If your baby needs a supplement of expressed breastmilk or formula, a nursing supplementer can help you enjoy the closeness of breastfeeding while your milk production increases.
You can use a supplementer to:
- Stimulate breastmilk production while feeding infant formula or expressed mil, without using bottles.
- Breastfeed an adopted baby.
- Breastfeed as a non-birth parent.
- Maintain breastfeeding if your milk production isn’t able to meet your baby’s needs eg insufficient glandular tissue.
- Maintain breastfeeing if your milk production is compromised eg breast surgery or reduction.
- Encourage a baby who is reluctant to breastfeed.
- Breastfeed a baby who is unable to feed effectively because of sucking or health problems. However this will only work if you baby can feed well enough to obtain milk.
How it works
How to use
Available products
Different supplements
How to use a nursing supplementer
Cleaning
Eliminating supplements
Seek Support
How it works
A nursing supplementer lets a baby get any supplement he needs at the breast without using bottles. The supplementer container holds the milk, which travels through a tube into your baby’s mouth while he breastfeeds. As he swallows, he continues sucking, stimulating your milk production.
If you are breastfeeding expressing your milk, and giving top-ups to your baby, you may find it simpler to use a supplementer, which allows all the feeding to happen at the breast.
A good latch-on
It’s especially important that your baby latches on deeply at the breast when you are using a supplementer. Get help with positioning and attachment so your baby can get milk from the breast as well as from the supplementer.
Different supplements
Expressed breastmilk Your expressed breastmilk is the first choice for a supplement. If your baby has feeding difficulties, expressing will help you maintain and increase your milk production. To find our more about increasing your supply, see our article How to Increase Your Milk Supply. And for more information on Expressing Your Milk our article can help.
Donor milk Human milk banks provide pasteurized, screened donor milk.
Infant formula Concentrated and ready-to-feed forms of infant formula are less likely to clog nursing supplementer tubing than powdered forms. Although expensive, ready-to-feed formula may also be more convenient when you are out and about or at home without help. Powdered infant formula is not sterile, so always follow the NHS guidelines for preparing it.
Available products
Disposable bag system This uses disposable sterile plastic bags with a top opening and a single tube. Milk only flows when a baby sucks and it is discreet to use as the bags are not bulky or noisy. You can also feed lying down without fear of leaks. When your baby sucks, the flow increases as the flow of milk from your breast decreases. This reinforces proper suckling, making the most of your milk production. (As in photograph above.)
Bottle system This system uses a bottle with a tube for each breast, making switching sides easy or for twins. Each tube can be clamped. Three tube widths are available. Sets can be cleaned and reused. (As seen in the photograph below.)
Homemade system You can make your own supplementer using an ordinary baby bottle, bottle teat and an infant nasogastric feeding tube (size #5 french, 52-75 length). Tubing can be obtained from online suppliers. (As seen in the first and last photos in this article.)
Cut a small hole in the bottle teat so the tube fits tightly. Thread the tube through the teat from the inside and attach the teat normally so the end of the tube sits in the supplement. The tube end is rounded and won’t hurt your baby’s mouth. Pierce a second hole in the teat, or use a teat with a vent to allow air in so your baby won’t need to suck harder as the bottle empties. The bottle needs to stay upright. You may find tucking it into your bra keeps it in place.
Photo courtesy of Michelle Green
How to use a nursing supplementer
Introduce the tube into your baby’s mouth along with the breast at the very beginning of a breastfeed by placing it between your baby’s upper lip and cupped tongue. If your baby doesn’t like the feel of the tube on the roof of his mouth try placing it so it lies along his tongue. Or, slip the tube into the corner of your baby’s mouth once he is well-attached at the breast.
You may need to extend the tube past the end of your nipple – experiment to see what works for your baby. The tube can be secured to your breast with medical tape. Taping along the tube is generally more secure than taping across it.
To hold the tube in position some mothers use fabric sticking plasters cut from a long strip. They thread the tube under the non-sticky sections.
The tube can be easily removed while the plasters stay in place, reducing skin irritation from tape removal and providing a guide for positioning each time.
