Normalizing How Difficult Feeding Can Be in the NICU or other ICU Units
Many families enter the NICU because of a premature birth, a prenatal diagnosis, or a complication discovered at delivery. Over time, the initial medical challenges often begin to improve, and families start to believe that the hardest part is behind them. Then, just as discharge begins to feel close, a new and unexpected challenge emerges: feeding.
When the Finish Line Feels Just Out of Reach
It can be surprising and even frustrating when a baby who has recovered from surgery, passed medical evaluations, or grown stronger still isn’t ready to eat entirely by mouth or gain weight consistently. Yet this is one of the most common experiences in the NICU, and one of the least talked about.
For many babies, feeding is not simply a routine task; it’s their primary exercise. Each feeding is a training session in coordination, endurance, and growth. Like a runner preparing for a marathon, your baby is gradually building the endurance needed to complete every feeding by mouth. In premature babies, this takes time. If your baby was born with other complications affecting breathing, such as Congenital Diaphragmatic Hernia or Bronchopulmonary Dysplasia, learning to coordinate sucking, swallowing, and breathing can be extra challenging and takes time.
Understanding the Process of Building Endurance
In the beginning, your baby might take only small amounts or even sleep through some feeds. Rest is part of the process as it allows recovery and energy building. Over time, you might notice progress: perhaps your baby eats well every other feeding, then three out of four, until eventually every feeding is by mouth. These incremental steps are signs of progress, not delay.
Even though it can be hard to wait, especially when home feels so close, this period is essential. Feeding requires a delicate balance of sucking, swallowing, and breathing, and babies must coordinate all three before they can safely and efficiently feed on their own.
How the NICU Team and SLPs Support Feeding
This is where a Speech-Language Pathologist (SLP) plays a vital role in the NICU. SLPs specialize in feeding and swallowing development. They assess your baby’s coordination and help determine the best strategies for safe and effective feeding.
An SLP may recommend:
The most appropriate bottle and nipple flow rate
Adjustments to feeding position for comfort and safety
Techniques to support suck–swallow–breathe coordination
Education for parents on how to replicate these techniques at home
By fine-tuning these factors, the SLP helps your baby use energy efficiently and make steady progress toward full oral feeding.
A Gentle Reminder: Progress Takes Time
Feeding difficulties in the NICU are not setbacks, they are part of the natural process of recovery and growth. Your baby has already overcome significant challenges, and learning to feed independently is one more milestone in that journey.
So if your baby needs extra time or an supplemental or alternative means to receive breastmilk or formula, or increased calories to gain weight before discharge, know that this is normal. With support from your NICU team, your baby is building endurance, coordination, and confidence, all of which will serve them well beyond the hospital walls.
