Kirsten asks about encouraging prem babies to feed on demand when they are
first discharged home, particularly the instruction,  "Your baby will eat
about every 3 hours. Some babies may eat as frequently as 1 1/2 - 2 hours.
Occasionally
you baby may sleep for 5 hours. If your baby sleeps longer than 5 hours
wake him up for a feed. Otherwise let the baby determine the time for the
feed."

Firstly, how nice that you have such a baby-friendly neonatologist.  However
I find that prem babies are difficult to breastfeed "on demand" because they
tend to sleep so much, ("happy-to-starve" behaviour) and consequently they
may not be "demanding" enough.  If I am working with a mom whose prem baby
is about to be discharged I suggest that she may have to be the one to
remind the baby to eat until he grows stronger, and that she may not be able
to "trust" him at first because he is so little.  I recommend that she
ensures that the baby breastfeeds, with at least 10 mins swallowing *at
least* every 3 hours, day and night (minimum 8 times/24 hours) *and* that
she ensures that the breasts are well drained after breastfeeds by
expressing/pumping afterwards. If the baby is waking up easily and
breastfeeding well enough to produce a good urine/stool output (6 - 8 wets
with clear urine, 3 - 5 stools each 24 hours) then she can feed "on demand".
However, if the baby is sleepy or feeding for short times or the output is
low, I suggest feeding EBM instead of breastfeeds (150 - 180 ml/kg/day
divided by 8, for every 3 hours), even if she has to feed him while he is
fast asleep, until he *does* become demanding.  This seems to keep the
baby's energy levels up and the weight gain good, and the baby gradually
takes over for himself as soon as he can.  Hope this helps.

Pamela Morrison IBCLC, Zimbabwe