Pumping for a Baby in the NICU

JanelMS, RD, LDN, CBS

Read time: 6 minutes

What to know about pumping for a premature or ill baby in the NICU

  • What are the benefits of breastmilk for a premature or ill baby

  • Learn how to get started with pumping for your baby

  • Understand how to maintain and build your breastmilk supply

Most parents don’t expect their baby to go to the NICU after being born. And while the birth of your baby should be a wonderful and joyous event, this unexpected surprise can also be stressful, exhausting, and emotionally draining.

If you were planning to breastfeed, what happens when your baby will be spending days, weeks, or even months in the NICU? Can you still provide breastmilk, and will your body respond to pumping? The short answer is: Yes, absolutely!

The first step is to let your NICU support team and baby’s doctors know that you’d like to provide breastmilk or work on breastfeeding directly. Getting their support will be key to helping make your breastfeeding goals work. They will help ensure your baby is given any amount of breastmilk you’re able to express, as well as provide you with information on pumping, breastmilk storage guidelines, and even breastfeeding support for when the time comes.

Read on to learn how to pump for your baby in the NICU while also setting up your breastmilk supply for the long term.

Benefits of breastmilk for a premature or ill baby in the NICU

While pumping for your NICU baby can be time consuming and challenging, it can also be an important way for you to be involved with your baby’s care – especially when so much may feel out of your control right now.

Breast milk offers significant health benefits to your baby, especially if they are premature or ill. In fact, breastmilk produced for a premature baby is different than that produced for a baby born full term. This premature breastmilk, especially colostrum, is higher in protein and certain minerals.1 It also has different types of fat that are more easily absorbed.1

Breastmilk is also easier to digest than formula, which may be helpful if your little one’s digestive track is not fully developed yet.2Even the bioactive components of milk, such as growth hormone and those components that are immune system protective, are increased in the milk made for premature babies.3

Providing breastmilk to a premature baby may also help reduce the risk of serious diseases and complications, and may even be associated with fewer hospital stays during the first year of life.3,4,5 In fact, the benefits are so great that the American Academy of Pediatrics recommends that all babies born prematurely be given breastmilk, even if from a donor.12

If your baby is born particularly small and needs supplementation from formula or specialized human milk fortifier, any amount of breastmilk will still provide benefits.4

Read more: What are the Benefits of Breastmilk?

Should I hand express or use a breast pump when expressing milk for my premature or ill baby?

It is important to begin expressing breastmilk right away for your baby; within 6 hours of baby’s birth.13

First: hand express

Sometimes hand expression is recommended during the first few days after birth. This manual way of expressing breastmilk may help produce more milk than an electric pump when expressing colostrum.6 Many mothers find it more comfortable than a pump at first as well.

Colostrum is the yellow, thick ‘first milk’. It is nutrient-dense and will sustain your baby until your mature milk starts to come in.7

Note that you may only get a few drops of colostrum, about 1 teaspoon every feeding.8 This is normal! Since your baby’s stomach is small, this amount will meet their needs initially. Especially since they will feed frequently: 8 to 12 times per 24 hours. Every day you will begin to produce a bit more.

Hand express into a small clean cup or even onto a clean spoon to help catch every drop.

You’ll want to hand express 8 to 12 times per 24 hours to make enough for your baby, help stimulate your milk supply, and let your body know how much your baby needs.2,11

Read more: How and When to Hand Express

Next: Switch to an electric breast pump

After the first few days, switch to a hospital-grade electric pump that pumps both breasts at the same time (a ‘double’ pump). This type of pump is most efficient and powerful, and can help you make the most out of each pumping session as well as help establish a good breastmilk supply for the long term.9,10

Continue to pump 8 to 12 times per 24 hours, or as often as your baby is feeding.

Pumping tips

  • Pump both breasts at the same time. Getting a hands-free pumping bra may be helpful.

  • Use the ‘let-down’ or ‘massage’ mode on the pump for the first few minutes, which is a lower suction at a higher speed. Then switch to the ‘expression’ phase once milk starts to come out, which is a slower speed with higher suction.

  • Adjust the suction so that pumping does not hurt. Be sure to use the correct fitting flange for the same reason.

  • Pump for 10 to 20 minutes, or until about 2 minutes after the milk stops flowing.

