Late pre-term babies are babies that are born from 34 weeks to 36 weeks and 6 days. Because babies are often judged more on their first appearance or size, some late pre-term babies miss the care that they may need. Especially in terms of feedings. This post is for all of the families of late pre-term babies and what I think can be helpful to know at the beginning of their feeding journeys!
First let’s start by discussing some of the main reasons why late pre-term babies need a little more attention.
Obviously, they arrive Earth-side a little earlier than expected… with that, their development is going to be different than a baby that remained in the womb. In the final weeks of pregnancy, there is a lot of development and skill-building going on. Your baby now has to do that work (and the work of learning to adapt) on the outside of the womb. So baby is dealing with a lot and still developing a lot as well.
- Baby may be sleepy and not waking for feeds –> encourage feeding at first sight of hunger cues OR at least 3 hours after the START of the previous feeding.
Babies that are late pre-term MAY miss their own internal cue to wake up which means that as a parent, you have to wake baby up. I always like to reiterate that babies don’t come with alarm clocks built in. This means they may not be ready to feed at that perfect 3 hour mark. And that’s okay but for the sake of baby’s age, it can be beneficial to attempt a feeding at this age.
- Baby may be over-stimulated –> feed in a calm setting and decrease as much external stimuli as possible
This means turning off any extra lights or noise. It also means less tactile stimulation. A lot of parents will consistently rub, stroke, or lightly poke baby. These things might make baby more withdrawn and opposed to waking for feeds. Any attempt to calm the environment (while also keeping baby awake LOL) should be made.
- Baby may be at-risk for more blood sugar issues –> frequent skin to skin and feedings and decreasing energy used by infant
Decrease in fat stores (less brown fat and subcutaneous fat) leads to a decreased ability to maintain temperature regulation which can ultimately lead to decreased blood glucose (hypoglycemia). Keeping baby’s temperature regulated can be done with skin-to-skin. Parents body warmth can keep baby warm. It also helps them prepare for feedings. If you’re concerned about baby getting cool, you can do skin-to-skin with your shirt, gown, or blanket over baby’s back.
- Baby may be at-risk for jaundice –> early, frequent feedings to secrete meconium.
It’s tricky right? Baby is so sleepy in the beginning because of their age. Jaundice can also make a baby even sleepier… So getting these early and frequent feedings can be TOUGH. But with things like hand expression and additional supplementation methods, it can be done! You can hand express and spoon, syringe, or cup feed if necessary. The more the baby poops, the more they excrete bilirubin which causes the jaundice!
- Baby may become tired while feeding and have labored breathing –> learn signs of respiratory distress and how to stop it.
For every baby the signs will be different but when you notice that baby is struggling to breathe, skin-to-skin can be helpful at regulating breathing and overall behaviors.
- Baby may have issues with suck coordination (weak suck) –> use breast compressions to assist baby with milk removal.
Breast compressions are great for every baby but especially for the late pre-term baby. Because they can potentially lack fat pads in their cheeks, their suck may be weaker or less organized. Compressions can help essentially hand express more milk into their mouths which helps them get the milk they need. It can also help keep them awake and active during feedings.
- Baby may have issues with maintaining latch (weak suck) –> may need a nipple shield to assist with feeding efficiency.
Also due to their suck and lack of fat pads in their cheeks, their oral cavity may have more space. A nipple shield and fill that space making the suck more efficient. A nipple shield can also help assist them with a deeper, more efficient latch. While some people may seem opposed to a nipple shield, remember that there’s nothing wrong with using a feeding aid that is HELPING the situation. A nipple shield can always be discontinued in the future. Just make sure you’re working with a LC while using the shield to make sure that the sizing is correct. ?
- Baby may not adequately transfer milk –> adding in pumping or hand expression to the feeding plan may be necessary.
No one wants to triple feed or need to pump and/or hand express when the plan was to exclusively breastfeed BUT sometimes it’s warranted. If your baby is not adequately withdrawing the milk, then you may need to come in after baby and get it out yourself. That can be through pumping or hand expression. Hand expression usually works better in the early days of colostrum and pumping can work better with more mature milk. But there’s no right or wrong way, some people like pumping the entire time and some like hand expression. Find what works for you. But definitely work with a LC to determine the feeding plan that works for you and YOUR baby.
- Baby may need more milk –> supplementation with donor milk or formula (or YOUR expressed breast milk) may be in your feeding plan
Hey! I know supplementing isn’t always in someone’s plan but I like to give the heads up that it can potentially happen AND it’s totally okay if it does. Supplementation with formula or donor milk in the early days will not derail your breastfeeding journey! It can actually help. So don’t feel as though you’ve failed if you have to supplement. You’re helping baby thrive so they can be ready for feeding on you! But it’s also important to work with a LC who can help you navigate this. There are specific amounts of supplementation that the Academy of Breastfeeding Medicine recommend but the numbers will also be tailored to your unique situation.
- Baby may need assistance with supplementation –> education on paced bottle feeding, using an SNS or other methods of supplementation
There are tons of ways to introduce supplemental milk to your baby. Working with a LC or feeding specialist will help you determine which method works best for your family while also focusing on feeding directly on you.
As you can see, there is a lot to be mindful about when it comes to a late pre-term baby. Of course your baby can feed successfully but they may just need more help AND THAT’S OKAY! Be patient with your baby and be patient with yourself
*as always stated, I cannot give you direct medical advice. this post is for education purposes only. please work with a LC in regards to a detailed feeding plan for you and your baby.