Dr ravari finger feeding, dropper, spoon, syringe and bottle feeding

‫شيرمادر‬ ‫با‬ ‫تغذيه‬ ‫ترويج‬ ‫علمي‬ ‫انجمن‬ ‫مديره‬ ‫هيئت‬ ‫عضو‬
‫شيرمادر‬ ‫کشوری‬ ‫کميته‬ ‫عضو‬
Alternative Feeding Methods Related to Breastfeeding

Dr.Ravari, Newborn Skyroom 1 Dec 2020
Positioning of tube for Finger Feeding

Finger Feeding (best learned by watching and doing)
 The use of finger feeding with a
syringe to push milk into the
baby's mouth is too difficult and
not more effective
 Is “parent led” rather than “baby
led,” allowing more parental
control over milk flow.
 This can be an advantage for
babies who have trouble drawing
the milk out of feeding tubes.

Finger Feeding
Finger-feeding with a periodontal syringe (glove optional) Finger-feeding with a Finger Feeder

 Finger feeding involves a baby receiving breast milk or
formula via a very fine feeding tube while they suck an
adult finger.
 Sometimes a curved tip syringe or finger feeder is used to
drip milk into a baby ’s mouth alongside the finger instead
of a tube.
 Finger feeding a baby can be an alternative to using a bottle
if a baby isn’t breastfeeding yet and it can also be used as a
suck training technique.
What is Finger Feeding?

 When a baby won’t latch
 If the baby refused the breast or was too tired to nurse, did not
latch well and therefore did not get milk well
 Can be used as suck training to improve breastfeeding technique
 Avoiding bottle preference
 Sore nipples(although proper positioning and good latch help
sore nipples more often than finger feeding)
 Separation from mother, but won’t take a bottle (short term
alternatives such as cup feeding or syringe feeding are possible)
When is finger feeding useful?

 Helps to learn to latch-on and suck the breast .
◦ More like a breastfeed than cup feeding or bottle feeding, so can
help a baby use the correct sucking technique for breastfeeding
 To evaluate sucking and tongue movements
 Avoids nipple confusion or bottle preference before breastfeeding is
well established
 Maintains skin-to-skin contact while baby feeds
 Finger feeding for Oral Motor Facilitation
 Help to improve coordination of feeding behaviors versus exercises
done with a finger without milk or a pacifier since finger feeding is
more task-specific.
Advantages of finger feeding

 Bringing the tongue forward
 Relaxing the tongue
Finger feeding variations for suck training

 If Tongue Tip Elevation Obstructs Attachment
◦ In facilitative strategies:
 Tickle down the tongue tip with an adult ﬁnger immediately before attachment
 Finger feeding can be useful for habitual tongue-tip elevation by teaching the infant that milk
belongs on top of the tongue.
 If the Tongue Is Retracted or Unable to Grasp the Breast
◦ Facilitative strategy:
 Massage the tongue with a ﬁngertip until it extends over the lower gum. Fingerfeed for one or
more feedings.
 If the Tongue Is Humped or Blocking the Infant’s Oral Cavity
◦ Facilitative strategy:
 Massage the posterior tongue, drawing gently forward in the baby’s mouth.
 Fingerfeed with gentle counterpressure to the humped area of the tongue.
Advantages of finger feeding

 Baby has to keep his tongue down
and forward in his mouth to cover
his gums
 Baby uses a wide open mouth on the
finger to recreate a deep latch
◦ use your largest finger
 Baby can control the flow of milk, if
he doesn’t suck there will be a pause
in milk low
How is a finger feed like a breastfeed?

 A baby with some oral-motor competency can use
the Hazelbaker FingerFeeder.
 Its container rests in the feeder’s hand, and a soft,
flexible tube can be held to the finger with the
thumb or taped to the finger .
 The top of the container contains a valve, so the
infant needs to draw milk from the tube by forming
negative pressure in the mouth.
 The container is soft enough to allow the feeder to
squeeze it to supplement the infant’s efforts, if
needed.
Hazelbaker FingerFeeder

