Selecting and using breastfeeding,
breast feeding, devices, equipment, lactation, lactation consultant, breastfeeding
educator, SNS, feeding tube device, cup feeding, finger feeding
Selecting and Using Breastfeeding
Devices and Equipment
Selecting the proper solution to lactation management problems is a complex blend of
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the lactation consultants experience |
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the infant’s capabilities and limitations |
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the mother’s anatomy and physiology |
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the mother’s ability to cope with the situation |
This is a general guideline for using breastfeeding aids in various clinical situations. It is only a guide. The lactation consultant must consider all factors before recommending a plan of care. More than one problem may be present. There is no one device or technique that is useful for all situations. You must select the most appropriate solution.
Often the plan of care moves from the first choice solution, if unsuccessful, to the second choice solution and if it is unsuccessful, to the next choice. This may take a matter of minutes, days or weeks. As the situation improves, the plan may move from the last choice to the next higher choice and so on, until resolution.
During treatment phase of care, move from left to right as the situation warrants, more than one intervention may be used at a time
During the recovery phase of care, move from the right to the left as the situation improves
(If you wish to print this chart, use the landscape function on your printer)
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Problem |
First choice solution |
Second choice solution |
Third choice solution |
Forth choice solution |
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Difficult latch-on |
Correct positioning and latch-on |
Curved tip syringe with milk used at the breast to entice baby to latch-on |
Nipple shield to assist with latch-on. May also use curved tip syringe to assist with latch-on |
Add FTD system to increase the milk flow |
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Breast refusal |
Skin-to-skin time with mother & correct positioning and latch-on |
Cup or spoon feed while continuing skin-to-skin Dribble milk over nipple |
Nipple shield to assist with latch-on |
Bottle - Long shank with wide base. Place bottle so wide part of nipple is at infant’s gum line. Baby held vertically, bottle held horizontally |
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Sore, damaged nipples (abraded skin) |
Correct positioning and latch-on |
Lanolin preparation and breast shells |
Temporarily use breast pump until nipples heal |
Nipple shield to relieve mother’s pain - short term use |
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Sore, damaged nipples (broken skin) |
Correct positioning and latch-on |
Hydrogel dressing |
Temporarily use breast pump until nipples heal |
Nipple shield to relieve mother’s pain - short term use |
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Flat or inverted nipples |
No intervention if nipples are flexible. Breast shells for in-elactic nipples during last 2-3 weeks of pregnancy and first weeks of breastfeeding |
Breast pump to pull nipples out and increase elasticity. Breast shells used near time of delivery and the first weeks of breastfeeding |
Cup or spoon feed baby while skin-to-skin. Nothing else in baby's mouth
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Nipple shield |
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Shallow latch-on Tight mouth |
Correct positioning and latch-on |
Nipple shield to encourage wider open mouth |
Bottle - Long shank, wide base nipple. Place bottle so wide part of nipple is at infant’s gum line to encourage a wider mouth while suckling. Baby held vertically, bottle held horizontally |
Eyedropper or spoon or cup feeding |
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Over-active let down Baby chokes at breast |
Hand compression blocking some milk ducts during let-down, then release. Supine positioning ("Australian Hold") |
Breastfeed on 1 breast per feeding - pump minimally, stopping pumping as soon as milk supply adjusts |
Institute measures to reduce milk supply if over-active let-down is due to over-supply |
Nipple shield temporarily until baby can handle flow |
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Low maternal milk supply |
FTD at breast to increase infant intake and maternal breast stimulation. Correct positioning and latch-on |
Pumping with hospital grade breast pump |
Herbal supplements |
Physician assessment of mom and prescription galactogogues |
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Infant displays incorrect tongue position and/or movement |
No intervention if baby transfers milk well and mother is comfortable |
Suck training and put baby to breast. Correct positioning and latch-on |
Suck training with finger feeding and curved tip syringe or finger feeder device |
Suck training with finger feeding with FTD |
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Infant requires supplementation due to hospital policies or medical condition |
Supplement at breast with curved tip syringe or FTD |
Supplement with cup |
Supplement with bottle with long shank, wide base nipple. Place bottle so wide part of nipple is at infant’s gum line. Baby held vertically, bottle held horizontally. |
Supplement with eye dropper or spoon |
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Adoptive nursing |
FTD at the breast Use breast pump regularly |
Supplement with bottle with long shank, wide base nipple until milk supply increases. Baby held vertical, bottle held horizontal |
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Neurologically impaired baby, preeme baby, low muscle tone |
Correct positioning and latch-on. Use Dancer hand position |
FTD at the breast Use breast pump regularly |
Use Haberman bottle |
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Cleft lip and/or palate babies |
Correct positioning and latch-on. Use nipple skin to fill in defect |
Use Haberman bottle |
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Baby with high sucking needs, fussy baby |
Allow to feed at the breast until satiated. Assure adequate weight gain |
Use comfort techniques : skin-to-skin, sound, motion to soothe baby |
Use pacifier after feeding to settle baby |
FTD - Feeding tube device: Commercially made device commonly called a Supplementary Nurser System or Lact-aid, or made from a 5 Fr feeding tube and a 20 cc syringe or a 5 Fr feeding tube and a bottle of milk.
Developed by Vergie Hughes RN MS IBCLC
Peer review by Jane Bradshaw RN BSN IBCLC 5/2004
Lactation Education Resources Fairfax, VA 22031 (703) 691-2069