Milk flow – too fast or too slow?
Constant milk flow can cause ineffective feeding as your baby will not need to actively suck to get milk. When using a supplementer you will see the milk travel along the tube to your baby’s mouth. Adjust the tube position and container height so your baby gets milk quickly when he starts sucking. Check he isn’t overwhelmed with milk, especially if he has heart or breathing difficulties or is premature.
Slow down the flow of milk by lowering the milk container, raising the tubing or using thinner tubing. Or pinch the tube to slow or stop milk flow. If using the bottle system, stop milk flowing by clamping the tube in the slots in the bottle likd. To speed up milk flow, raise the bottle, use wider tubing or use two tubes at the same breast. You may need to adjust the tube in your baby’s mouth to create more suction.
Cleaning
To avoid having to throw away tubing when milk had dried inside, force cold water through the tube at least three times straight after use, using the bottle of a 5-10ml syringe. Using warm water may cause fat to cling to the sides of the tube.
For commercial supplementers follow the manufacturers’ cleaning instructions. For homemade systems, follow the NHS guidance when cleaning the bottles and teats. Wash the tubing with hot soapy water, rinse with clean water and force air through the tube (or spin the tube fast) to dry. Take extra care if using infant formula. Store the clean supplementer parts in a sealed container in the fridge.
Nasogastic tubes should not be boiled, steamed or chemically sterilised as they are not designed for multiple uses. If your baby is at a higher risk of infection, a commercial system may be a safer option than a homemade system. Replace the nasogastric tube when it starts to stiffen, after about a week.
Eliminating supplements
The use of infant formula is sometimes essential to meet a baby’s nutritional needs. You may need to use formula as a stopgap measure, while you work to increase your milk production. Supplementing with formula without protecting your milk supply may reduce the duration of your breastfeeding experience.
Over time, you may be able to reduce the amount of supplement your baby needs as your milk production increases. Expressing in between feeds will signal to your breasts to make more milk and give you some milk for the next feed. For more on Increasing Your Milk Supply, see our article.
Begin the feed with your baby taking milk just from the breast. When he is no longer swallowing regularly start the supplementer. If your baby is reluctant to nurse at all, start the milk flowing at the beginning of a feed to get him started. As your breasts start to make more milk you will notice your baby takes less supplement, especially at certain times of day.
For more information on managing and reducing supplements see My Baby Needs More Milk and Relactation and Induced Lactation.
Seek support
Whether using a supplementer as a temporary or a long-term solution, support from your local LLL Leader and group can be a great help. For individual face-to-face help or a home visit, you could also consult a board certified lactation consultant (IBCLC) or specialist breastfeeding clinic.
Written by Karen Butler, Sue Upstone & mothers of LLLGB. Photos courtesy of Lynn Adams, Rae Vacher Lowe and Alison Widdup.
Further reading
Comfortable Breastfeeding
My Baby Needs More Milk
My Baby Won’t Breastfeed
Expressing Your Milk
Hand Expressing Your Breastmilk
How to Increase Your Milk Supply
Using donor milk and formula to support breastfeeding
Nipple Confusion
Relactation and Induced Lactation
Mothers’ stories
In praise of at breast supplementers
Breastfeeding with a nursing supplementer
LLLI articles
At breast supplementer nursing
Books
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Exclusively Pumping Breastmilk. Casemore, S. Gray Lion Publishing, 2014
Making More Milk Second Edition. Marasco, L and West, D., NY: McGraw-Hill, 2019.
Other websites
Homemade Supplemental Nursing System
NHS leaflet: Guide to bottle feeding
Increasing milk production
Nursing Supplementers
Please note: LLLGB does not endorse any particular breastfeeding product, aid or device or brand. La Leche League GB supports the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly Resolutions (referred to together as “the Code”). For more information about LLLGB’s support of the Code, see here.
Nursing Trainer System: www.lact-aid.com
Supplemental Nursing System: www.medela.co.uk
This information is available in printed form from the LLLGB shop.
Copyright LLLGB 2022.