Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the NICU, with often devastating consequences. The etiology of NEC is probably multifactorial, with preterm infants at the highest risk. The relationship between feeding and NEC was identified in the 1970s, leading to delayed feeding becoming standard treatment in NICUs. More recent research suggests that early feedings not only are safe, but reduce other morbidities associated with prematurity. Standardized feeding guidelines seem to confer some benefits in decreasing NEC, despite a wide variability in feeding practices within the published guidelines. A standardized approach to the management of feeding problems may be the key. This article briefly reviews the pathogenesis of NEC and examines studies of various feeding practices for their relationship to the development of NEC. It also highlights the potential benefits of breast milk in NEC prevention.