With early and frequent breastfeeding attempts, most mothers and babies can successfully establish breastfeeding. Although initially some infants may not latch effectively or feed well, most will succeed with time and practice. If your baby is not breastfeeding well, having inadequate diaper output, showing signs of excessive weight loss, or other issues, temporary supplementation may be necessary. If a supplement is medically necessary, mother’s own milk is the preferred option, followed by donor human milk, and then formula.¹ 

While a bottle may seem like the most practical way to offer your baby extra milk, research shows that introducing artificial nipples to breastfed babies can have negative effects on breastfeeding. Babies who get bottles before breastfeeding is well established are more likely to refuse to breastfeed, have difficulty latching, wean earlier, and are less likely to transition to exclusive breastfeeding.² Breastfeeding is considered well established when mothers have a sufficient milk supply, when their baby has a consistent, comfortable, and effective latch, and appropriate weight gain. It’s important to know that the time required to establish breastfeeding varies between mothers and their babies.

Providing any needed supplement through an alternative feeding method will ensure your baby is well fed, while giving you both time to work on improving breastfeeding. Alternative feeding methods are also preferred to prevent overfeeding and to encourage self-regulation. 

Alternative feeding methods may be helpful for a variety of circumstances:

Spoon

Using a spoon to offer your baby supplemental colostrum in the first few days is a low tech intervention to ensure your baby is getting plenty of milk while you are both learning to breastfeed.¹  If your newborn is having trouble latching or is extra sleepy, hand express your colostrum directly onto a spoon and offer it at the next feeding, while continuing to offer your breast frequently.

How to Spoon Feed  

1. Hold your baby in an upright position.
2. Fill the spoon with milk and bring it to the baby’s bottom lip.
3. Allow your baby to instinctively lap up and swallow the milk.
4. Allow your baby to set the pace and length of the feeding.

Cup

Using a medicine cup is another way to provide supplements.^1,3 Even the smallest of infants can drink from a cup. Studies show premature infants benefit significantly from cup feeding compared to bottle feeding.¹ With cup feeding, your baby will use the same muscles they use for breastfeeding (thrusting the tongue forward to lap up the milk). Cup feeding is an excellent short-term feeding option that encourages breastfeeding.^1,3

How to Cup Feed

1. Make sure your baby is awake and alert.  Hold them in an upright position.
2. Place a bib or towel under your baby’s chin. 
3. Bring the cup to the baby’s mouth, grazing the bottom lip. Your baby will begin to lap or slurp up the milk. As the baby feeds, slowly lift the cup but do not pour into the baby’s mouth. 
4. Allow baby breaks and burp as needed. 
5. Continue the process until feeding is complete. 

Syringe

Feeding your baby using a syringe can be done in combination with breastfeeding.¹ When your baby is latching to the breast, insert the tip of the syringe in the corner of your baby’s mouth and slowly press the syringe to give the supplementation. Syringe feeding can also be used with the addition of small flexible tubing at the breast or with your finger. Ideally, with a sleepy baby, this will encourage them to breastfeed actively with a deeper latch. 

Finger Feeding 

Finger feeding involves the use of a thin tube attached to a syringe filled with expressed breast milk or formula. Wash your hands with hot soapy water or use a glove. Place your index finger, soft side up toward the roof of baby’s mouth, and allow them to suckle on your finger. It is important to have your baby open their mouth wide so they learn the same skills they will need to breastfeed.¹  Insert the tubing, next to your finger, in the corner of baby’s mouth and slowly press on the syringe to provide the supplement. This temporary method can train a baby to suck and latch correctly and strengthen oral development.

Supplemental Nursing System (SNS)

A supplemental nursing system is used while the baby is breastfeeding, eliminating the need to offer a supplement after breastfeeding.¹, For this method, a small thin feeding tube will be attached to your breast, and the end of the tube will be connected to a bottle or small container (such as a syringe) with breast milk or formula. SNS can be used short or long-term. The benefits of using an SNS include practicing direct breastfeeding, more skin-to-skin time, and the stimulation of more milk production. An SNS is preferred if the baby is latching well, but cannot receive an adequate amount of breast milk or is sleepy at the breast. As baby breastfeeds, they receive milk directly from the breast plus the added supplement.¹

Reasons for using an SNS can include:

• preterm baby
• latching with poor milk transfer 
• low milk supply
• breast surgery, such as reduction
• induced lactation and relactation 

Bottle Feeding

Bottle feeding is the most common method of feeding babies. Not all bottle nipples labeled as “breastfeeding friendly” work well for breastfed babies.² Many bottle nipples, even slow flow nipples, have a much faster flow than the breast. When choosing a nipple, look for a shape that encourages your baby to latch deeply, extend their tongue, and cup their tongue around the nipple with relaxed lips.  A bottle nipple that slopes gradually from the tip to the base will help to ensure that they get a deep latch and not just nipple feed.

Pacing the flow of the supplement that your baby consumes will make the transition from bottle to breast easier. Paced bottle feeding helps to prevent gas, reflux, colic, overfeeding, and choking, and can be especially important for premature infants. 

How to use Paced Bottle Feeding

What If I Have Questions?

If you are interested in learning more, this Aeroflow class expands on some of the topics discussed above:

• Ultimate Breastfeeding Prep

Want More Info?

For a directory of Aeroflow’s other Care Guides offering information on pregnancy, baby care, and more, browse our comprehensive list of titles:

References