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7.5.1 Feeding-line device at the breast

There are various types of feeding-line devices commercially available; they can also be improvised. The supplemental milk is contained in a soft pouch or bottle, and a length of fine, soft tubing reaches from the milk receptacle to the breast at the nipple/areolar complex.

As the baby suckles at the breast, milk is removed from both the breast and the feeding-line device. This is an excellent method of providing supplemental milk. It avoids any possibility of suck confusion, stimulates the mother's breastmilk production, enhances the infant's suck vigor by creating a steady milk flow and lessens the likelihood of breast refusal when supplementation becomes necessary.

Unlike any other form of supplemental feeding method, the at-breast supplementer will never compromise the mother's milk supply and in most circumstances, it will enhace milk supply or stimulate supply to achieve the highest possible production in the individual mother.

When to choose an at-breast feed line

An at-breast supplemental feed line provides a constant flow of milk to the infant while he suckles on the breast. The infant will draw milk from the breast and the supplementer at the same time. It may be very useful for:
  • newborn requiring supplementation for medical reasons
  • mothers with a chronic low supply (ie. due to infant poor feeding or conditions such as hypoplasia)
  • failing to thrive infants who are still willing to breastfeed
  • infants with low tone (primary hypotonia or secondary due to underfeeding)
  • some cases of breast refusal in the older infant who is frustrated with a slow milk flow

Clinical tip

Insufficient milk flow will very quickly cause the infant to lapse into non-nutritive sucking or display breast refusal behaviour.
Newborns imprint that the breast is the place which provides all their needs. An at-breast feed line can rescue a breastfeeding relationship which is threatened by poor infant-breast association. Consider a feed line as a first choice rather than a last resort. Become proficient with it's use so that you can confidently assist mothers.

Does your unit use any feed lines? Practice with a 'home-made' version using a syringe and naso-gastric feedling tube and organise to purchase a demonstartion kit which mothers would use at home for longer term supplementing.

Equipment

  • the feeding line device, ready-to-use
  • hypoallergenic tape
Note: an improvised feedline can be may with a 10/20ml syringe, or other milk receptacle, and an infant-size naso-gastric tube. The tube is placed alongside the nipple as with the kit feeding line.

Preparation

  • Warm the milk to be used as a supplement.
  • Prime the tubing with the supplement milk, either by gravity or by vacuum (suction).
  • Tape the distal end of the tubing to lie alongside the mother's nipple, with tape away from where baby will latch. The tubing is best placed on the breast to be just above the corner of the infant's mouth, not in the middle of the top lip.

Technique

  • Latch the baby as usual, ensuring the soft tubing passes into baby's mouth as he latches to the breast. (Instruct the mother to visualise that the tubing will be running alongside the length of the nipple so it sits in the groove of the tongue during sucking.
  • Breastfeed as usual.
  • Milk flow can be controlled by

    • raising the milk container; the flow of the supplement is easier to initiate and requires less suction to maintain flow,
    • lowering the milk container; the flow will be slower, requiring greater suction from the baby, or
    • clamping the tubing off initially, encouraging baby to remove as much breastmilk from the breast as possible before unclamping the supplement.
At-breast supplemental feeding line.

At-breast supplemental feeding line.
© Goldfarb Breastfeeding Clinic