Feeding cues for premies

Welcoming a new baby can be a miraculous, yet overwhelming experience for even the best-prepared parents. Knowing when to change a messy diaper comes naturally for most. But how do you know exactly when your newborn is ready to eat?

The question is especially difficult for babies who are born preterm and may need a little extra help and support from mom and dad.

“Logan was born at just 32 weeks, so he had a lot of growing he still needed to do,” says Christine Demasi from the baby’s crib-side in the intermediate care nursery at Advocate Illinois Masonic Medical Center in Chicago. “He was born so young, he still doesn’t really know the difference between breathing, sucking and swallowing.”

Demasi has been learning to interpret Logan’s signals that he’s hungry in the five weeks since he was born. She says it’s a “whole different experience” than she went through with her 20-month-old son.

“When Cooper was born, he already sort of knew, instinctually, how to breathe and drink and pace himself,” she says. “With Logan, we found the best ways that work for him—position, pace and how he shows he’s ready to eat,” she says. “Every baby is different.”

In the five weeks since Logan’s birth, Demasi worked with Anne Albi, a speech-language pathologist at the medical center. They worked together to discover Logan’s cues for feeding, as well as how to feed him and how to tell that he is full.

“In the past, babies in the NICU (neonatal intensive care unit) had been placed on a rigid feeding schedule, taking prescribed amounts,” Albi says. This approach — still widely used—often involves waking the baby and prodding him to eat when he may not be hungry or ready to eat.  In some circumstances, a baby risks essentially being “force-fed.”

“Some babies learn to associate feeding with discomfort, rather than satisfaction or pleasure,” says Dr. Radley Helin, a neonatologist at Illinois Masonic Medical Center.  “On the other hand, the strategy can result in missed opportunities for feeding when the baby is actually interested. Feeding is like any other human activity—when something goes well, we want to do it again.”

“(This traditional approach to feeding) lays the groundwork for feeding issues as the baby ages,” Albi says. “Poor weight gain, difficulty transitioning to solid food—some refuse to eat at all or choke on their food. When early feeding experiences are unpleasant, the effects can be seen months and even years later.”

Albi says she works with new moms on cue-based feeding, an approach that teaches parents to watch for signs that baby is ready to eat, including:

• Being awake and alert
• Displaying the “rooting reflex,” movement toward the breast—mom shouldn’t chase to feed
• Readily opening the mouth
• Good tone in the body, with hands held toward the middle of the body

“By learning more about her baby’s unique behaviors, communication between mother and baby is improved, laying a positive foundation for feeding,” Dr. Helin says.

“All healthy babies will generally let you know when they’re hungry, but some babies sleep more heavily and may need to be woken up for feeding” says Helin.  “On the first day, a baby may eat only four to five times. But by day three, a healthy-term baby will typically be eating eight to 12 times per day. A rule of thumb is that newborns shouldn’t go more than three to four hours without feeding.”

So, what cues will Demasi take home with Logan to know when he’s ready for his next meal?

“He gets what I call his ‘bird face,’ where he’s scrunching up his eyebrows and looking for food,” she says. “And I know when he’s done if milk is leaking out the side of his mouth. He’s still learning to swallow and breathe.”