5 Simple Tips For Breastfeeding A Small Baby

Is there anything as cute as a tiny little baby? Babies born between 36-39 weeks or less than 8 pounds warm our hearts with their exquisite little features, their sweet, cuddly natures, and the cutest little expressions. But when it comes to breastfeeding these small babies, it’s not unusual for parents to wonder, what did I get myself into? Feeding sometimes takes extra time, vigilance and persistence to get off to a good start. Why?

Little babies can struggle to eat. They are very sleepy and get worn out easily. They might not have figured out how to arrange their latch/suck/swallow rhythm well, so they might not efficiently remove milk from the breast. And, because their tummy is so small they may struggle with their tummy filling up before they have taken in enough calories.

Breastfeeding small babies does take a little extra care and attention. My name is Suzzie Vehrs, a Doula of six years and an almost Certified Breastfeeding Specialist (I’m finishing up my last class now) who has helped many mothers with small babies successfully breastfeed. Today, I want pass on a few tips and tricks to make breastfeeding a small baby easier.

Why Is Breastmilk Important For Small Babies?

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Breast milk is important for all babies. However, small babies are a bit more fragile than their older and larger peers, so the benefits of breastfeeding are even more pronounced. While formula is a good tool when breastfeeding doesn’t work out, many parents don’t realize how big the benefits of breastmilk are.

In the short time, formula feeding increases the risk of common childhood infections such as diarrhea, ear infections and lower respiratory infections. Here’s the part that often stops parents in their tracks: babies who are fed formula have more than a 250 percent higher risk of being hospitalized for lower respiratory tract infections in their first year of life compared with babies who are exclusively breastfed for at least four months. Another sobering reality is this: infants who are never breastfed have a 56 percent higher risk of sudden infant death syndrome compared with those who receive breast milk.

From my experience with mothers in the immediate postpartum, most mothers can succeed with breastfeeding a small baby if they want to and have the right support. I am writing this article to help mothers anticipate, identify and manage some of the more common problems that pop up with breastfeeding a smaller baby. And you know what, if you’re a formula all the way mama, that is okay too! I hope you love your feeding journey no matter which method you pick.

5 Tips For Breastfeeding Success With a Small Baby

1. Make Sure A Small Baby Gets Enough

As much as I love breastmilk, and hope that mothers have access to donor milk if their own milk is not available, the most important thing to feeding a small baby is to make sure they are getting enough. Because they are prone to fall asleep while eating, or may look like they are eating while they are only suckling, sometimes this is more challenging than expected.

So how do you know your baby is getting enough?

In the first 24 hours they should not lose more than 3% of their birth weight. This is a smaller acceptable loss than for larger babies. They should have one wet diaper in the first 24 hours.

By day 3 they should not have lost more than 7% of their birth weight. They should continue having 2 wet diapers on day two and 3 wet diapers on day three.

By day 4 they should stop losing weight. By day 4, a baby who is getting enough breast milk will usually have at least four wet diapers and a few good-sized, yellow, seedy stools each day.

From day 5 on they should gain weight, From here on they should gain about once ounce or 28–34 g/day and continue to have 4-6 wet diapers a day. If they are having enough wet diapers, then you can be confident they are getting enough. (If you are a bit anxious and prefer your baby to be weighed a changing table scale can be an easy, but not necessarily needed addition to your baby station.)

If your baby is not satisfied after a 30-40 minute feed, it is appropriate to supplement small quantities, 5-10 mL at a time the first day, and 10-30mL after that if they are still hungry after a nursing session. You can tell your baby is hungry if they cannot be soothed by walking and soothing, are chomping on their hands or if they are sleeping more than 3-4 hours at a time and skipping feeds.

2. Protect Your Supply

The first two weeks are essential to building a strong milk supply. While it is sometimes possible to increase a supply after this time, hormonally, the body is primed to use these two weeks after birth to get to a solid 24-30 ounces a day. If the baby is not taking in this much, then a mother may struggle to ever get her supply up to a full amount, unless she pumps and saves some.

Small babies, born between 5-7 pounds, might take up to a month to begin eating a full 25 ounces a day, whereas larger babies will get to this amount in just the first couple weeks. However, a mom’s supply is not guaranteed to continue increasing with the baby, especially if she is skipping feeds or supplementing with formula because the bottle is easier for the baby. Want to know a cool fact? Once a baby reaching their full intake of about 25-30 ounces a day, they more or less consume that much milk each day for the rest of their breastfeeding journey.

Your goal should be to reach 25 ounces a day of milk sometime between week 2-4 after birth, even if that means putting a small amount in the freezer because your baby isn’t quite eating that amount yet.

How To Protect Your Milk Supply

Pumping is almost unavoidable if you want your baby to be exclusively breastfed and you have a small baby. A lactation consultant can help you figure out a personalized plan for you baby. However, if you’re looking for a general guideline, start by pumping after a feed once in the morning and once in the evening.

Pump on both sides for about 10-15 minutes. After the first week, you should start having about 1-4 ounces from a pumping session. If your baby is gaining an ounce a day, put this extra in the freezer, now you have a stash for the first time you need to step away and let someone else feed your baby. If your baby is not gaining an ounce a day, have your birth partner give this milk back to your baby.

If you need help, book a virtual breastfeeding consultation with the Nest Lactation.

