Preemie Bottle Feeding: What I Learned Feeding My Premature Baby

Feeding was one of the biggest parts of our NICU experience after my daughter was born at 33 weeks and 1 day. Before having a premature baby, I had no idea how much went into teaching a preemie how to eat or that feeding could be one of the things keeping a baby in the NICU.

My daughter started with a feeding tube, eventually learned to drink from a bottle and came home using a Dr. Brown’s Ultra-Preemie nipple. Even after we left the NICU, feeding continued to evolve as she got stronger, moved through different nipple flows and gradually started drinking more.

The biggest thing I learned is that preemie feeding isn’t necessarily a straight line. Sometimes she would have an amazing feed and then barely be interested in the next one. Even now, I’ve had to remind myself to watch my baby rather than getting too caught up in how much a schedule says she “should” be eating.

If you’re in the NICU wondering when your baby is finally going to finish a bottle, or you’ve just brought your preemie home and are trying to figure out bottles, nipple flows and feeding schedules, this is what our experience looked like. Every premature baby has different feeding and nutritional needs, so always follow the feeding plan provided by your NICU team and pediatrician.

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How Does a Preemie Eat in the NICU?

When my daughter was first born, she wasn’t able to sit down and drink a bottle the way I had experienced with my full-term baby. She initially received donor milk through a feeding tube.

I was also able to give her the small amount of colostrum I produced. There wasn’t enough to fill a bottle, so the NICU gave us a tiny applicator or swab that allowed the colostrum to be placed on her lips or inside her mouth.

After a few days, our NICU transitioned her from donor milk to premature infant formula. I don’t know the specific reason they made that decision for her, and feeding plans can look very different from one premature baby to another.

Premature babies can have different nutritional needs than babies born at term. Depending on the baby, a NICU feeding plan might involve a mother’s own milk, donor milk, fortified human milk, preterm formula or some combination. This is one of those areas where I would absolutely follow your NICU’s recommendations rather than another parent’s feeding plan.

Learning to Bottle Feed in the NICU

Eventually, my daughter was ready to start practicing with a bottle. I remember being surprised when I saw the bottle for the first time because it was an actual Dr. Brown’s bottle. For some reason, I had imagined NICU bottles looking like tiny doll bottles, but instead there she was, this incredibly tiny baby, learning to drink from a regular bottle with an extremely slow-flow nipple.

Our NICU started her on a Dr. Brown’s Ultra-Preemie nipple. I had never even heard of an Ultra-Preemie nipple before this experience. It wasn’t something I researched or chose. It was what her NICU team determined was appropriate for her at the time.

There was also a very specific way I was taught to position her and hold the bottle while feeding her. Feeding a premature baby wasn’t as simple as putting a bottle in her mouth and waiting for her to drink it.

Sometimes I would sit there for what felt like forever waiting for her to start sucking. She might eventually decide she was interested and have a great feed, while other times she simply wasn’t going to do it. When that happened, we didn’t force her.

What Happened When She Didn’t Finish a Bottle?

One of the hardest parts of preemie bottle feeding was learning that a good feed didn’t necessarily mean the next one would be good too. There were feeds when my daughter would take the bottle really well, which made me think we had finally turned a corner, and then the next time I tried, she might barely be interested.

If she wasn’t able or ready to take enough from the bottle, she could receive the feeding through her tube instead. There were times when I sat with her for quite a while hoping she would start sucking and eventually she did. There were other times when we stopped trying because she simply wasn’t ready.

Thankfully, we didn’t have issues with her oxygen levels during bottle feeds. For us, the challenge was much more about whether she was awake, interested and ready to eat. It was another example of what I came to think of as the two steps forward, one step back nature of the NICU because progress didn’t happen in a perfectly straight line.

Feeding Was One of Our Last NICU Milestones

By the end of our NICU stay, feeding was really the biggest thing standing between my daughter and going home. She needed to consistently take enough of her bottles on her own for our NICU team to feel comfortable removing the feeding tube and eventually discharging her.

