Special situations


The premature baby is one who was born before 37 weeks of gestation. Breast milk offered exclusively for preterm infants significantly reduces the incidence and severity of some specific diseases that occur only at this stage of the baby's life, but there is also a lower rate of rehospitalization.

Generally, the preterm baby stays for some time in the hospital until he or she is able to go home (from 1.800g). In hospitalizations,, they need specialized care, performed by health professionals, which may make it difficult for parents to initiate an approach. However, this interaction between parents and the baby is very important for growth and development of premature and therefore guaranteed by law. Check here the Ordinance GM nº 1.153, of May 22, 2014.

To facilitate interaction, parents can talk to their baby before touching them. His mother's soft voice soothes him and his tender touch gives him security and tranquility. Performing skin-to-skin contact, breastfeeding and doing the kangaroo method will greatly aid in the recovery of baby's weight as well as provide its development. Skin-to-skin contact with baby also maintains body temperature, aiding in lung and heart function.

Placing the baby in a “kangaroo position” consists of keeping it with the least amount of clothing possible, in order to favor skin-to-skin contact with the mother or father, who must therefore be with the chest exposed. It is recommended, for the baby, only the use of diapers. In cooler regions, socks and cap can also be used. The baby is placed against the chest, heart with heart.

The premature infant is a drowsy baby, who needs to be awakened and stimulated at feed times. Initially, if there is too much difficulty in sucking, the mother to express her milk and offer it in a little glass. The baby will take it easily and it is possible to suck the breast right away (the mother should always offer the breast before the cup to see if it sucks).

It is not recommended to offer the milk in the bottle, because the baby gets used to the nipple that is offered to him for more times. He gets used to the shape, consistency, texture and elasticity of the rubber teat and also to the way of sucking on it. To avoid confusion, it is important to offer only the breast as it will facilitate breastfeeding.  

When the baby breastfeeds, he / she performs a “milking” (which is good, because it works the entire baby's facial muscles). With the bottle, on the contrary, it sucks the milk as we suck a straw, not using the facial muscles properly, and may later present dental, respiratory and language problems.

Safety tips on how to use the cup:

1 - Wash your hands before giving milk in the cup to the baby;

2 - Observe the milk´s temperature  (if it is not the mother's milk taken at the same time);

3 - Place the baby in a semi-seated position;

4 - Support the edge of the cup on the baby's lower lip to prevent it from pushing the cup out with the tongue;

5 - Wait for the baby to drink the milk and do not force it to swallow.

The frequency of breastfeeding will depend on how often he requests the breast, both day and night (free demand), ranging from eight to 12 times a day. When the premature infant sleeps a lot (for periods longer than three hours) it is necessary to wake him up to nurse. As they grow older, babies are accommodating at their own rate of frequency and duration of the nursing.

Low weight

It is considered a low birth weight baby born with a weight less than 2,500 g, after 37 or more weeks of gestation. The same breastfeeding recommendations for the premature baby are for the low weight baby. The difference is that the low weight baby is usually not as sleepy and is more active and eager to suckle. Carrying out the kangaroo method and breastfeeding it whenever possible will cause your baby to regain weight faster.

Cleft lip (cleft palate or harelip)

The cleft lip and palate, also known as cleft palate or cleft lip, are congenital malformations that occur early in pregnancy due to lack of fusion of the maxillary and middle nasal processes, which occurs for various reasons.

Right after birth, according to the clinical conditions, the baby with cleft should be fed with breast milk, either by tube, breast or cup. The high nutritional value and immunological qualities of breast milk help fight infections, such as the middle ear, which is very common in these babies.

It is important to note that the fissured baby has the possibility of being breastfed. Many are born vigorous and are able to make a good suckle to the breast in the baby sitting position or vertical to the neck, with manual support of the jaw, to provide a good lip seal.

Other babies present difficulties in lip closure, stabilization of the mandible or keep the tongue posteriorized in the oral cavity, and may present longer time in the feedings. Difficulties vary according to the complexity of the malformation. These infants need a phonoaudiologist treatment to prepare the orofacial structures for the feeding process and later the communication.

The technique of the “emptied breast” at the beginning of suction training contributes to the adaptation of the baby to the flow and coordination of suction, breathing and swallowing. Posture elevated to the lap or in the baby sitting position contributes to tongue pre-positioning and stabilization of the mandible.

It is known that suction is an intrauterine reflex experienced by the fetus, which will train the orofacial musculature. In the baby with cleft lip this mechanism is also present. Therefore, it is able to adapt to the anatomical structures, as long as parents receive appropriate orientations. So when you receive the baby's diagnosis, seek help from a human milk bank.

Breastfeeding is NOT contraindicated in the case of lip fissures. It should be stimulated and evaluated by health professionals from a human milk bank.

Early counseling to the family, initiated in the maternity ward by a multidisciplinary team, plays a decisive role in establishing breastfeeding, ensuring a good development of the baby and providing security and support to the family.

Adoptive breastfeeding

The breast milk production happens through hormonal action and baby sucking stimulation. However, studies report that even non-biological (adoptive) mothers, if stimulated, can produce milk and breastfeed their babies through the induced lactation technique.

A woman can breastfeed a baby even if it has not been generated by her. On the other hand, at least half of the women who try to breastfeed a foster child need to complement the feeding with formula or other foods.

