ALTERNATIVES TO BOTTLES
At times, it may be necessary to give a breastfed baby supplements of expressed breastmilk or infant formula. However, using an artificial nipple (i.e., any nipple that’s not attached to mom) to feed a young breastfeeding infant is likely to lead to nipple confusion. The sucking technique which baby learns from the rubber nipple does not work at the breast, and baby quickly becomes frustrated. This is why bottles are not the best choice for giving supplement to infants less than four weeks of age.
Alternatives include cup-feeding, spoon-feeding, an eyedropper or feeding syringe, or a nursing supplementer. Which method to choose depends on your reasons for supplementing, how long you will be giving supplements, and your own preferences. You’ll also need to consider what kind of supplemental milk you will give your baby.
WHAT KIND OF SUPPLEMENT TO GIVE
The best supplement to use is mother’s own expressed milk. If your baby is not nursing well, you’ll need to pump after breastfeeding in order to stimulate you milk supply. Milk that is expressed shortly after baby is fed at the breast has a high fat content and makes an ideal supplement.
If you must use formula supplements, consult your doctor about which one to use and how much.
Yes, even newborns can drink milk from a cup. They don’t gulp it down like grown-ups. Instead they lap it up like kittens. Infants who are given supplements in a cup are less likely to get nipple confused and more likely to go on to successfully breastfeed. Some nurseries have used cup-feeding in infants with gestational ages as young as thirty weeks. Research has shown that not only is it possible for preemies to drink from a cup, but they also maintain a more stable blood-oxygen level during cup-feeding than during bottle-feeding.
Here’s what to do:
• Use a small cup (shot-glass size) that holds just 1 or 2 ounces of human milk or formula. Cups made of flexible plastic allow you to bend the cup into a spout shape. You can use a small cup that you may already have in your home or purchase cups made especially for infant feeding. These are available from Leche League International and Ameda Egnell, as well as from hospitals and lactation consultants.
• Fill the cup at least half full with the supplement. Fill several cups so you don’t have to interrupt the rhythm of the feed to refill the cup.
• Tuck a cloth diaper or small towel under baby’s chin to absorb drips, or use an absorbent bib. You might want to swaddle baby in a receiving blanket to keep his hands out of the way.
• Hold baby on you lap in an upright supported position.
• Hold the cup to baby’s lips and tilt it until the milk just reaches his lips.
• Be patient. Allow baby to lap up the milk and swallow at his own pace. Don’t pour the milk into baby’s mouth; he may sputter and choke. Let baby set the pace, and let him decide when he’s finished.
You can also feed a baby supplements with a spoon. Support her upright on your lap as you would for cup-feeding and offer small spoonfuls of milk, placing the tip of the spoon on her lower lip. Allow her to take the milk and swallow at her own pace.
EYEDROPPER OR FEEDING SYRINGE
Use a plastic eyedropper to drop milk into baby’s mouth while holding him upright on your lap. A feeding syringe is similar to an eyedropper, but it holds more. You can also use a feeding syringe to supplement a baby at the breast. Insert the tip of the syringe into baby’s mouth while he is latched on, and depress the plunger to reward the baby when he sucks.
NURSING SUPPLEMENTER (also known as an SNS or supplemental nutrition system)
This device allows baby to receive supplements of formula or expressed human milk while sucking at the breast. A container for the milk (either a bag or a plastic bottle) hangs from a cord around mother’s neck. Narrow silicone tubing runs from the container to the tip of mother’s nipple and is secured with tape. When the baby latches onto the breast, he also takes the tubing into his mouth. When he sucks, he gets the supplement along with milk from the mother’s breast. The sucking helps stimulate the mother’s milk supply, and the supplement rewards the baby for sucking properly.
A nursing supplementer is used by mothers who are nursing adopted babies, as well as by mothers who are relactating (reestablishing a milk supply after a premature weaning). Nursing supplementers are also used with preemies or babies with various kinds of sucking problems that prevent them from getting enough milk directly from the breast. To use a supplementer, the baby must be willing and able to latch onto the breast.
There are two kinds of supplementers: the Medela Supplemental Nursing System and the Lact-Aid Nursing Trainer System , https://www.lact-aid.com/trainer-systems. The Medela SNS uses a hard plastic bottle to hold the milk; the Lact-Aid system used a plastic bag. Both come with detailed instructions on how to use the device and how to clean it.
Talk to a lactation consultant before using a nursing supplementer. She can help you decide if this is the best choice in your situation. She will also help you resolve the breastfeeding problem that has created the need for a supplementer.
Finger-feeding uses a nursing supplementer to deliver milk while baby sucks on an adult finger. The supplementer’s tubing is taped to the adult finger, and the finger is gently inserted in the baby’s mouth. You can also use a feeding syringe for finger feeding. Gently insert the tip of the syringe into baby mouth while he sucks on your finger. Depress the plunger to deliver milk when the baby sucks, and pause when the baby pauses.
OTHER FEEDING DEVICES
Other types of feeding devices may be used in various kinds of special circumstances. These devices have special nipples or other ingenious ways of delivering milk. For example, a special bottle, known as the Haberman Feeder, is used for infants with oral-facial abnormalities, such as cleft lip or palate, receding jaw, or babies who have a developmentally delayed suck. This bottle has a long nipple and a valve that regulates the flow of milk. Lactation consultants or speech pathologists who have had special training in managing infants with anatomic or neurologic factors that affect feeding can recommend which type of feeder would be best for your baby.
WHICH METHOD TO CHOOSE
When to give supplements with a cup (or a spoon or eyedropper):
• When baby has not yet learned how to latch onto the breast,
• When baby is having problems with nipple confusion
• When it’s likely that baby will need supplementation for a relatively short period of time
• When an older breastfed baby refuses the bottle
When to use a supplementer:
• When baby is able to latch onto the breast, but can’t get sufficient nourishment from breastfeeding alone.
• When training a baby to suck correctly at the breast (get help from a lactation consultant).
• When the need for supplements is likely to continue for several weeks. (It may take a few days to become comfortable with using a supplementer, which is why many advisors suggest cup-feeding when the need for supplements is only short-term.)
• When you wish to supplement baby at the breast and avoid the time and effort required to give baby an additional feeding after nursing sessions.
• When relactating or nursing an adopted baby.
When to use finger-feeding:
• When baby has not yet learned how to latch onto the breast
• When teaching a baby to suck correctly (get help from a lactation consultant)
A lactation consultant can help you decide which method will work best for you and your baby and can help you locate and purchase special feeding equipment. She will also help create a plan for gradually eliminating the need for supplements.