrum, you can feed it to your baby. Your body starts to make breast milk about 3 to 4 days after giving birth.

If you’re not breastfeeding, your baby may get formula or breast milk from a donor (also called donor breast milk). Formula is a milk product you can feed your baby instead of breast milk. Donor breast milk is breast milk that’s been donated to a milk bank. A milk bank receives and stores donated breast milk, tests it to make sure it’s safe and sends it to families of babies who need it. Donor breast milk is prescribed by your baby’s provider. It has all the benefits of your own breast milk. Sometimes babies get both breast milk and formula. Talk to your baby’s provider about the best food for your baby while he’s in the NICU.

How do you feed your baby in the NICU?

The way you feed your baby depends on her medical condition and how well she can suck and swallow. You can feed her:

• By breastfeeding. If your baby can’t breastfeed, you can feed her breast milk that you pump from your breasts.
• Breast milk or formula through a bottle
• Breast milk or formula through a feeding tube. A feeding tube is a tube that goes into your baby’s stomach to give her food when she can’t get it from regular feeding. Depending on your baby’s condition, she may need a gastronomy tube (also called a g-tube), a nasogastric tube (also called an NG tube) or an orogastric tube (also called an OG tube). A g-tube goes directly into your baby’s stomach. An NG tube goes through your baby’s nose, down the esophagus and into your baby’s stomach. An OG tube goes into your baby’s mouth, down the esophagus and into your baby’s stomach.
• Through an intravenous line (also called an IV). This is for babies who are very small or sick. Your baby’s health care provider places a small tube in a vein in your baby’s hand, foot, scalp or belly button. Your baby get fluids and important nutrients through the IV to help her grow.

Depending on your baby’s condition, you may use a few of these methods together to feed your baby. For example, your baby may get food from a feeding tube and an IV.

How can you give your baby breast milk if your baby can’t breastfeed yet?

If your baby isn’t ready to breastfeed, you can pump your breast milk. A breast pump helps remove milk from your breasts. Using a breast pump may feel awkward at first. But with practice, pumping gets easier and more comfortable. A nurse or lactation consultant in the NICU can show you how to use the pump. A lactation consultant is someone with special training to help all women breastfeed, even women who have special breastfeeding problems.

As soon as your baby can, let her practice sucking at your breast to get ready for breastfeeding. This is called non-nutritive sucking. Here’s how to do it: Pump your breasts until they’re empty. Then let your baby touch and taste your breast to help her get used to what breastfeeding is like.

What can you do if you’re not making enough breast milk?

Some moms may have trouble making breast milk. It can be hard for moms with health conditions before or during pregnancy or after their baby was born. If you’re worried that you’re not making enough breast milk, talk with a nurse or lactation consultant in the NICU. You also can get help from a breastfeeding support group. A support group is a group of people who have the same kind of concerns. They meet together to try to help each other. You can find a breastfeeding support group that meets together in person or online.   

You may be able to build up your milk supply (the amount of milk you make when breastfeeding) by:

• Getting rest. Your body produces more milk when it’s rested.
• Eating healthy foods and drinking a lot of fluid, like water, juice or milk. When you breastfeed, your body loses fluid. It’s important that you get that fluid back through what you drink.
• Using a breast pump after or between feedings. When you pump your breasts often, they make more breast milk.
• Pumping your breasts until they’re empty each time you pump
• Doing kangaroo care (also called skin-to-skin care). This is when you put your baby, dressed only in a diaper, on your bare chest.

How can you feed more than one baby?

If you have multiples (twins, triplets or more) in the NICU, learn how each baby feeds best. For example, you may find that one baby feeds better from the breast and one feeds better from the bottle. Or one baby may do better on breast milk and one does better on formula. Or you may decide to pump breast milk for all your babies and only use formula when needed. 

Take your time to figure out what works best for you and your babies. And expect to adjust your plans as your babies grow. Once they’re healthy, you can breastfeed two babies at once. Ask for help holding one baby while you get settled with the other. With practice, you can manage both by yourself.

More information

• American Academy of Pediatrics
• La Leche League International
• International Lactation Consultant Association
• womenshealth.gov/breastfeeding

Last reviewed: April, 2019

See also: Breastfeeding is best, Feeding your baby formula, Keeping breast milk safe and healthy, Share your story, Using a breast pump