Infant - Parent
Author: TLN

Ask the IBCLC: A Guide to Breastfeeding for Preemies, Multiples and Infants Requiring Special Care

We’re sharing expert info on nursing and pumping for babies who need extra care

Congratulations! Your baby—or babies—has/have arrived. But if your little one needs extra medical care and special attention, your start to breastfeeding might look a bit different. The good news? Breast milk will help your baby’s development and protect them from illness. Here’s our guide to breastfeeding for preemies and more.

So get a great breast pump (we can help with that!), consider renting a hospital-grade pump to establish your supply, and hang on for an amazing, challenging, life-changing ride. We’ve rounded up expert advice to get your breastfeeding journey started strong, no matter what the special circumstances.

Premature baby

If your baby is born premature, they may not be big enough or strong enough to latch, suck, breathe, and transfer milk at first (it’s a pretty complex skill!). In that case, you’ll need to pump and bottle feed breast milk for some period of time. Plan to pump frequently—as many as eight to 10 times a day around the clock—to build your supply.

Around six to seven weeks before your due date, depending on your baby’s cardiac and respiratory status, your baby may be able to nurse at the breast for “non-nutritive” feedings, meaning they can practice nursing but aren’t able to transfer much milk. By five to six weeks before the due date, your baby may begin to be able to transfer some milk. During this time, you’ll need to continue pumping as frequently as your baby feeds to keep your supply up. 

You may also need to fortify your breast milk with formula, under the direction of your baby’s medical team. Fortification can be used to ensure your baby gets some of the end-of-pregnancy minerals they may have missed out on, or to increase the calories-per-ounce if they don’t have the energy or ability to drink a larger volume.


Twins, triplets, oh my! You may wonder if it’s possible to produce enough milk for more than one baby—and the answer is yes (incredible, right?). It’s all about supply and demand, so your body will respond to frequent, effective nursing and pumping. 

Multiples are often born premature so all the previous info would also apply here in that case. When you and your babies are ready to start nursing, try feeding one baby at a time to get to know each one’s latch before moving to simultaneous nursing. Yes, it’s incredibly difficult to wake a sleeping baby so that you can feed both babies together, but the alternative is a never-ending rotation of babies to feed. A double nursing pillow is a must! You may need some help positioning the babies at first, but with time and practice, you’ll all get the hang of it. (Depending on the type of pillow, you can also use it to bottle-feed the babies together.)

Like all breastfeeding parents, a well-balanced diet will support your energy and your supply. But when breastfeeding multiples, keep in mind that you’ll burn even more calories, so you’ll need to take more in each day.

Allergies and intolerances

When you’re nursing or pumping, traces of what you eat and drink make their way into your breast milk. If your baby experiences a lot of discomfort, excessive fussiness, unusual stools, reflux and/or skin rashes, they may have an allergy or intolerance. Keep an eye on symptoms and reactions, and be sure to discuss what you’ve noticed with your pediatrician. Though the most common culprit is cow’s milk protein (dairy), pinpointing the cause of your baby’s discomfort can be tough, and caring for a fussy baby takes a lot of time and patience. 

If your breastfed baby has an intolerance or allergy, check food labels carefully to make sure you don’t eat something that will cause a reaction. To help prevent reflux, try using more upright nursing positions, giving smaller, more frequent feedings, stopping to burp often and holding your little one upright for as much as 30 minutes after feedings. You’ll also want to use a specialty or hypoallergenic formula if you need to supplement. Check with your pediatrician for samples (or get in touch with our team to get it covered through your insurance) as these formulas can be pricey.

Cleft lip and palate

Isolated orofacial clefts—which are cleft lips and cleft palates that occur with no other major defect— are one of the most common birth defects in the U.S. Babies with cleft lips or palates can be prone to ear infections and have to undergo surgery to repair the cleft, so breast milk is especially beneficial for these little ones in preventing infections and passing along antibodies.

A baby who is born with a cleft lip may be able to transfer milk through nursing. Finding the right position to create a good seal with your baby’s mouth is key. Typically, a cleft palate prevents a baby’s mouth from having the suction required to nurse or drink from a typical bottle. If you’re not able to create that seal or suction, you can exclusively pump and bottle feed with a special feeding device, such as a Dr. Brown’s specialty bottle or a Haberman Feeder. These bottles allow your baby to compress the nipple to release milk, rather than suck. Feedings may take extra time, require specific positioning and involve additional jaw and chin support. Don’t be alarmed if some milk goes up and out your baby’s nose—this can be common with a cleft.

No matter what the circumstances, know this: we see how hard you’re working to feed your baby and help them grow. Be sure to give yourself a break! Parents are superheros, but even superheroes need time and space to recoup their strength. When a single feeding requires nursing and pumping and bottle feeding or balancing more than one baby on your lap, get help with other household tasks like groceries, meals, cleaning, and laundry. Let other people feed the baby so you can rest or have some downtime. And if you need to supplement with formula, it’s okay. 

We’re here to support all parents, so reach out to our team for help with securing an insurance-covered breast pump or connecting with an International Board Certified Lactation Consultant who has experience with premature babies, multiples, or infants who require special care.