At-Breast Supplementers
Another Tool in the Tool-Belt
There are many reasons a baby may not be able to transfer all the milk or colostrum they need directly from the breast. Sometimes supplementation is indicated as a temporary “bridge” while milk volume increases. Other times, supplementation may be needed longer-term due to infant feeding challenges or maternal low milk supply.
Whatever the reason, once it’s determined that a breastfeeding baby needs supplementation, the next question becomes: What is the best way to provide it while still supporting breastfeeding goals?
In the United States, the default method for supplementation is usually a bottle with an artificial nipple. There are hundreds of bottles on the market, all claiming to be the “best” choice for breastfeeding babies. But despite the marketing, bottle feeding creates a very different feeding experience for the baby than what is experienced with direct breastfeeding.
The shape, texture, firmness, smell, length, and flow of a bottle nipple differ significantly from the breast. For a newborn who is just learning how to suckle effectively, that makes a big difference.
Suckling is a motor skill — one that newborns learn through repetition. In the early days, nature supports this learning process beautifully by providing colostrum. Colostrum is thick, slow-flowing, and available in small volumes, giving babies the opportunity to practice coordinating suck-swallow-breathe patterns safely and effectively. In fact, when adults or children have swallowing difficulties, liquids are often thickened to slow flow and reduce the risk of aspiration. Isn’t nature amazing?
Like crawling or walking, feeding skills develop through repeated practice. Babies do not master breastfeeding on day one. They learn through repetition at the breast. When we introduce a completely different feeding mechanism early on, it can interrupt that learning process and slow progress toward effective breastfeeding.
There is evidence to support alternative supplementation methods which may be less disruptive to breastfeeding than bottle feeding. The most studied alternative is cup feeding, which has been shown to be safe and effective even for very young infants. However, cup feeding has not gained widespread popularity in the U.S.
That leaves two commonly used alternatives:
Syringe/finger feeding
At-breast supplementers (ABS)
While syringe feeding can work well for small volumes, especially in the first day or two, an at-breast supplementer has advantages for babies who are able to latch and suckle well at the breast and may need more volume.
What is an ABS?
An at breast supplementer is a device that provides a thin tube which flows from a container of milk into baby’s mouth while they breastfeed.
Why an ABS?
An “at-breast-supplementer” delivers milk while the baby is feeding at the breast. That matters for both learning and milk production.
Benefits include:
Keeps the baby actively interested in breastfeeding
Reinforces the motor pattern of breastfeeding instead of introducing a different feeding skill
May decrease or eliminate the need for pumping
Supports continued breast stimulation during supplementation
Can be hands-free once connected
Allows baby to receive milk at the breast while connecting with mom
For many families, this can mean transforming “triple-feeding,”
Breastfeed
Pump
Give supplement
…into one integrated feeding experience.
Who May Benefit From an ABS?
At-breast supplementers can be especially helpful for:
Babies with poor milk transfer
Babies with excessive weight loss in the first few days or later slow weight gain
Babies who latch but fall asleep quickly at the breast
Babies who become frustrated or pull away due to low milk flow
Babies transitioning back to the breast after bottle feeding
Mothers working to increase milk supply
Parents with chronic low milk production due to breast surgery or insufficient glandular tissue
Adoptive, induced lactation, or co-nursing families
Is an ABS Right for Everyone?
No feeding tool works for every family!
At-breast supplementers are no different. They might feel awkward or overwhelming at first. Some parents love them immediately; others find them cumbersome. But for families strongly hoping to preserve or build a breastfeeding relationship, an ABS deserves to be presented as an option.
Importantly, families do not need to use the ABS at every feeding to see benefit. Even incorporating it a few times each day can help move a baby toward breastfeeding instead of away from it.
Most hospitals have access to simple “starter” systems that can be incredibly useful during the transition from colostrum to mature milk production.
When breastfeeding isn’t going as mom planned, it can be disappointing. A supplementer is one way to preserve breastfeeding, while making sure baby is getting the milk they need.
Parents deserve to know about all the supplementation methods and to have an opportunity to try them, to determine what feels most comfortable. That means discussing the benefits and limitations of each method. Families should have the autonomy to choose the method that best aligns with their goals and capacity.
Support Matters Most
Whenever breastfeeding becomes complicated, support is essential.
Any family using an ABS would benefit from close follow-up with an outpatient IBCLC. Families should not have to work this out alone. Skilled lactation support can turn a tool that feels difficult into a tool that ulitmately becomes empowering.
References
McKinney CM, Glass RP, Coffey P, Rue T, Vaughn MG, Cunningham M. Feeding neonates by cup: a systematic review of the literature. Matern Child Health J. 2016;20(8):1620-1633. doi:10.1007/s10995-016-1961-9
Çelik F, Sen S, Karayagiz Muslu G. Effects of oral stimulation and supplemental nursing system on the transition time to full breast of mother and sucking success in preterm infants: a randomized controlled trial. Clin Nurs Res.2022;31(5):891-900. doi:10.1177/10547738211058312