 Trim long finger nails and wash your hands prior to finger feeding
 Hold your baby comfortably , with the baby’s head supported with one hand behind the shoulders
 Hold the rounded end of a small feeding tube (e.g. 5fr or 6fr) along the side of your finger, make a
gentle curve between the thumb and middle finger , or tape it in position if preferred, the end of
the tube should not extend past your finger tip
 Encourage a wide gape—tickle the baby’s mouth gently or brushing your finger against your
baby’s lips
 Slide your finger gently along the baby’s hard palate so that the sot pad of your finger tip is
uppermost and resting against the roof of your baby ’s mouth
◦ at the junction of the hard and sot palates
◦ avoid going too far to cause gagging or discomfort
 Check your baby’s lips are not folded in
◦ Pull down the baby's chin, if his lower lip is sucked in
 Try to keep your finger as much as possible straight or flat
 The technique is working if the baby is drinking. If slow, raise bottle above baby’s head.
A step by step guide to finger feeding

 When the infant sucks, a small bolus (0.5–1.0 ml) is delivered to the
infant.
 If milk spills from the corner of the baby’s lips, the respiratory rate
increases markedly; if the baby shows any stress signs (splayed fingers
or widened eyes), the milk flow is slowed.
 Ideally, feeding should proceed at a pace that allows a 1:1 suck–
swallow ratio during sucking bursts, particularly at the beginning of a
feeding.
 Feeding should follow the normal burst–pause pattern of a 3–5 second
respiratory break after a sucking burst of 5–20 sucks, depending on
the infant’s maturity and aerobic capacity.
Finger feeding

 Is not appropriate for all babies
 Cleaning the tubes properly is difficult
 The flow of milk may be too fast or too slow
 A sore mouth
 A finger is not the same as a breast
◦ Pushing a finger too far into baby ’s mouth, or the tube extending further than
a finger tip could cause gagging or discomfort.
◦ It’s important to watch your baby closely for signs of stress or they could start to
resist anything entering their mouth (oral aversion) including a breast.
 Infants can become addicted to this type of feeding and weaning them to the breast
can be difficult.
 Some healthcare professionals consider the placement of a finger inside the infant’s
mouth to be an invasive procedure and are reluctant to implement this method
Disadvantages of finger feeding(some concerns )

Please Note:
If the baby is taking the breast, it is far better to use the
lactation aid tube at the breast(SNS),
If supplementation is truly necessary Again, finger feeding is
not a good method of supplementation in the latching baby

 Recommended steps to implementation of the Baby Friendly Hospital Initiative
Implementing the Baby Friendly Hospital Initiative:
The role of finger feeding
Breastfeeding Review 2003; 11(1): 5–9

 The aim of our study was to assess the effectiveness of the finger
feeding method in encouraging a breastfeeding-type suck, in preterm
infants who were commencing oral feeding.
 Through identification of a developing faulty suck or correction of a
faulty sucking technique, we hypothesised that it would be practicable
to improve the number of infants exclusively breastfeeding on
discharge from NICU.
 Substitution of finger feeding for bottle feeding in preterm infants with
developing or faulty sucking techniques in a hospital in Perth, Australia,
increased the rate of breastfeeding on discharge from 44% to 71%
Implementing the Baby Friendly Hospital Initiative:
The role of finger feeding
Supporting Sucking Skills in Breastfeeding Infants, Third Edition2017

 The control group comprised 27 newborns fed through the cup-feeding
technique, 13 of whom had 32-34 weeks of gestational age and 14 had
34-36 weeks of GA
 The experimental group, fed using the finger-feeding technique,
comprised a total of 26 newborns, 12 with 32-34 weeks of GA and 14 with
34-36 weeks of GA.
◦ In both GA ranges, the control group showed significantly higher values of milk loss when
compared with the experimental group, with a higher loss in the corrected GA range of 32-34
weeks.
◦ The time of feeding in the experimental group was longer than the time of feeding in the control
group
◦ Regarding weight gain (during 1-5 days), In the control group, the median weight difference
between the 1st and the last weight assessment was 145.0 g, while in the experimental group, the
median was 85.0 g.
Comparison of the finger-feeding versus cup feeding methods in
the transition from gastric to oral feeding in preterm infants
J. Pediatr. (Rio J.) vol.93 no.6 Porto Alegre Nov./Dec. 2017

Comparison of the finger-feeding versus cup feeding methods in
the transition from gastric to oral feeding in preterm infants
J. Pediatr. (Rio J.) vol.93 no.6 Porto Alegre Nov./Dec.2017
 Complications occurred significantly more often among neonates with
32-34 weeks of GA in the control group
Complications in the control group (CG) and in the
experimental group (EG) with 32-34 weeks of
gestational age (GA and 34 + 1 to 36 + 6 weeks GA
Presence of complications during the
oral feeding: these complications were
oxygen saturation, cyanosis, respiratory
effort, and gagging. The observation of
these signs of stress was performed by
the nursing team.

