e-Library of Evidence for Nutrition Actions (eLENA)

Demand feeding for low-birth-weight infants

Every year, more than 20 million infants are born weighing less than 2500 g – over 96% of them in developing countries. These low-birth-weight infants are at increased risk of neonatal morbidity and mortality.

WHO recommends that low-birth-weight infants should be fed mother's own milk. If these infants cannot be fed mother's own milk, they should be fed donor human milk (in settings where safe and affordable milk banking facilities are available or can be set up) or standard infant formula.

Low-birth-weight infants who need to be fed by an alternative oral feeding method should be fed by cup or spoon. Limited evidence suggests that feeding low-birth-weight infants in response to their hunger cues (ad libitum or demand/semi demand) rather than at scheduled intervals allows earlier attainment of full oral feeding and earlier hospital discharge.

WHO recommends that low-birth-weight infants who are fully or mostly fed by an alternative oral feeding method should be fed based on infants’ hunger cues, except when the infant remains asleep beyond three hours since the last feed.

The full set of recommendations are provided within the guidance documents referenced below.

WHO documents

GRC-approved guidelines


Systematic reviews used to develop guidelines
Related Cochrane reviews
Clinical trials

Last update:

25 March 2014 13:35 CET

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee


There is not yet any implementation information related to this intervention in GINA