Alternative feeding methods

To preserve the integrity of breastfeeding establishment and duration among term and preterm infants who require long or short term supplemental or complementary feedings.

• cost and availability
• ease of use and cleaning
• stress to the infant
• whether adequate milk volume can be fed in 20-30 minutes
• whether anticipated use is short or long term
• maternal preference
• whether the method enhances development of breastfeeding skills.

Criteria to consider:

Bottle feeding

"Why not just use a bottle? "

"It is important to preserve the reflexes and natural sucking mechanism in an infant of a mother who intends to breastfeed. The action of sucking at the breast is a "rocker" like action and a vacuum is created which draws the milk out of the breast. The action of sucking on an artificial teat is a "piston" like action which compresses the teat to extract the liquid. In order to improve the long term duration of breastfeeding it is essential to explore all available options, prior to offering an artificial teat, when giving supplementation to an infant whose mother is planning to breastfeed."

Joint Commission encouraged moms to ask staff not to give their baby a pacifier or bottle, indicating that these should not be given until babe is 4 weeks old and breastfeeding is well established. (Nov. 2013 Speak up campaign)

Ten Steps to Successful Breastfeeding: WHO and Unicef

Step 6: Give newborn infant no food or drink other than breastmilk, unless medically indicated.

Step 9: Give no artificial teat or pacifiers to breastfeeding infants.

Clinical Practice guideline, Ballarat Health Services. Alternative feeding Methods (2010)

Bottle feeding is the most commonly used method of supplementation in more affluent regions of the world, but is of concern because of distinct differences in tongue and jaw movements, differences in flow, and long-term developmental concerns.

And of course, SAFETY!

Steps to decrease supplementation use in Normal Newborn and support breastfeeding:

"Do you feel a research project coming on?"

With very little research on the use or efficacy of alternative feeding methods, or whether their use truly increases breastfeeding success rates, maybe we take the lead.....

Protecting Breastfeeding and providing "tailored" care:

• Adopted delayed bathing policy from BMC (evidenced-based practice that can promote establishment of breastfeeding, decrease stress, stabilize temp, blood sugar, etc.)
• Continued skin to skin holding as often as tolerated to promote and establish breastfeeding, milk supply and it is also evidenced-based to assist in regulating blood sugars.
• If supplementation is medically indicated for an exclusively breastfed baby, use alternative feeding method for administration, preferably SNS at breast; otherwise cup or finger feeding.
• Allow for expressed breastmilk to be the supplementation if volumes needed are able to be obtained.

Hypoglycemia in breastfed Neonates

Any approach to management needs to account for the overall metabolic and physiologic status of the infant and should not unnecessarily disrupt the mother-infant relationship and breastfeeding. The definition of a plasma glucose concentration at which intervention is indicated needs to be tailored to the clinical situation and the particular characteristics of a given infant.

PEDIATRICS, vol. 127, #3 March 2011 (from the AAP)

Per ABM protocol # 1:

1) Newborns with documented hypoglycemia should continue to breastfeed Q 1-2 hours or feed 3-5 ml/kg (up to 10 ml/kg) of expressed breastmilk or formula. Cont. to monitor blood glucose concentration AC until the value is acceptable and stable.

Cup feeding

If blood glucose levels do not stablize and/or the infant is unable to suck or feedings are not tolerated, it is recommended that forced feedings be avoided, (e.g. NG tube) and IV glucose therapy begin.

Early and frequent skin to skin contact and frequent breastfeeding has been proven to regulate blood sugar.

Cup feeding is a method of feeding a baby that has been around for a very long time and is used throughout the world.

"Cup feeding has been shown safe for both term and preterm infants and may help preserve breastfeeding duration among those who require multiple supplemental feedings."

ABM Protocol #3

SNS

Supplemental Nursing System

• It enables both breastfeeding and supplementation to be done at the same time, decreasing the time spent to accomplish each feeding.

• A feeding can easily be consumed within the allotted 20-30 minutes (ABM, 2011).

• It can also increase the efficacy of milk removal at the breast.

Supplemental nursing systems have the advantage of supplying appropriate supplement while simultaneously stimulating the breast to produce more milk and reinforcing the infants' feeding at the breast.

Disadvantages of commercial SNS: awkward to use, difficult to clean and expensive. ( Would use for specific patients with long term needs. Ex: IGT, hypoplasia, breast augmentation history, adoptive mother).

A simpler version, supplementing with a 5 french feeding tube and syringe while infant is at breast, may be effective.

ABM # 3 (2009)

The Goal:

Conclusion:

We all want what is best for our babies and their families. We want the best outcomes for them. Breastfeeding is certainly NOT an easy process for most at first, especially in the initial days of establishing when they are in our care! We NEED to work together to support our mom's and babies and give them the absolute best environment and supportive care to establish breastfeeding.

Finger feeding

Alternative feeding methods

Finger feeding is a technique in which it's main purpose is to prepare a baby to take the breast when they are refusing or reluctant to latch on. It is a great way to pre-feed a baby who is being prepared to attempt breastfeeding. It is not preferred for entire supplemental feedings. SNS or cup feedings are preferred for full supplemental feeds.

Reference:

1. ABM protocol # 3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2009. Pg. 175,178.

2. Cole, Sandra. Breastfeeding Challenges Made Easy for Late Preterm Infants. Springer Publishing, 2014.

3. Breastfeeding Handbook for Physicians. AAP and The American College of Obstetricians and Gynecologists, 2006. pg. 164-166.

4. Cup feeding for low-birth weight infants unable to fully breastfeed, 2011. http://www.who.int/elena/titles/cupfeeding infants/en/

5. The Ten Steps to Successful Breastfeeding. World Health Organization. http://www.babyfriendlyusa.org

6. Nye, Carla. Transitioning Premature Infants from Gavage to Breast. Neonatal Network, vol. 27, No. 1, Jan/Feb 2008.

There are many alternative feeding methods from which to choose:

a SNS device at the breast, cup feeding, spoon or dropper feeding, finger-feeding, syringe feeding, or bottle feeding.

*An optimal supplemental feeding device has not yet been identified, and may vary from one infant to another. NO method is without potential risk or benefit.

There is very little evidence about the safety and efficacy of most alternative feeding methods and their effect on breastfeeding.

ABM Protocol #3

Alternative feeding methods