Sunday, February 21, 2010

Supplemental feeding techniques for a breastfed baby

Welcome to the February Carnival of Breastfeeding: Overcoming breastfeeding challenges

This month, we're sharing our stories of overcoming breastfeeding difficulties. Be sure to check out the links at the end for the other participants' excellent posts! I'll be adding more throughout the day Feb. 22.

Supplemental feeding techniques for a breastfed baby == Hobo Mama

If you're wanting to breastfeed your baby but need to supplement with expressed breast milk or artificial formula for whatever reason, there are ways to do the supplemental feeding to encourage future breastfeeding success.

If you supplement with bottle feeding, particularly with a very young baby, you run the risk of causing nipple or quick-flow preference in your baby, jeopardizing the possibility of feeding partially or exclusively at the breast.

When Mikko was born, an overzealous nurse wanted to give him a bottle of formula. That one action set up a cascade of consequences, in which Mikko developed a flow preference where he would shriek and refuse to latch if he didn't immediately receive a strong flow of milk and we therefore spent a week doing supplemental feeding with first formula and then pumped breast milk. At the end of that brief but frustrating time, Mikko transitioned to feeding fully on the breast, so here are some techniques that might help you if you're in the same situation. Reasons you might be are because your baby was born premature or with latch problems (perhaps due to a physical deformity of the mouth or tongue or a developmental delay), or because of interference with the baby's breastfeeding instincts, as was the case with us, or if you've adopted an infant and are inducing lactation.

Here are four supplemental feeding methods that don't involve artificial nipples, in order from easiest to hardest, and I'll describe them in detail further down:

  • syringe feeding
  • cup or spoon feeding
  • finger feeding
  • supplemental syringe at the breast
  • supplemental tube at the breast

For any of these methods, you could use artificial formula, but it's even better if you can use breast milk, either by pumping your own breast milk or by arranging for a breast milk bank donation if your baby qualifies due to health issues. Pumping while caring for a newborn is, unfortunately, even more exhausting than caring for an exclusively breastfeeding newborn, but it's worth it to keep up your milk supply if you wish to transition over to exclusive (or partial) breastfeeding. All I can say to encourage you on this journey is that it is so much easier to breastfeed, so if you keep at it, you'll find the difficulty level drop off dramatically once your baby has transitioned off supplemental feeding, or is old enough that bottles are an acceptable substitute for the other supplemental methods (usually after about six weeks, but pay attention to your baby's cues — if latching to breastfeed is going badly, hold off longer).

The "best" method, then, is the most difficult, which is supplementing with expressed breast milk while the baby is at the breast, so that she can learn to start suckling and make the connection of sucking at the nipple = warm, yummy food. If you find this method causing too much frustration in either you or your hungry baby, start off with one of the easier methods to calm those first hunger pangs, and then switch to using a tube at the breast when the initial impatience is over.

Syringe Feeding

With syringe feeding, you fill a small, needle-less syringe with milk and press it slowly to squirt it into your baby's mouth as he swallows. You can get a specially shaped syringe with Supplemental feeding techniques for a breastfed baby == Hobo Mamaa thin, curved tip. You can use an eyedropper if smaller amounts are needed, such as for a preemie or with colostrum. This is a relatively easy way to get calories into your baby, but one concern is that this doesn't meet any of his sucking needs. You can add in sucking opportunities by slipping a finger alongside the syringe, as in Finger Feeding below and in the picture at left. Particularly if there's no sucking involved, save this one for when you need to stave off those hunger pangs right quick.

Cup or Spoon Feeding

In this type of feeding, you use a small cup or spoon and encourage her to lap up the milk with her tongue at her own pace. Even newborns can theoretically learn to drink from a cup if given a Supplemental feeding techniques for a breastfed baby == Hobo Mamachance. You can use a standard small cup you have around or a specialty item like this flexible feeding cup (similar cup in photo to right) or this wide spoon feeder that can be attached to a bottle (see a similar spoon in the photo at the very top of this post). I've said this type of feeding is a step up in difficulty from syringe feeding because you have to prop your baby up more and persuade your baby to take in the milk; it also tends to be messier, so have a cloth ready under her chin. To me, when we tried the method at a few months of age, it was more to coordinate. However, it's a good way to get a more significant amount of milk into your baby than a typical syringe can hold (unless the syringe is attached to a tube dipped into a bottle), and it is an on-demand type of feeding in that the baby controls the amount of milk she ingests. Similar to syringe feeding, however, this does nothing to satisfy the baby's sucking needs or train her to feed at the breast.

