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Breastfeeding the Hospitalized Baby
by Cyndi Egbert

While it is a blessed fact that babies come in two genders, for the sake of clarity, mother is referred to as she and baby is referred to as he for the purposes of this information sheet.

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None of the information contained herein is meant to provide medical or legal advice.  These are merely suggestions. All decisions should be discussed with your health care provider.

This information is a guideline, a starting point for discussion with your child’s caregivers.  Because each child’s condition and situation is unique, anything affecting the child’s overall well-being should be agreed upon by all involved.  It must be stressed that, ultimately, the parents have the final say on all aspects of their child’s care.

Because preemies have very specific issues, I have not addressed their special needs in this context. There is information available from La Leche League International on the special situation of breastfeeding a preemie.

Breastfeeding the Hopsitalized Baby--main text
Appendix A  Glossary of Useful Terms
 Appendix B  The Chain of Command
 Appendix C  Where to Find Help
 Quick Checklist   At-A-Glance Reference

Pregnancy is generally a time of anticipating wonderful things to come.  Even when the pregnancy was unexpected, most mothers are eager to greet and come to know their new child by the time of the birth.  The thought that there might be a problem occurs to all of us at one time or another; but it is usually dismissed quickly as unfounded.  Sometimes it is apparent during the pregnancy that something is amiss, but more often it is at delivery or within a few days after that problems show up. An older baby may suddenly become very ill and require hospitalization.  As unfortunate as these things are, it is more unfortunate still that many mothers, overwhelmed by their child’s condition, the medical staff and the hospital setting itself, conclude that breastfeeding is no longer an option.  Breastfeeding may be abandoned or never initiated.  Following are a few guidelines that may help breastfeeding remain a viable option.

  • If your baby is unable to nurse for a time, the main priority in regards to nursing is to establish or maintain a milk supply.  Pumping as often as possible is advisable.  The reality of pumping is that it is likely to take a half-hour or so for each session.  Pumping, labeling the containers and washing your equipment is time consuming.  If your child has a private room, you may be able to keep a pump with you so that you don’t have to go to a pumping station.  Hand expression can be invaluable in this situation because of the minimum of equipment, but it’s a learned art.  If your child is in an open ward or ICU, you may be able to draw the privacy curtain and either hand express or use a battery operated pump without having to leave your child.  Obtaining the cooperation of your child’s nurses is often as simple as asking.

  • Be sure to check on the hospital’s storage policies.  They vary from hospital to hospital and may include special storage containers or a time limit on how long milk can be stored before use.  Do not ever discard expressed milk.  When your child is unable to receive milk because of intubation (being on a breathing machine) or other problems, it may seem ridiculous to be storing ounces and ounces of milk that can’t be used yet.  When the baby is able to receive your milk, it can disappear at an amazing rate.  The more milk you have in reserve, the less pressured you’ll feel if your baby is unable to nurse well as he recovers.  Often, as they slowly regain their strength, babies will be tube-fed through their nose (NG tube) to conserve energy needed for healing.  Pouring two ounces every two or three hours down that tube can add up very quickly.

  • Once you can hold and cuddle your baby, put him to the breast even if he’s too weak to nurse.  The stimulation to the breast will aid in your pumping efforts and it will help your baby to learn or relearn that not all touching is bad.  Some babies have an aversion to anything touching their face or mouth after being intubated for a time.  You may be able to help prevent this by allowing him the chance to suck on your finger even while intubated.  In any case, do not force the issue if the baby doesn’t want to nuzzle the nipple.  You may need to start slowly, perhaps letting him rest his head on your chest with your shirt down and gradually working up to more skin contact until his face is lying on your chest with your shirt up.  Eventually he’ll get the idea.

  • This always seems to be redundant advice, but it is important and bears repeating.  Try to rest and eat.  When you’re worried about your sick baby you may not feel like eating or be unable to sleep for more than an hour or two at a time.  Inadequate rest and nutrition may interfere with your milk supply.  Don’t expect perfection.  Sleep as much as possible and try to eat at least two small meals a day.  On the ward it will be possible to keep a snack or nutritious drink nearby.  In ICU you may be able to keep at least a cup of water handy.  It depends on ICU policy and also the nurse on duty, but it’s worth asking.

