alternative feeding methods
for breastfed babies, cup feeding, finger feeding, lactation consultant,
lactation, breastfeeding educator, breast feeding
Chapter
V
Alternative Feeding Methods for Breastfed Babies
Learning Objectives
At the completion of this learning activity,
the learner will be able to:
list 5 reasons to avoid bottle nipple use in the breastfed
baby
describe 3 methods to feed babies without bottles
locate equipment needed for alternative feedings
develop a plan of care for a breastfeeding baby using
alternative feeding methods
Introduction
Traditionally, babies who cannot breastfeed temporarily, are fed using a bottle nipple. But for many babies and their mothers, this can result in problems that are difficult to correct. Alternative feeding methods, including finger feeding, cup feeding and complimentary feeding at the breast, are a temporary solution. Return the baby to the breast as soon as possible.
Occasionally breastfed babies may require "extra feedings"
Indications for "extra feedings"
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Low blood sugar (blood sugar <45) |
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Poor urinary output |
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High specific gravity >1.015 |
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Prolonged poor breastfeeding (three feedings) |
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Inability of the mother to breastfeed due to infection |
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Post-surgery |
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Maternal exhaustion |
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Low weight gain / failure to thrive |
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Breast refusal |
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And others... |
Concerns about bottle feeding a breastfed infant.
1. Nipple confusion. The infant refuses the breast or has difficulty locating and latching-on to the breast after using a bottle nipple. Symptoms can include repeatedly latching-on and letting go, shaking the head from side, frustration and crying, being unable to recognize the breast even when it is in the mouth. Risk factors are babies who are premature, even those just "a little early" at 36-38 weeks gestation, or who have had large doses of medications during labor or mothers who have flat or inverted nipples. 2. Breast engorgement. If the mother’s breasts are not emptied regularly emptied by breastfeeding and become overly filled with milk. This often causes severe discomfort any may cause further breastfeeding problems i.e., plugged ducts, mastitis. 3. Sore nipples. Mother’s nipples become sore because of the improper sucking patterns that can develop by the with the improper use of a bottle nipple. 4. Reduced milk supply. Lack of adequate breast stimulation from interruption of breastfeeding can result in a delay in the milk "coming-in" and an long-term reduction in breastmilk production. 5. Shortened duration of breastfeeding. Because the problems that can develop may be difficult to resolve, breastfeeding may be terminated sooner than the mother intended.
Alternative Feeding Methods
for Breastfed Babies: Finger Feeding
To avoid iatrogenic problems, finger feeding is one of several techniques that may be substituted until the baby can be brought back to the breast.
Advantages:
* Avoids nipple confusion
* Helps correct incorrect tongue motions while sucking
* Brings infant's tongue forward rather than back
* Infant can pace the rapidity and quantity of his feeds
Disadvantages:
* Harder to learn
* More intrusive
* Infant may become dependent on method
* Infant can "forget" jaw excursion (moving the jaw up and down
during sucking)
Situations where finger feeding may help:
* Improper sucking technique
* Nipple confusion
* Jaundiced infant
* Poor urinary output or high urine specific gravity
* Refusal to latch-on
* Neurological disorders
* Low blood sugar
Procedure for finger feeding:
Position the infant in a semi-upright position. Wash hands (non-family members should wear a glove or finger cot with powder rinsed off). Introduce the finger into infant’s mouth pad up, slowly moving it back to the juncture between the hard and the soft palate. If baby resists, withdraw finger slightly, pause until the baby is comfortable and gently continue to advance the finger to the soft palate.
Place a 5 Fr catheter, feeding tube device or periodontal syringe next to your finger. As the infant sucks, reward correct sucking motions with a small bolus of milk.
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Mock Periodontal Syringe If periodontal syringes are not readily available, you can use other common equipment. A 5 Fr feeding tube attached to a 10 or 20 cc syringe works well. Butterfly IV tubing, blood drawing tubing or other thin tubing can also be used. Be sure to cut off the needle! The thin, flexible tubing will be easy to slip into the baby’s mouth at the time of latch-on. Small squirts of milk can be given as the baby sucks. |
Alternative Feeding
Methods
for Breastfed Babies: Cup or spoon feeding
To avoid iatrogenic problems, cup or spoon feeding is one of several techniques that may be substituted until the baby can be brought back to the breast.
Advantages:
* Avoids nipple confusion
* Non-intrusive
* Brings infant's tongue forward rather than back
* Infant can pace the rapidity and quantity of his feeds
* Easy to learn
Disadvantages:
* Does not fulfill the infant's need to
suck
* May become dependent on method
* May be messy
* Can be easily substituted for breastfeeding because it is so easy
Indications for cup or spoon feeding:
* Nipple confusion
* Jaundiced infant
* Poor urinary output or high urine specific gravity
* Refusal to latch-on
* Low blood sugar
* Flat nipples
Procedure for cup or spoon feeding:
* Swaddle infant and hold in a semi-upright
sitting position
* Fill the spoon or a 1 ounce medicine cup (or any shot glass, medicine
spoon or other small clean container) at least ½ full of pumped breastmilk
or formula
* Place the container to infant's mouth, touching the corners of the upper
lip
* Allow the spoon or cup to rest gently on the lower lip
* Tip the spoon or cup so milk is just touching infant's lips
* A few drops may be trickled into infant's mouth to start
* The infant may keep his tongue forward and drink sips or lap from the
spoon or cup
* Allow the infant time to swallow
* Do not pour milk into the infant's mouth
* Leave the spoon or cup in position, refilling only when necessary
* Let the infant pace the feeding
* Stop to burp from time to time
* Spoon or cup feeding is easily learned and can be taught to parents
if their baby will need supplemental feedings.
