I do not have access to an SNS in the facility I work at now. I use a #5
French feeding tube (ala Dr. Jack Newma) with the tubing submerged in a
bottle or cup. I believe Dr. Jack suggests to close the tube or do not
insert it and let the infant suckle at the breast until nutritive sucking
stops. At that point add breast compression to get a few more nutritive
sucks in. When that ceases even w/ breast compression, then open or add the
supplementer. Allow the baby to take what he wants.

During this time the baby could possibly and very likely get some breastmik
along w/ the milk in the supplementer and mom could have some letdowns.

I use the 'supply line' to keep the baby at the breast and to avoid bottles
in the early postpartum period when supplements are needed. I also use the
'supply line' to demonstrate to parents the difference between nutritive
suck and non-nutritive suck when they are about to be discharged and the
baby has not really had an effective feeding. When they see and hear the
very obvious difference in the baby flutter sucking and basically just
hanging on vs the open pause close type of active sucking as the baby
swallows and transfers milk, they have an idea of what effective bf should
look like. Of course f/u is so important (but not always what I would like
it to be) and monitoring of wet/dirty diapers and wt gain.

Also, I bet there is a way to ultrasound this process w/ the supplemental
fluid having a dye in it so that it could be seen the breastmilk transfer
and the supplementer milk transfer how much and at what times, and
correlated w/ the baby's tongue/jaw action. Peter Hartmann?

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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