4 Signs a Premature Infant is Ready to Breastfeed

Jenny Murray, BSN, RN / February 2018


When it comes to NICU patient discharge, there is one final process that must happen.

Fast forward through the obvious critical stages of an infant’s stay in the NICU. Breathing has stabilized, the arterial line has been discontinued. Now there remains one major obstacle prior to discharge: feeding.

Premature infant breastfeeding readiness

Premature infants develop the ability to breastfeed at their own pace. That can lead to parental frustration and concern.

The nurse is left to answer two of the biggest questions from a NICU parent, “When will my baby go home?” and “How long will it take him/her to learn to eat?”

As I’ve said many times throughout my career, there is no gestational age or weight that will determine when any one infant is ready to breastfeed over another. There are signs, however, that an infant is ready to attempt breastfeeding. It is important that we help parents recognize these signs as well. It empowers them to engage in caring for their baby.

4 signs of breastfeeding readiness

There are a variety of non-verbal cues an infant may display that indicate they are ready to breastfeed.  For this discussion, I have included four of those signs.

  1. Is the infant physiologically stable?

Physiologic stability is important to note before feeding. Preterm infants are at risk for hypoxemia and bradycardia secondary to breathing irregularities simply because they are preterm. Ensuring respiratory stability prior to feeding sets them up for a successful feeding experience and reduces the risk of these events during feeding. The negative impact these events can have on both baby and mom go beyond a simple “event.”

  1. Does the infant have good muscle tone?

This correlates with the infant’s ability to maintain enough energy to breastfeed and to engage in the task of feeding. If an infant does not have good muscle tone, they become disorganized and expend a great amount of energy attempting to feed.¹

  1. Does the infant maintain an awake/alert state?

An infant who is awake and alert prior to their “touch time” or is easily aroused and engaged during their “touch time” may be ready to attempt breastfeeding. Studies suggest that an infant’s ability to maintain an awake/alert period 5 minutes prior to feeding correlates with a greater number of sucks and longer bursts of sucking in the first five minutes.²

  1. Is the infant rooting?

Rooting and/or placing hands to mouth is a sign of neurodevelopmental readiness for feeding.  When the infant is placed skin-to-skin, they may start to root on the breast or “lick.”  If so, this is indicative of organized oral-motor functioning and a good sign that the infant is ready to engage in sucking. In addition, it is important to note that an infant’s tongue is down following the rooting reflex. An infant who thrusts their tongue to their palate is giving you the non-verbal cue that they may not be ready to feed.²

If you have identified an infant is “cueing” and ready to breastfeed, it is important to remain very cognizant of their ability to maintain the rhythmic suck-swallow-breathe pattern. This is an ongoing assessment and the caregiver and/or mother need to be aware of the signs that a feeding should be stopped. This is extremely important to maintain a positive feeding experience for both mom and baby.

Clear, evidence-based guidelines should be available for the caregiver to enable effective assessment of infant maturity and readiness for oral feeding. It is helpful to implement a quantifiable and measurable tool that documents feeding readiness to provide consistency. 4,5


Looking for more on this topic? Read Oral Aversion and Feeding Behaviors.



  1. Jones, L. Oral Feeding Readiness in the Neonatal Intensive Care Unit.  Neonatal Network.  2012;31(3):148-155.
  2. Thoyre, S., Shaker, C., & Pridham, K. The Early Feeding Skills Assessment for Preterm Infants.  Neonatal Network.  2005;24(3):7-16.
  3. Lubbe, W. Clinicians guide for cue-based transition to oral feeding in preterm infants:  An easy-to-use clinical guide.  Journal of Evaluation in Clinical Practice, 2017;00:1-9.  https://doi.org/10.1111/jep.12721
  4. Ludwig, S.M., Waitzman, K.A. (2007). Changing feeding outcomes to reflect infant –driven feeding practice. Newborn and Infant Nursing Reviews. 7(3). 155-160.
  5. Newland, L., L’Huillier, M., Petrey, B. (2013). Implementation of Cue-Based Feeding in a Level III NICU. Neonatal Network. 32(2), 132-137.


About the Author

Jenny Murray, BSN, RN, began her career 18 years ago as a neonatal nurse in neonatal intensive care. She has since served in a variety of nursing leadership roles within the NICU. Her experience in those roles has driven her love for education and research, especially educating and supporting clinicians in the advancing, innovative world of neonatology. Jenny currently works as a Clinical NICU Specialist for Medela LLC.