Breastfeeding Wheel: Steps to breastfeeding a premature infant

Step 1 - Skin-to-skin contact starts as soon as infant is stable, and is the first step toward breastfeeding.

Step 2 - Mouth / nose against the nipple. Baby may just rest with mouth against nipple.

Step 3 - Mother expresses milk for the baby - With mouth against nipple mother expresses drops of milk or colostrum onto baby’s lip. Baby may lick nipple or open mouth and---

Step 4 - Smell, Suckle breast, or may open mouth and hold nipple or take one or two tentative sucks.*

Step 5 - Rooting - Baby is awake and alert and actively searching for breast. Putting hands into mouth, licking and showing feeding cues. *

Step 6 - Awake / alert for first suckling. May take one or two sucks, or have a sucking burst of five to fifteen sucks, with long pauses between sucking bursts, or may take a few sucks and come off breast. *

Step 7 - Holding on to the nipple- Suckling and swallowing. Infant has sustained nursing session, may last for 5 to 10 minutes or longer, with frequent pauses but stays latched on to nipple. May nurse with eyes open or closed. Soft swallows can be heard (sounds like ah). *

Step 8 - Breast Meal - Check weight, reduces supplements. As infant takes more milk at breast, he/she will need fewer supplements. Consider pre and post test weights on Baby Weigh Scale. *

Step 9 - Breastfeeding partly on demand. When infant is awake and showing feeding cues, and mother is available, baby should be breastfeed. When sleepy or not interested in feeding Baby should be gavaged.

Step 10- Mother and baby are together day and night and breastfeeding frequently. This step often does not happen until after discharge from the hospital, and frequently is around or after the date baby was due.

*A "wheel" rotates in both directions. Baby may be at Step 6 for one feed, and then move back to Step 4 for the next several feedings. Patience and support, for both the mother and infant are most important!