NICU Nurse, Mama Heart. Here for every tiny step.
One of the biggest challenges premature babies face in the NICU is learning how to eat safely. While sucking is actually a natural reflex—even babies born as early as 23 weeks can often suck—learning how to coordinate sucking, swallowing, and breathing is a much more complex skill. Paced feeding in the most commonly used method of feeding babies in the NICU.
This is often called the “suck-swallow-breathe” coordination, and it takes a lot of practice to master. Many premature babies struggle with this skill, especially those born at earlier gestational ages.
Sometimes a baby may try to take a breath before they have fully swallowed their milk, causing them to cough or choke. Other times, they become so excited about eating that they focus entirely on drinking and forget to pause for breaths. As a NICU nurse, I’ve watched many babies enthusiastically “chug” their bottles, only to have their oxygen levels dip because, in that moment, eating seems much more important than breathing!
The good news is that there are several ways we can support babies as they learn this important skill.
Side-Lying Position and Paced Feeding in the NICU
One of the most common techniques used for paced feeding in the NICU is feeding babies in a side-lying position.
Instead of holding your baby upright in a traditional cradle position, your baby is gently positioned on their side while feeding. This position offers several benefits:
1. It gives milk a place to collect if your baby needs a break.
When babies are side-lying, milk can pool in the cheek instead of flowing directly toward the back of the throat. If your baby needs an extra moment to breathe, they have more control over the milk already in their mouth.
2. It allows the person feeding the baby to have better control of milk flow.
During side-lying feeds, the person holding the bottle can adjust how much milk fills the nipple.
If your baby is coordinating their suck-swallow-breathe pattern well, you can tilt the bottle so the nipple stays full of milk. If your baby starts drinking too quickly, forgets to pause for breaths, or seems overwhelmed, you can lower the bottle slightly so the nipple is only partially filled.
This slows the flow of milk and gives your baby greater control while they learn. If needed, you can even stop the milk flow temporarily without removing the bottle from their mouth, allowing them to rest and breathe while maintaining their latch.
This feeding technique is known as paced feeding in the NICU, and it is one of the most effective ways we help premature babies develop safe feeding skills.
Slow-Flow Nipples Support Paced Feeding
Another important tool used during paced feeding in the NICU is a slow-flow bottle nipple.
Slow-flow nipples allow only a small amount of milk to pass through with each suck. This gives premature babies more time to coordinate their sucking, swallowing, and breathing without becoming overwhelmed.
Many NICUs use specialized nipples that are designed specifically for premature infants. Because every baby’s feeding needs are different, it’s important to work closely with your baby’s nurses, occupational therapists, speech therapists, or feeding specialists when choosing a bottle and nipple for home.
My Favorite Bottle Recommendation
As a NICU nurse, my personal favorite bottle recommendation for many preemies is the Dr. Brown’s Preemie Nipple.
I find it to be one of the closest options available to what we commonly use in the NICU. One of the biggest advantages is the ability to easily transition between flow rates. If your baby needs a slower flow, you can move to an Ultra-Preemie nipple. If they begin feeding more efficiently, you can transition to a faster nipple as their skills develop.
Signs your baby may need a slower flow include:
- Frequent coughing or choking during feeds
- Milk spilling from the mouth
- Difficulty coordinating breathing and swallowing
Signs your baby may be ready for a faster flow include:
- Consistently taking close to 30 minutes or longer to finish bottles
- Feeding efficiently without signs of stress
- Strong feeding endurance and coordination
Dr. Brown’s bottles also include an internal vent system designed to reduce the amount of air babies swallow during feeds. This can help decrease gas, discomfort, and reflux symptoms.
While every baby is different and you should always follow your care team’s recommendations, this is one of the bottles we frequently recommend for NICU graduates. I’ve also personally used Dr. Brown’s bottles with my own children as a mom.
Feeding Is Your Baby’s Workout
One of the most important things for parents to understand is that feeding challenges are not only about coordination.
Premature babies also have to build endurance.
A baby may have excellent suck-swallow-breathe coordination and still struggle to finish a bottle simply because they become tired.
The best comparison I’ve found is marathon training.
If you decided tomorrow that you wanted to run a marathon, you wouldn’t expect to complete 26.2 miles on your first day. You would gradually build strength, endurance, and stamina over time.
For premature babies, feeding is their marathon.
Every bottle feed is a workout. Every day they are building strength and practicing a skill that requires coordination, energy, and endurance.
Some days your baby may surprise you and finish every bottle. Other days they may seem sleepy and only take small volumes. They may have an amazing day of feeding followed by a day where they need more rest.
This is completely normal.
One of the hardest parts of the NICU journey is that your healthcare team often cannot tell you exactly when your baby will be taking full feeds safely enough to go home. Every baby develops these skills at their own pace.
It can feel frustrating, but try not to compare your baby’s progress to anyone else’s.
With time, practice, and maturity, most premature babies continue to improve. Just as a marathon runner gradually builds endurance through training, your baby is building the skills and stamina needed to safely eat and thrive at home.
Learn mor about signs your baby is ready to eat and signs that they might need a break in my blog: Cue-Based Feeding for Premature Babies in the NICU, here!
How Parents Can Help
One of the best ways to become comfortable with feeding your premature baby is to participate as often as possible.
Work closely with your baby’s nurses and therapists. Learn your baby’s feeding cues. Notice when they seem ready for a break, when they become stressed, and when they are feeding comfortably.
The more opportunities you have to practice feeding your baby before discharge, the more confident you will feel when it’s time to bring them home.
Remember: feeding is a skill, and like any skill, it takes time to learn. Be patient with your baby, celebrate the small victories, and trust that each feeding is helping them move one step closer to home.
This version naturally incorporates the keyword “paced feeding in the NICU” several times while keeping the tone warm, encouraging, and from the perspective of an experienced NICU nurse. It should also read more smoothly for parents who may be feeling anxious about their baby’s feeding journey.
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Medical Disclosure: The content on this website is provided for informational and educational purposes only and is not intended as medical advice. While I am a NICU nurse, the information shared on this website is based on personal experience, general knowledge, and educational background. It is not a substitute for professional medical advice, diagnosis, or treatment.
Always seek the advice of your physician, pediatrician, or other qualified healthcare provider regarding any medical concerns you may have about yourself or your child. Never disregard professional medical advice or delay seeking it because of something you have read on this website. Use of the information on this site is solely at your own risk.