Breastfeeding a Premature Baby or Child with Special Needs
About Breastfeeding
Many babies are born with special needs. A premature baby may not have enough time to fully develop before it is born. Other babies may have a birth defect like a cleft lip, cleft palate, or a genetic defect such as Down syndrome. No matter what the issue, your baby may still be able to breastfeed. However, it may take a little longer to teach your baby how to breastfeed. With extra patience, some special equipment, and helpful techniques you may be able to help your baby begin to breastfeed. Below you will find information about:
Preterm or Premature Babies
Preterm babies are those born before 37 weeks gestation. They are often very small and need extra help getting a good start in life. Breast milk can be very important in helping preterm and low birth weight babies. It can help protect them from infection and to gain weight. Your breasts will produce breast milk with the nutrients especially to help meet your premature baby needs.
If your preterm baby cannot feed at the breast, it is important to work with your doctor and a lactation specialist to decide the best way to feed him. If baby is born 35 weeks gestation or earlier baby may need more care. He may have a harder time feeding at the breast than a baby born at 37 weeks or later. Do not be discouraged if baby cannot feed at the breast. You can still provide healthy breast milk for your newborn. Baby may learn to latch on the breast later.
Pumping for a Preterm Baby
If your preterm baby is not yet ready to start feeding at the breast, you should use a breast pump to provide breast milk. The use of a breast pump can help you maintain and even increase the amount of milk that your breasts make. If baby is at a low weight, it is important to pump out as much milk as you can. Check with your doctor and lactation specialist to know how often you need to pump to have a good milk supply.
Your milk is made up of foremilk (the milk that comes out first) and hindmilk (the milk that comes out second). Normally the foremilk and hindmilk are mixed together before it is fed to baby or stored. But if baby needs to gain weight the doctor may recommend that you feed baby extra hindmilk. Hindmilk has more fat and calories than foremilk and will help baby gain weight. Talk to your doctor and lactation specialist when deciding how to best meet the needs of both you and baby. It will be easier to make this decision if you know your long term feeding goals for baby.
Why Use an Alternative Feeding Method?
If baby can feed at the breast, tell the nurses or other caretakers to bring him to you to feed. If baby cannot feed at the breast now but you still want to breastfeed when baby is able, avoid using a bottle when feeding. Using a bottle early in baby’s life can cause nipple confusion. Nipple confusion can make it harder for baby to feed at the breast. Instead of using a bottle, you can use an alternative feeding method, which will prevent nipple confusion. Sometimes, the only option for feeding is a small tube that goes directly into baby’s stomach. If this is the case, baby can still be fed your pumped breast milk.
Skin-to-Skin Contact
If you cannot feed at the breast, you may still be able provide skin-to-skin contact. Check with your doctor to see if this is possible. Your body heat can warm baby. For both you and baby, skin-to-skin contact can help prepare for breastfeeding when the time comes. Other benefits of skin-to-skin contact for baby include improved heart rate patterns, sleep alert periods, and temperature control. For mother, skin-to-skin contact can help in bonding with baby and can help the breasts produce more milk. If you are able to only breastfeed and not use formula, make sure that the doctor, nurses, and anyone who helps care for baby know so they will not give formula to baby.
Cleft Lip and Cleft Palate
A cleft lip and cleft palate are birth defects that affect the lips and mouth. Breastfeeding a baby with a cleft lip and cleft palate has different challenges. It can be worth the effort to give baby the nutrients she needs. Breast milk can help baby have fewer illnesses.
A cleft palate is a gap that occurs in the roof of the mouth in the hard or the soft palate. The hard palate is in the front and the soft palate is in the back. The gap can be a small or large.
A cleft lip happens in the fifth week of pregnancy. It is caused when the upper lip fails to come together when baby’s face is being formed. Like cleft palates, cleft lips also vary in size and seriousness. The cleft can be on one side only (unilateral) or on two sides (bilateral). It can continue into the gum, and can join with a cleft palate to create a cleft palate and cleft lip.
