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A baby born before the 37th week of pregnancy is considered premature. Premature babies often have difficulty feeding, for a variety of reasons. The more premature the baby, the more problems he's likely to develop; a baby born before 34 weeks probably will need tube feedings until he develops both the strength to suck well and the ability to coordinate the suck and swallow reflexes. Preemie feeding problems can last for many months and are often interrelated.
Feeding a preemie can seem like an all-day affair. A preemie doesn't have the muscle strength that a full-term baby does; he can't suck for as long without tiring, especially if he also has breathing difficulties. Eating takes more effort and coordination than it might seem. A preemie often tires before he takes in enough food for optimal growth. If he repeatedly tires too soon, he might need to take part of his feeding via a tube that goes directly into his stomach. Preemies often lack the ability to coordinate their sucking and swallowing with their breathing, which makes them choke or gag frequently unless they eat slowly.
Premature babies often have tubes placed in their mouth or noses. This can be uncomfortable and sets them up for a long-term feeding problem called oral aversion or oral defensiveness. A baby with oral aversion doesn't like anything near his mouth or face, because experience has taught him that objects that come near his face often hurt him. Familiarizing the baby with being touched on the face and then around the mouth is often the first step in overcoming oral aversion, but it can take time and patience to overcome months of negative experiences in the neonatal intensive care unit. Speech therapists, occupational therapists and lactation consultants often work with growing preemies, who can remain orally defensive for months, to teach them to eat normally.
Gastrointestinal reflux occurs when the sphincter muscle between the esophagus and stomach doesn't close tightly, a common problem in preemies. Acid from the stomach travels up into the esophagus, causing pain that often occurs after eating. The baby begins to associate eating with discomfort and may refuse to eat. Reflux can also cause vomiting that interferes with good nutrition and growth. A preemie with breathing issues is also at increased risk for reflux. Most babies outgrow reflux around 1 year. To counteract reflux, your doctor might have you hold or keep your baby upright for as much of the day as possible to help keep food down in the stomach where it belongs. Placing blocks under the head of the crib to keep his head elevated when he's lying down might also help. Acid blockers and neutralizers might also help.
When a baby can't effectively suck, swallow and breathe, he's at risk for aspirating his food. Many preemies already have compromised airways and breathing problems, which can worsen significantly if food enters their lungs. Aspiration can cause pneumonia or chronic respiratory infection. When bottle feeding, never forcibly squeeze milk into your baby's mouth by pressing the nipple against the roof or side of his mouth. If his skin turns dusky or blue while he eats, or if he chokes, has milk come out of his nose or vomits, he might be aspirating milk. Reflux and a decreased gag reflex also increase his risk for aspiration.
The intestines of a preemie baby are -- like the rest of him -- immature. Because his immature intestines move food more slowly through the intestines, your preemie is more likely to become constipated or to develop gas and stomach upset. Food also empties from the stomach more slowly, which can cause nausea and decreased interest in eating.