This information is presented to assist breastfeeding mothers who have been advised to supplement in addition to feeding on demand at the breast or who have infants unable to nurse at the breast. Expressed Breastmilk is the preferred substance to supplement with. If your doctor is not breastfeeding friendly you may want to consult with other sources before supplementing. Also note that it can take a few days for your milk to even come in, but until then all that is needed is the colostrum.

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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 feed

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.

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.

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.