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7.3.1 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 with the feeding line also in his mouth, milk is removed from both the breast and the feeding-line device. This is an excellent method of providing supplemental milk.

It

When to choose an at-breast feed line

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 and become proficient with its use so that you can confidently assist mothers.

How to use a tube-feeding device at the breast

Assemble what you need

  • the feeding line device, assembled
  • hypoallergenic tape
  • the supplement
  • an alert baby who is willing to latch to the breast

Preparation

  • It is assumed you will have already discussed everything about the need for supplementation and what and how it will be given with the mother and the infant's doctor.
  • Warm the milk to be used as a supplement.
  • Prime the tubing with the supplement milk, either by gravity or by vacuum (suction).

Technique

  • 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.
  • 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.