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When Supplementation of a Breastfed Newborn Is Medically Necessary

Supplemental Nursing System (SNS)
If your baby can latch on and breastfeed but requires supplemental milk for a legitimate medical reason, it is possible to feed the supplement while your baby nurses at the breast by using the SNS device. This method causes no disruption of nursing and actually enhances breastfeeding by giving the baby an immediate reward for her efforts. Convenient starter SNS kits are available for short-term use. Ask whether the lactation specialist at your hospital or one of the newborn nurses has experience using the SNS and could assist you. The SNS works best when a baby has learned to latch on correctly to the breast, but still requires additional milk. Babies with significant latch-on problems may not be able to correctly grasp the SNS tubing while taking the breast.

Cup, spoon, dropper, syringe. In other parts of the world, newborns who require supplemental milk frequently are fed by cup or other method that avoids the use of bottles. Some experts claim that alternative feeding methods are preferable to bottle-feeding, especially when a baby who does not yet know how to breastfeed effectively requires supplemental milk. Cup feeding is not difficult and several options exist, ranging from one-ounce plastic medicine cups available in every hospital to specially made cup-feeding devices designed for supplementing breastfed newborns. Inquire whether one of these methods might be used to give your baby the prescribed supplement and ask that the technique be taught to you.

To cup feed, the baby is held upright and the brim of the cup rests gently on the lower lip. The cup is tipped slightly so the milk just touches the baby's lips. The milk is not poured! Rather, the infant is allowed to lap and then sip the milk at his own pace.

Because babies need to suck, both for comfort and for proper development of the oral structures and speech, I don't advocate cup feeding for the long term. Rather, I see it as a temporary method of giving necessary supplement that is unlikely to interfere with learning to breastfeed. Once a mother's milk increases in abundance, supplement may no longer be necessary if a baby has learned to nurse effectively.

A baby also can be fed with a plastic spoon used in a similar manner to a cup. Some health care providers use an eyedropper to feed milk the same way oral medications are given to a baby. Others have experience feeding newborns with a regular syringe (without the needle, of course) or a periodontal syringe that has a curved plastic tip. If your baby needs supplement, and you prefer a bottle not be used, one of these options might be suitable when an SNS is not available. Don't try using any of these alternative methods yourself without receiving firsthand supervision from a health professional experienced in their use.

Deciding What Type of Supplemental Milk to Use
A mother's own expressed breast milk makes the ideal supplement. You may be able to obtain sufficient colostrum or milk using a hospital-grade electric breast pump. If a larger volume of milk is needed than can be expressed, formula will be necessary (unless you are fortunate enough to have access to screened, processed donor breast milk from a milk bank. If formula becomes necessary for your baby while in the hospital, deciding which one to use can leave your head spinning. Ideally the decision would be made jointly with your baby's doctor and based on your family history of allergies and other medical factors. Hopefully, only a minimal amount of supplement will be necessary until your own milk increases in volume. In addition to the multiple brands of cow's milk-based infant formula available in the United States, several soy-based options also exist. However, soy formula has no advantage over cow's milk-based formula for supplementing breastfed infants and has no proven value in preventing allergies. When a strong family history exists for allergic disease, such as food allergies, asthma, or eczema, I prefer to use a hypoallergenic formula, despite its extra expense. When one or more family members has allergic disease, it becomes especially desirable for mothers to breastfeed as long as possible. A lactose-free, cow's milk-based formula also is available. However, I see no advantage to avoiding lactose in a breastfed baby, since breast milk itself contains the milk sugar, lactose.

From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.

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