I remember watching those bottles so closely because I knew feeding was connected to when we could finally take her home. When you’re sitting in the NICU watching your baby refuse a bottle, knowing that eating is one of the things keeping her there, it’s almost impossible not to feel frustrated or scared.

But you can’t force a premature baby to be ready before they’re ready. At the beginning of our stay, we had been told that she could potentially remain in the NICU until her due date. Because she had been born about seven weeks early, I mentally prepared myself for the possibility of a long stay.

Instead, she came home after just under two and a half weeks. There really was a point when feeding seemed to click for her, but it wasn’t because we discovered some trick that suddenly taught her how to eat. She got stronger and more mature, and eventually she was ready.

Why Did My Preemie Need Higher-Calorie Formula?

Weight gain was another important part of my daughter’s NICU stay. She initially received 22-calorie premature infant formula, but at one point she wasn’t gaining weight the way her medical team wanted.

Her team temporarily increased the calorie concentration to 24 calories rather than increasing the amount she was drinking. She was only on the higher-calorie feeding plan for a couple of days before she started gaining weight and her team moved her back to 22-calorie formula.

This is definitely not something I would try to recreate based on another baby’s experience. Premature babies can have very specific nutritional requirements, and changing the concentration of formula should only be done according to instructions from your baby’s medical team.

What Bottle and Nipple Did Our Preemie Use?

Our NICU used Dr. Brown’s bottles with the Ultra-Preemie nipple, so that’s exactly what I bought for home. I didn’t spend hours comparing the best bottles for preemies or trying multiple bottle brands because she had learned to eat using Dr. Brown’s in the NICU, and I wanted to keep things consistent when she came home. I’ve shared more about how long babies use preemie nipples and what that progression looked like for us.

We started with 4-ounce bottles because she was drinking such small amounts. There was no reason for us to immediately buy a large collection of 8-ounce bottles when she was only taking around two ounces at a time. The nipple was the part that ended up changing much more frequently than the bottle itself.

How We Moved From Ultra-Preemie to Faster Nipple Flows

My daughter started with an Ultra-Preemie nipple, then progressed to Preemie, Transition and Size 1, with additional changes as she got older. I didn’t move her up because she reached a specific age. Instead, I watched how she was eating.

When it seemed like she was working really hard to get milk out of the bottle or feeds were taking much longer, I would consider moving to a faster flow. The first change was from Ultra-Preemie to Preemie.

Later, my night nurse told me about Dr. Brown’s Transition nipple. I hadn’t even known it existed, but it gave us another option between the slower Preemie nipple and Size 1. Having those smaller steps was really helpful because I learned that moving up a nipple size isn’t necessarily permanent. If you're trying to figure out whether your baby is ready to move up, I also wrote about when to change bottle nipple flow and the signs I watched for.

Sometimes a Faster Nipple Was Too Fast

One of the clearest signs that a nipple flow wasn’t working for my daughter was a sudden change in how she handled the bottle. If she drank much faster than usual and then had significantly more spit-up or almost threw the feeding back up, that told me something wasn’t right.

There were times when we moved up a nipple size and then went back down because the faster flow simply wasn’t working well for her yet. As she got older and started daycare, we continued adjusting nipple flows based on how she was actually feeding.

It wasn’t a perfect progression where she moved to a larger number and could never go backward. That experience changed the way I think about bottle nipples completely because the number on the nipple isn’t a milestone your baby needs to achieve. It’s simply a tool for getting milk to your baby at a flow they can comfortably handle.

How I Kept My Sleepy Preemie Awake for Bottles

When my daughter first came home, she was still an incredibly sleepy baby. We had to wake her every three hours to eat, including overnight, and sometimes the bigger challenge wasn’t getting her to take the bottle. It was getting her awake enough to care about the bottle in the first place.

One thing that worked surprisingly well for us was opening or unzipping her sleeper. That little change would often wake her up enough to become more interested in eating. I would also gently tickle her toes or sometimes lightly blow on her face to wake her up a little.

