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This baby needs to receive supplementation. It is best that the baby receive this via lactation aid because:
1. The baby is still on the breast and breastfeeding.
2. Babies learn to breastfeed by breastfeeding.
3. Mothers learn to breastfeed by breastfeeding.
4. The baby is still getting milk from the breast thus helping increase the mothers milk production.
5. The baby is not likely to reject the breast as he would if he were supplemented by bottle or by any method not on the breast.
6. There is more to breastfeeding than breastmilk; the baby and mother are in close physical contact.
One way to introduce the tube is to insert it while the baby is at the breast as in this video clip. The other is to line up the tube with the nipple and latch the baby on the breast and lactation aid tube at the same time.
Note the position of the baby:
1. The babys chin touches the breast but nose does not touch.
2. The baby covers more of the areola with his lower lip than his upper lip.
3. The baby is slightly tilted up towards the mother.
The baby has now fed from both breasts and is not getting much milk flow (mostly nibbling at the breast—see video clips of babies drinking or not drinking). It is time to supplement.
Note the following:
1. The breast tissue is eased out of the way so that the corner of the babys mouth is visible.
2. The fact that the baby is tilted slightly upwards makes it easier to find the corner of the babys mouth and insert the tube.
3. The tube is inserted in the corner of the babys mouth.
4. The tube is pushed almost straight back towards the back of the babys throat but also slightly upward toward the roof of the babys mouth.
5. The milk moves down the tube to the babys mouth, but the baby does not drink (see video clips of babies drinking or not drinking). Something is not working.
6. The mother is attempting compression, but compression should be done when the baby is sucking and not drinking, not when the baby is not sucking at all. Moreover, compression while the baby is being supplemented at the breast with a lactation aid is not necessary.
7. At 21 seconds into the video, I fiddle with the tube placement, and now it starts working. The baby is drinking.
8. Notice the baby pops his eyes open when he starts getting milk again. Babies are not lazy; they respond to milk flow. Young babies such as this one tend to fall asleep when the flow of milk is slow, not necessarily if they have had enough.
9. More fiddling with the tube at about 35 seconds. If the baby is well latched on and tube is well placed, supplementing using the lactation aid takes no more time than giving the baby the bottle or finger feeding. Using finger feeding to supplement when the baby takes the breast is not the best approach either.
10. At about 1 minute into the video, I pull the babys chin down a bit. Remember, good latch and good placement of the tube make this system work best. Pulling down the chin gets more of the breast into the babys mouth.
11. At about 1 minute and 18 seconds, we bring the baby around even more asymmetrically by having the mother push the babys bottom in with her forearm.
12. At about 1 minute and 55 seconds, milk comes out of the babys mouth means something is not right. Baby has slipped off the breast or the tube has moved. Fiddling with the tube again makes it work properly again.
This video is courtesy of Newman Breastfeeding Clinic and Institute (NBCI).
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