Formula Vs Breastfeeding Your Premature Baby

Jennifer Douglas Jennifer Douglas

A premature infant is a baby born before 37 weeks gestation. Having a premature infant can be a time of great stress and when it comes to feeding your infant there will be lots of questions.

It is possible that your baby may need a short time on parental nutrition (TPN) which is nutrition delivered via intravenous, followed by tube feeding and then on to oral feeding (breast or bottle). Your medical team can support you in the decisions about feeding your baby and whether you would like to breastfeed or formula feed your child.


Breastmilk has been shown to greatly improve outcomes for a premature infant as it reduces the risk of complications, such as necrotizing enterocolitis and sepsis. Breastmilk from a mother of a baby born prematurely has been found to be higher in protein and higher levels of growth factor and immune-active molecules from a mother of a term baby. If your baby is tube fed or only managing a bottle rather than breast, then you will need to express in order to give your baby breastmilk. A lactation consultant can help with getting a machine to express, giving advice on getting your baby to latch at the breast and give ideas on how to increase milk production. If it is possible to have skin to skin contact with your baby this can help progress your baby to breastfeeding and also help stimulate breastmilk production. Donor milk is often available at some neonatal wards if you cannot breastfeed for any reason. Breastmilk given on the neonatal unit may be fortified with breastmilk fortifier to improve growth.

If you are breastfeeding it is important to feed yourself well. High stress can reduce your appetite and feeding yourself can be overlooked when you are worried about your baby. Accept food from friends and family with open arms. Eating small and nutritious snacks over the days such as nuts, oat muesli bars, dried fruit, peanut butter on toast, cheese and crackers, yoghurt and fruit can help with breastmilk production.

If you are unable to produce breastmilk or would prefer not to, then your baby can be given a commercially prepared infant formula specially designed for premature infants. These formulas are usually higher in calories and protein than standard infant formula.

After your baby goes home you can continue to feed your baby either breastmilk or formula. Breastmilk is unlikely to need continued fortification when you go home. If using formula you can continue on a premature infant formula or switch to a standard commercially prepared formula. You can discuss this with the hospital or community Dietitian. Breastmilk and formula should be given exclusively until your baby is around 6 months actual age when solids can be introduced. Breastmilk and formula will give your child the majority of their nutrition for the first year of life.

When choosing between breastmilk and formula for your premature baby it is important to look at the advantages and disadvantages. Both will feed your baby and encourage bonding with your baby. Breastmilk offers your baby personalised milk that changes formulation over the months, weeks and hours to suit your babies needs, it is free, served at the perfect temperature, easy for baby to digest, and available on-demand. Breastmilk gives immune antibodies from you to your baby and prevents a number of diseases for you and your baby, such as ENT infections, allergy, cardiovascular disease, obesity and breastfed infants are likely to have a higher IQ. The disadvantages of breastfeeding is that you need to keep up supply with regular feeding, you may not be able to take certain medications and you may have less freedom to travel/work. Formula has improved considerably over the years and the advantages are that you know how much your baby is taking (which can be important if growth is a concern), anyone can feed your baby and different formulas are available depending on age and medical condition. The disadvantages of formula are that it comes at a financial cost and there is an increase in risk of allergy, infections, obesity and diarrhoea associated with formula feeding. It is important that your infant is not fed on plain cow, goat, soy, almond milks as these do not contain the adequate calories, vitamins and minerals for your infant. These milks are also very high in protein and sodium, which can cause increased strain on your babies kidney’s. These milks can be introduced from 6 months in food, but not as a drink until they are 12 months old. It is also important that baby is fed on a commercially prepared formula and you should avoid making homemade formulas as these can be low in calories, protein and can be too high or too low in vitamins and minerals leading to risk of malnutrition or toxicity.