The journey with a premature baby is often filled with unexpected challenges, and breastfeeding may not always be feasible. It’s important to remember that feeding your baby — no matter how — makes you a great mom. Many preemie babies are fed via bottle or tube. Rather than feeling guilty, focus on the love and care you provide through every feeding. Our obligation as mothers is to make sure our children are nourished; we don’t always decide how. Remember, your worth as a mother is not measured by the method of feeding, but by the boundless love and support you give to your baby every day.

Mothers of preemies who breastfeed provide their babies with milk especially formulated for preemie development. Preemies receive many benefits from breastfeeding, including protection against infection, better developmental outcome and reduced stress. However, there are many mothers who cannot breastfeed for a variety of reasons, and while this is not ideal, some babies do well with either donated milk or formula.

See Nutrition & Fluids for even more information.

In the last 3 months of pregnancy, large protein molecules called immunoglobulins cross the placenta and are stored in the growing fetus. These immunoglobulins protect a newborn against the infections that the mother is immune to — for up to 5 or 6 months after birth. Although a premature baby misses out on some of this special protection because of the timing of birth, you can still provide him with immunoglobulins through breast milk. The milk you produce in the first few days after giving birth (colostrum) has the highest concentration of immunoglobulins, but you continue to give your baby extra immunoglobulins for as long as you give him your breast milk.

Human milk is important for the optimal growth and development of full-term babies, but it is even more important for babies born prematurely. A preemie’s stomach and intestines (which the NICU staff will refer to as his gastrointestinal tract, GI tract or gut) are even smaller and less mature than that of a full-term baby.

As the mother of a premature baby, your milk will be different for the first few weeks than the breast milk of a mother who gives birth at term. Niflaos haBorei — your body knows that your baby came early, and it provides milk that is better for the baby’s needs. For the first 2 to 4 weeks after birth, your milk will contain more protein, fat calories, calcium phosphorus, magnesium, zinc, sodium and chloride than full-term milk. This early milk also has a laxative effect on your baby’s bowels, helping him to pass the first stools (called meconium). This is an important sign the GI tract is working and helps resolve jaundice. Nurses notice that babies fed their mother’s milk tolerate feedings better than those fed formula. Human milk is easy to digest, with very little left over in the baby’s stomach. Because formula forms larger curds during the digestive process than breast milk, babies given formula commonly have undigested milk in their stomach 2 to 3 hours after feeding.

Brain growth and development are rapid in the final 3 months of gestation. During the latter part of pregnancy, the fetal brain more than doubles in size and weight, and nearly doubles again in the first year of life and well into the second year. Several studies have suggested that breastfeeding improves mental development. In fact, greater amounts of breast milk intake (compared with formula) have been correlated with higher developmental outcome among the smallest preterm babies.

Although breastfeeding requires skill and maturity on your baby’s part, research has demonstrated that it can be less stressful than bottle feeding. Possible difficulties of bottle feeding (because of the fast flow of milk from a bottle) are so common that doctors and nurses have come to think of them as “normal” responses to feeding: irregular or pauses in breathing (apnea) with a resulting drop in oxygen saturation, slower heart rate (bradycardia) and blue skin color (cyanosis). Baby can “pace” better during breastfeeding, controlling the flow of milk and pausing when necessary. During breastfeeding, a baby stays warm, his heart rate remains regular and oxygen levels stabilize (or even improve).

Another advantage of breastfeeding is it provides your baby the warmth and physical closeness of skin-to-skin contact when ready to nurse. You’re probably keenly aware that the amount of time you can spend holding, rocking, and cuddling your baby may be limited because he is in the intensive care nursery. As soon as your baby is ready to breastfeed, you’ll get to hold your newborn against your body. If you bottle feed, you can make an effort to hold your baby skin-to-skin — but when you breastfeed, you automatically have that contact at every feeding.

Check out the links below for additional information and guidance.