I wasn’t trying to force her to finish a bottle. I was simply trying to get my very sleepy baby awake enough to eat the feeding her medical team had recommended. If your preemie is difficult to wake or isn’t taking the amount your medical team expects, that’s something I would discuss with your pediatrician or NICU team rather than relying on tricks another parent used.

How Much Did My Preemie Eat After Coming Home?

When my daughter first came home from the NICU, she was drinking around two ounces every three hours. We continued waking her for feeds because she wasn’t necessarily going to wake up and demand a bottle herself. My husband and I alternated overnight feedings, and feeding every three hours became the rhythm of our days and nights.

As she grew, I did what I had done with my older child and used Moms on Call as one reference for feeding amounts and schedules. With my premature baby, though, I looked at those recommendations through the lens of her corrected age and, more importantly, what she was actually doing.

There have been times when a schedule made me think she wasn’t eating enough. I even reached out to our pediatrician because she wasn’t finishing the amount I thought a baby her age should be drinking.

Our pediatrician gave me a minimum intake they were comfortable with for her and reassured me that she was doing fine. That conversation was an important reminder that a feeding schedule or parenting book doesn’t know my baby’s growth history or medical needs. Her pediatrician does.

Why I Didn’t Automatically Switch From Feeding Every Three Hours to Every Four

This has continued even as we’ve introduced solids. With my first baby, once we introduced solids, I moved him toward bottles every four hours. I haven’t done that with my daughter yet.

She has been drinking around five ounces at a time for what feels like a very long time. Some schedules suggest a larger bottle for a baby around her age, but five ounces is often what she wants.

If I simply stretched her from every three hours to every four without her taking more at each feed, she would end up consuming fewer ounces during the day. So I haven’t made that change just because it’s what I did with my first baby or because a schedule says it’s time.

Instead, I watch her, consider her corrected age and talk to her pediatrician when I’m concerned. That has probably been the biggest lesson from feeding my preemie: use schedules as tools, not rules, and pay attention to the baby in front of you.

My Decision to Formula Feed My Preemie

I had already decided during my pregnancy that I planned to formula feed my daughter. I had ultimately been happy with my decision to formula feed my first baby, and I knew I didn’t want to go through the uncertainty and stress I had experienced around breastfeeding again. I felt confident in that decision during my pregnancy.

Then my daughter arrived seven weeks early and suddenly I questioned everything. She was so small that I started wondering whether I should breastfeed because maybe she needed something from me that I wasn’t giving her. I gave her the colostrum I was able to produce, which I felt good about, and she received donor milk initially.

But when I thought about actually beginning the process of breastfeeding or pumping, I still knew it wasn’t the right choice for me. That was surprisingly difficult to say out loud because I was recovering from an emergency C-section, severe preeclampsia and HELLP syndrome while my baby was in the NICU.

Lactation consultants and other members of the medical team understandably asked about my feeding plans, but for some reason I didn’t feel like I had the strength at that moment to keep explaining my decision. Eventually, my husband spoke up for me and explained that we were going to formula feed, and I remember feeling relieved that he did.

If you already know how you want to feed your baby, I think this is something worth discussing with your partner before delivery if you can. Having someone who knows your wishes and can advocate for you can be incredibly helpful if you’re suddenly in a situation where you don’t feel able to advocate for yourself.

For me, formula feeding was the right decision. Another parent may feel just as strongly about breastfeeding, pumping, donor milk or combination feeding. Premature babies can have additional nutritional needs, so the specific milk, formula, fortification or supplements your baby needs should be determined with your baby’s medical team.

What I Wish I Knew About Preemie Bottle Feeding

I wish I had understood that feeding progress wasn’t going to happen in a straight line. A baby can finish a bottle beautifully and then seem completely uninterested in the next one. A nipple can work perfectly for weeks and suddenly seem too slow, or you can move to a faster nipple and discover that your baby isn’t actually ready for it yet.