  • Try to avoid rubber nipples, bottles or pacifiers.  A baby that is unable to nurse for a while may get even more confused if given rubber nipples to suck on.  Drinking from a bottle is more physiologically stressful than nursing and requires a whole different set of actions.  Sometimes there may be a hospital policy involved.  In the cardiac ICU we were in, it was policy that a baby be able to suck from a bottle, lying down, before being transferred to the ward.  The theory was that if the baby could accomplish such a physically stressful feat without going into cardiac arrest, it was probably safe to move him into a less supervised setting.  I finally had to go to the surgeon to request that this policy be waived in my daughter’s case.  He agreed and that was the end of it, but no one under him had the authority to agree to my request.  You can start by asking a nurse, but always take your requests to the top of the command chain if you are not getting the answer you want.  (See appendix B)

Once your baby is physically able to nurse, different issues come into the picture.

  • Your baby may have some difficulties with the act of nursing.  This may be due to being intubated, an aversion to being touched around the face or mouth, congestion, weakness or congenital abnormalities of the mouth.  Some problems, such as weakness or congestion, may just take some  time to resolve.  A very weak baby will likely be tube-fed to conserve energy, and in that case nutrition will not be the main concern.  Other problems may warrant a consultation with the lactation consultant on staff or a local La Leche League Leader.  She will be able to offer concrete suggestions, perform an evaluation, or refer you to an appropriate therapist and/or other resources.

  • You will hear more about calories during this time than you have heard throughout your entire life unless you’re a weight loss counselor.  Breastmilk is calculated as having 20 calories per ounce.  High calorie formulas, containing 24-27 calories per ounce, are frequently advised for use in compromised babies.  Human Milk Fortifier (HMF), developed for use with premature infants, is often used as a “filler” when an infant is being tube-fed expressed breastmilk.  HMF is cow’s milk based and as such may cause an allergic reaction.  A full-term baby on HMF may also need to be monitored for electrolyte imbalances because they don’t have the same nutritional deficiencies as preemies.  Another commonly used filler is Polycose.  It is basically a simple carbohydrate, but may also cause allergic reactions.  Various studies have concluded that the caloric content of human milk varies from mother to mother and may also differ in a single mother through the course of the day.  An analysis of your milk to determine how many calories per ounce your baby is receiving may be an option.

  • If your baby won’t nurse and is being tube-fed, try to avoid giving medications by mouth.  Oral medication can usually be put down the tube.  This avoids any additional negative oral stimulation and may make efforts to breastfeed go a little more smoothly.

  • Try to find at least one contact person who is supportive of your efforts to breastfeed.  The isolation of being in the hospital with a sick baby is very stressful.  Trying to nurse your baby without anyone to encourage you during this time is doubly difficult.  The hospital staff are often so caught up with calories and “ins” (milliliters taken in each day), not to mention the dreaded daily weight check, that breastfeeding may be viewed as an inconvenience.  It is much more difficult to measure.  Someone who can pat you on the back when you’re discouraged and celebrate with you when you’ve made progress, no matter how little, can be invaluable.  If you have no close friends who would fit the bill, contact a local La Leche League Leader.

  • Finally, try not to get too discouraged.  There are some babies who will never physically be able to nurse.  They are the exception rather than the rule.  Most babies, with patience and perseverance, will eventually be able to reap the many benefits of breastfeeding.

I know how difficult it is to breastfeed in adverse circumstances.  My own daughter would not have been breastfed were it not for my background as a former La Leche League Leader.  Even with my determination, there were many obstacles to overcome.

I am thankful for the friends who were able to support me through the six weeks we spent at the hospital.  My daughter did not successfully nurse until after she was discharged at six weeks of age.  At two months of age she had still not regained her birthweight!  Two months after that, however, she was actually plump. She is frequently ill and has had pneumonia a number of times.  Many of the pediatric nurses at her hospital know us on sight!  Yet, when I talk with other parents of children with her problems, I realize how very lucky we’ve been.  I am sure that breastfeeding has prevented far worse complications than the ones we deal with.  So while no one can promise that your child will never get sick again if you breastfeed, you can be sure that the benefits will still be tremendous.

Be sure to read the appendices to this article. Click on "next."


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