 Materials and Methods: Totally 70 babies were included in this prospective randomized
controlled study. Finger feeding method was applied in Group 1 (n = 35) and syringe
feeding method was applied in Group 2 (n = 35).
 Results:
◦ Predicted comfort and distress scores of Group 1 were significantly lower than those of Group 2.
This means that babies in the finger feeding group had better comfort than the those in Group 2
(p = 0.000).
◦ Time passed for transition to breastfeeding was significantly shorter than that in Group 2
(19.4 ±15.0 days versus 29.7 ±10.2 days, p = 0.000).
◦ Group 1 had lower amount of food leakage while feeding and their average weight gain at the
end of 10th day was significantly higher (322.1 ±82.3 g versus 252 ±108.4 g, p = 0.004). They also
were discharged earlier than Group 2 (25.8 ±17.4 days versus 35.9 ±13.0 days, p = 0.001).
 Conclusion: Finger feeding method is an effective way for increasing sucking abilities,
accelerating transition to breastfeeding, and shortens duration of hospitalization in
preterm infants.

Comparison of the Finger Feeding Method Versus Syringe Feeding Method in
Supporting Sucking Skills of Preterm Babies
Breastfeeding Medicine VOL. 15, NO. 11 | Clinical Research, 9 Nov 2020
https://doi.org/10.1089/bfm.2020.0043

 Types
◦ 10 ml to 50 ml capacity with a gavage tube 5F or tubing
from butterfly needle
◦ Periodontal syringe, 10ml with a curved tip
◦ Regular syringes (1,2,5.10,20 ml )are usually not used
because the infant have difficulty in complete seal
◦ Finger feeder attached to syringe
 Provide milk incentives at the breast in order to achieve latch-on
 Complementary feeding
Syringes

 An alternative is to use periodontal syringe
commonly used by dentists, which has a nicely
curved hard tip instead of a needle.
 Baby first latches to the breast, and then the
plastic tip of the syringe is gently sneaked into
the corner of his mouth no more than an eighth
to a quarter of an inch (two and a half to five
millimeters).
 As baby sucks, the plunger is depressed with
short taps to deliver small amounts of milk
whenever baby’s jaw drops.
Periodontal syringe

Regular syringes
Regular syringes

For encourage sucking during breastfeeding
For supplemental feeding
during finger sucking
For minimal enteral feeding
Finger feeder

 At the breast;
◦ insert the tip of the syringe(Periodontal syringe
or Finger feeder) just inside the infant's lips at
the corner of his or her mouth
◦ Give a small bolus of milk(.25-.5ml)when the
baby sucks rate initially “ suck: bolus :suck :
bolus” When infant is suckling well the pattern
will be “suck, suck, bolus: suck, suck, bolus” or
“suck, suck, suck, bolus: suck, suck, suck, bolus”
Syringes (Technique)

 Can be used for very small amounts of
milk, for example colostrum.
 Feeding with syringes and droppers is not
faster than cup-feeding.
 Place a very small amount (not more than
0.5 ml at a time) in the baby’s cheek
(between the cheek and gums)and let the
baby swallow that before giving more.
Syringe or Dropper

Limitations (Syringe or Dropper)
 Often needs a second person to help
 Is a foreign object in the mouth
 Milk Can be improperly injected in to
mouth causing the baby to choke
 Syringes and droppers are more
difficult to clean and more expensive.
 Is a slow way to feed baby

 Advantages
◦ Avoids the use of artificial nipples
◦ Inexpensive and widely available
◦ Easy to use and teach parents
◦ Can be used for very small amounts
of milk (colostrum)
◦ Baby may be more eager to
breastfeed because suckling need s
are not met
Spoon-feeding

Dr.Ravari, Newborn Skyroom 1 Dec 2020Dr Ravari
Spoon-feeding (Technique)
 The baby should be alert with a
functioning swallow reflex
 Position the baby in a semi-upright
 Place the spoon just inside the
infant's lips over the tongue
 Allow the infant to pace the feeding
by sipping or lapping
 Avoid pouring the milk into the
baby's mouth