3. Skin To Skin And No Pressure Feeds

Many mothers know the benefits of skin-to-skin contact with their baby in the first hours after birth, but what surprises some families is the benefits of skin to skin throughout the first month home. Early continuous and prolonged skin-to-skin contact between the mother and her baby helps the baby with so many things. There is no such thing as too much skin to skin with a newborn. If you are home and lounging, have them against your skin if possible.

When skin to skin is practiced regularly, breastfeeding is more likely to be successful and babies are more likely to still be breastfeeding at one month and four months old! When mothers do skin to skin with their baby, a baby almost immediately becomes less stressed, as seen in a change in the heart rate variability, reduced cortisol and increased oxytocin (the love hormone!). They also have better sleep organization and learn sleep/wake cycles sooner.

How To Skin To Skin At Home With A Small Baby

Skin to skin is not difficult. If you have pajamas or a robe with a button or zip front, simply unbutton, slip baby inside and cover both of you with a warm blanket (unless that makes you sweat, then just stay uncovered). Allow your baby to eat as much as they want during this time. You may find that they latch and unlatch or fall asleep while eating. This is okay! In fact, the practice is important.

Small babies sometimes have difficulty with stamina, meaning that they eat a bit, get worn out by the effort, then fall asleep, only to wake up in a few minutes and repeat. It is okay to let your infant take sips. You will see that if you do skin to skin for an hour, they will usually get a good feed sometime in that time. This can be a lovely practice to stack with your morning and evening pumping session.

For your morning and evening feed grab a snack and a drink, turn on your favorite show or podcast, get cozy skin to skin, and just let them latch, eat and repeat, no pressure to get it done in a certain time. Long feeds totally acceptable. After about 40 minutes to an hour, if they are zonked out, hand them off to a partner and finish with your ten minute pumping session. (Dad’s can do skin to skin at this time too! if they want)

3. Wake Them Up To Eat

Getting enough feeds is sometimes tricky with little babies. Older babies will wake up hungry and demand food. Little babies sometimes wake regularly to eat, sometimes they don’t. A newborn in the first 2 weeks, should eat 8-12 times in a day. Some of this will be cluster feeds. Meaning they wake up at 7, then are hungry again by 8, and maybe again at 9. Some of these will be more spread out. for example, your baby sleeps at 6 and doesn’t wake up to eat again until 9. This is totally okay. However, if your baby is not waking up to eat at least 8 times a day the first two weeks, make sure to wake them. Simply set a timer on your watch at the beginning of a feed for 3 hours later. If they haven’t woken up by that time, wake them up and encourage them to eat again.

You baby will eat at least 8 times a day for about 6-8 weeks, at which time they may decrease consolidate one or two feeds or they might not.

4. Encourage Your Let Down Before Latching

You may find that your baby is happy to eat at the breast if the milk is easy to get, but has a hard time getting the flow started themselves. If your baby is giving up before you think the milk is really flowing, try to make it a bit easier for them. Simple ways to encourage a let down are hand expression, smelling your baby’s head, taking a deep breath and imagining the milk just being there for your baby (I know it sounds silly, but I learned this from mothers who told me this was the best thing they did to get out of stress mode and into that ‘everything is just working out for us’ feeling).

5. Slow Down Bottle Feedings

Bottle feeding can take a while and sometimes parents want to rush this. If you can, resist the urge to speed a bottle feed. Keep the preemie nipple on the bottle until your baby can easily go between breast and bottle. Hold the baby upright to feed so that the bottle is held parallel to the floor. This makes the baby have to do the work of drinking the bottle instead of the bottle just pouring into the babies mouth. Last but not least, when bottle feeding, stop the feed a couple times to burp your baby.

How Can Dads Support Feeding A Small Birth Weight Baby?

Some dads wonder what they can do to help their small baby. They don’t have the milk – so does that mean they just have to wait to be involved? Nope. There are things dads can do right away. First, make sure you also get an hour of skin to skin each day. Skin to skin is one of the best ways to help your baby’s short and long term health, please don’t underestimate it.

You can also be the one to do everything but the feeds. Change diapers. Walk and bounce the baby if they are fed but needing soothing. Set up snack stations and make sure that every time a mom feeds the baby, someone is feeding her – she needs more calories and electrolytes than ever. So bring her snacks and water bottles.

When you do your skin to skin, make sure mom does one thing for herself. In those early days, this often means giving her time to take a shower and to nap. Later it will mean making sure she has hobby time just like you do.

And – perhaps the most useful of all, don’t let her forget she is doing well. She is beautiful. And that you love her. Most moms need to hear these simple words of encouragement more than you know. The attentive, patient and physically present energy you bring will create a sense of safety and love which will create ripples of health to your partner and your baby.

Conclusion On Feeding A Small Baby

Your baby is only going to be small for a very short time. Enjoy how perfectly adorable they are. Don’t be afraid to ask for support if you need it. And please, take your time and appreciate how incredible you are for creating this perfect little life!

Sources

1. Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women’s Health (US). The Surgeon General’s Call to Action to Support Breastfeeding. Rockville (MD): Office of the Surgeon General (US); 2011. The Importance of Breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK52687/
2. BREASTFEEDING MEDICINEVolume 11, Number 10, 2016 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2016.29031.egb
3. Gabriel Altit, Danica Hamilton, Karel O’Brien, Skin-to-skin care (SSC) for term and preterm infants, Paediatrics & Child Health, Volume 29, Issue 4, July 2024, Pages 238–245, https://doi.org/10.1093/pch/pxae015