Finger Feeding

Supplemental feeding techniques for a breastfed baby == Hobo MamaIn finger feeding, you thread a very thin tube alongside one finger and let the baby suck on both your upturned finger and the tube; the tube is either attached to a syringe or dipped into an open bottle of breastmilk or formula. If your baby can suck, he will suck up the breastmilk himself; if his sucking isn't strong enough, you can depress the syringe yourself. (As mentioned in Syringe Feeding, you could alternatively tuck a syringe alongside your finger but wait for the sucking to know when to depress the syringe.) Dr. Jack Newman describes finger feeding in this link: Finger Feeding. It's a good method in that it lets babies suck, and as Newman mentions, trains them Supplemental feeding techniques for a breastfed baby == Hobo Mamain the technique they'll need at the breast. It does take some coordination, though, and parents can tape the tube securely all the way up their finger and hand if they want less to fidget with. To tempt your baby, get the flow started for him by sucking the liquid to the very tip of the tube. In our experience, once we tasted the difference between formula and breastmilk, we decided to use breastmilk exclusively if possible!

One advantage of these first three types of supplemental feeding methods to point out, and as you can see from the photographs, is that either parent, or another caregiver entirely, can perform the feedings. However, if you want to promote breastfeeding, eventually you'll have to try a method that incorporates the breast, and the sooner the better as far as successfully learning to nurse is concerned.

Syringe Feeding at the Breast

Supplemental feeding techniques for a breastfed baby == Hobo Mama
As Dr. Jack Newman says: "Babies learn to breastfeed by breastfeeding. Mothers learn to breastfeed by breastfeeding. The baby continues to get your milk. The baby won't reject the breast. There is more to breastfeeding than the breastmilk." Therefore, if possible, supplement at the breast to get your baby used to feeding there and stimulate your milk supply.

For syring feeding at the breast, latch your baby on, and then dip a corner of the syringe into the corner of his mouth and push when he sucks so that he will be rewarded with any sucking by a whole mouth full of milk. It can help to have a partner for this sort of maneuvering.

Tube Feeding at the Breast

Supplemental feeding techniques for a breastfed baby == Hobo MamaHere's Dr. Newman's handout for using a lactation aid. With this method, you latch the baby on to the breast and then slip a thin tube into the side of her mouth. The tube can be attached to a syringe that you push or dipped into a bottle for the baby to suck under her own steam. Again, you might have to sip on the tube to get the milk to the top so that it will start to flow immediately. This type of feeding is the best supplemental method because it encourages latching, it equates suckling with receiving milk, it stimulates milk production in the breast, and it makes for the easiest transition to full breastfeeding, as sometimes babies will continue to suck even when the tube runs dry. It can be a complicated juggling act, however, so some women prefer to have a partner help out with holding the tube and bottle, or tape the tube between their breasts. There are specialized long-term supplemental nursing systems you can buy that will make this technique more convenient if you foresee supplementing for an extended time (as with a very premature or adopted baby); such systems generally hang on a cord between your breasts and are easier to keep in place. I couldn't find a copyright-free photo to post, but here are a couple links to such a system in use: Nursing with the marvelous SNS from Gabriela Dora on flickr and SNS — feeding tube system at You can see the thin tube stretching into the infant's mouth and read a story of nursing using donor milk at Steph's Story on

A note on financing: Breastfeeding in itself is absolutely free, but using any of these supplemental methods can incur unexpected costs. If your baby is receiving medical care, see what the hospital might have available for you to make things cheaper and easier. We received all our tubes and syringes in a take-home bag from the nurse, and she also helped us arrange a week-long rental of a quality double electric pump for a reasonable price. Again, if you plan to express milk long term (for any of the above reasons or because you plan to return to work outside the home, for instance), you might wish to buy your own electric pump. If cost is an issue, see if your health insurance covers any of the cost, or check with your local WIC office or ask a lactation consultant or La Leche League leader if they know of other avenues.

Supplemental feeding techniques for a breastfed baby == Hobo MamaI hope that gives you some ideas of the options available for non-bottle supplemental feeding for newborns. Obviously, you should consult your pediatrician and an international board-certified lactation consultant (IBCLC) for advice and suggestions specific to your baby. My goal for this article is just to give an idea of the range of alternative feeding methods available that are unlikely to interfere with future breastfeeding success. That way, if a healthcare professional suggests that bottle feeding is the best or only way to supplement a newborn when you desire a future breastfeeding relationship, you can offer an alternate feeding method and find a lactation consultant to back you up. I wish you and your baby all the best, no matter what you decide or what the outcome.

To round off my own experience, the good news is that we cycled through all of these methods and came out the other side — exclusively breastfeeding. And our breastfeeding relationship is still going strong! It was worth all the inconvenience and heartache of trying these alternative methods, knowing it was keeping our goal of successfully feeding at the breast alive. Once we transitioned into full breastfeeding, I was astonished at how easy it was!

