WORDS YOU MAY HEAR:
EBM: expressed breast milk
HMF: human milk fortifier, a nutritional
supplement added to breast milk to provide
the premature baby with additional calories,
protein, minerals and vitamins.
Gavage: tube used for feeding. It is passed
through the baby’s nose or mouth into the
stomach to deliver milk feeds. Also called
“nasogastric tube” (“ng” or nose to
stomach) or “orogastric tube” (“og” or
mouth to stomach).
Indwelling tube: used to describe a tube
which is left in place, usually through the
nose, between feeds.
“q3h”: “every 3 hours” . Used to describe
the frequency of a feed or medication.
“Ad lib” feeding is letting your baby take as
much milk as they want whenever they want
it. Your baby should be in phase 4 to try ad
lib feeding, or they may not be able to take
enough milk. The final test is to see your
baby gaining weight, usually 20 to 30 grams
each day if they are close to going home.
Reflux: reflux is milk traveling from the
stomach back up into the mouth. It can
cause very large spit-ups. The same babies
that have reflux may have drops in their
heart rate (bradycardia) or pauses in
breathing (apnea). These may occur at the
same time as the reflux but is not
necessarily caused by reflux. Reflux is
VERY common in premature babies.
Holding your baby upright or raising up the
head of the cot after feeding may help
improve reflux.
OTHER FEEDING STUFF:
Some babies are fed via a tube that is left in
place between feeds (indwelling tube),
while others have the tube placed just for
the feed (“in-out” or intermittent tube). Both
types of tube have their advantages and
disadvantages. Some babies object to
having the tube placed every few hours,
while other babies can have more problems
with breathing or with reflux with an
indwelling tube. Your baby’s preference
may also change as they grow. The nurses
and doctors may try both indwelling and inout tubes at different times to see which is
best for your baby.
Most breast-fed babies feed every 3 hours
(q3h), or even more frequently when they
are close to going home. If your baby is
close to taking all their own feeds but is not
waking every 3 hours, your doctors/nurses
may try feeds every 4 hours to give your
baby more rest between feeds.
Extra nutritional supplements (such as
HMF) are usually stopped before your baby
goes home. The nurses and doctors will
want to see that your baby can gain weight
well without the extra supplements before
leaving the hospital.
Some babies are sent home on extra feed
supplements. Your baby’s doctor and the
dietician will talk to you about this if it is
needed. All breast fed babies will go home
on Vitamin D drops and most premature
babies will go home on iron drops.
SOFI: Step-Wise Oral Feeding in
Infants
Information for Parents/Guardians of
Premature Babies
For a premature baby, learning to take a
breast or bottle feed can be challenging.
Being able to suck and swallow milk and
breathe all at the same time is complex.
For premature babies, learning to feed by
mouth can cause them to need more
oxygen or to have more pauses in their
breathing (apneas). It can require energy
that a small baby may not have.
Feeding is a skill which needs practice,
and it also requires energy. It is
important for your baby that they are
given the chance to practice without
using all their energy. They need energy
to grow.
WHAT IS SOFI?
SOFI is a feeding plan that works as a kind
of “training program” for babies born before
35 weeks. It allows your baby to start
feeding a little each day, increasing only
when he or she is able to.
WHAT ARE THE “PHASES”?
SOFI has 4 phases.
Phase 1 is all about learning to suck
and to breathe at the same time, without
worrying about swallowing milk. In SOFI
it is called “Prefeeding”. This includes
sucking on a soother, skin-to-skin
cuddling, and providing expressed
breast milk for your baby if you choose.
Nuzzling at the breast during skin-toskin is an excellent way of promoting
feeding skills without tiring your baby.
Sick or ventilated babies may stay in
Phase 1 of SOFI for several weeks.
Before moving to phase 2, your baby
must be getting all their fluids through a
tube (no more IV!), must have stable
breathing, and show signs of being
interested in feeding. Usually very
premature babies will be at least 32
weeks “corrected” before they are ready
for phase 2.
Phase 2 is all about learning to swallow
milk at the same time as sucking and
breathing. If your baby is taking one or
two feeds in 24 hours, he/she is in the
“early feeding” phase. Most babies will
not be able to take the same amount by
breast and bottle when they are first
given a feed, as they have been getting
each feed by tube. In “early feeding”,
your baby will start with just one breast
or bottle feed in 24 hours.
The nurse will chart how much milk your
baby has taken. If it was a small
amount, your baby will have a chance to
take one feed again the following day. If
your baby took almost the whole feed (at
least 80%) then he/she will be offered
up to 2 feeds the next day if he/she is
still showing they have enough energy.
increase if they manage to take 80% of
their “target”.
The timing of feeds will be based on
when your baby is ready. It is nice to
plan ahead for you to be there for the
feed, but if your baby is sleeping then it
is better to wait until he or she is more
alert. Babies can also tell us when they
are stressed. The nurse will talk to you
about signs (cues) that your baby is alert
but not stressed.
Phase 4 is the “transition to home”. Your
baby is now trying 7 or 8 feeds each
day. Breast feeds can be topped up by
bottle, but we wouldn’t want your baby
to try to feed for more than 45 minutes in
total each time, so they have time to rest
before the next feed. This is when you
will be thinking about how all this is
going to work out at home for you, and
your nurse can talk to you about feeding
your baby once you are both home.
Some premature babies need to go
home with extra supplements in their
milk. The NICU dietician and your
doctor may talk to you about this.
As your baby is still in the early stages
of learning to feed, the nurse will be
carefully monitoring your baby during
the feed, and if fed by bottle, the first
bottle feeds are usually given by your
nurse. The nurses will show you how
you can support your baby in learning to
feed.
When your baby is taking 3 feeds each
24 hours they have reached Phase 3.
We call this “skill building”. As you work
on breast feeding many babies may
“stay” rather than “progress” to taking
more feeds. This is quite normal. It may
take several weeks to reach the next
phase.
If your baby has tried a feed but hasn’t
taken all that they need, the feed will be
topped up by tube. Giving your baby a
bottle after their breast feed will mean
they use more energy so they may be
too tired for the next feed. It’s all about
learning skills, not over-exercising!
The number of feeds your baby is
offered each day will continue to
Sometimes a very premature baby may
need the occasional bottle to take
supplements in the milk to help growth.
The needs of all babies are different,
and for your baby his/her needs will
change over time. SOFI provides a
framework to allow your baby time to
develop and practice the skills needed
to feed, as well as time to grow, gain
strength and recover from any medical
problems your premature baby may
have had.
For more information on feeding your
baby, please talk to your baby’s nurses
and doctors.