Methods of feeding expressed breast milk to your baby

All of the supplementary feeding methods detailed below should ideally be demonstrated to parents by a Lactation Consultant, Midwife or other competent Breastfeeding specialist, who should in most situations, is able to provide the necessary equipment or give you advice on where to purchase it.

Finger feeding

Using a feeding tube attached to your finger with tape, the other end of the tube can be connected to a syringe or placed in a bottle or other container. Baby learns to suckle as they would at the breast, in that the tongue and jaw move in a similar way to Breastfeeding, in addition the milk is mixed with salivary amylases in the mouth assisting with digestion. There is little risk with this method of baby aspirating milk into their lungs.

Feeding tubes are usually available from community midwives, Lactation Consultants and other Breastfeeding specialists. The ideal size is 6FR. The tubes can be cleaned by flushing them with a syringe and warm soapy water, then flushed with clean water and then hung on the racking of a steam steriliser. Alternatively they can be cleaned with sterilising solution.

This method is particularly effective for mothers wishing to minimize the possibility of their baby acquiring the preference the milk flow that a bottle teat may provide. It may sometimes be necessary to adjust the position of the end of the NG tube on the finger to prevent damage to baby’s mouth; some babies prefer to have the tube attached to the side of the finger.

Ensure that baby is swallowing milk and do not allow it to pool in their mouth as this could cause them to gag or choke. The flow can be controlled by either raising or lowering the syringe or bottle, don’t forget to give baby winding breaks!

Syringe feeding

This can undertaken by directing the milk a tiny amount at a time to the inside of the cheek, the parent’s finger can also be placed in the mouth with the tip of the syringe similar to finger feeding. Follow the safety tips as for finger feeding.

Spoon feeding

Hold baby in an upright position, the spoon can be held to the baby’s bottom lip and baby laps the milk out of the spoon, this may not be suitable if your baby is tongue tied as they may have difficulty extending their tongue over the gums to lap the milk. Avoid pouring the milk into baby’s mouth as this can result in gagging, choking or aspiration.

Cup feeding

The milk is placed in a special baby feeding cup or something similar like an egg cup, and baby is fed as above as in spoon feeding. It is important to observe the safety tips described above, and again this method may not be suitable for Tongue-tie babies.

Supplemental nursing system

This is a device where the milk is placed in a bottle or syringe that can be hung around the mother’s neck. A fine tube is connected from the bottle and can be taped to the mother’s breasts or her finger.

This device has a valve system so that the baby only gets the milk in the bottle when they suckle. The tubes can also be attached to the parent’s finger or attached underneath a nipple shield for babies that need the palate stimulating prosthetic effect of this.

The bottle is usually made of soft plastic that can be squeezed gently during the course of a feed to simulate breast compression and or milk let downs. Don’t forget to offer baby winding breaks.

A note on the use of nipple shields
You may find the use a nipple shield helpful if;

• The nipples are flat or inverted (nipple shields offer a prosthetic effect stimulating baby’s palate, enabling them to suckle)
• Baby is tongue tied
• The nipples are damaged or painful

The use of nipple shields is advisable as a temporary measure for the above reasons, however when using them it is important to get the right size for you, by the diameter of the nipple not the length. The images above demonstrate how they should be applied, it is not necessary for the nipple to reach right to the end of the teat.

When using a nipple shield it is important that baby breast feeds and it not just sucking on the end of the nipple shield. To do this, ensure good Breastfeeding technique and that baby’s cheeks are in contact with the breast, you should not be able to see the teat of the nipple shield moving in and out of baby’s mouth. For more advice on positioning your baby correctly for Breastfeeding with or without a nipple shield please read my Problem Free Feed download.

Bottle feeding

Breastfed babies suckle, bottle fed babies suck.

When babies breastfeed they have to get the nipple in just the right place in their mouth, exert negative pressure (suck), move their tongue in a rhythmic wave like motion, form a collection of milk (bolus), coordinate the swallow without inducing gagging, breathe, initiate milk let downs and cope with variations in flow. All at the same time! They have acquired a specific neural pathway to achieve this when they breastfeed.

Bottle feeding is different; the tongue moves in a different way, and flow is largely controlled by the teat opening size. When a breastfed baby is offered a bottle they need to acquire a new neural pathway, this can take time.

Some babies may leak or dribble milk from their mouths whilst bottle feeding. This can be due to inadequate tongue mobility as a consequence of the presence of a tongue tie. It may also be due to baby over excursioning (bringing their jaw down too far whilst feeding). Feeding baby in a more upright position and supporting the chin with your index finger or rolled muslin to prevent over excursion can help.

When using expressed breast milk a smaller bottle i.e. 160 mls is preferable, as it presents a smaller surface area for the fat to stick to the inside of the bottle, (the fat sticking to the inside of the bottle means that the baby doesn’t get this important part of the feed). Bottles with valve systems that enable the baby to exert a similar negative pressure in the mouth similar to when they breastfeed may be beneficial.

Some mothers find a banana shaped bottle angle easier for some babies to feed and ensure that the breast milk is always in contact with the teat.

Whilst Breastfeeding use a slow flow teat, once baby is competent with this, you may progress to faster flow teats. Baby is ready for faster flow teats if they are sucking too hard on the teat causing it to collapse and deflate.

For more information on feeding your baby from a feeding device, read Katherine’s complete guide Your breast fed baby and expressed breast milk