Since working with parents in the neonatal intensive care unit (NICU) for more than 15 years (can I really be that old?) it seems every parent enters the NICU certain of one thing—their baby needs to grow to go home. We dietitians become pretty obsessed with our calorie counting and celebration of each gram of weight gain. In the hospital, everyone—doctors, nurses, dietitians, lactation consultants and especially parents—is focused on babies gaining weight. We give lots of calories and nutrients to babies so they will not only grow but grow at a fast rate. To take in as many calories as a premature infant does, a 150 pound adult would have to eat about 8,000 calories a day. That is a lot! And we don’t only want them to grow heavy, we want them to grow bone and muscle and organs. It takes lots of nutrition to grow a baby in the NICU.
Thankfully, once babies go home, the need to count every calorie and gram of weight gain typically stops. Although parents are aware that their babies need to continue to grow, they aren’t quite certain how to achieve appropriate growth at home. Below are some commonly asked questions and answers related to growing babies at home that will, hopefully, help parents with this transition.
Can I breastfeed my baby at home?
Yes! Most babies who were in the NICU can direct breastfeed a least a few feedings each day. Most moms will need to keep pumping at home initially to keep their milk supplies high while their baby is learning to breastfeed better.
Can I exclusively breastfeed at home?
Many babies who were in the NICU will be able to work up to exclusive breastfeeding and grow. Initially, some infants will take mom’s milk with some powdered formula added to bring up the calories and nutrients or will take a couple feeds a day of formula. Your breastmilk is perfect! Some babies who spend time in the NICU have high nutrition needs beyond what breastmilk provides and will benefit from small amounts of formula. You can talk to your infant’s neonatologist to let them know if you prefer to add powdered formula to your milk or to give a few feeds for formula each day.
What formula should I give my baby at home?
Your neonatologist will tell you what formula to use at home. Most babies discharged from the NICU either go home on term formula or transitional (also called follow-up) formula. Term formula is designed to be as close to human milk as possible. Transitional formula has extra protein and nutrients that many preterm infants needs for to grow. If formula is mixed using the directions on the can, term formula will be 20 calories per ounce and transitional formula will be 22 calories per ounce. Since both these formula types come in powder, they can be mixed using a different recipe to make the calories higher per ounce. Your nurse or dietitian will review with you how to mix the formula your baby gets discharged on, especially if the instructions will be different than what is written on the can. Because there is an Infant Formula Act in the United States, there is little difference between different term formulas and different transitional formulas, including generic versions.
When can I give my baby foods other than breastmilk or formula to eat?
When your baby is about 6 months from his or her due date, you can begin introducing new foods. Starting solid food based on your baby’s actual birthday is generally too early to start solids. Babies cannot properly digest anything other than breastmilk or formula prior to 6 months corrected age.
For many parents, it is difficult to make the transition home because they are so accustomed to having those daily weights we get in the NICU. It helps if the feeding plan for home is used several days prior to discharge to make sure the baby is growing. Sometimes it is also useful for parents to go to their pediatrician for a weekly weight for the first month at home to put their minds at ease. Once they see that their infant is growing at home, they can really start enjoying their new baby.
Amy Brandes, RD, LD, IBCLC is a Registered Dietitian and International Board Certified Lactation Consultant from Austin, Texas. She received her Bachelor’s degree in Speech Communications from Texas Christian University and completed a Coordinated Program in Dietetics from the University of Texas at Austin. Amy completed a Neonatal Nutrition Fellowship at the Medical University of South Carolina and has worked as a Neonatal Dietitian for more 15 years. Currently, Amy manages Perinatal Nutrition and Lactation Services for the Seton Healthcare Family.