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 2.5kg – over 96% of them in developing countries. These low-birth-weight (LBW) infants are at increased risk of early growth retardation, infectious disease, developmental delay and death during infancy and childhood.

Most LBW is a consequence of preterm birth, small size for gestational age, or both.

Interventions to improve the feeding of LBW infants are likely to improve the immediate and longer-term health and well-being of the individual infant and have a significant impact on neonatal and infant mortality levels in the population.

WHO recommends that LBW 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.

LBW infants who need to be fed by an alternative oral feeding method should be fed by cup or spoon. Limited evidence suggests that feeding LBW 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 recommendations

LBW 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.

This recommendation is relevant for settings with an adequate number of health-care providers.

This recommendation does not address sick LBW infants or infants with birth weight less than 1.0 kg.


This is one of several WHO recommendations on feeding of LBW infants. The full set of recommendations can be found in 'Full set of recommendations' and in the guideline, under ‘WHO documents’ below.

WHO documents

WHO documents

GRC-approved guidelines


Systematic reviews used to develop the guidelines
Related Cochrane reviews
Clinical trials

Last update:

10 October 2016 12:16 CEST

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

Essential Nutrition Actions

This intervention is supported by Essential Nutrition Actions targeting the first 1000 days of life.