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Using a Lactation Aid
Handout #5. Lactation Aid. Revised
January 2005
Written by Jack Newman, MD, FRCPC. © 2005
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?
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Babies learn to breastfeed by breastfeeding
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Mothers learn to breastfeed by breastfeeding
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The baby continues to get your milk even
while being supplemented
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The baby will not reject the breast, which
is very possible if supplementing off the breast
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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)
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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.
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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.
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The tube may be taped to the breast if the
mother desires, though this is not really necessary and not
always helpful.
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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.
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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.
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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.
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Do not cut off the end of the tube. It works
fine as it is.
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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.
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A trick for easier use: Wear a shirt with pockets,
and put the bottle in the pocket.
Cleaning the Device
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Do not boil the tube of the non-manufactured
aid. It is not made to be boiled.
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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
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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.
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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?
see
my book Dr. Jack Newman's Guide to Breastfeeding (called
The
Ultimate Breastfeeding Book of Answers in the USA)
See also the website www.thebirthden.com/Newman.html
for videos on how to latch a baby on, how to know the baby is getting
milk, how to use compression and how to use a lactation aid.
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
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