It is worth remembering that what determines milk production is the stimulation of the baby when sucking the breast. However, the hormones that the body produces during pregnancy help to prepare the woman's body for breastfeeding and without them it is more difficult to start the production of breast milk.

It is not complicated to induce lactation, to wit, to make a woman's breasts begin to produce breast milk. But in the case of adoption, what is in the way is the question of time. The arrival of the baby is usually unexpected, so it is difficult to prepare in advance. The most guaranteed is to think of breastfeeding as a bonus for you and your baby, but not as the only source of nutrition.

Caution! Cross-nursing (when a baby is breastfed by a "wet nurse") is not recommended because breast milk can infect children with transmissible diseases, such as AIDS. Babies can also pass it on to the woman who breastfeeds him. In the case of infants of women with HIV, the program for the prevention and control of mother-to-child HIV transmission recommends the use of artificial milk formulas.


Down syndrome

Down Syndrome is a genetically determined human condition caused by a chromosomal disorder called Trisomy 21. This syndrome is the major cause of intellectual disability in the population, being the most common in humans. For every 600 to 800 births in Brazil, a baby is born with Down Syndrome, regardless of ethnicity, gender or social class.

Babies with Down syndrome are hypotonic (hypotonia alters the development of the child, delaying the acquisition of motor skills such as head support, rolling, sitting, crawling, crawling, walking and running). However, they can and should be breastfed as any baby, and may need a differentiated position such as the cradle hold position or the sitting position. In addition to the already known benefits for all children, breastfeeding will protect babies with the syndrome of the infections they are most susceptible and also will assist in the development of the child.

Breastfeeding Position:

Global stimulation should begin as soon as the child's health permits and breastfeeding is the first stimulus. Growth and development monitoring follows specific development curves from 0 to 2 years (see below). It is worth mentioning that these children will need multiprofessional follow-up with pediatricians, neurologists, speech therapists, physiotherapists, nurses, among others.

Check the Ministry of Health's Guidelines for Attention to People with Down's Syndrome.

Growth Curve for Girls 0-24 Months with Down's Syndrome

Growth Curve for Girls 0-24 Months with Down's Syndrome

Baby hospitalized in Intensive Care Unit

Breastmilk is the best food for the baby hospitalized in a Neonatal Intensive Care Unit (NICU), as it helps prevent infections, because it decreases the risk of allergies, and helps to better recover from many diseases. As soon as possible, he will receive processed milk from his mother by the human milk bank and / or be breastfed.

Stay tuned! It is very important the participation of the family in the care of this baby. Free access is guaranteed to the mother and the father under any circumstances, regardless of the Neonatal Unit and the Risk of the Newborn. Check GM Ordinance Nº 1.153 of May 22, 2014.

What do you need to know while your baby is in the NICU?

The baby's nutrition can be:

  • Parental Nutrition - when your baby receives nutrition through a venous access (at this time, he can not feed himself yet, remaining on a zero diet, ie, fasting).
  • Enteral Nutrition - When your baby receives nutrition through the mouth (breast and / or cup) or through a tube that goes straight to the stomach, enteral nutrition causes the baby's food to pass through the digestive system.

While it receives Parenteral Nutrition and stays fasting, it is important that you maintain a good production of milk before and after discharge.

In addition, whenever possible, and after discharge and supervision of the medical and nursing staff of the NICU, keep skin-to-skin contact with your baby.

This skin contact will help in the initiation of breastfeeding.

To stimulate and maintain the production of breast milk, there go some tips:

After visiting / being with your baby in the NICU, find a quiet place, sit comfortably, think about your baby and if possible listen to a relaxing song;

At this time, massage the entire breast (beginning with the areola) in circular movements and try to remove the milk right after the massage that can be performed every three hours (but do not need to wake up at dawn to do so). Thus, it will maintain a good production of milk for your baby;

If there in the hospital where your baby is hospitalized is a human milk bank, you can seek support from this team;

If you express milk, be sure to label the glass bottle with: NAME, DATE and TIME of the first milk collection;

Store your milk in the freezer (remember that the freezer is valid for up to 15 days);

Delivered to the human milk bank so they can pasteurize the milk and send it to your baby as soon as it is prescribed by the doctor.

After Enteral Nutrition, the baby can feed directly through the mouth (breast and / or cup) or through a tube.

If the feeding is by mouth, the ideal is that you breastfeed on demand, that is, whenever the baby shows signs of hunger.

Zika Virus, Dengue and Chikungunya

Breastfeeding should not be interrupted, nor the breast milk donations in cases of mothers diagnosed with Zika virus, Dengue or Chikungunya. Although viral particles have been found in breast milk, there are no studies and tests that attest the ability of these particles to transmit the disease. The recommendation from both the Ministry of Health and the World Health Organization (WHO) is that the infants continue breastfeeding. The recommendations are also valid for children born with congenital malformations, such as microcephaly.

Diseases that contraindicate breastfeeding

The Ministry of Health recommends that mothers with HTLV-2 and HIV do not breast-feed. However, the processing and pasteurization of milked human milk (62.5 o C / 30 min.), According to the recommendation of the Brazilian Network of Human Milk Banks (rBLH-BR), are safe and allow the inactivation of HIV particles, both in free form and inside infected cells.

In addition, cross-nursing (breastfeeding another baby than your own child) is strictly contraindicated.
Press released by the HMB-IFF-FIOCRUZ, Ministry of Health