Syringe/Finger Feeding
An alternate feeding method for the early days
Finger feeding has traditionally been described as an infant feeding method where a small feeding tube is attached to a container of milk and the tube is then placed over the adult finger. The baby then suckles on the finger, drawing the milk up through the tube. Another similar alternate way of feeding is syringe/finger feeding. With this method, instead of a feeding tube, a small oral syringe is introduced to the corner of baby’s mouth while baby is suckling on a finger, or sometimes while baby is at the breast. So, you may wonder why are alternate feeding methods other than bottle nipple preferred for breastfeeding babies anyway?
Alternate feeding methods are recommended in order to avoid nipple confusion or nipple preference in the early days of life. Maybe you’ve heard, or know of babies who have happily gone back and forth between bottle and breast? Maybe you’re not sure you even believe in nipple confusion or preference? While “confusion,” or “preference” can be difficult to measure, a 2021 integrative review did show that the consequences of offering artificial nipples to breastfed infants are mostly negative and associated with the newborn. These consequences included early weaning, refusal to breastfeed, impaired suction technique, incorrect latch-on, interference with orofacial development, and interruption of exclusive breastfeeding. Mothers who offered artificial nipples to their infants were more likely to experience pain, nipple fissures, frustration, and reduced interaction with their infants. As an IBCLC in practice for over 30 years, I can attest to the fact that most of the babies I’ve worked with who have received bottle nipples in the early days of life, have soon lost interest in breastfeeding. It’s not uncommon for mothers to seek out the help of an IBCLC in the first weeks of life for this very reason. Supplements were indicated in the hospital and bottle nipples were used. Not only is the baby now not latching, but mom’s milk supply is decreasing as well, due to lack of stimulation. Bringing a baby back to the breast after days (or longer) of bottle feeding is hard on both the mother and the baby.
There are several alternate feeding methods available when supplementation is indicated. Cup feeding, finger feeding, lactation-aids, and spoon feeding are all common alternate feeding methods. These methods are used world-wide. Of all the alternative feeding methods, cup feeding is probably the most researched – let’s look at this review from 2018:
Twelve studies were examined for information on safety and efficacy of cup feeding as an alternative supplemental feeding method for preterm breastfed infants. Studies were grouped into categories of outcomes that included (a) safety and physiologic properties; (b) breastfeeding outcomes. Results: Use of cup feeding resulted in more stable heart rate and oxygen saturation than bottle feeding with similar weight gain. Additionally, breastfeeding rates were higher at discharge with continued higher rates at 3 and 6 months post-discharge for cup fed infants.
Next on the evidence-based list is the traditional finger feeding method. An RCT from 2020 which included 70 babies showed that the finger feeding method was an effective way to increase sucking abilities, accelerate transition to breastfeeding, and to shorten duration of hospitalization in preterm infants.
Syringe/finger feeding is just a simple variation of traditional finger feeding. It works quite well when baby needs “a bridge,” of milk until mom’s milk supply increases. What’s so great about it? Well first of all it is more likely that baby will get appropriate volumes of milk. Bottle feeding often leads to over-feeding in the early days, another deterrent to breastfeeding. Secondly, it does allow the baby to be suckling - either at the breast or on a finger, and the baby can then associate this behavior with getting small volumes of milk as they would at the breast in the first few days. And finally, it’s simple, safe and effective.
But what about going home? Can families go home finger/syringe feeding? Well, that depends on what the parents want to do. Some parents would prefer to use an alternate feeding method, at least until day 4-5, until lactogenesis II occurs – or until “the milk comes in.” If that’s the case, we educate the parents about this method of feeding, just like we educate bottle-feeding parents. Same rules apply – baby is upright, baby is suckling, and parents are monitoring the feeding, giving appropriate volumes, allowing baby to pace the feeding. We wouldn’t want the bottle-feeding baby flat on his back, or mom/dad trying to feed a baby that wasn’t suckling, or propping a bottle – and so we educate them on safe bottle-feeding. We do the same for alternate feeding methods. We teach and then observe the parents demonstrate back. Some parents may prefer to switch to bottle nipples at discharge because they are more comfortable with that, and of course that is their decision. In either case, if breastfeeding is the desired goal for infant feeding and the baby needs supplementing at discharge, close follow-up is indicated. Baby should be seen by provider within 1-2 days of discharge and outpatient lactation care should be scheduled.
When families face breastfeeding challenges right from the start, it can be overwhelming. They need the support of their health care team to know that these challenges can be overcome with good lactation care and follow-up. Mixed messages about feeding can cause further confusion for new parents. The collaboration of the team helps to instill confidence in families, and with good collaboration, babies are well cared for, and families are very likely to achieve their desired infant feeding goals.
Penny F, Judge M, Brownell E, McGrath JM. Cup Feeding as a Supplemental, Alternative Feeding Method for Preterm Breastfed Infants: An Integrative Review. Matern Child Health J. 2018 Nov;22(11):1568-1579.
Buldur E, et al. Comparison of the Finger Feeding Method Versus Syringe Feeding Method in Supporting Sucking Skills of Preterm Babies. Breastfeed Med. 2020 Nov;15(11):703-708.
Consequences of Using Artificial Nipples in Exclusive Breastfeeding: An Integrative Review. Aquichan, 21(3), e2132. Epub September 30, 2021