Weaning premature babies
Overview
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All babies will get to a point where breast or formula milk will no longer provide them with all their required nutrients.
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At this stage, the introduction of solids foods to their diets becomes essential.
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The introduction of solid foods will also help babies develop their lip, tongue and jaw movements and the exposure to new tastes and textures will encourage eating a range of foods, which is important for helping them to eat a balanced diet later in life.
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It is also a time where you can involve all the members of your family in feeding your baby.
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So how do we know when is the right time to introduce solids to a preterm baby? Read on for more information.
When to start weaning preterm babies
For the general population, the introduction of solids is not recommended before 6 months.1
For special groups such as preterm infants, these government guidelines don’t apply.1
There are no national guidelines for weaning preterm babies but a review of available literature provides the following recommendations: 2
- Weaning premature babies should be considered between 5 and 8 months uncorrected age.
- They should be at least 3 months corrected age to allow for sufficient motor development.
- Deciding on the actual time of weaning a preterm baby should be based on observing cues for weaning readiness in each individual infant.2-4
- Once weaning has started it should progress according to standard weaning guidelines, paying attention to providing appropriate nutrient dense weaning foods.4
Cues for weaning readiness in healthy preterm infants2
Positioning:
- Has some head control and stable head position with or without support
- Can be supported easily in a sitting position on a lap, bouncy or high chair
- It is not recommended to introduce a preterm infant to solids if they cannot be assisted to achieve the above skills2
Behaviours:
- Alert and appears ready for a new type of feeding
- Showing an interest in others eating2
Oral skills:
- Is able to breast, bottle or cup feed efficiently (if not managing milk feeds efficiently, a specialist speech and language assessment is recommended)
- Started to bring their hands to their mouth
- Is exploring fingers or toys with their mouth
- Is demonstrating munching (up and down jaw movements) when mouthing non-food items2
Further support
BLISS have produced a practical guideline for parents of preterm infants and covers the following information:3
Access the full guidelines here.
- Why is weaning important?
- When should I wean my premature baby?
- How do I start weaning?
- What foods can my baby have?
- How lumpy should food be?
- What about food allergies?
- What if my baby refuses food?
- Which drinks can I give my baby?
- Things to remember
Useful links
BLISS – www.bliss.org.uk
Best Beginnings – www.bestbeginnings.org.uk
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Scientific Advisory Committee on Nutrition (SACN). Minutes 2nd Meeting 27th September 2001, agenda item 5, paragraph 18.
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King C. An evidence-based guide to weaning preterm infants. Paediatric Child Health, 2009, 19 405−14.
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BLISS. Weaning your premature baby. Available here. https://www.bliss.org.uk/parents/about-your-baby/feeding/weaning-your-premature-baby (accessed April 2020)
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King C & Tavener K. 2015. Preterm Infants . In Shaw (4th Ed.) Clinical Paediatric Dietetics (pp 83-103), Wiley Blackwell, Chichester.
IMPORTANT NOTICE:
The World Health Organisation (WHO) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breastfeeding – in particular the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since it will have a negative effect on breastfeeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breastfeed. Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively bottle-fed, more than one can (400 g) per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast milk is not only the best, but also the most economical food for babies. If a decision to use an infant formula is taken, it is important to give instructions on correct preparation methods, emphasising that unboiled water, unsterilised bottles or incorrect dilution can all lead to illness.