  • Massage your breasts while pumping

  • Hand massage after pumping to get the last drops and fully empty the breast.14,15,16

Read more: Top Tips for Breast Pumping

Learn about: How to Choose the Right Breast Pump

Stimulating and increasing breastmilk supply while your baby is in the NICU

If your baby is able to be held while in the NICU, holding your baby skin-to-skin – also called Kangaroo Care - helps stimulate your milk production hormones.12 Try to do skin-to-skin whenever you are able, and if you are able to pump in the hospital directly after skin-to-skin, that may be helpful as well.1

If you are unable to hold your baby, you can pump close by while visiting the NICU.

While at home, look at pictures and videos of your baby, or even smell an article of their used clothing for extra stimulation while you pump. Visualization can also help.19 Imagine your baby breastfeeding and milk flowing freely.

While it is normal to feel stressed when your baby is ill or in the NICU, try to find support through family, friends, and NICU support staff. Unfortunately, stress can negatively impact breastmilk supply.18 Try listening to soothing music, drinking tea, or using other relaxation techniques while pumping to help make the most of each session.

If you find a routine that works well, use it every time. The body can be trained to expect a pumping session, and this may help with stimulating a ‘let-down’ (when milk starts flowing) as well as with breastmilk production.22,23

Finally, taking care of yourself through good nutrition and hydration can help support your milk supply.20,21

Read more: How Much Should I Eat While Breastfeeding

Setting up your breastmilk supply for the long term

Milk supply is based on a supply and demand relationship, so the more the breasts are stimulated and emptied, the more the body is signaled to make milk.17

While feeding your baby at the breast is best done on demand, pumping is most successful when done on a schedule. And many premature babies are fed on a schedule as well. Aim to pump at the same time each day so that your body knows to make milk at that time.

Even if your baby is unable to eat much of your breast milk at the beginning, keep pumping consistently. The first month is very important for setting up your supply.17

Establishing your breast milk supply will help you be prepared for if and when your baby is ready to nurse.

If you have pumping or breastmilk supply questions, our team of registered dietitians, fellow moms, and lactation specialists, are available from Monday – Friday 8 am – 6 pm (ET) and Saturday – Sunday 8 am – 2 pm (ET) to help support you. Chat now!

Safe breast milk storage for premature babies

It is important to practice safely handling the pumped milk when you are transporting it to the hospital. Milk storage guidelines are different for premature or hospitalized babies, as these babies are at higher risk for infection.3

Discuss storage and transportation guidelines for pumped breastmilk with the NICU medical providers. Every hospital may have a slightly different set of instructions for labeling, storing, and transport of breastmilk.3

Whenever possible, take your pump to the hospital to pump fresh milk for baby’s next feeding.

Transitioning to breastfeeding your premature baby

By 29 weeks’ gestation, most babies have developed their rooting reflex, or ability to find the nipple.24 At this age the ability to suckle is not yet fully formed. By 31 weeks, some babies may be able to perform a few short bursts of suckling and swallowing. However, most babies are able to fully breastfeed by 38 weeks’ gestation.24

If your baby is stable and the NICU medical staff permits it, you can begin holding baby skin to skin at the breast around 29 to 30 weeks. Allow them to nuzzle, root, and perhaps latch but note they will likely not be able to have full feeds at the breast.1

Keep practicing latching and suckling with your baby as you’re able and by 38 weeks your little one may be taking full feeds at the breast. Important factors to help graduate to breastfeeding include good breastfeeding positioning, frequent practice breastfeeding sessions, and support of those around you.24

And if possible, enlist the help of a lactation consultant on staff at the hospital.

Read more: 6 Breastfeeding Positions for You and Your Baby

Learn about: Top Breastfeeding Latching Tips

Let's Chat!

We know parenting often means sleepless nights, stressful days, and countless questions and confusion, and we want to support you in your feeding journey and beyond.

Our Happy Baby Experts are a team of lactation consultants and registered dietitians certified in infant and maternal nutrition – and they’re all moms, too, which means they’ve been there and seen that. They’re here to help on our free, live chat platform Monday - Friday 8am-6pm (ET), and Saturday - Sunday 8am-2pm (ET).Chat Now!

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For more on this topic, check out the following articles:

Breastfeeding: How and When to use a Nipple Shield

Choosing the Best Bottles and Nipples for your Baby

Breastfeeding: How to Support a Good Milk Supply

Formula Feeding On Demand vs on a Schedule

Breastfeeding On Demand vs on a Schedule