Premature Babies: Care, Feeding and Development

A premature (preterm) baby is one born before 37 completed weeks of pregnancy. These babies need extra warmth, help with feeding and closer follow-up, but many grow up healthy with the right care.

This guide explains the stages of prematurity, what premature babies need, how feeding works, and how development is tracked after you go home.

What counts as premature?

The World Health Organization (WHO) groups preterm births by how early the baby arrives:

• Extremely preterm: before 28 weeks
• Very preterm: 28 to under 32 weeks
• Moderate to late preterm: 32 to 37 weeks

The US National Institute of Child Health and Human Development (NICHD) adds that late preterm means 34 through 36 weeks, and that more than 70% of preterm babies are born in this range. Late preterm babies often do better, but they still need careful watching. A full-term pregnancy is 39 weeks through 40 weeks and 6 days.

Why babies are born early

WHO explains that most preterm births start on their own with early labour. In other cases a medical problem, such as an infection or a pregnancy complication, makes doctors advise an early induction or a caesarean birth. Twin or multiple pregnancies, infections, diabetes and high blood pressure are among the known contributors. Often no clear cause is found, so it is never useful to blame yourself.

WHO also notes that more than 1 in 10 babies worldwide were born preterm in 2020, and that southern Asia is one of the regions where most preterm births occur. Regular antenatal visits help doctors spot risks early. See our guide to high-risk pregnancy to learn more.

What premature babies need most

Babies born early have organs, such as the lungs, brain and liver, that are still developing. NICHD explains that the earlier the baby is born, the higher the risk of serious problems. Typical needs include:

• Warmth: small babies lose heat quickly, so skin-to-skin contact and warm clothing matter
• Breathing support: some babies need help with breathing in the first days, and WHO lists simple measures that doctors may use
• Feeding support: sucking and swallowing may not be ready at first
• Hygiene: frequent hand washing by everyone who handles the baby
• Regular weighing: to check that growth is on track

WHO’s 2022 recommendations include starting kangaroo mother care (skin-to-skin contact) early and keeping mothers and babies together unless the baby is critically ill. Read more in our guide to kangaroo mother care.

Feeding a premature baby

Mother’s own milk is the first choice. India’s national guidance on feeding low birth weight babies, summarised by the National Health Mission, lists the order of preference as breast milk first, then donor milk from other mothers, then formula when there is not enough breast milk, and animal milk last. Always follow your doctor’s advice on which option your baby needs.

If your baby cannot suckle directly at first, the same material describes other ways to feed, such as a tube, spoon, paladai or cup. The baby then moves step by step towards feeding from the breast. A tiny baby may lose some weight in the first days. The national material says this should not go beyond 10 to 15% of birth weight, and most babies regain their birth weight by about 2 weeks.

Tip: if you are pumping milk, ask the hospital team about safe collection and storage so your baby gets the full benefit of your milk.

Corrected age and development

Doctors often use “corrected age” for a premature baby. It means the age your baby would be if they had been born on the due date. A baby born two months early and now four months old has a corrected age of about two months. Milestones such as smiling, rolling and sitting are usually judged against corrected age, especially in the first two years.

NICHD warns that preterm babies are at higher risk of developmental delay, cerebral palsy and vision or hearing problems. Many premature babies develop normally, and early checks mean any difficulty can be helped sooner.

Starting solids

A National Health Service hospital leaflet from Cambridge says preterm babies usually start solids at about four to six months of corrected age. Babies born very early may need to wait longer, and a dietitian can guide you. Look for three or four signs of readiness, such as sitting with little support, steady head control, reaching for food or opening the mouth when it is offered. Our guide to starting solid foods has more.

Follow-up after going home

The Government of India’s kangaroo mother care material describes follow-up as essential. For babies who go home on kangaroo care, the first follow-up is at one week, then every two weeks for the next two visits, with more visits until the baby reaches 40 weeks of corrected age or 2,500 grams. Community health workers (ASHAs) also visit the home. These visits check growth, feeding, behaviour and development.

• Keep every follow-up appointment, even when your baby seems well
• Carry the discharge papers and vaccination card each time
• Ask whether your baby needs hearing and eye checks
• Keep vaccinations on schedule; see our baby vaccination chart

When to be cautious: premature babies can get sick quickly. Never wait overnight to see whether a fever, breathing trouble or poor feeding improves on its own.

Emotional support for parents

Having a baby early can be frightening and tiring. It is normal to feel worried, guilty or exhausted. Ask for help from family, speak openly with the care team, and tell your doctor if low mood or anxiety lasts more than a couple of weeks. Support for new mothers is part of postnatal and newborn care.

When to see a doctor

Seek medical help urgently if your premature baby has:

• Fast, noisy or laboured breathing, or pauses in breathing
• A fever, or a body that feels cold
• Blue, grey or very pale skin
• Refusal to feed, repeated vomiting or very few wet nappies
• Unusual sleepiness, limpness or a very weak cry
• Yellow skin or eyes that seems to be getting worse
• Seizures or jerking movements

If you notice any of these, go straight to the nearest emergency department. Our emergency page explains how to reach us at any hour.

Talk to a doctor

If you have questions about caring for a premature baby or planning future pregnancies, our team is here to help. You can book an appointment or call +91 944 103 0587. This article is for general awareness and is not a substitute for a doctor's advice.