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 recommendations

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.

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

The full set of recommendations for feeding of low birth-weight infants can be found in the guideline, Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries , under ‘WHO documents’ below.

WHO documents

GRC-approved guidelines


Systematic reviews used to develop guidelines
Related Cochrane reviews
Clinical trials

Last update:

10 October 2014 12:28 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.