From tube to breast: supporting early feeding in our neonatal unit
World breastfeeding week (1-7 August) is a time to recognise breastfeeding as a powerful foundation for lifelong health, development, and equity. The theme for this year is on the ongoing support women and babies need from the healthcare system through their breastfeeding journey – from pregnancy through to early childhood. Here, Annie, a neonatal speech and language therapist within our neonatal unit, shares how she supports early development, bonding, and breastfeeding success during the first crucial weeks and months of a baby’s life.
Tell us about your role.
I’ve been doing this role for over 20 years now and am regularly asked what a speech and language therapist is doing on a neonatal unit. My role is to identify babies at risk of feeding or communication difficulties and to support these babies and their families to establish safe and positive oral feeding, while also helping with early development and communication. I also help empower and educate colleagues on our neonatal units on how to integrate specific, developmental care.
Many babies on our neonatal unit have trouble feeding and communicating early on. This might be because they are born early, are sick, or have medical conditions that affect their brain development or the ability to suck and swallow. As a result, these babies can’t feed by mouth straight away and are fed via a tube instead.
The first choice of milk for these vulnerable babies is their mother’s own milk, so we need to support mums to express enough milk as soon as possible after birth and regularly until their baby can suck this milk directly from a breast or bottle. Establishing a milk supply is hard work, with mums having to express with a mechanical pump every few hours, and babies can spend one or two months on our neonatal unit before they are ready to go home.
Annie"Sometimes babies are immature or have problems co-ordinating sucking and swallowing and breathing. My job is then to work alongside the parents and nurses to assess the feeding and suggest strategies for supporting the baby’s developmental skills."
We also need to support babies with positive touch during skin-to-skin contact, mouthcares with tastes of milk, and by sucking on a dummy during tube feeds before they can start breast or bottle feeding.* We use these exercises to observe when the baby is ready to start sucking on a breast or bottle, and to teach parents how to read their baby’s cues and communication so that they can feel confident in bonding with their baby and being able to feed them safely.
Sometimes babies are immature or have problems co-ordinating sucking and swallowing and breathing. My job is then to work alongside the parents and nurses to assess the feeding and suggest strategies for supporting the baby’s developmental skills.
I also provide advice on how to overcome barriers preventing parents from experiencing the close contact they need to develop early bonding with their baby, such as if their baby is being nursed in an incubator or attached to monitors and/or ventilators.
Do you have a typical working day?
I often start my day with a multidisciplinary ward round where the whole allied health team joins the doctors and nurses to go to each cotside and learn from parents about how their babies are doing.
We practice family delivered care where parents are enabled to do as much of their baby's neonatal care as possible and to be partners with our neonatal team. This really helps with parents developing a close and loving relationship with their baby and being experts in their care so that they feel confident when it's time to take their baby home.
Most people think of speech therapy as helping with talking — how does your role support newborns (and their parents), especially in those early days?
We encourage parents to talk to their babies and to read and sing to them even while they are in the incubator or out having cuddles. Parents voices are familiar and calming, and babies recognise their voices from being in utero.
Babies also learn by listening, watching their parents, and hearing language, so encouraging parents to interact with their baby, take turns and copy their communication helps provide a rich environment for future language development.
Annie
"We practice family delivered care where parents are enabled to do as much of their baby's neonatal care as possible and to be partners with our neonatal team."
How do you work alongside other colleagues to support parents and newborns?
Our maternity and neonatal services are fully accredited by the Unicef Baby Friendly Initiative, and we work together closely to provide the required staff education to support these standards of enabling close and loving relationships, breastfeeding, and supporting parents as partners in care.
We work across our skill sets and as a whole team – which includes clinical psychologists, physiotherapists, occupational therapists, dietetics, lactation consultants, and our community outreach team – to do what we can to best help families in the neonatal feeding journey.
As a multidisciplinary team, our first choice of milk for our premature and at-risk babies is breast milk, however we acknowledge that for some mothers, whose babies arrive in the world much earlier than expected, this isn’t always an option. They may not be ready to produce milk right away and they may need additional support to start expressing and collecting enough milk to feed their baby. We also work with colleagues from the milk bank at Queen Charlotte’s & Chelsea Hospital to offer donated breastmilk to help ‘bridge the gap’ for when new mothers might be able to produce enough milk independently.
What advice do you give to parents about bonding and communicating with their baby?
The neonatal environment can be daunting and scary, it is not where they expected to be as new parents, but we reassure them that they have a vital role to play in their baby's neonatal care, and that we will support them to do the very best that they can.
We also reassure parents that they know their babies best and that we are here to listen to them so that we can then tailor our care and advice to them as a family. We try to make them feel as in control as possible as part of our efforts to deliver truly family-centred care.
- Find out more about World Breastfeeding Week 2025
- Discover how our milk bank supports extremely premature and sick babies
* When tasting milk, 'mouthcares' refers to the process of maintaining oral hygiene and comfort, especially in infants, by cleaning the mouth to prevent infection, promote development, and help the baby associate the taste and smell of milk with feeding.
