POLICY/PROCEDURE TITLE:
Women & Infant Services
RELATED TO:
[ ] Medical Center Policy (MCP)
[ ] Nursing Practice Stds.
[ x ] JCAHO
[ ] Patient Care Stds.
[ ] QA
[ ] Other
Breastfeeding:
Supplementation/Alternative Feeding
Methods for Newborns (>35 weeks)
[ ] ADMINISTRATIVE
[ x ] CLINICAL
PAGE 1 OF 3
Effective date: 1/09,
Reviewed date: 1/10
Revision date: 8/10
Unit/Department of Origin: FMCC
Other Approval:
[ x ] Title 22
POLICY STATEMENT:
1. To maintain the integrity of breastfeeding for the mother/infant dyad and provide temporary alternative
methods of feeding should the infant not be able to sustain a latch at the breast, not have successful
milk transfer, be temporarily separated from the mother or require additional supplementation.
2. When making the decision to give formula supplementation it is necessary to look at all the factors
involved including infant ability to breastfeed and transfer milk, maternal milk production, and infant
weight and hydration status. Weight loss alone does not imply the need for formula supplementation.
RESPONSIBLE PARTY:
Nurses and Lactation Educators from FMCC, Birth Center, L&D and ISCC.
EQUIPMENT:
10 ml syringe
5 fr feeding tube
Tape
Medicine cup
Gloves
Volufeeder and nipple
PROCEDURE:
1. Assess infant ability to feed: observation at breast, latch score, weight loss, hydration status.
2. Assess mother’s breastmilk supply at least every 12 hours and prn to determine if supplementation is
needed.
3. Consider a pre/post weight check in order to assess milk transfer.
4. Avoid bottles if possible for supplementation.
5. Mothers who are supplementing should be double pumping every 3 hours to stimulate milk supply and
empty breasts, unless infant is latching and sucking well.
6. Criteria for supplementation:
 Infant weight loss > 10% and maternal milk volume judged to be insufficient.
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Baby with extreme hunger cues (“frantic”, excessive weight loss (>10%), signs/symptoms of
dehydration, hyperbilirubinemia judged to secondary to poor intake) and maternal milk volume
judged to be insufficient.
Infant more than 24 hours old and unable to latch and/or suck.
Hypoglycemia after breastfeeding (see W&IS P&P: Hypoglycemia Management of Newborns at
Risk).
Late preterm (<37 weeks)/low birth weight/IUGR infant.
Maternal insistence after education.
Brief infant separation from mother.
7. If it is determined that supplementation is necessary, establish which alternative feeding method will be
most beneficial to couplet.
8. Please see W&IS Feeding Guidelines for frequency and volume of supplementation.
9. Supplemental Nursing System (SNS): feeding tube at breast while breastfeeding. This is the
preferred method to encourage exclusive breastfeeding and stimulate the breasts in order to increase
milk production.
 Wash hands
 Prepare equipment: draw up human milk or term formula into 10 ml syringe(s) or 20cc syringe
as intake increases. Connect syringe and prime a 5 fr feeding tube with milk. If a bottle and
nipple are being used instead of 20 cc syringe, make a hole in the nipple and place feeding tube
through hole.
 Place feeding tube at nipple, extending approximately ¼ inch past the nipple. Suggested tube
placement is at 12 o’clock position for football/clutch position or 9 o’clock (right breast)/3 o’clock
(left breast) for cradle hold. Tube should be placed at top of infant’s mouth between the nipple
and palate. Tube can be taped vertically for easier placement.
 Latch infant with correct alignment.
 If positioned correctly, milk will be drawn out of syringe with each suck.
 If infant is not pulling the milk from the syringe, the milk can be slowly advanced by gently
pushing on the plunger as the infant sucks.
 Supplementing with the tube should generally not exceed volumes of 60cc or be used longer
than one continuous week.
10. Finger Feeding: feeding tube with a finger. This method can be used when mother is unavailable,
exhausted or has sore nipples and unable to latch infant.
 Wash hands
 Put on gloves. If parent is doing the finger feeding, gloves are not necessary.
 Prepare equipment: draw up human milk or term formula into 10 ml syringe(s) or 20cc syringe.
Connect syringe and prime a 5 fr feeding tube with milk. If a bottle is being used instead of
syringe for greater volume, make a hole in the nipple and place feeding tube through hole.
 Place feeding tube either along the side or pad of the finger. The end of the feeding tube should
meet the end of the finger. Tape to secure placement.
 Use finger tip to elicit a rooting reflex and insert finger and tube when infant opens mouth.
Finger should be inserted with pad side on the infant’s hard palate. If positioned correctly, milk
should be drawn out with each suck.
 If infant is not pulling the milk from the syringe, the milk can be slowly advanced by gently
pushing on the plunger as the infant sucks.
 Supplementing with the tube should generally not exceed volumes of 60cc or be used longer
than one continuous week.
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11. Cup feeding: supplemental feeding using a medicine cup. This method can be used when mother is
unavailable, exhausted or has sore nipples and unable to latch infant.
 Assess infant for coordinated suck and swallow. If not swallowing well do not use this method.
 Pour 5-10 mls of human milk or term formula into a medicine cup. Refill the cup as needed.
 Place infant in a semi sitting position.
 Direct the rim of the cup towards the corners of the upper lip and gums with it gently
touching/resting on the lower lip. Do not apply pressure to the lower lip.
 Tip cup so that milk touches lips. The infant should begin to lap the milk from the cup. The
tongue should form a trough to bring the milk to the back of the throat so that swallowing can
occur. Milk should not be poured into infant’s mouth.
 Observe infant’s natural pauses between bursts of swallows. It is important to let the infant
pace herself/himself.
12. Documentation: Document all supplemental feedings.
 Reason/need for supplementation
 Date and time of feeding
 Method of feeding
 Quantity of supplementation
 Infant’s response
REFERENCES:
Lauwers, J. (2005). Counseling the Nursing Mother: A Lactation Consultant’s Guide. Massachusetts: Jones
and Barlett Sudbury.
Lawrence, R.A., Lawerence R.M. (2005). Breastfeeding: A Guide for the Medical Professional. St Louis:
Mosby.
Riordan, J. (2005). Breastfeeding and Human Lactation. Massachusetts: Jones and Barlett Sudbury.
Wellstart International: Lactation Management Program (2000).