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Finger Feeding

Introduction

Finger feeding is a method that helps train the baby to take the breast. It can also be used to avoid artificial nipples, but its primary purpose is to help latch on a baby who refuses to latch on. (See handout #26 When a Baby Refuses to Latch On). If you want to breastfeed successfully, it is better to avoid the use of artificial nipples before your milk supply is well established. Finger feeding may be used if:

1. The baby refuses the breast for whatever reason, or if the baby is too sleepy at the breast to nurse well. It is also a very good way to wake up a sleepy baby during the first few days of life.
2. The baby does not seem to be able to latch on to the breast properly, and thus does not get milk well. (However, if a lactation aid can be used at the breast, why use finger feeding?).
3. The baby is separated from the mother, for whatever reason. However, in such a situation, a cup is probably a better method of feeding the baby.
4. Breastfeeding is stopped temporarily (there are very few legitimate reasons to stop breastfeeding. See handout #9a and #9b, You Should Continue Breastfeeding).
5. Your nipples are so sore that you cannot put the baby to the breast. Finger feeding for several days may allow your nipples to heal without causing more problems by getting the baby used to an artificial nipple. Cup feeding is also more appropriate in this situation and takes less time. This is only a last resort. Proper positioning and a good latch help sore nipples far more frequently than finger feeding (Handout #3, Sore Nipples). And a good all purpose nipple ointment will help more. This so called “nipple holiday” is usually a mistake and if suggested within the first few days of life is a terrible mistake. Taking the baby off the breast does not always result in painless feedings once you start again, and sometimes the baby will refuse to latch on.

Finger feeding is much more similar to breastfeeding than is bottle feeding. In order to finger feed, the baby must keep his tongue down and forward over the gums, the mouth wide open (the larger the finger used, the better), and the jaw forward. Furthermore, the motion of the tongue and jaw is similar to what the baby does while feeding at the breast. Finger feeding is best used to prepare the baby who is refusing to latch on to take the breast. It should be used for a minute or two, at the most, just before trying the baby on the breast if the baby is refusing to latch on. Cup feeding is usually easier and faster when the mother is not present to feed the baby and is better to finish the feeding, if finger feeding is slow.

Please Note: If the baby is taking the breast, it is better by far to use the lactation aid tube at the breast, if supplementation is truly necessary (See handout A: Protocol to Increase Breastmilk Intake by the Baby, and handout #5, Using a Lactation Aid). What sense does it make to finger feed after breastfeeding?

Finger feeding (best learned by watching and doing)

1. Wash your hands. It is better if the fingernail on the finger you will use has been cut short, but this is not necessary.
2. It is best to position yourself and the baby comfortably. The baby’s head should be supported with one hand behind his shoulders and neck; the baby should be on your lap, half seated, and facing you. However, any position which is comfortable for you and the baby and which allows you to keep your finger flat in the baby’s mouth will do.
3. You will need a lactation aid, made up of a feeding tube (#5F, 36" long), and a feeding bottle with expressed breast milk, sugar water, or if necessary, formula, depending on the circumstances. The feeding tube is passed through the enlarged nipple hole into the fluid.
4. Line up the tube so that it sits on the soft part of your index (or other) finger. The end of the tube should line up no further than the end of your finger. It is easiest to grip the tube, about where it makes a gentle curve, between your thumb and middle finger and then position your index finger under the tube. If this is done properly, there is no need to tape the tube to your finger.
5. Using the finger with the tube, tickle the baby’s lips lightly until the baby opens up his mouth enough to allow your finger to enter. If the baby is very sleepy, but needs to be fed, the finger may be gently insinuated into his mouth. Pull the baby’s lower lip out if necessary. Generally, the baby will begin to suckle even if asleep, and receiving liquids will then usually awaken him.
6. Insert your finger with the tube so that the soft part of your finger remains upwards. Keep your finger as flat as possible, thus keeping the baby’s tongue flat and forward. Usually the baby will begin sucking on the finger, and allow the finger to enter quite far. The baby will not usually gag on your finger even if it is in his mouth quite far, unless the baby is not hungry or he is very used to bottles.
7. Pull down the baby’s chin, if his lower lip is sucked in.
8. The technique is working if the baby is drinking. If feeding is very slow, you may raise the bottle above the baby’s head, but usually this should not be necessary. Try to keep your finger straight, flattening the baby’s tongue. Try not to point your finger up, but keep it flat.
9. The use of finger feeding with a syringe to push milk into the baby’s mouth is, in my opinion, too difficult for the mother to do alone and definitely not more effective than simply using a bottle with the nipple hole enlarged and the tube coming from it. The idea of finger feeding is not to feed the baby! The idea is to train the baby to suck properly, so pushing milk into his mouth defeats the whole purpose of finger feeding.

If you are having trouble getting the baby to latch on to or to suckle at the breast, remember that a ravenous baby can make the going very difficult. Take the edge off his hunger by using the finger feeding technique for a minute or so. Once the baby has settled a little, and sucks well on your finger (usually only a minute or so), try offering the breast again. If you still encounter difficulty, do not be discouraged. Go back to finger feeding and try again later in the feed or next feeding. This technique usually works. Sometimes several days, or on occasion a week or more, of finger feeding are necessary, however.

If you are leaving the hospital finger feeding the baby, make an appointment with the clinic within a day or so of discharge. The earlier the better.

Once the baby is taking the breast, he may still require the lactation aid to supplement for a period of time. Although the baby may take the breast, the latch can still be less than ideal, and the suckle may still not be efficient enough to ensure adequate intake.

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.