Breastfeeding and Supplementing Breastfeeding In the hospital Pumping Tools and Tricks

How to Supplement

I know, your plan is to breastfeed. However, if breastfeeding isn’t going well or your baby is separated from you, your baby may need to be supplemented. Supplementation can be with your own expressed milk, donor breastmilk, or formula. The old me wouldn’t dare recommend something as terrible as formula. But the current me knows that 1- formula isn’t terrible and 2- you have to feed the baby, no matter what! This article will focus on the different ways to get the supplement into your baby.

By mouth:

If your baby is able to be fed by mouth, these are the most common ways to accomplish that:

  • oral syringe: Most hospitals have a variety of oral syringes available. The 1ml syringes are great for the early days when mom is collecting very small amounts of colostrum. Larger volume syringes are available, as well, up to 60 ml. The baby will not suck on the syringe. You will gently push some of the supplement into the baby’s mouth, preferably the cheek area, and encourage the baby to swallow it. Repeat until the baby is finished or supplement is gone. I like to use these as a first choice when having to supplement if the volume is small (<10ml). Toss after use and use a new one each time. Watch this video of syringe feeding.
  • spoon: This is a common spoon. Nothing fancy. This works great for mother to hand express directly into the spoon and feed to baby, without changing containers. The one drawback is the inability to accurately measure volume. Gently tip the spoon into the baby’s mouth and allow a little of the supplement to flow into the baby’s mouth. Encourage the baby to swallow it. These are awesome and easy to use, but in a hospital setting, you will be encouraged to measure exact volume when possible. Super easy to clean! Read about hand expression here.
  • cup: There are infant feeding cups made specifically for this purpose, but also any soft edge, flexible cup will work. Gently tip the cup into the baby’s mouth and allow a little of the supplement to flow into the baby’s mouth. Encourage the baby to swallow it. Also, super easy to clean! Watch this video of cup feeding.
  • finger feeding: This is accomplished by the supplement being delivered to the baby via a feeding tube that runs along side of the caregiver’s gloved finger. The baby sucks on the finger and is able to transfer the milk from the tube. The flow of the supplement from the tube is driven by the baby’s suction, unless the syringe is elevated to encourage gravity to move the milk quickly, or the syringe plunger is being pushed. By allowing the baby to control the flow, you are ensuring that baby doesn’t choke because the flow is too fast. Watch this video of finger feeding.
  • supplemental nursing system: This device/ method is similar to finger feeding in that the supplement is delivered via a small tube while baby sucks. In this case the baby will be sucking at the breast and the small tube will run alongside the nipple so the baby is theoretically getting milk from the breast and the tube simultaneously. There are a few drawbacks with these. For one, they can be a real pain in the rear to use. The bottle (or whatever container the milk is in) needs to be held or attached to mom in some way, preferably higher than the breast. Most people add a small piece of tape to hold the tube in place. Some people like to use a nipple shield with these because it will sort of hold the tube in place alongside the nipple. The flow should be driven by the baby’s sucking, but it can be messy if baby isn’t sucking well. Also, they can be difficult to clean and reassemble. The devices designed for this can also be expensive. A cheaper, easier version is to use a 5f feeding tube with a 30 or 60ml syringe attached, with or without the plunger. I’m not a huge fan of these and rarely have a mother insist on using one.
  • bottle: In the clinical setting, this is most often the first choice, but not necessarily the best. In some cases, sucking on a bottle nipple can lead to nipple confusion and breastfeeding difficulties. Babies have a difficult time controlling the flow, even on a slow flow nipple, and are more likely to choke and have breathing difficulties using a bottle. However, when the volume to be supplemented is large (>10ml) or baby is very disorganized and could benefit from a little suck/swallow practice, I tend to use a bottle with a slow flow nipple. Generally lactation consultants recommend wide base nipples to mimic the wide mouth that babies have when latched to the breast, but we don’t have these in the hospital. We have an abundance of the free nipples from the formula company so that’s what is used. I always start with slow flow. These flow fairly quickly, even though they’re “slow flow”. If you’re being pressured to use the bottle and you’re unsure, you can always refuse. Ultimately, we just need to feed the baby. If a supplement is needed and the bottle is the preferred way, that’s ok. You will continue to work on breastfeeding until you find success.

Other methods:

  • NG/ OG: If the baby is unable to be fed by mouth, the baby may be fed via a nasogastric or orogastric tube. This is a feeding tube that goes directly into the baby’s stomach via either the nose or the mouth. The external end of the tube is connected to a syringe which holds the supplement. In some cases, the syringe will be on a pump to deliver the feed over a measured amount of time.

Your job:

If your baby isn’t feeding well or you are separated from your baby, begin expressing your milk as soon as possible. Hand expression has been shown to be the most effective method in the early days. Read here about hand expression. You can also use an electric breast pump to collect your milk. However you choose to do it, make sure you do it early and often. Express as if you were feeding the baby: every 2-3 hours around the clock for about 15 minutes. Here is a great video about hand expression.

Continue to offer the breast first at every feeding. Work with the lactation consultant as much as possible.

Be patient with yourself and the baby. You are both brand new to this and have lots of learning to do!

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