Breastfeeding with a Cleft Lip
The main challenge of breastfeeding a baby with cleft lip is trying to fill the cleft so that baby can have a good seal on the breast. Without the seal baby cannot create enough suction to remove the breast milk well. There are many different ways to help baby to have create a seal when breastfeeding:
- Fill up the cleft with your thumb or finger.
- Use the “Dancer Hand Position” to support your breast and baby’s chin so that you can fill up the cleft with your breast tissue. Cup your breast with your fingers with your thumb pointing upward. The baby’s chin will rest at the bottom of the “U” shape created by your hand. Your forefinger and thumb will support baby’s head while your other three fingers support your breast.
- Support the breast with the index finger on top of the areola and the middle finger on the bottom of the areola. This will help fill the cleft with breast tissue as the nipple protrudes.
- Any feeding position that has the baby’s head facing the breast straight on will help to fill the cleft.
As you are learning to breastfeed your baby with a cleft lip, work with your nurse, doctor, or lactation specialist to make sure that baby is sealing onto the breast well. Baby needs to establish negative pressure and be sucking well. Always monitor baby’s weight gain well to make sure she is gaining well. A cleft lip is normally fixed through surgery when baby is anywhere from 1 month to 10 weeks old.
BreastFeeding with a Cleft Palate
Breastfeeding a baby with a cleft palate has different challenges than breastfeeding a baby with a cleft lip. If the cleft is bad enough the doctor and surgeon may suggest that you not feed at the breast at all. Baby sometimes cannot physically feed at the breast. She may have a harder time getting the milk into her stomach and end up breathing it in. The doctor or surgeon may also recommend the use of a prosthesis to plug the cleft palate making breastfeeding easier.
Baby may not be able to feed at the breast until after the defect is fixed. Giving pumped breast milk may be your best option. A cleft palate is normally repaired before 10 months. After a surgery, the surgeon may want you to feed baby in a certain way until the palate can heal at least part of the way. Baby may need to be fed with a tube that runs into her mouth. She can be fed pumped breast milk but will not need to suck. Baby will still receive the healthy benefits of breast milk.
Down Syndrome
One out of every 700 to 800 babies is born with Down syndrome. The risk of having a baby with Down syndrome increases with the age of the mother. Even though the risk increases with age, a woman under the age of 35 is more likely to have a baby with Down syndrome. This is because a woman under the age of 35 is more likely to have a baby.
Risk of Having a Baby with Down Syndrome
· Women under age 23—1 in 2,000 births
· Women at age 30—1 in 1,300 births
· Women at age 35—1 in 400 births
· Women at age 40—1 in 90 births
· Women at age 45—1 in 32 births
· Women at age 50—1 in 8 births
Breastfeeding and Complications with Down Syndrome
A child with Down syndrome may also have other birth defects that need different kinds of treatment. Forty percent of babies with Down syndrome are born with some type of heart defect. This may require a heart operation within the first year of life. If baby has a heart defect, he may have a hard time learning how to feed. If this is the case, you will need to be extra patient in teaching him how to feed while waiting for the heart defect to be fixed. It is usually easier to breastfeed a baby with both Down syndrome and a heart defect after the defect has been fixed.
About 4% of babies with Down syndrome are born with a blockage in the upper intestines, called duodenal atresia. Breastfeeding a baby with duodenal atresia is very beneficial as human milk is easier to digest and can help prevent infection.
Breastfeeding Benefits for Children with Down Syndrome
Breastfeeding has many benefits for a baby with Down syndrome. Examples of these benefits are:
- Breast milk gives extra protection against infection, especially respiratory infection, which babies with Down syndrome are more likely to have.
- Breastfeeding can help create a closer mother-child bond. This is important if you are having a hard time bonding with baby because he is different from what you expected.
- A lot of babies with Down syndrome are hypotonic, meaning that the muscles in their face are weak or floppy. Breastfeeding is a great way for baby to exercise the muscles in his lips, mouth, and tongue so they can become stronger. Breastfeeding improves mouth and tongue coordination, which will help baby learn how to talk and eat easier.
