What is Finger Feeding?

Finger feeding involves a baby receiving breast milk or formula via a very fine feeding tube while they suck an adult finger. When a baby sucks on the finger and tube with their tongue in the right position, and with their lips making a seal on the finger, milk is drawn up the feeding tube (a nasogastric tube) from a container of milk. Sometimes a curved tip syringe 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 or cup if a baby isn’t breastfeeding yet and it can also be used as a suck training technique. This article looks at the reasons why finger feeding with a feeding tube can be useful, how to do it, and the pros and cons.

When is finger feeding useful?

Finger feeding can be useful in a number of situations:

#1 When a baby won’t latch

If a baby refuses to latch to the breast, finger feeding can help to prepare a baby for breastfeeding. The sucking technique to finger feed is similar to that which will be used at breast. Finger feeding can be used to wake up a non-latching sleepy newborn baby to give them some calories 1 or to calm a hungry and frustrated baby and take the edge off their appetite before latching.

#2 Suck training

Because finger feeding has similarities to breastfeeding, finger feeding can be used as a suck training technique to improve tongue function.

#3 Avoiding bottle preference

Finger feeding before a baby can latch to the breast avoids introducing bottles and potential nipple confusion or bottle preference before breastfeeding is established. However a baby who is very sleepy or has low stamina from being underweight may struggle to take adequate volumes with finger feeding as a sole method of supplementation.

#4 Sore nipples

Finger feeding can be used for a day or two if a mother’s nipples are too sore and damaged to breastfeed to give them a chance to heal without introducing bottles. However, Jack Newman, a Canadian paediatrician and breastfeeding expert, cautions against interrupting breastfeeding unless absolutely necessary as sometimes the baby can be reluctant to go back to the breast 2.  Breastfeeding can often continue uninterrupted with sore nipples once positioning has improved the latch. See Causes of Sore Nipples and Treatments for Sore Nipples for more suggestions for sore nipples.

#5 Separation from mother

There can be situations where a breastfed baby must be separated from their mother but won’t take a bottle. Short term alternatives such as cup feeding or syringe feeding are possible, but if baby will suck on a finger, then finger feeding could be another short term solution.

A young baby finger feeding
Try to keep the tube running along the side of your finger rather than above it so that the tube won’t rub against your baby’s hard palate

Advantages of finger feeding

  • More like a breastfeed than cup feeding or bottle feeding, so can help a baby use the correct sucking technique for breastfeeding
  • Avoids nipple confusion or bottle preference before breastfeeding is well established
  • Keeps a baby fed if they are not latching or refusing a bottle
  • Maintains skin-to-skin contact while baby feeds
  • Can be used as suck training to improve breastfeeding technique

Disadvantages of finger feeding

  • Is not appropriate for all babies and is not the ideal method of providing calories to a baby who needs more milk (Newman, 2009). Some babies may be aware of the tube or find it difficult to get milk via the tube. Try cup feeding or see our Tips to Bottle Feed a Breastfed Baby for alternatives.
  • Difficulty sourcing and cleaning feeding tubes and it can feel awkward to finger feed especially if milk leaks in a home made system.
  • Flow may be too fast or too slow—flow rate can be increased with a larger diameter tube or by holding the container of milk above baby’s head and flow rate can be decreased with a smaller diameter tube. See Homemade Supplemental Nursing System for more information about flow rates
  • A sore mouth? If the tube is held on top of a finger it can rub against your baby’s hard palate potentially giving them a sore mouth. Try to keep the tube running along the side of your finger.
  • A finger is not the same as a breast, more research is needed on the safety and long term implications of finger feeding. 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—including a breast.

How is a finger feed like a breastfeed?