Do not attempt this on baby who is not alert or who is sleepy.
Alternative Feeding Methods
for Breastfed Babies:
Complimentary Feeding at the Breast
Advantages:
* Avoids nipple confusion
* Involves the mother
* Keeps the infant in contact with the breast
* Infant can pace the rapidity and quantity of his own feeds
* Encourages stronger suck and swallow
* Allows stimulation of mother's breasts
Disadvantages:
* Mother may need the help of another
person
* May be awkward to use and time consuming
* Cost varies from $3 to $45 depending on equipment used
Indications for complimenting at the breast:
* Nipple confusion
* Jaundiced infant
* Poor urinary output or high urine specific gravity
* Low blood sugar
* Low milk supply
Procedure for complimentary feeding at the breast
* Place infant at breast in cradle or
football hold.
* Assist infant to latch-on.
* Slip 5 Fr feeding tube, a commercially available feeding tube device
or periodontal syringe into corner of infant's mouth
or
* Tape the tubing to the breast so the infant takes both the breast and
the tubing in during latch-on. The tubing will be less obtrusive to the
infant if it is placed in the corner of the mouth.
* Reward sucking with small bolus of milk.
* Observe for swallowing and signs of too fast or slow milk
This technique can be taught to a family
member to assist the breastfeeding mother.
This technique will not correct an improper sucking technique.
Rinse the apparatus with cool water to prevent coagulation of the proteins before washing with hot, soapy water. Force water through the tubing. Allow to air dry.
| You can modify the flow from a commercially available feeding tube device by raising or lowering it’s position. Lower will result in a flow only when the baby sucks; higher will result in a spontaneous flow. In certain babies with a very weak suck, the unused tube (if you are using a set-up with double tubes) may be released so it acts as a vent, increasing the flow. If even faster flow is desired, both tubes can be used simultaneously. |
| To learn to do these techniques, seek the help of an experienced Certified Lactation Consultant. They are advanced techniques and can cause serious problems if done inappropriately or incorrectly. |
Therapeutic Bottle feeding the Breastfed Baby
There may be times when doing some short term or intermittent bottle feeding may be a stepping stone to successful breastfeeding. Of course, the feeding of choice is the mother’s pumped breastmilk, but formula may be necessary in selected situations.
Situations were judicious use of bottle feeding may be helpful:
Allow extremely sore nipples time to heal when they are not responding to attempts to correct the positioning and latch-on.
Disorganized or dysfunctional suckle.
Mother has emotionally reached her "limit" and needs a short break.
The baby will not open his mouth wide enough to achieve a deep latch-on.
Parents or their primary health care provider are reluctant to try alternative types of feeding methods (finger feeding, cups, etc) in trying to remedy a problem.
Choosing a bottle:
Select a bottle nipple which promotes a breastfeeding suckle and most closely resembles a correctly positioned breast nipple (teat) in the infant’s mouth (deep latch-on, slow flow, suction, jaw compression and tongue stripping of the nipple). Many bottle nipples promote a shallow latch-on, fast flow, jaw clench and elevated posterior tongue.
Select a nipple with a long shank, wide base and small holes preferably on the top rather than the tip. Bottle nipples that have been used successfully include Avent System newborn nipple, Munchkin slow flow nipple, Health Flow stage I nipple, Gerber NUK nipple. The baby should be able to finish a feeding in 15-20 minutes. Use either smaller or larger size holes or more holes in the nipple to achieve this.
Using the bottle nipple correctly:
Position the nipple fully in the infant’s mouth (at least 1 inch) so the lips cover the broad base and the jaw is open wide. Hold the baby as if breastfeeding, switching arms mid-feeding, talk and caress the baby during feedings and snuggle the baby after feedings. Offer lots of skin-to-skin contact during and between feedings.
Position the baby so he is nearly sitting upright. Hold the bottle in a nearly horizontal position so that gravity does not cause the milk to flow quickly. Position the bottle just so that fluid is filling the tip of the nipple.
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Incorrect |
Correct |
Specialty bottles:
There are bottles with special features for unique situations.
The Haberman bottle has a nipple with a adjustable/variable flow depending on positioning. It may be useful for infants that have a weak suck or disorganized suck. The Haberman bottle is available from Medela, Inc.
The Adiri bottle is made of soft, rounded silicone resembling a breast, with a straight nipple. It is a new one piece bottle and nipple combination and there is little experience with it’s use. It does require jaw compression at the base of the nipple to obtain milk. The manufacturer does not claim it will be useful in correcting sucking problems. It is available from Adiri BreastBottle.
Returning the baby to the breast:
Bottle feed the baby with his cheek to the breast. Offer the breast using correct positioning and latch-on at a time that the baby is not frantically hungry. The baby may be more willing to go back to the breast if a ounce or so is given by bottle and then he is switched quickly to the breast. Always make the breast a comforting and non-stressful place to be. Do not persist at the breast for that feeding if the baby is stressed or crying. Offer the bottle and try again at the next feeding. Patience and persistence will pay off.
Determining which alternative feeding method is appropriate for the situation
This discussion
and chart will help you make the best choice.
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This module was written by Vergie Hughes RN MS IBCLC. If you have questions or would like to talk to the author, click here.