When can a premature baby start bottle feeding?

Some premies need help until they're ready

To feed from breast or bottle, babies must be able to coordinate a pattern of sucking, swallowing, and breathing.  Without that pattern, babies can aspirate breast milk or formula into their lungs.  Most premature infants (premies) can manage that pattern by the time they are 34 weeks of (gestational) age.

Tube feeding for young premies

Younger or sick premies need a feeding tube before they can start bottle feeding.  Feeding tubes usually go through a baby's nose or mouth and into the baby's stomach. The premie formula is then given in all at once (called a bolus), or through a slow and continuous delivery. If a baby has severe reflux or poor stomach emptying, the tube might need to bypass the stomach and deliver the formula into the duodenum, the first portion of the intestine. 

To test a baby's bottle feeding readiness, a feeding specialist or skilled nurse will offer a small amount of water to the infant by mouth.  If the premie can drink the water, he or she can start drinking tiny amounts of formula. Meanwhile, the infant will continue to get the rest of his or her feedings through the tube and / or an intravenous feeding (called TPN). 

Pacifiers prep premies for bottle feeding

Often babies with feeding tubes are given pacifiers to teach them how to suck from a bottle or breast. The pacifiers help premies coordinate the proper sucking, swallowing, and breathing techniques needed to move formula through the gastrointestinal tract. Be aware that pacifiers can also increase air swallowing and cause mild discomfort in some infants.

No more thickeners for premies

Until recently, thickeners were used to prevent aspiration while sucking and swallowing. However, research shows that thickeners can increase the risk of developing severe intestinal problems, including necrotizing enterocolitis (NEC).  As a result, thickeners are not recommend until babies are older and have less vulnerable intestines. 

Bottom line

Premature infants need tube feedings and pacifiers to prepare them for successful bottle feeding.