8.3.1  Breastfeeding and cup feeding

During the first week of the baby’s life, the mother needs extra support from you and from the family to encourage her to initiate exclusive breastfeeding and maintain it until her tiny baby is able to suckle without any problem. Babies born between 34-36 weeks of gestation can usually suckle breast milk adequately, but very preterm babies may have difficulty breastfeeding. Breastfeeding a very preterm baby is a challenge. The frequency of feeding should be every two hours, including through the night.

If babies born before 34 weeks cannot suckle adequately, they can be fed expressed breast milk using a small very clean cup. (We describe how to do this in the next section.) Tiny or early babies who are able to suckle breast milk may also need feeding with additional expressed breast milk from a cup occasionally, to make sure they are getting enough nourishment. All babies who are on cup feeding have to be given around 60 ml/kg/day (that is 60 ml of breast milk for every kilogram of the baby’s weight every day) and increase this by 20 ml/kg/day as the baby demands more feeding.

Extremely preterm babies born before 32 weeks of gestation may not be able to breastfeed at all and need to be started on intravenous fluids. This is one of the reasons why all babies less than 32 weeks of gestation should be referred to health facilities immediately.