A supplemental nursing system (SNS) or “supply line” allows a mother to feed her baby supplemental milk at the breast. It can be used as a short-term aid on the way back to full breastfeeding and can sometimes be used longer-term. The SNS feeding tube can also be used as a way to finger-feed your baby either as a sucking exercise or when transitioning your baby back to the breast. Keeping in touch with an IBCLC lactation consultant or your health professional is advisable while you are using an SNS. For the pros and cons of this method of feeding and further information on commercial supplementers and how to use them see Breastfeeding With a Supplemental Nursing System. This article describes how to make a homemade supplemental nursing system.
Making a homemade supplemental nursing system
You will need
- An ordinary feeding or storage bottle and teat
- A 5 or 6 French, 50cm or 90cm feeding tube (nasogastric tube) 1
- A 5ml or 10ml syringe for flushing and cleaning the tube—your local pharmacy may sell these or online stores like Amazon sell individually wrapped sterile syringes.
- Slightly enlarge the hole of a bottle teat or vent (with clean scissors) so that you can feed the tubing upwards through the teat. The plastic attachment (an open/close valve) on the feeding tube sits in the milk at the bottom of the bottle (make sure the valve is open). A tight fit for the tube through the bottle nipple will reduce spillage.
- Add your expressed breast milk or formula supplement to the bottle. Screw the artificial teat onto the bottle with the feeding tube threaded through it and the valve end of the tube submerged in the milk.
- Piercing a second hole in the teat, or using a teat with a vent, allows air into the bottle so your baby doesn’t need to suck harder as the bottle empties. Some mothers find it works well without the extra hole.
- Place the bottle on a table close to where you are feeding your baby, or put it in a shirt pocket, between your breasts or between your knees depending on the length of the tube.
- The free rounded end of the tube should lie alongside mother’s nipple and be taken into the baby’s mouth when he begins to suck. Alternatively you can latch your baby on the breast first, and then slide the tube into the corner of the baby’s mouth when you are ready (for example after he has breastfed on both breasts first).
- Some mothers find it useful to tape the tube to their breast with surgical tape or a plaster and others prefer not to, experiment to find what works for you. If you tape the tube to your breast before your baby latches, make sure the tape is far enough away from your nipple so that it won’t interfere with your baby’s latch. Also check that the tube isn’t extended further than your nipple or it may make your baby gag or reach the back of his throat (taping it to the breast will help avoid this). Jack Newman, a Canadian paediatrician and breastfeeding expert says the tube only needs to be over the baby’s gums to work properly 2.
Adjusting milk flow
If your baby can make a good seal on the the breast with the tube in place, you will soon see milk rise up the tube into his mouth and he will start swallowing. If the flow of milk seems too fast (your baby is gulping milk too quickly) or too slow (you can’t hear many swallows) you can adjust the flow by;
- Adjusting the height of the bottle of milk. The bottle containing the supplement should not need to be held higher than your baby’s head to work. The higher the bottle the faster the flow of milk.
- Using different sized tubes to alter milk flow. The wider the diameter of the tube the faster the flow of milk, 6 French (6 fr) is a wider tube than 5 fr.
- Pinching the tube to narrow the diameter and slow the flow.
If your baby struggles to suck milk up the tube to get the flow started he may start to get frustrated. Filling the tube with breast milk using the 5 ml syringe will require less work and give him an instant reward. You could also experiment lifting the bottle higher to get the flow started.
Tips from Jack Newman
Jack Newman has some tips for using a lactation aid in the following article including the benefits of using one and how to wean your baby from using it when you are ready:
[The lactation aid] 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.
- Discuss with health care team. The homemade system is endorsed by some hospitals34 and medical professionals5 but parents are encouraged to discuss the suitability of this feeding method with their own health professionals as it may not suit every baby.
- Use at own risk. A single use nasogastric feeding tube is manufactured to be used as a feeding tube that carries food internally via a baby’s nose and throat into their stomach—not as an external feeding mechanism to run alongside the breast or finger. Please note that when using any device in a different way to a manufacturer’s intended use you do so at your own risk. Commercial purpose made versions of supplemental nursing systems are available for long term use—see Breastfeeding With a Supplemental Nursing System for further details.
- Feeding tubes are very difficult to clean properly and need to be replaced frequently, see next section.
Replace feeding tubes every day
Single use nasogastric feeding tubes are not made to withstand boiling or steam sterilisation which makes them very difficult to clean properly. Chemical cleaning by cold water sterilisation could also break down the tube lining. Disposable tubes should therefore be replaced frequently with new. In their fact sheet, the Royal Women’s Hospital in Australia advise replacing tubes (and the syringes used to flush them out) every 24 hours 6. Canadian paediatrician Jack Newman discusses that with careful washing, tubes may be reused for a few days 7.
- Inspect tubes carefully for signs of wear and tear before use and bear in mind that although tubes may look clean, bacterial cultures may be building inside8.
- If your baby is premature, or particularly vulnerable to infection it will be especially important to discuss using a homemade supplementer with the health professionals caring for your baby, to observe very careful hygiene and replace the tubes very frequently.
Cleaning the homemade supplemental nursing system
Cleaning the bottle and teat
Clean and sterilise the bottle and teat as usual—See Sterilising Baby Bottles (National Health Service website, 2016).
Cleaning the feeding tube
Rinsing and cleaning tubes as soon as possible after use will remove any milk residue before milk can start to dry in the supply line. Precise cleaning instructions for feeding tubes vary slightly between practitioners. Washing instructions include:
- Push cool boiled water through the feeding tube with a 5ml or 10ml syringe in the end-cap straight after use and repeat several times as needed 9. Warm water for the initial rinse could cause the milk to curdle and stick to the inside of the tubing making cleaning more difficult.
- After thoroughly rinsing with cold water, some recommendations advocate flushing the tubes with hot soapy water and then rinsing thoroughly1011.
- After washing, shaking the tubes (e.g. making a lasso action with the tube) can remove most of the water inside. They can then be left to dry (Newman, 2009) or stored in a clean sealed container in the fridge.
- Change the tube for a new one every 24 hours (see above).
See below for cleaning information from the Royal Women’s Hospital fact sheet, and Counseling the Nursing Mother:
After 24 hours the tube and syringe must be discarded. A new tube and syringe must then be used for the next 24 hours.
As soon as the feed is finished the tubing must be cleaned to avoid milk drying in the tubing and to prevent growth of bacteria:
- Use a 10ml syringe to flush 10mls of cooled boiled water through the tube.
- Flush the tube at least 3 times, or more if there is any milk residue visible in the tube.
- Store the cleaned tube in a sealed clean container or plastic bag in the refrigerator until next use.
After every use the tubing needs to be flushed with cold water, washed with hot soapy water, and then rinsed with clear water.
The Centers for Disease Control and Prevention (CDC) recommends using a washing bowl that is separate to the family sink for cleaning a baby’s feeding equipment 12. For cleaning information for tubes supplied with a commercial supplementer—always check the manufacturer’s instructions.
Making a Supplementary Nursing System, Canadian Childbearing Almanac
A homemade supplemental nursing system can be used as a way to give your baby supplemental milk at the breast or via finger feeding. It is an alternative to commercially available supplementers, cup feeding, or using a bottle. A supplementary nursing system is not suitable for all babies and is best used under the supervision of an IBCLC lactation consultant or other health professional. A homemade system involves adapting the use of a disposable nasogastric tube which is not intended to be repeatedly washed and reused, so tubes must be replaced often. This article should be read in conjunction with Breastfeeding With a Supplemental Nursing System which discusses all the advantages and disadvantages of using this kind of device.