I find that if mom is willing to use one, feeding tubes at breast are 
generally very effective. Some babies with very poor sucking skills may 
take several days to be able to reliably move milk from the devices, and 
for them I might use a syringe and tube and have mom give boluses.

WHen I use a tube in a bottle a la Dr. Jack Newman, I generally use one 
of the red "premie" nipples I've confiscated from parents who've been 
given them in the hospital. I have a whole bag! I cut a small slit in 
the nipple tip and thread the tube through to prevent leaking. There are 
also commercially available caps with a hole for the tube.

If mom has sufficient financial resources, I generally recommend the 
Lact Aid Nursing Trainer. It leaks less, and moms tend to dislike it 
less than other commercially available devices, in my experience. (Few 
women actually like supplementers!) I mainly use the SNS when mom has 
twins or if she used it with a previous infant and wants to use it again.

Catherine Watson Genna, IBCLC  NYC

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