How to offer additional milk to a baby who is not gaining weight? It is likely that the first thing that comes to your mind is a bottle. But if you have previously looked for information it is also likely that other methods such as finger-syringe, cup and spoon will come to your mind.
Choosing one of these methods on how to offer additional, supplemental milk, either expressed or artificial, to a baby who is not gaining weight can be a complex choice. In this post we explain the pros and cons of each method, to make it easier for you to choose the most appropriate method in your case:
How to offer supplementation:
Finger syringe method
The syringe-finger method is ideal in the first days or weeks of a baby and allows small volumes of colostrum or milk to be offered.
You only need a 5 to 20 ml syringe, depending on your preference. A trick to avoid having to carry the syringe around and keep the baby waiting is to place several full syringes in a cup so that you only have to change an empty syringe for a full one.
Place your baby with its head higher than its bottom. Introduce one of your fingers, clean and with very short nails, towards the baby’s palate. To choose the finger, we look for the one that most closely resembles the size of the nipple, as the finger will replace the nipple in the baby’s mouth.
The area between the soft and hard palate is stimulated with the fingertip, and the baby is expected to start suckling. At this point, press the plunger of the syringe so that the baby gets the milk. If the baby stops suckling, pause as well.
This method is very useful for babies with sucking difficulties or who are very sleepy, as they can take milk without effort. Babies who have difficulties sucking or have alterations in the positioning of the tongue can also benefit from this method, as the baby has to place the tongue in a similar position to the one it should be in when breastfeeding. This method is sometimes done with an adapter at the end of the syringe or with a tube, which can make the process a little easier, but in case the baby does not gain weight, it would be better not to use these, as part of the fat from the milk sticks to the plastic of the tube.
Positive aspects: it is an inexpensive method and it is easy to obtain the necessary equipment, in this case, the syringe. In addition, and very importantly, it respects when the baby is full. When the baby doesn’t want any more milk, it pushes out the adult’s finger from its mouth and ends the process. This is an ideal method for babies who are weak or have lost a lot of weight, as it does not require them to be awake to eat.
Negative aspects: among the less positive aspects, we should highlight that it requires time and patience from the adult and when the baby increases the amount she/he drinks this method usually becomes too slow.
Supplemental Nursing System (SNS)
The SNS is a device composed mainly of two parts, a “bottle” and two tubes. The bottle is usually placed between the two breasts (at a greater or lesser height depending on how high we want the milk flow to be) and the tube is placed on the nipple or on the side so when the baby latches on, the tube is also introduced into her mouth. In this way, when the baby breastfeeds, she stimulates the breast and suckles milk from the tube.
The SNS is the only supplementation method that encourages direct feeding at the breast and while the baby stimulates the breast, she receives the supplemented expressed breastmilk or formula she may need. This also optimises time, as it allows two things to be done at the same time, which in the case of the supplementation process is very useful.
There is the option of making a homemade SNS with a paediatric nasogastric tube 5 or 6, using a traditional feeding bottle as a recipient. The teat is inverted (placed inside the bottle) and the tube is passed through the hole in the teat.
Positive aspects: this method allows the baby to keep the breast as a feeding reference and to drink substantial volumes of milk. It is therefore an ideal method for children who are not newborns, as long as they are not underweight or have sucking difficulties, are not “sleeping beauties” and do not have hypotonia, as those babies are sometimes unable to get the milk they need.
Negative aspects: we must take into account that the SNS may not be very practical as it is sometimes complicated to place and when the mother is outside her house or during night feeds, this can be complicated to manage. It is also important to make sure that the baby does not get too used to the tube. Sometimes, the baby becomes “dependent” on the tube, and only accepts breastfeeding if the tube is placed on the nipple. For this reason, it is important to cut off the milk supply from the tube, either by clamping it with your fingers or, if you have purchased a commercial SNS, with the specific provision for this purpose. And we should not forget that if the baby has difficulties breastfeeding or maintaining suckling at the breast, this method is not very convenient, as it is likely that she will not get all the milk she needs.
Glass / cup / mug
A cup is one of the most recommended feeding methods, as it has very positive aspects. Additionally, it allows us to offer milk to babies of all ages, from premature to older babies and depending on the size of the cup, we can offer small or larger quantities of milk.
It is ideal for the occasional supplementation processes, or when the baby refuses any other feeding method. It is often used when the mother returns to paid work and the baby repeatedly rejects the bottle as a new feeding method.
When you offer milk in a cup to your baby, she should be seated or semi-seated, so that the baby’s head is higher than the bum. In this way, the baby sets the pace at which she wants to swallow the milk.
Positive aspects: the WHO recommends this method of supplementation because it is hygienic and cheap.
Negative aspects: the adult who administers the milk needs to know well how to do this, be patient and do not pour the milk into the baby’s mouth, as the baby may choke. Perhaps the least positive aspect of all is that the milk can spill out, which can be a nuisance if there is a low supply of breastmilk.
A spoon is an ideal way to offer small amounts of milk to a baby. It is very practical in the first few days when the mother has colostrum and the amount of milk she expresses is very small.
Any type of spoon can be used to offer milk with this method, it does not need to be a special one. But do take into account (if the baby is less than 6 months old), that the spoon should not be inserted into the baby’s mouth. It should be left at the corner of the lip so that the baby can stick out its tongue and drink the milk by itself. If the baby is over 6 months old, she will already accept the milk being put by spoon into her mouth and will be able to drink the milk in this way.
Positive aspects: if used for colostrum, the mother can massage and express breastmilk directly on the spoon and offer it to the baby, without the need of anything else, but she needs to know how to express breastmilk manually.
Negative aspects: this is a slow method that requires skill by the person offering the milk and it can sometimes spill, which is a problem when there is a small amount of expressed milk.
Finally, the bottle, the method that in most cases is used first and which, also in most cases, is rejected by the baby. This creates a lot of frustration for adults trying to offer milk to the baby.
It is a feeding method that is considered fast, but this does not necessarily have to be good. It is important, that the baby has time to show satiety during the feeding process. This will indicate that the baby does not need more milk and thus avoid overfeeding.
We should also be aware that there is no “teat” that looks like the nipple, even though every brand tries to promote its teat as “the most similar to the nipple”. It is therefore important to look for teats that are long, soft and with a wide base and make sure it is always properly given. Bear also in mind, that some teats can be very hard or difficult for some babies to suck and this can make the feeding process more difficult.
Positive aspects: the biggest plus point is that it allows large volumes of milk to be offered in a method that most people know how to offer without prior training. This method is ideal when the baby’s feeding is going to be prolonged or when it is necessary for situations where you need to get the baby back to sleep as quickly as possible.
Negative aspects: the most important difficulty with this type of supplementation is that the so-called nipple-teat confusion can occur, which can cause the baby to reject the breast and not want to breastfeed anymore, thus ending the breastfeeding journey.
As you can see, when deciding how to offer additional milk to a baby who is not gaining weight, there are many options. It would be important to discuss with a lactation expert, such as an IBCLC, what would be the ideal solution in your personal case.