- Breastfeeding provides extra stimulation through skin-to-skin contact, which will help baby develop more fully.
There can be challenges with breastfeeding a baby with Down syndrome. About one half of babies with Down syndrome have weak, hypotonic muscles that make it harder for baby to feed at the breast. If baby is not strong enough to remove milk from the breast well, you may need to pump. Often babies with Down syndrome are very sleepy and it may be hard to wake baby up enough to feed. Talk to a breastfeeding specialist if you have questions or concerns about breastfeeding your baby with Down syndrome.
Hypotonic Face
With a little patience and a lot of support, a baby with a hypotonic face can be taught to feed at the breast. Breastfeeding will help strengthen the face muscles. You can help baby breastfeed by following these tips:
- Support his body with pillows so that your hands are free.
- With one hand support his head and with the other hand support your breast.
- You may need to concentrate on supporting baby’s jaw and chin with the hand that is supporting his head. This can be done using the Dancer Hand Position. Cup your breast with your fingers and thumb pointing upward. The baby’s chin will rest at the bottom of the “U” shape created by your hand. Your forefinger and thumb can support baby while you can use your other three fingers to support your breast.
Providing this extra support can help baby focus on getting the milk from the breast. Extra support can allow him to spend his energy on feeding instead of supporting his body so he can feed longer without getting as tired.
Sleepy Baby
If your baby is a sleepy baby, try to wake him up and stimulate him before he feeds. If he falls asleep during the feed continue to stimulate him throughout the feeding. He needs to stay awake to get enough milk, including the hindmilk.
There are many different ways to wake and stimulate your baby so he can breastfeed. Use what works best for you.
- Talk to baby and make eye contact
- Unwrap baby so he is not too warm
- Hold baby in a standing position
- Change baby’s diaper
- Wipe baby’s forehead with cool, damp cloth
- Stimulate baby’s mouth by rubbing her lips with your finger or putting breast milk on them.
- Rub baby’s skin, especially the hands and feet.
- Gently move baby around, either doing slow sit-ups with his feet facing towards you, bending him at the hips, or through playing “pat-a-cake”.
- During a feeding, burp baby and/or switch to other breast several times. If you do switch breasts, remember that it is also important for baby to get the hindmilk.
- Give baby a bath.
Low Weight Gain
Babies with Down syndrome often have a hard time gaining weight. The baby’s weight may need to be monitored by the doctor. If baby is not gaining enough weight and not feeding well at the breast express your hindmilk after baby is done feeding. The hindmilk is rich in fat and nutrients. You can feed it to baby as a supplement which can help him gain weight.
Other Breastfeeding Issues
Babies with Down syndrome often have other problems that make it more difficult to breastfeed. Some babies with Down syndrome have problems with swallowing and often choke while feeding. To help with this problem, put your baby’s throat and neck higher than your nipple and hold your baby in an upright position. If baby swallows a lot of air while breastfeeding it is a good idea to burp him more frequently.
If you have difficulty with breastfeeding, it is important to talk to a lactation specialist. Babies with Down syndrome may need extra patience while they are learning new feeding skills. Most importantly, find a method that works for you and baby.
Getting Ready for an Operation
Many babies with a special need are scheduled for some kind of operation within the first year of life. A baby with a cleft lip or palate may need an operation to fix the cleft. A baby with Down syndrome may need an operation to fix a heart defect. No matter what the operation is, talk to the baby’s surgeon about any feeding restrictions that may happen before or after an operation. This may include not feeding baby for a certain amount of time before the operation, or certain ways to feed baby before or after the operation. If baby is fed with a tube going to his stomach, then you can still give pumped breast milk. If baby cannot feed at the breast, but you do not want to give a bottle, then an alternative feeding method may be the best solution for you. Always talk with your doctor and breastfeeding specialist to see how breastfeeding can work for you.