 In addition to the negative physiological effects, bottle
feeding constitutes an obstacle to breastfeeding because
facial muscles are activated in a way that differs from the
oral motor pattern used during breastfeeding.
 Bottle feeding promotes the view of feeding as the provision
of fixed volumes at fixed intervals by anybody—it does not
require the mother’s presence. Furthermore, it is mainly a
feeding method, in contrast with breastfeeding, which is also
the newborn infant’s main strategy for self-regulation during
the process of adaptation to the extra-uterine environment.
Bottle Feeding

Electromyography (EMG) studies have
confirmed that muscle activation is
different between breastfeeding and
bottle feeding, with less use of the
mentalis and masseter muscles and more
use of the buccinator and orbicularis oris
muscles in bottle feeding
Muscle activation in Bottle feeding v/s Breastfeeding

 The cardiorespiratory system of a preterm infant is immature,
with bradycardia, irregular respiration, and apnea
 Difficulty maintaining adequate oxygen saturation is the main
concern during feeding.
 Decisions about the choice of a feeding method are primarily
based on protection of the infant’s physiological stability.
 However, these signs of sensitivity or instability are observed
in connection with bottle feeding, not breastfeeding.
physiological instability observed in bottle feeding

 Common observations during bottle feeding were
◦ Uncoordinated sucking and swallowing;
◦ Reduced breathing;
◦ Higher incidences of bradycardia, apnea, and
◦ Desaturation; lower levels of oxygen saturation;
progressive post feeding decline of transcutaneous
oxygen saturation; and
◦ lower temperature, whereas the same infants—also very
preterm infants—remained stable during breastfeeding
Physiological Stability During Breastfeeding

Bottles and artificial nipples
 Concerns with bottles and artificial nipples interfering with
successful breastfeeding have led UNICEF and WHO to
include strong statements against their use. Concerns
include the following:
◦ The breastfed infant may prefer the bottle .
◦ Infants may develop a preference for a particular bottle nipple.
◦ Bottles and nipples are hard to clean properly.
◦ Mothers who are exposed to bottles in the postpartum report that their nipples
are more painful.
◦ Bottles are a popular symbol for infants, leading people to believe that bottles
are the normal infant feeding method ?!.

Bottles
 The upside of bottles is that they are
easy, convenient, and socially
acceptable.
 The downside is that there is a risk
of nipple confusion, flow preference
and nipple preference that could
jeopardize your breastfeeding
relationship.

 Bottle feeding can
separate the
epiglottis/soft palate
connection, elevate the
soft palate, drive the
tongue back and alter
the action of tongue
Bottle Feeding

 In a feeding policy based on prioritizing breastfeeding, bottle
feeding is considered appropriate when the mother:
◦ Is unable to breastfeed for medical reasons.
◦ Is unable to attain a milk production that satisfies her infant’s needs in
spite of her efforts.
◦ Intends to use mixed feeding (breast and bottle).
◦ Does not intend to breastfeed, which ought to be a result of an
informed decision and can have psychological explanations.
◦ Explicitly demands to use a bottle after information about advantages
of cup feeding and reasons for a restrictive attitude toward bottle
feeding.
Bottle Feeding
Ref: Supporting Sucking Skills in Breastfeeding Infants, Third Edition
‫شیرخوار‬‫مکیدن‬ ‫های‬‫مهارت‬ ‫از‬ ‫حمایت‬‫راوری‬ ‫دکتر‬ ‫نلخیص‬ ‫و‬‫ترجمه‬2017

Dr.Ravari, Newborn Skyroom Oct 2020
 When using a bottle for a breastfed
infant, or to encourage more
normal feeding skills in an infant
not yet breastfeeding, an artificial
nipple that is cylindrical, with a
rounded end (not orthodontic), a
smooth graduated slope to the
nipple (not indented), and a wider
base is usually preferable
Mixed Breastfeeding and Bottle-feeding

 Babies may maintain latching skills
better if they are stimulated to latch
onto the bottle more like they attach to
the breast.
 The teat can be held across the infant’s
upper lips with the tip at the philtrum
(the ridge between nose and upper lip)
to cue a wide gape, and the infant can
be snuggled onto the bottle as it is
tipped into the mouth.
Bottle-feeding

Mixed Breastfeeding and Bottle-feeding
 When to Offer the Bottle
◦ Christina Smillie, M.D., IBCLC, suggests
an alternative way that she calls the
“Finish at the Breast” method of bottle
supplementation.
◦ In her practice, she observed that
babies who quenched their initial
hunger and thirst with a bottle first
tended to have more patience feeding
at the breast.

Dr ravari finger feeding, dropper, spoon, syringe and bottle feeding

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