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Introduction
A lactation aid is a device
that allows a breastfeeding mother to supplement
her baby with expressed breastmilk, formula,
glucose water with added colostrum or glucose
water without using an artificial nipple.
The early use of an artificial nipple may
result in the baby becoming "bottle
spoiled" or "nipple confused"
because it interferes with the way a baby
latches on to the breast. Actually, the
baby is not confused. The baby knows exactly
what the score is. If he goes to the breast
and gets little milk and slow flow and then
gets a bottle with rapid flow, especially
in the first few days, most can figure that
one out fairly quickly.
The better a baby latches
on, the easier it is for him to get milk,
particularly if the mother’s supply
is low. In the first few days, there is
not a lot of milk, but there is enough,
if the baby gets what’s available.
But, because of a poor latch, if the baby
does not get milk well from the breast,
he may fall asleep or push away from the
breast when the flow of milk slows down.
Thus the baby may refuse the breast, be
very fussy at the breast, gain weight poorly,
lose weight or even become dehydrated in
the first week. The mother may develop sore
nipples. Though artificial nipples do not
always cause problems, their use when things
are already going badly will rarely make
things better, and usually make things worse.
I do not believe that the “newer bottles
nipples” are any better than the old
ones. The lactation aid is by far the best
way to supplement, if the supplement is
truly necessary. (However, proper latching
on of the baby usually allows the baby to
get more milk, and thus it is often possible
to avoid the supplement). It is better than
using a syringe, cup feeding, finger feeding
or any other method, since the baby is at
the breast and breastfeeding. Babies, like
adults, learn by doing. Furthermore, the
baby supplemented at the breast is also
getting breastmilk from the breast. And
there is more to breastfeeding than breastmilk.
Why is the lactation aid better?
1. Babies learn to breastfeed
by breastfeeding
2. Mothers learn to breastfeed by breastfeeding
3. The baby continues to get your milk
even while being supplemented
4. The baby will not reject the breast,
which is very possible if supplementing
off the breast
5. There is more to breastfeeding than
the breastmilk
What is a lactation
aid?
A lactation aid consists
of a container for the supplement—usually
a feeding bottle with an enlarged nipple
hole—and a long, thin tube leading
from this container. Manufactured lactation
aids are also available and are easier to
use in some situations, but not necessarily.
Manufactured lactation aids are particularly
useful when the need for a lactation aid
arises in an older baby, when a mother needs
to supplement twins, when the need for a
lactation aid will be long term, or whenever
difficulty arises using the improvised lactation
aid. Though the manufactured lactation aid
is not inexpensive, the cost is about equal
to two weeks of the usual milk based formula.
Please Note: Using a tube with a
syringe, with or without a plunger, instead
of the setup mentioned above, seems unnecessarily
complicated and adds nothing to the effectiveness
of the technique. On the contrary, it is
more cumbersome.
Using the lactation
aid (Improvised). (Use should be shown
by a person experienced in helping mothers
with breastfeeding)
1. The baby may be latched
on to the breast first, and the tube slipped
into the baby's mouth at the appropriate
time (after the baby has nursed on at least
both sides first). The better the latch,
the better the baby will get your milk and
the easier the aid will be to use, and the
more quickly you will be able to get rid
of it and the supplements. The breast should
be gently eased out of the way so that the
corner of the baby's mouth is seen, and
the tube, held between the index finger
and thumb, should be slipped into the corner
of the baby's mouth so that it enters straight
towards the back of the baby's mouth and
at the same time, slightly upwards towards
the roof of the mouth. The tube is well
placed when the supplemental fluid works
its way down the tube at a rather rapid
rate. There is usually no need to fill the
tube with supplemental fluid before putting
it into the baby's mouth.
2. Or, the baby is latched
on to the breast and the tube, which is
run along the mother's breast and nipple,
at the same time. The better the baby's
latch, the easier the lactation aid is to
use. Also, the better the latch, the more
likely and the more rapidly the baby will
be able to do without the lactation aid.
Therefore, proper positioning and latching
on of the baby are still very important.
3. The tube may be taped
to the breast if the mother desires, though
this is not really necessary and not always
helpful.
4. The tube does not need
to pass the end of the nipple and needs
to be only just past the baby's gums to
function properly. It does seem to function
better if the tube is placed in the corner
of the baby's mouth and enters straight
into the baby's mouth over the tongue. (Point
it slightly to the roof of the baby's mouth).
It is occasionally helpful for the mother
to hold the tube in place with her finger,
as some babies tend to push the tube out
of position with their tongues.
5. The bottle containing
the supplement should not be higher than
the baby's head. If the lactation aid functions
only when the bottle is held higher than
the baby's head, something is wrong. Keep
the bottle higher only if the doctor or
lactation specialist suggests this.
6. Unless otherwise instructed,
it is best to use the tube with every feed,
though some mothers find it easier not to
use it during the night. Better eight supplements
a day of 30 ml (1 ounce) per feeding than
2 large supplements a day of 120 ml (4 ounces)
each.
7. Do not cut off the end
of the tube. It works fine as it is.
8. It should not take an
hour for the baby to drink an ounce of milk
from the lactation aid. If it is taking
this long, the tube is probably not well
positioned, or the baby is poorly latched
on, or both. When the lactation aid is functioning
well, it takes 15-20 minutes, usually less,
for the baby to take 30 ml of the supplement.
9. A trick for easier use:
Wear a shirt with pockets, and put the bottle
in the pocket.
Cleaning the device
l. Do not boil the tube
of the non-manufactured aid. It is not made
to be boiled.
2. After using the device,
clean the bottle and nipple as usual. Do
not boil the tube. The tube should be emptied
after use and then rinsed through with hot
water (suck up hot water into the tube from
a cup) and then hung up to dry. Soap, though
not necessary, may be used if desired, but
rinse the tube well. Tubes may become stiff
and unsuitable for use after about a week.
Weaning the baby from
the lactation device
1. Maintain contact
with the breastfeeding clinic for advice
about weaning the baby from the lactation
aid. See the Protocol
to Increase Breastmilk Intake by the Baby.
2. Weaning the baby from
the aid may take several weeks or only a
short while. Do not be discouraged and do
not try to force the weaning. Usually, the
amount of milk required in the lactation
aid increases over one or two weeks, and
then levels out for a variable period of
time before decreasing. The whole process
may take two to eight weeks, although some
mothers have used the device only a few
days, whereas others have not been able
to stop it at all. Rapid improvement sometimes
occurs after a long period of little change.
3. Observe the baby's
nursing. If you do not know how to know
if the baby is drinking, ask. Put the baby
onto the breast, allow the baby to nurse
as long as he is suckling and drinking,
then use breast compression (handout #15,
Breast
Compression) to keep the baby drinking;
then repeat the process on the second breast.
You can return to the first breast and continue
back and forth as long as the baby is drinking.
After you have finished feeding on both
breasts, insert the tube into the baby's
mouth. Allow the baby to nurse until satisfied
using the lactation aid.
Questions? (416) 813-5757
(option 3) or drjacknewman@sympatico.ca
or my book Dr. Jack Newman’s Guide
to Breastfeeding (called The Ultimate Breastfeeding
Book of Answers in the USA)
See
also the videos
on how to latch a baby on, how to know the
baby is getting milk, how to use compression,
how to use a lactation aid, as well as other
information sheets
on breastfeeding.
Handout
#5. Lactation Aid. Revised January 2005
Written by Jack Newman, MD, FRCPC. ©
2005
This
handout may be copied and distributed without
further permission, on the condition that
it is not used in any context in which the
WHO code on the marketing of breastmilk
substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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