Infant Feeding in Emergencies: A Guide for Mothers (WHO - OMS, 1997, 48 p.): What about premature or very small babies?

Infant Feeding in Emergencies: A Guide for Mothers (WHO - OMS, 1997, 48 p.)

		(introduction...)
		Foreword
		Introduction
		Why is breastfeeding so important?
		Are commercially-made baby milks as good as breastfeeding?
		Why are commercially-made baby milks not so good?
		But can every woman breastfeed?
		But why don't the experts tell us this if breastfeeding is so important?
		Do babies also need tea and water?
		When do babies need more than just breast-milk?
		So a sick baby should go on breastfeeding?
		Do breastfed babies get fewer diseases?
		But my friend's baby got ill and he was breastfed
		So breastfeeding is like a medicine?
		People say that stress stops the milk, so during stressful times how can we breastfeed?
		What about women who have lost a lot of weight? Can they produce milk?
		Do we need special nutrition for breastfeeding?
		But what about anaemic women? Does breastfeeding drain their strength?
		Someone told me breastfeeding stopped you getting pregnant, but isn't that just a story?
		How does breastfeeding work?
		What about women with small breasts or flat nipples?
		You said the baby has a part too. What can he do?
		Why is the baby's suckling-action important?
		How does a baby stimulate the milk?
		The first principle of breastfeeding: good attachment
		Why does good attachment not always come naturally to the baby?
		Why does the baby not always get this right?
		Sometimes it is hard to get a baby close because he is swaddled and his clothing gets in the way
		Even if my baby attaches well, how can I be sure there will be enough milk?
		You said earlier that milk changes during a feed. Can you explain that?
		But I thought you must feed from both breasts?
		You said earlier that confidence was important but not everyone has that. What can we do?
		I know women with breastfeeding problems. Can they be helped?
		My mother told me that you always get sore nipples and you just have to put up with them
		What about special creams for sore nipples? How can we get them during an emergency?
		With this baby-led feeding how can I be hygienic and wash my nipples?
		So if I get my baby well-attached, I will never get sore nipples?
		You say breastfeeding should not hurt, but what about the engorgement that every woman gets a few days after the birth?
		You mentioned blocked ducts, mastitis and abscess. Are they common and how can we treat them?
		All these problems make breastfeeding look too difficult
		You said earlier that you can breastfeed even if you have stopped completely. How can this be done?
		Food supplies can be precarious. How can we feed the babies over 6 months who need more than breast-milk alone?
		What about premature or very small babies?
		I can see the reason for expressing milk for sick or premature babies, but must all women learn to express?
		How do I express milk?
		I can see that breastfeeding is possible in most cases, but we still have to face the times when it is not possible: emergencies create orphans, abandoned babies and severely ill or wounded mothers
		Is it possible to feed a baby artificially without a bottle?
		How do you cup-feed a baby?
		A final word

What about premature or very small babies?

As we said earlier, the more vulnerable the baby the more important it is he receives breast-milk. Breastfeeding is less stressful than bottle-feeding for a premature or small baby who can suckle.

If a baby is too premature or too weak to breastfeed, he can be tube fed with your expressed breast-milk. A cup can be safely used to feed a healthy pre-term baby from around 32 weeks gestation. Cups have several advantages over tubes. The baby controls his own intake and the contact with the expressed breast-milk may stimulate the digestive enzymes in his mouth. He is also held closely to be fed which is good for his development.

If a baby has to be tube-fed he can benefit from nuzzling at your breast. He will then learn to associate the smell and taste of your breast with a full stomach. You can express a little breast-milk directly into his mouth. Stay near your baby as much as you can. Express your milk as soon as possible after the birth. Express frequently, at least 6-8 times a day. However small the amount any breast-milk is valuable for your baby's progress. Some mothers of premature or low birth weight babies can produce sufficient breast-milk, others need to supplement, ideally with expressed breast-milk from other mothers.

It is important when feeding expressed breast-milk to ensure that the baby gets enough of the fat-rich hindmilk. This fattier milk is more likely to stick to the sides of the feeding tubes. Less fat is lost from cup feeding.