You can also look at a feeding chart and convince yourself that your baby should be drinking more, only to have your pediatrician tell you that your baby is growing appropriately and doing just fine. There are so many numbers involved in feeding a premature baby: ounces, calories, nipple sizes, feeding intervals, weight and corrected age.

It is very easy to start treating those numbers like a test you’re supposed to pass. My daughter taught me that they’re information, not a grade, and the most useful thing I learned was to watch the baby in front of me.

If Your Preemie Isn’t Finishing Bottles in the NICU

This was probably the hardest part for me because I knew finishing bottles was one of the things standing between us and home. If you’re sitting next to an incubator right now watching your baby struggle with a bottle, I know how hard it is to be patient. You want to help, you want your baby to eat and you want to go home.

But one of the things our NICU experience taught me was that I couldn’t force my daughter to be ready. Sometimes I could sit patiently and give her time to start sucking. Sometimes she needed a break. Sometimes the feeding tube had to do the work because she simply wasn’t ready to do it herself.

Then, little by little, she got stronger. The baby we were told could potentially stay in the NICU until her due date came home after just under two and a half weeks. Her feeding wasn’t perfect forever after that, either, and we continued adjusting bottles, nipple flows, ounces and schedules as she grew.

Patience was probably the hardest part of feeding a preemie. Looking back, it was also one of the most important things I learned because so much of her progress simply required giving her time to get stronger and be ready.

Once discharge started feeling possible, I also had to quickly figure out which preemie essentials we actually needed at home.

Frequently Asked Questions About Preemie Bottle Feeding

Can preemies drink from a bottle?

Some premature babies can bottle feed once they are developmentally and medically ready, while others initially need tube feeding or other feeding support. My daughter started with a feeding tube and gradually learned to take bottles in the NICU. Your baby’s NICU team will determine when and how to introduce oral feeds safely.

What nipple flow should a preemie use?

There isn’t one nipple flow that’s right for every premature baby. Our NICU started my daughter on a Dr. Brown’s Ultra-Preemie nipple, and she later progressed through Preemie, Transition and Size 1 as her feeding skills developed. I would follow your NICU team’s recommendation initially and watch for feeding changes as your baby grows.

How do you know when to move a preemie to a faster nipple?

For us, feeds taking much longer and my daughter appearing to work harder to get milk were signs that we might need to try a faster flow. When a faster nipple caused her to drink unusually quickly and have significantly more spit-up, we sometimes went back down. If you’re unsure, ask your baby’s pediatrician or feeding specialist rather than changing nipple flow solely based on age.

How often does a preemie need to eat after leaving the NICU?

Our daughter came home eating about every three hours, including overnight, and we had to wake her for feeds because she was so sleepy. Your baby’s feeding frequency will depend on factors including gestational age, growth and medical history, so follow the schedule provided by your NICU or pediatrician.

How do you keep a sleepy preemie awake during a bottle?

For our daughter, opening her sleeper, gently tickling her toes or lightly blowing on her face sometimes helped wake her enough to eat. Premature babies can be very sleepy, though, so difficulty waking for feeds or consistently not eating the recommended amount is something I would discuss with your baby’s medical team.

Do preemies need special formula?

Some premature babies have nutritional needs that differ from full-term babies, but that doesn’t mean every preemie needs the same formula or feeding plan. My daughter was discharged on a 22-calorie premature infant formula after briefly receiving a higher-calorie feeding plan in the NICU.

Other babies may receive breast milk, fortified human milk, donor milk, formula or a combination. Your baby’s NICU team or pediatrician should determine what feeding plan is appropriate for your baby.

A Note From Me

This article shares my personal experience feeding my daughter after she was born at 33 weeks and 1 day. It is not intended to provide an individualized feeding plan for another premature baby.

Premature babies can have specific nutritional, developmental and medical needs. Always follow your NICU team’s or pediatrician’s recommendations about feeding frequency, formula preparation, fortification, bottle and nipple selection, supplements and how much your baby should be eating.