Finger feeding is said to reinforce good breastfeeding technique by a number of similarities:

  • Baby has to keep his tongue down and forward in his mouth to cover his gums (Newman, 2009)
  • Baby uses a wide open mouth on the finger to recreate a deep latch—use your largest finger
  • Baby has to suck actively to bring milk up the tube, just as he does at the breast to initiate a let down (milk ejection reflex)
  • Baby can control the flow of milk, if he doesn’t suck there will be a pause in milk flow

A step by step guide to finger feeding

Finger feeding is best shown in person by your IBCLC lactation consultant or health care professional. Detailed instructions for finger feeding can be found in Jack Newman’s article Finger and Cup Feeding or in Supporting Sucking Skills in Breastfeeding Infants or Breastfeeding and Human Lactation Information for using the Hazelbaker™ FingerFeeder can be found on fingerfeeder.com

The steps for finger feeding with a feeding tube include:

  1. Trim long finger nails and wash your hands prior to finger feeding
  2. Hold your baby comfortably so that he can suckle your finger when it is held flat in his mouth
  3. Hold the rounded end of a 5fr feeding tube along the side of your finger or tape it in position if preferred, the end of the tube should not extend past your finger tip
  4. Check that the opposite end of the tube is submerged in your expressed breast milk or formula and that the valve is open
  5. Encourage a wide gape—by brushing your finger against your baby’s lips.
  6. Slide your finger gently along the baby’s hard palate so that the soft pad of your finger tip is uppermost and resting against the roof of your baby’s mouth. Let your baby take your finger into his mouth as far as he is comfortable—avoid going too far to cause gagging or discomfort. Your baby will normally grasp the finger with his tongue and suck it deeply into his mouth so that the finger pad rests towards the back of his mouth at the junction of the hard and soft palates (some authors call this the “S-spot” 3). The nail side of your finger should be centred against the tongue. If your baby seems to gag on even your finger tip, contact your IBCLC lactation consultant.
  7. Check your baby’s lips are not folded in, the top lip should rest on your finger making a seal and the lower lip be turned out. Pull on the chin gently just enough to bring the lip out if it is tucked in.
  8. Try to keep your finger straight or flat to help encourage the correct tongue position and without applying pressure to the roof of your baby’s mouth, only maintain gentle contact. Good contact with the centre of baby’s tongue and his hard palate recreates the right position of the breast and nipple in baby’s mouth and helps to stimulate central grooving of the tongue which is important for swallowing.
  9. Your baby will receive milk via the feeding tube at his own pace and the milk will gradually be drained from the bottle or container. Milk delivery is stopped when the tongue pulls back or the back of the tongue is humped against the finger, and resumed when the tongue tip is brought back over the gum ridge and the back of the tongue drops slightly.

Finger feeding video

Finger feeding as suck training

Suck training is a name used for exercises or therapies that can help a baby’s tongue function for breastfeeding (or bottle feeding). Done correctly with the steps above, finger feeding is a form of suck training and can help improve the way the tongue moves during feeding by encouraging the tongue forward in the baby’s mouth and reducing excessive humping of the back of the tongue. Lifting the back of the tongue is an important part of normal sucking but not in excess as may be found with a baby with poor tongue action. The goal is not to completely flatten the tongue but to help baby keep the tongue tip over his gums (the gum ridge). Dropping the back of baby’s tongue, even a little, may be enough to make breastfeeding more comfortable for the mother 4.

Cautions for finger feeding exercises

  • Carry out suck training under the guidance of your IBCLC lactation consultant or other health care professional. Your baby may need tailored exercises to help specific suck issues.
  • Mouth and tongue exercises should always be gentle and enjoyable for a baby. It’s important to be sensitive to your baby’s responses and stop an exercise if your baby is not enjoying it. Irritating your baby with intrusive exercises in his mouth could cause him to refuse anything in his mouth including a breast (called oral aversion) 5.
  • If finger feeding exercises don’t help or a baby doesn’t seem to enjoy the exercises, another strategy should be considered. Contact your IBCLC lactation consultant.

Finger feeding variations for suck training

Bringing the tongue forward

Your baby won’t be able to receive milk until he extends his tongue tip past his gums. A small circular massage on the back of the tongue with the (trimmed) nail side of the finger can encourage the tongue forward. And if your baby is excessively humping the back of his tongue, angling your fingertip downward against the excessively humped tongue with a little counter-pressure, or using a gentle stroking motion as if to flatten the hump can often encourage the tongue forward in the mouth (Watson Genna, 2017).