External webpage links that are helpful:

If you feel comfortable sharing, feel free to tell of your own experiences with supplemental feeding and what worked best for you. I was trying to remember some stories that are already out there, and these came to mind. To read of a negative experience with supplemental feeding that eventually turned to the positive, I found this account of "Nipple Intervention," by Whozat, particularly moving. Here's Amber Strocel's account of bottle feeding a premature baby and struggling to transition to breastfeeding but making it with the proper support and equipment. If you have a blog post chronicling your experiences with supplemental feeding, feel free to leave the link for us.

Enjoy these posts from our other carnival participants:

Line drawings copyright Lactation Education Resources.
Photos courtesy, from top, kburgert, Mister.Tee, McBeth,
Spamily, and EraPhernalia Vintage, all via flickr (cc).


Bibliomama said...

I would just want people to be aware of the danger of aspiration in cup feeding -- I would prefer the syringe method.

You're right about needing to make your wishes known to medical staff in the case of a hospital birth. I ended up having a crash c-section with my son under general anaesthetic -- which was traumatic enough, but when I woke up my husband informed me that the baby's blood sugar was low and they were giving him sugar water in a bottle, which nearly sent me into hysterics. Then they kept wanting me to nurse him using the football hold because of my scar -- and he was a humongous baby. Finally I ignored them all and used the standard hold (not sure what it's called) and he turned out to be a champion nurser. But I also heard the hospital breastfeeding consultant being unbelievably bitchy and haranguing my roommate, so insensitivity is found on both sides (just to stay balanced).

Jenny said...

thanks for this very informative post. this is a great resource to share with mothers - very detailed and with helpful pictures.

Anonymous said...

It's amazing how many options there are for supplementing! Thanks for getting this info out there. I definitely didn't know you could supplement other ways than just a bottle. I hope I don't ever have to, but I'm glad that I know so much more about my options now.

molly said...

At Eden's first check up with the NP she wanted us to supplement with formula because she felt Eden was too small. I refused to give her a bottle, so we went to a breastfeeding class at a local hospital and they gave me a tube. It was awkward and I never got the hang of it. We ended up using a syringe after I had breastfed her.

She ended up catching up eventually and is now in the 90th percentile for height and 70th for weight. In retrospect I really wish the NP had not given us the formula. Ironically, she was the one that showed me how to position Eden correctly so we got a good latch, too. Huh.

Great post, Lauren! Thanks!

Melodie said...

What a wonderful helpful post Lauren! I love that you found pictures of most of these types of feedings too. A visual image of a technique one has never done before makes such a difference! Good job!

Anonymous said...

I've heard stories of babies becoming nipple confused with finger feeding. Obviously not in the same way as with bottle-feeding, but it can lead to latch problems in some cases. It's just something to keep in mind.

The other thing I like to keep in mind is that while tubing and pumps and so on can be expensive, it is a limited-time cost, whereas formula is ongoing. Spending the money to see you over the hump is an investment that will pay off in the long run if you're successful.

As for me, my first child was born 6 weeks early and spent her first week in the NICU. She was given a bottle of supplemental formula before I had a chance to breastfeed, and she subsequently refused to latch. I don't think this could have been avoided, even if I HAD been consulted prior to giving the bottle. We were on different floors and I was extremely unwell, so I couldn't get down to the nursery to sit in a chair in a bright room around the clock. The staff was NOT open to alternative feeding methods. It is very difficult to swim against that stream, because you want them to like you so that they will work with you and get your baby out of there faster. Before they discharge your baby her or she needs to be taking all feeds by breast or bottle.

In the end I used nipple shields to overcome the nipple confusion, and then I weaned off of those. For the time we used them they were a lifesaver. They eliminated the refusal to latch and allowed my daughter to breastfeed, and let me give up the grueling pumping regimen.

Anonymous said...

As a low supply mom, I highly recommend Lact-Aids over the SNS system.

Lisa C said...

My lactation specialist told us to sit our baby up and hold the bottle horizontally so the baby really had to suck to get the milk out. We also used the bottle nipples with the smallest hole. Even if he still developed 'nipple confusion' at least he wouldn't get flow preference from the bottle. Just a bit of advice for anyone overwhelmed by the tubes and syringes.

Lauren Wayne said...

All right, clearly I should run my articles past y'all before I post. Oh, wait, that's what comments are for. Thanks for all the extra tips and advice, everyone! Love it.

Dena said...

I had to supplement for a month, mostly because of low supply and that I didn't get my son to the breast soon enough and often enough. Anyway, I syringe fed at the breast and used the SNS. That was one of the most difficult months of my life! It was well worth it however, and my 11 month old is still in love with his milky from the breast. Thanks for sharing and pointing out that even if breastfeeding doesn't go as smoothly at first as one might hope, there is still a way to get there!

Tanya Roberts, BSEd, LC said...

The feeding tube used by Jack Newman is harder to find in the US than it is in Canada, but it can be found here!

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