If your baby was born before 37 weeks of pregnancy, they are considered premature. Late preterm babies (34–36 weeks of pregnancy), early term babies (37–38 weeks of pregnancy), or full-term babies with low birth weight are usually healthy enough to stay with their parents in the postnatal ward and breastfeed directly. Nevertheless, these babies are still missing weeks— or perhaps only days—of full growth in the womb to lay down the necessary energy and nutrient reserves that allow their bodily functions, immune system, and central nervous system to mature.
Breast milk is the optimal food for these little early starters: it fights off infections, is easy to digest, shields the intestinal mucosa, and promotes the baby’s neurological, cognitive, and visual development.
To ensure successful breastfeeding, these little babies need extra attention and support, especially in the first few weeks. It is important to make sure that:
- Your baby is getting enough calories and
- Your milk production is optimally stimulated.
Due to their immaturity, late preterm babies usually show less interest and have less stamina than full-term babies. They also find it more difficult to coordinate sucking, swallowing and breathing. These babies sleep more and often fall asleep more quickly during feeds. In addition, their feeding cues are less obvious, giving the impression that they are satisfied and full.
This can lead to breastfeeding difficulties, increased weight loss, poor weight gain and insufficient milk production. Medical risks such as hypoglycaemia or severe neonatal jaundice are exacerbated by the reduced intake of breast milk.
The first few days are crucial
On the first day after birth, your baby is likely to be more active and alert than in the coming days. It is therefore important to use these first 24 hours intensively as a “power day” by keeping the following points in mind:
Immediately after birth, direct skin-to-skin contact and intuitive breastfeeding (self-attachment) should be encouraged. Separation of mother and baby should be avoided as much as possible. In the first few days, small and young babies in particular benefit from the reclined breastfeeding position of intuitive breastfeeding. This allows them to make optimal use of their reflexes. The modified cradle hold, also known as premature baby hold, is also a helpful breastfeeding position for the early days.
It is important to ensure that your baby receives colostrum within the first hour of life. If breastfeeding is not possible during this time, hand-expressed colostrum should be given instead.
Your newborn should receive colostrum every hour until the fifth hour of life, and then every 2–3 hours thereafter – ideallydirectly at the breast and/or colostrum that has been freshly expressed or yielded as recently as possible. Direct skin contact helps you recognise your baby’s early feeding cues and respond to them promptly. If necessary, you may breastfeed your baby while they are drowsy, offer colostrum or gently wake them for breastfeeding.
If you already know during pregnancy that your baby will be born more than 2–3 weeks before their estimated due date, colostrum obtained before, during or immediately after birth can provide a valuable safety net. However, the enzymes in fresh colostrum are most effective. Frequent breastfeeding and milk expression are key to establishing a good milk supply. Therefore, colostrum collected antenatally should never be used as a substitute for frequent breastfeeding and milk expression. Instead, in addition to breastfeeding your baby, you should stimulate your breasts by expressing milk by hand and, from the second day after birth, with a breast pump (using power pumping if necessary). If your premature baby is too tired to effectively stimulate your breasts, you should pump milk 4–6 times/24 hours starting on day 2 after birth to optimally stimulate milk production in addition to your baby suckling at the breast. As the days progress, the pumping frequency can be increased to 8–10 times/24 hours.
It is okay to increase your milk production beyond your baby’s current needs (e.g., more than 750 ml in 24 hours). As your baby begins to nurse more frequently and actively, you can gradually reduce pumping again.
In addition, applying breast compressions during breastfeeding can help babies with low energy levels to take in larger amounts of fat-rich milk.
Frequent, short, and effective feeds (at least 10–12 times in 24 hours) are better than infrequent, prolonged feeds that may tire your baby unnecessarily. Encourage your baby to breastfeed whenever possible – you may need to gently wake them up during longer sleep periods.
It is not enough to hold a baby at the breast for 15 minutes — what truly matters is ensuring that they are suckling effectively during this time. Reassuring signs that your baby is receiving milk include rhythmic, persistent, and pain-free suckling, as well as audible and/or visible swallowing. Spontaneous leaking of milk from the other breast indicates a milk ejection reflex, which many mothers also feel. Once abundant milk production has begun, the breasts usually feel softer after breastfeeding.
To prevent your child from having not enough energy to show feeding cues, to transfer enough milk, and to stimulate sufficient milk production, it is necessary to monitor their weight development and nappy output. If necessary, temporary supplementation in addition to breastfeeding may be required. Ideally, you should use your own expressed breast milk or —if no human milk from a milk bank is available — infant formula. Preferably, this should be fed in a breastfeeding-friendly manner and at or close to the breast. Often, even a small amount of supplementation gives the baby the energy boost they need to ultimately breastfeed effectively on their own and meet their needs.
Some babies also benefit from the careful use of a nipple shield, which can make it easier for them to latch on to the breast.
Colostrum and breast milk are a precious gift – the better you stimulate your milk production in the early days and weeks, the more likely you are to enjoy a long and rewarding breastfeeding journey.
Helpful additional information
- Feeding Cues
- Colostrum Collection
- Breast Compressions
- Increasing Milk Production
- Lactation & Breastfeeding 2023-3 – Help! Have I got Enough Milk?
- By Pump
- Lactation & Breastfeeding 2020-2 – Every Drop Counts
- EN Power-Pumping.pdf– Powerpumping
- Breastfeeding Positions
- Weight Decelopment
- Nipple shields
References
- ABM Clinical Protocol #10: Breastfeeding the Late Preterm (34-36 6/7 Weeks of Gestation) and Early Term Infants (37-38 6/7 Weeks of Gestation) Second Revision 2016
- EISL – https://www.stillen-institut.com/de/late-preterm-babys.html (Zugriff: 1.10. 2025)
- ESPHGHAN: Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition; JPN 2019;69:259-270)
- Köster, Das späte Frühgeborene: eine Herausforderung in der Stillberatung; Die Hebamme 2014; 27:246-251
- La Leche Liga International – https://laleche.org.uk/feeding-late-preterm-babies/(Zugriff: 1.10.2025)
INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANTS (IBCLCS)
are the only internationally approved breastfeeding and lactation specialists with a medical background. They provide assistance and counselling in all questions related to breastfeeding and breast milk feeding, help with positioning and latching, with breastfeeding problems, and advise on the correct use of breastfeeding aids. IBCLCs support families with premature babies, multiple births or children with special needs. They provide information on issues such as complementary feeding and returning to work, and also counsel and support mothers and families who cannot, are not allowed to or do not want to breastfeed, long after they have weaned.