Zenana, I don't think we have any research which shows the vacuum needed to 
pull the supplement out of any method. I don't think there is any actual 
research comparing any of these supplementer devices against one another.

Here is my take: I rarely use the SNS or starter SNS because moms don't like 
them. They will try them once or twice and quit using them. Latching on 
problems using the SNS is the main issue that makes my clients stop using 
the SNS. I work for WIC and we can not get the Lactaid but other people say 
the Lactaid is easier to use than the SNS.

My preferred method is a periodontal syringe at the breast because mothers 
like it better and will stick with it for several days. When I worked in a 
hospital, we could not get per. syringes and we used #5 French feeding tubes 
with a 20 ml syringe. I prefer the smaller 20 ml over the 30-35 because the 
bigger ones were harder for moms to handle. But, you have to refill the 
smaller one in between breasts if you are supplementing alot. I cut the #5 
French feeding tube off just above the side holes so there is only one hole 
and less dripping or fast flow.

I mostly work with those babies who do not actively suck and need to be 
taught how to transfer milk from the breast. I like syringes because you can 
plunge them gently and the liquid that goes into the baby's mouth makes them 
swallow then suck. You can keep gently plunging until baby is doing long 
repetitions of active sucking and learning that milk comes when he works the 
breast properly. You can remove it and only use a little if needed. They are 
cheaper than the SNS. Some babies will suck more actively and remove the 
milk themselves from the supplementer device while others need the constant 
drip or flow to remind them to suck.  I find the syringe method is easier 
for moms to teach active sucking with. But they are not hands free or 
without some problems of their own.

Bottom line, mom has to chose which method she is comfortable with, 
sometimes even bottles, or the whole idea doesn't work.

Kathy Eng, BSW, IBCLC 

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