Relaxing the tongue

Another suck-training technique that doesn’t require a feeding tube is described in Breastfeeding and Human Lactation based on that of Marmet and Shell 6. As above, encourage baby to gape but before your baby takes your finger deep in his mouth, use the pad of your finger to massage the outside of the lower gums and the top of the upper gums. Then, when baby is sucking your finger, apply pressure to the humped tongue for a few seconds and alternate rubbing the hard palate with a gentle downward and forward pressure of the tongue. Praise your baby when their tongue relaxes.

The baby who doesn’t keep sucking

Milk can be dripped into baby’s mouth, either directly with a curved tip syringe or if a syringe of milk is fitted to the end of the feeding tube to fill the tube with milk prior to a feed. The taste of a little milk in baby’s mouth can help to condition the baby to the idea that sucking provides milk.

Where can I get a finger feeding supplementer

The instructions for making a homemade finger feeding tool can be found in Homemade Supplemental Nursing System. The equipment and the first four steps of “setting up” are the same as when making a homemade at-breast supplemental system. It is also possible to buy a purpose made finger feeder online called the Hazelbaker™ FingerFeeder (email aidanandevallc@gmail.com) or to use the tubes from a Medela Supplemental Nursing System.

Where can I get feeding tubes?

Your IBCLC lactation consultant may carry feeding tubes for finger feeding and plastic syringes to clean them, or they may know of a local source. Many medical suppliers in UK sell individually wrapped sterile nasogastric tubes by the box such as Vygon, IMS Euro or Pennine Health Care however it can be difficult for parents to source small numbers of tubes.

How can I clean the tubes?

While commercially made supplementers are made to withstand sterilising—disposable feeding tubes from a homemade system are not intended for reusing in this way and won’t stand up to boiling or steam sterilisation. If you are using a disposable feeding tube it should be replaced with a new tube frequently, some mothers use a new tube each day or more often. If they are cleaned thoroughly however, Jack Newman 7 suggests tubes can be washed and reused for a few days before replacing. Tubes can be rinsed out straight after use by using a syringe in the end-cap to push cold water through the tube to remove milk, followed by flushing through with hot soapy water, and finally rinsing well. Residual water can be forced out of the tube by shaking the tube in a lasso action. Some mothers store washed tubes in a refrigerator between uses. Instructions for cleaning commercial devices will be supplied with the equipment or online e.g. see How Do I Clean the Hazelbaker™ FingerFeeder?

baby feeding with a home made finger feeding device

Is long term finger feeding safe?

Finger feeding information does not seem to be based on any extensive research studies and relies on the experience of practitioners in the field who have used this technique. A breast widens a baby’s palate in a way that a bottle teat or finger can’t and tubes are difficult to clean properly. Until more research is available it would seem appropriate to limit finger feeding to short term use for encouraging a baby back to breast and suck training exercises. Alison Hazelbaker explains:

Breastfeeding still remains the ideal way to feed babies. Finger-feeding should be used only as a means to correct sucking problems or to keep the baby well fed until he or she can go to breast.

One study in Australia 8 found that finger-feeding as part of the feeding regimen ensured that a larger percentage of babies in the NICU were able to transition to breast successfully, whereas their bottle-feeding counterparts were less likely to do so. No other study has looked at finger-feeding.

Summary

Feeding a baby via a fine feeding tube held alongside a finger is known as finger feeding. It is also possible to finger feed by dripping milk alongside a finger with a curved tip syringe. Finger feeding with a tube has a number of uses such as a suck training exercise to improve a baby’s tongue function or as an alternative to bottle feeding for short term use. There isn’t any substantial research on the safety of finger feeding and most information has been provided through the experience of lactation consultants who have used finger feeding in their work. Always carry out finger feeding under the guidance of your IBCLC lactation consultant or other health care professional.

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