Supplementation is a way to give your baby extra nutrition and calories while breastfeeding. Read about what supplies are required and tips for successful feeding.
Key points
Supplementation is a way to give your baby extra nutrition and calories while breastfeeding.
Side-lying bottle feeding, lactation aids, and finger feeding are all methods used to supplement breastfeeding babies.
A feeding session usually lasts between 20 and 30 minutes, including supplementation.
Keeping babies in a breastfeeding position during supplementation allows them to use all the feeding skills they are born with.
If your baby’s feeds are being supplemented, you will need to frequently check your baby’s weight to ensure that they are growing well.
Introduction
The terms 'mother' and 'breastfeeding' are used throughout our documents; we recognize and respect that individuals and families may use other preferred terminology.
Why do I need to supplement my baby’s feeds?
There are a variety of reasons for supplementing your baby’s feeds both while they are in the hospital and once they go home. A few reasons might include:
Your milk supply is low or you are not able to breastfeed.
Your baby needs extra calories or liquids to gain weight.
Your baby gets tired easily during feedings and this is impacting your baby’s weight gain.
Supplementation methods
Supplementation is a way to give your infant extra nutrition and calories while breastfeeding. The extra liquid food that you provide to your baby is called a feeding supplement.
The most common supplementation methods include:
Side-lying bottle feeding
A lactation aid
Finger feeding
If your baby requires supplemental feeding, speak to a lactation consultant (LC) or health-care provider for support in the use and assessment of feeding techniques and supplies.
Preparing for the treatment
Supplies you will need to supplement your baby’s feeds
Supplies you will need to feed your baby using a bottle
You may substitute the number 5 French feeding tube and bottle/syringe with a Supplemental Nursing System, which is a feeding device that includes both a feeding supplement reservoir and a feeding tube.
Ask your LC or health-care provider where to buy these supplies. Some hospitals, drugstores and medical supply stores may carry them. If you are unable to get these supplies at your location, they can also be ordered in person, on the phone or online from The Specialty Food Shop at The Hospital for Sick Children in Toronto. For details, go to: https://www.specialtyfoodshop.ca/products/baby-kids/infant-feeding-supplies/breast-pumps-supplies or call 1-800-737-7976. The Specialty Food Shop may be able to ship these supplies to your location.
The Supplemental Nursing System is also available from the manufacturer. For details, go to: http://www.medela.ca/.
Treatment
Side-lying bottle feeding
Side-lying bottle feeding works best in a ‘football hold’ (see illustration). It is important to keep the bottle parallel with the floor and to keep the bottle nipple half full so that gravity is not driving the feed. Using a slow flow nipple also helps to make sure the milk flow is not too fast for your baby.
Prepare the feeding supplement of expressed breast milk or formula. If you are using a fortified feed, follow the recipe written by your baby’s dietitian.
Pour the supplement into the bottle.
Lie your baby on their side and support their neck and head with your hand. The bottle is held in the opposite hand.
Touch baby’s lips with the bottle nipple and let the baby pull it into their mouth. Keep the nipple touching the roof of the baby’s mouth during the feed. A typical feed lasts 20–30 minutes. Encourage the baby to drive the feed, allowing them to pace themselves.
Lactation aid
A lactation aid works best with babies who are latching (attaching) and feeding well at the breast. Getting started with a lactation aid can sometimes be challenging. It takes a bit of practice, but it gets easier each time you do it. Ask your nurse/LC to help you with one of these two methods of using a lactation aid while breastfeeding.
Method 1: Taping the lactation aid to your breast before your baby latches to the breast
Prepare the feeding supplement of expressed breast milk or formula. If you are using a fortified feed, follow the recipe written by your baby’s dietitian.
Lactation aid using a syringeFasten the syringe to your clothing.
If you are using a syringe, fasten the wide end of the feeding tube to the tip of the syringe. Remove the plunger from the syringe. Pour the feeding supplement into the syringe. Put the elastic band around the top of the syringe. Then put a safety pin through the end of the elastic so that you can fasten the syringe to your clothing. The bottom of the syringe should be at the same level as your baby's head.
Lactation aid using a bottleThe bottle should be at the level of the baby's head.
If you are using a bottle, put the small end of the feeding tube through the enlarged nipple hole, leaving the large end of the tube touching the bottom of the bottle. Pour the supplement into the bottle. Put the bottle on a flat surface close to you, at the level of the baby's head.
Hold the breast so that your thumb and fingers are parallel to the baby’s lips. If required, you can secure the feeding tube under your thumb.
Tape the small end of the feeding tube to your breast. The feeding tube should come down from the top of your breast or come from the side of your breast. The feeding tube should end just at the end of your nipple.
Milk will flow along the tube when the tube is in the correct position.
Latch your baby onto your breast so that their mouth covers the end of the tube and the breast.
Method 2: Sliding the lactation aid into the baby's mouth after the baby latches onto your breast
Prepare the feeding supplement of expressed breast milk or formula. If you are using a fortified feed, follow the recipe written by your baby’s dietitian.
If you are using a syringe, fasten the wide end of the feeding tube to the tip of the syringe. Remove the plunger from the syringe. Pour the feeding supplement into the syringe. Put the elastic band around the top of the syringe. Then put a safety pin through the end of the elastic so that you can fasten the syringe to your clothing. The bottom of the syringe should be at the same level as your baby's head.
If you are using a bottle, put the small end of the feeding tube through the enlarged nipple hole, leaving the large end of the tube touching the bottom of the bottle. Pour the supplement into the bottle. Put the bottle on a flat surface close to you, at the level of the baby's head.
Latch your baby onto your breast.
Latch your baby onto your breast. Your baby should be latched on well and feeding.
