If your baby needs a supplement of expressed breastmilk or formula, a nursing supplementer can give him that extra milk while he is feeding at the breast. Supplementers can help mums have an at-breast relationship with their baby.
You can use a supplementer to:
- Stimulate breastmilk production while feeding infant formula, to avoid using bottles.
- Breastfeed an adopted baby.
- Enjoy the closeness of breastfeeding as your milk production increases.
- Encourage a baby who is reluctant to breastfeed.
- Maintain breastfeeding in situations where milk production is compromised, eg health problems, breast surgery or damage.
- A supplementer can sometimes help a baby who is unable to feed effectively because of sucking or health problems. However this will only work if your baby can feed well enough to obtain milk.
A nursing supplementer lets a baby get any supplement he needs at the breast without using bottles. The supplementer container hangs around your neck and tubing delivers small amounts into your baby’s mouth while he breastfeeds. As he swallows, he continues sucking, stimulating your milk production. This also saves you time.
Introduce the tube into your baby’s mouth along with the breast at the very beginning of a breastfeed by placing it between your baby’s upper lip and cupped tongue. If your baby doesn’t like the feel of the tube on the roof of his mouth try placing it so it lies along his tongue.
Or, slip the tube into the corner of your baby’s mouth once he is well-attached at the breast. The tubing usually needs to extend about 6mm past the tip of your nipple to allow for nipple extension when your baby sucks.
It can be secured to your breast with medical tape. Taping along the tube is generally more secure than taping across it.
To hold the tube in position some mothers use fabric sticking plasters cut from a long strip. They thread the tube under the non-sticky sections.
The tube can be easily removed while the plasters stay in place, reducing skin irritation from tape removal and providing a guide for positioning each time.
See the section below on Available Products for a comparison of available commercial and homemade supplementers.
A good latch-on
It’s especially important that your baby latches on deeply at the breast when you are using a supplementer. Get help with positioning and attachment so your baby can get milk from the breast as well as from the supplementer. When using a supplementer you will see the milk travel along the tube to your baby’s mouth. Adjust the tube position and container height so your baby gets milk quickly when he starts sucking. Check he isn’t overwhelmed with milk, especially if he has heart or breathing difficulties or is premature.
Expressed breastmilk Your expressed breastmilk is the first choice for a supplement. If your baby has feeding difficulties, expressing will help you maintain and increase your milk production. Give your expressed milk to your baby before you give him any infant formula. To make the most of your precious milk avoid mixing the two together. There’s no need to warm any supplement before use—flowing through the tube against your skin will be enough to warm it a little.
Infant formula Concentrated and ready-to-feed forms of infant formula are less likely to clog nursing supplementer tubing than powdered forms. Although expensive, ready-to-feed formula may also be more convenient when you are out and about or at home without help. Powdered infant formula is not sterile, so always follow the NHS guidelines for preparing it.
With any devices used to give infant formula follow the manufacturer’s cleaning instructions and the information in the NHS leaflet. To avoid having to throw away tubing when milk has dried inside, wash it immediately after use or immerse it in a container of water. After every use wash the supplementer parts and tubing with hot soapy water, forcing water through the tubing using the bottle or the syringe provided. Then rinse in the same way with clean water and drip dry. Sterilise at least once a day.
Begin the feed with your baby taking milk just from the breast. When he is no longer swallowing regularly start the supplementer. If your baby is reluctant to nurse at all, start the milk flowing at the beginning of a feed to get him started. Put more supplement in the bottle than you think your baby will need. As your breasts start to make more milk you will notice your baby leaves more unused supplement when coming off the breast satisfied, especially at certain times of day.
Whether using a supplementer as a temporary or a long-term solution, support from your local LLL Leader and group can be a great help. For individual face-to-face help or a home visit, you could also consult a board certified lactation consultant (IBCLC) or specialist breastfeeding clinic.
Disposable bag system This uses disposable sterile plastic bags with a top opening and a single tube. Milk only flows when a baby sucks and it is discreet to use as the bags are not bulky or noisy. You can also feed lying down without fear of leaks. When your baby sucks, the flow increases as the flow of milk from your breast decreases. This reinforces proper suckling, making the most of your milk production.
Bottle system This system uses a bottle with a tube for each breast, making switching sides easy. Different tube widths are available. Sets can be cleaned and reused. Constant flow can cause ineffective feeding, so when you first use the supplementer start with the medium-width tube. To stop milk flowing through a tube clamp it in the slots in the bottle lid. Once a tube is unclamped, prevent flow by keeping any part of the tube higher than the level of liquid in the bottle. Once you lower the tube, supplement will flow, even when your baby is not actively suckling. Reduce flow so your baby has to actively suck to get milk by using thinner tubing or lowering the bottle. Increase flow by using wider tubing, or raising the bottle.
Homemade system For short-term use or to try out the method you can make a supplementer using an ordinary baby bottle, bottle teat and an infant nasogastric feeding tube (size #3.5 to #6 french). Tubing can be hard to obtain. Your midwife may be able to get some from the local neonatal unit and some lactation consultants keep tubing available for their clients. Cut a small hole in the bottle teat, just large enough to accept the tubing—a tight fit reduces the risk of spillage. Thread the tube through the teat from the inside and attach the teat normally so the end of the tube sits in the supplement. The tube end is rounded and won’t hurt your baby’s mouth. Pierce a second hole in the teat, or use a teat with a vent. This allows air in so your baby won’t need to suck harder as the bottle empties. The bottle needs to stay upright. Many mothers use a small bottle and hold it in place by tucking it into their bra. This method can be quite discreet. Nasogastric tubes should not be boiled or steamed. Replace the tube when it starts to stiffen, usually after a week.
Warning: Artificial infant milk, given when not absolutely essential to meet the baby’s nutritional needs, can lead to an early end to breastfeeding, put baby’s health at risk and may have social and financial implications. A decision to stop breastfeeding is not easily reversed.
Written by Karen Butler, Sue Upstone & mothers of LLLGB. Photos courtesy of Lynn Adams, Rae Vacher Lowe and Alison Widdup.
My Baby Needs More Milk
My Baby Won’t Breastfeed
In praise of at breast supplementers, a mother’s story
The Womanly Art Of Breastfeeding. LLLI, London: Pinter & Martin, 2010
The Breastfeeding Mother’s Guide To Making More Milk. West, D. and Marasco, L. McGraw-Hill, 2009.
please note: LLLGB does not endorse any particular breastfeeding product, aid or device
Nursing Trainer System: www.lact-aid.com
Supplemental Nursing System: www.expressyourselfmums.co.uk
The Breastfeeding Answer Book. Schaumburg, IL: LLLI, 2003.
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
Supporting Sucking Skills in Breastfed Infants. Watson, Genna, C. Sudbury, MA: Jones and Bartlett, 2008.
This information is available in printed form from the LLLGB shop.
Copyright LLLGB 2016.