When Your Baby is Born a Little Early

on January 06, 2014 in Breastfeeding


Many babies are born 3 weeks early, or even a bit earlier and these babies are referred to as “Late Pre-term Infants”.  Twins are typically late pre-term infants.  Babies born a few weeks early may be just a bit on the small size. Despite their size, you will probably be reassured that your little one is just like any other newborn.


Babies who are born a few weeks earlier than their due date are at a greater possibility for having low blood sugar, cold stress and becoming jaundiced in the first couple of days. But even more importantly, they are at greater risk for underfeeding. You may be encouraged to have your baby go to the breast often and your doctors and hospital staff may reassure you that they should be treated just like any other baby.  But these babies are referred to by experienced lactation consultants as “impostor babies”.


Late pre-term babies may go to breast and seemingly nurse well, but this group of newborns often may lose too much weight or fail to gain weight as expected. Instead of nursing vigorously, they tend to do more sleeping at the breast instead of drinking effectively.  This can delay the onset of abundant and/or mature milk production and in tern, can lessen your milk supply, contribute to limited stooling, and developing more jaundice.


We learned about this group of babies many years ago in our hospital based lactation clinic. This special group of newborns often returned to us in the clinic after being discharged, with either excessive weight loss or failure to gain weight. Needless to say, their mothers were upset and felt guilty that they have been doing something wrong, or that they should have known that the baby was not feeding well.


Breastfed babies should not lose more than 10% of their birth weight and should begin gaining about an ounce a day by the fifth day of life.  They should be stooling every day and their stools should be yellow by day five. Failure if this happening is a red flag that the baby needs to be evaluated for whether they are taking in an adequate amount of milk.  While any baby can fall into this category, the late pre-term infant is at much higher risk.


At our clinic, we began seeing so many of these early babies that we initiated a protocol to prevent excessive weight loss and failure to gain weight.  Many hospitals with experienced lactation consultants on staff also now identify these newborns and also follow this protocol to avoid the need to begin feeding formula and the risk of early weaning.


In our community, mothers of late pre-term infants are discharged home nursing every 2-3 hours.   They are sent home with a hospital grade pump and instructed to use it after each and every nursing for about 10 minutes. We refer to this as “insurance pumping”.  If the baby seems to be to be swallowing milk well during the feeding and appears content after nursing, the pumped milk can be refrigerated or frozen.  If on the other hand, the baby still seems hungry after the feed, the expressed milk can be used to supplement the nursing. Insurance pumping does as it is called.  It helps insure that milk production is high and that the baby will be more likely to take a good amount of milk even when the baby is a bit sleepy at the breast.


These mothers and their infants are then seen in the breastfeeding clinic and evaluated at a nursing session. We weigh the babies to make sure they have not lost an excessive amount of weight and by weighing them on an electronic scale both before and after a nursing, we can evaluate their milk intake as being sufficient or not.  If the baby is taking an adequate amount of milk, the mother can slowly be weaned off of the pump. If the baby is not taking enough milk, we can assist the mother in supplementing the baby with her own milk until the time comes that the baby is thriving without the supplement.


If you deliver a few weeks early, even if you are reassured that your baby is doing fine, don’t hesitate to take matters into your own hands. You can rent a pump from any number of rental stations if your hospital does not have a pump available for you. It is fairly easy to locate a local pump distributor.  One pump company offers a 24-hour phone line to locate a near by rental station.  Medela can be called at 1-800-TELL YOU and by entering your zip code, you will hear a listing of rental stations in your area. If you are WIC eligible (Women, Infants, and Children Food and Nutrition Service) they may be able to provide an electric pump for you.


Make plans to visit a lactation consultant if you have any concerns.  Ideally, your pediatrician sees your baby a few days after discharge.  If you baby is not gaining weight after 5 days of age, you can begin supplementing with your own milk and make an appointment with an experienced lactation professional when you need an evaluation or you have questions about your baby’s growth.


Nothing is more upsetting to learn that your baby is not thriving due to inadequate milk intake. The worst of it may be if you learn that your milk supply is now low due to inadequate breast stimulating and drainage. Many mothers may panic and reach for infant formula when it may be totally unnecessary. “Insurance pumping”, pumping after most nursings can prevent this from happening, even if you learn that your baby has lost too much weight or is not gaining weight as expected.


“The Nursing Mother’s Companion” includes detailed information about late-pre-term infants and helpful charts including 10% weight loss and how to figure out how much milk a baby requires at each age and weight.


Best wishes to you and your newborn!