Feeding your baby in the NICU

Breastfeeding Tips for Beginners

10 Questions About Providing Breast Milk to Your NICU Baby

Breastfeeding nutrition: Tips for moms

Formula can be wonderful for mothers who are unable to breastfeed or produce enough milk. There are some specially formulated ones with increased nutrients and calories. However, due to the nature of a preemie’s immature gut — particularly a micropreemie — the risk of serious infection and intestinal disease increases significantly when fed formula. It is for this reason that hospitals will speak about obtaining mother’s milk from a milk bank (and not only, as some may assume, that they are simply promoting breastfeeding). [See more on milk banks, below.]

Fortifier usually comes in smaller packets and is added to feeds, whether breastmilk or formula. This increases calorie intake and is not unusual when feeding premature babies. The hospital staff may feel it’s necessary to continue fortifier even once baby comes home. This will be followed up by your pediatrician.

If you have halachic/kashrus questions regarding formula or fortifier, don’t hesitate to ask a sheilah! Keep in mind that a child in the NICU is certainly considered a choleh. See our resources page for contact info for some kashrus agencies.

Note that some formulas and fortifiers are kosher without a symbol — another good reason to ask. You can also ask to look at the box, as sometimes the packets or cans will not bear a kosher symbol, but the commercial size box will. Always ask will respect!

The New York Milk Bank provides mother’s milk for hospitals around the New York and New Jersey area and beyond. It goes through a rigorous process of screening, testing and pasteurization. Generally, the hospital will make the necessary arrangements, but should you need, the NY Milk Bank can be reached at 212-956-MILK (6455) or nymilkbank.org.

There are occasional kosher milk runs; sometimes there is availability while other times there is not. Mrs. Chaya Millet is the contact for the kosher milk. She can be reached at 908-910-9485. The only exception to this is Westchester Medical Center who has established their own kosher mother’s milk process for their facility. For details, contact Rabbi Jacobsohn at 347-417-4740.

As mentioned above, NICUs avoid feeding formula to preemies and will almost always use mother’s milk, even if Mom cannot provide it, for any number of reasons. Note that Rabbanim allow this for a choleh, even if not from the kosher runs. Never hesitate to ask a halachic sheilah.

There are some Bikur Cholim organizations or independent gemachim which provide donated mother’s milk. However, this is not recommended for inpatient babies: It is both against hospital protocol and a possible danger to your baby to introduce milk to susceptible preemies that has not gone through a thorough process first. Upon homecoming, discuss this with your pediatrician.

It is common for preemies — certainly micropreemies — to be tube fed in the NICU, until they are ready to feed by mouth (PO). Often, tolerating and regulating feeds is the last milestone hoop to leap through at the end of a preemie’s NICU stay. This may include: developing the suck-swallow-breathe reflex (coordinating the three), feeding within a certain window of time, keeping feeds down (without vomiting) and learning to take an entire feed by mouth (PO). While this may be frustrating, having patience for a bit longer is worth it! Sometimes, a parent’s presence at more feedings can help the process along, but sometimes it will simply just take time. You can’t rush maturity!

There are times when a neonate has made great progress, is ready to go home, but is still not able to take all feeds by mouth. The hospital may determine it best to send baby home with a feeding tube. Parents will be shown the basics of how to manage the tubes after leaving the NICU.

Fondly called “tubies,” these babies may be on ng-tubes, g-tubes or jg-tubes. [See NICU Glossary for more detail .] They require technical care and you may need some further guidance. Of course, always reach out to your pediatrician and GI when needed.

Mrs. Perry Binet, M.Ed., has two children on feeding tubes, runs a camp for children with special needs and maintains a WhatsApp chat for frum mothers with tubie babies. She’s created an amazing guide for parents of babies on tubes, available HERE. She generously provides her contact information to parents as well.

If you encounter any other feeding concerns (whether on a tube or not), such as oral aversion, reflux, possible aspiration, changes in milk/food intake or weight, breastfeeding issues, etc., don’t hesitate to contact your child’s doctors, feeding therapist and/or a lactation consultant.

See our Jewish Resources section.