PICU Lactation Resources

In the PICU, babies may face a variety of challenges that affect their ability to feed directly by mouth. These challenges can include breathing difficulties, the need for a ventilator or supplemental oxygen, or the requirement for more specialized feeding methods due to surgery or medical conditions.

Feeding by Mouth

One of the major differences is that many babies in the PICU are still able to feed by mouth, though this will often be under close supervision. Depending on their condition, they may be able to breastfeed or take expressed milk via a bottle. However, in many cases, babies may need to receive nutrition through alternate means, such as a feeding tube, until they are strong enough to nurse effectively.

The Role of Breastfeeding

Breastfeeding is encouraged whenever possible in the PICU, as breast milk provides vital nutrients and antibodies that help support the baby’s immune system and promote healing. Nurses, lactation consultants, occupational therapists, and doctors will work closely with parents to make sure breastfeeding is feasible and safe. This may involve strategies such as:

• Breastfeeding with Assistance: If the baby is too weak or uncoordinated to latch effectively, a lactation consultant can help with techniques to encourage breastfeeding. Skin-to-skin contact (also known as kangaroo care) is often encouraged, as it can help stabilize the baby’s temperature, heart rate, and breathing, which in turn can support feeding.
• Pumping and Bottle-Feeding: If breastfeeding directly isn’t possible, expressing milk through a pump and providing it via bottle can be an alternative. The milk will still provide all the same essential nutrients.
• Transitioning from Tube Feedings: Many babies in the PICU are initially fed through a nasogastric tube (NG tube) or other feeding tubes until they are strong enough to feed by mouth. Once the baby’s condition improves, the medical team may help gradually transition them back to breastfeeding or bottle-feeding.

• Oral Feeding Difficulties: Babies in the PICU might have weak or uncoordinated sucking reflexes due to being premature, sedated, or experiencing respiratory issues. These factors can make it difficult for them to breastfeed or bottle-feed effectively.
• Breathing and Feeding: Some babies require respiratory support (like oxygen or a ventilator), which can make it hard for them to suck, swallow, and breathe at the same time. In such cases, alternative feeding methods like tube feeding may be used until the baby is stable enough to try oral feeding again.
• Medications and Feeding: Medications or sedation used in the PICU can sometimes affect a baby’s ability to latch or coordinate sucking and swallowing. In these situations, the medical team will determine the best course of action for ensuring the baby receives proper nutrition while managing the medical treatments.

Your breastmilk is like medicine for your baby, and it has many properties that help your baby heal, grow and fight infections. Even if your baby is not taking food in their stomach yet, or stops eating for some reason, they are still able to receive a drop of your milk every few hours until they are ready to eat again, we call it Oral Immune Therapy or OIT for short.

Your baby will receive a drop of your milk in their cheek every 2-4 hours and we will continue this practice until you are putting your baby to the breast or to bottle a few times each day.

Only your own breast milk will be used for oral immune therapy. Even if your baby is receiving formula for feeds, we will only give your milk directly in your baby’s mouth. Even small amounts that you pump will be used to benefit your baby.

When you express milk for your baby, we will keep 1-2ml in a separate sterile container to use for OIT. This breast milk will not be frozen and will be used within the next 48 hours.

If you are in the unit when you express your milk, you or your baby’s nurse can give it directly to your baby. It will provide the freshest milk for your baby.

The fresher the milk is, the more benefits it has.

Your baby’s nurse will tell you when it is no longer necessary to separate your milk.

To help families maintain their milk supply while their baby is in the PICU/NICU/admitted, we offer a Loaner Breastpump Program. Through this program, parents can borrow a Medela Symphony pump, which is the same high-quality pump used at the bedside in the PICU. This allows mothers to continue pumping at home overnight without the concern of losing their milk supply.

The loan is available on a short-term basis and requires a signed contract. This ensures that families have the necessary equipment to support their breastfeeding journey while also providing flexibility to go home and rest. The program is designed to give parents peace of mind, knowing that they can maintain their milk production until they are able to return to the hospital and resume direct breastfeeding or pumping.

By offering this service, we aim to support both the physical and emotional well-being of families, allowing them to be actively involved in their baby's care while managing their own needs at home