Slide the feeding tube in beside the nipple in the corner of the baby's mouth.
Once your baby is sucking well at the breast, slowly slide the feeding tube into the side of your baby's mouth. Aim the feeding tube toward the roof of the mouth on top of the tongue. Stop moving the tube when you see the feeding supplement start to move in the feeding tube towards the baby's mouth. Tape the feeding tube to your breast.
Milk will flow along the tube when the tube is in the correct position.
With either Method 1 or Method 2, you will know that the feeding tube is in the right place if you can see the feeding supplement start to move along the feeding tube each time your baby sucks.
Finger feeding
To finger feed your baby, follow these steps:
Wash your hands thoroughly. Parents can use their bare finger or thumb, or you can cover your hand with a hospital glove. Health-care professionals will wear a glove if they finger feed your baby. Make sure the nail on the finger or thumb that you will use is cut short so that you do not hurt your baby's mouth.
Finger feeding with a bottleThe bottle should be on a flat surface so the fluid in the bottle is level with the baby's head.
Pour the feeding supplement into a bottle. Put the wide end of the feeding tube into the feeding supplement. Put the small end of the feeding tube through the enlarged nipple hole, leaving the large end of the tube touching the bottom of the bottle. Place the bottle on a flat surface close to you so the fluid is at the same level as your baby's head.
Finger feeding with a syringeThe pinned syringe should be at the same level of your baby’s head.
If you are using a syringe, attach the wide end of the feeding tube to the tip of the syringe. Pour the feeding supplement into the syringe barrel. Place the elastic band around the top of the syringe. Then put a safety pin through the end of the elastic. Pin the syringe to your clothing so the bottom of the syringe is at the same level as your baby's head.
Sit comfortably with your baby on your lap. Your baby should be lying on their left side in the same position used for the ‘football hold’ for breastfeeding. Hold your finger or thumb soft side up. Place the thin end of the feeding tube on your finger/thumb so that the end of the feeding tube is at the end of your finger. Tape the feeding tube in place behind the second joint of your finger or the first joint of your thumb.
Tickle your baby's lip so that they start to root, then allow your baby to pull your finger into their mouth.
Let your fingertip move to the back of the baby's mouth with each suck. Your finger should just touch the ridge at the top of the mouth where the hard part of the mouth becomes soft. Your finger will be in your baby's mouth up to between the first and second knuckle.
The feeding supplement should flow when the baby sucks and stop when the baby stops sucking. You should hear swallowing with each suck.
More information about the treatment
Tips for using a lactation aid
The feeding supplement should flow when the baby sucks and stop when the baby stops sucking. Your baby is getting enough feeding supplement if you can hear them swallowing with each suck.
If your baby is not getting enough feeding supplement:
Check for bends or kinks in the feeding tube.
Check the position of the feeding tube in your baby's mouth.
Correct the height of the bottle or syringe of feeding supplement so that your baby can feed at their own pace. If your baby is getting the feeding supplement too fast, lower the bottle or syringe of feeding supplement a few inches below the baby's head.
Ask your baby's health-care provider how much feeding supplement your baby should be getting at each feeding and how often they should be fed.
This information will give you an idea of how much breast milk or formula to prepare and how often your baby might want to eat.
Cleaning your lactation aid
You can re-use your lactation aid supplies at home as long as you clean the supplies thoroughly right after use. Follow these steps to clean the supplies:
Wash your lactation aid supplies with warm soapy water, using a dish washing soap. Make sure to run the water through the tube as well as the supplement reservoir. If using a syringe, attach it to the larger end of the tube. Fill the syringe with soapy water. Insert the plunger and push the water through the tube. For bottles, make sure holes in nipples are not clogged.
Rinse the supplies well with clean warm water. Again, run this water through the tube. Make sure there is no dry feeding supplement left in any parts of the lactation aid supplies. If using a syringe, fill it with air and push the air through the tube to remove the water.
Keep the feeding supplies wrapped in a clean towel or in a sealed plastic bag after you wash them.
For home use, the feeding tube can be used for seven days or until the feeding tube becomes hard.
Note: You should not boil the lactation aid supplies because boiling will make the plastic hard.
How long should it take to feed your baby?
Supplemental feeding should not take longer than any other method of feeding. A feeding session usually lasts between 20 and 30 minutes.
Follow-up care
Knowing how long to supplement your baby
It is important that you understand why you are supplementing your baby’s feeds and how weight and growth will be monitored. See your baby’s health-care provider one to two days after leaving the hospital. Talk to them about your baby's weight and growth. Your baby should be weighed naked on a baby scale to measure an accurate weight. Your birth hospital may also have a breastfeeding clinic to help with feeds and monitor weight gain. Make sure that you take your baby to the doctor for regular check-ups to see how well your baby is gaining weight and growing.
As soon as your baby is at a good weight for their age, your baby's health-care provider will tell you how to slowly decrease the strength or amount of feeding supplement you give your baby. When your baby is getting enough milk from the breast alone, you will be able to stop the feeding supplement.
These are important signs that your baby is feeding well:
Your baby is gaining weight.
Your baby has at least six to eight soaking wet diapers every 24 hours by the time they are 5 days old.
Your baby has two or more bowel movements every 24 hours in the first month of life.
After a month, your baby may have fewer bowel movements each day but should still have six to eight soaking wet diapers every 24 hours.
When to seek medical attention
When to see a health-care provider
If you have any concerns about your baby at any time, call your health-care provider.
If you have concerns about the supplement you are feeding your baby, call your health-care provider.
At SickKids
At SickKids
If you have any questions about supplemental feeding or breastfeeding in general, please call the Breastfeeding Program at 416-813-5757 ext 2.
