During the first couple of days when the volume is small 10-20mls. I suggest using a 5 French feeding tube along with a 10ml syring. If the baby needs more than 10mls I use 2 10mls syringes. One of each side of the breast. I have found that when the volume is greater than 20 mls this is when the feeding tubes seem not to work the best. If mother has to swap syringes during the feeding session it can become difficult. The 20ml syringe is very hard to pull from for most babies. 

Recently I have had some hesitation with using the SNS or Lact-Aid. When doing pre and post weights I have found that babies tend to transfer less from the breast when using these. Of course this is NOT all babies. I am not sure the exact science behind it but I was thinking that maybe the baby has to create less pressure/tug/pull to get the milk removed from the SNS/lact-aid then to remove milk from the breast and these very smart babies will then create 'just enough' pressure to remove form the supplement devise and not mother. For these babies I have found it best to place baby at the naked breast for a set amount of time (either timed or by babies cues) and then having mother put the syringe in mouth. 

Jessica Callahan
RN, IBCLC
NC, USA

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