Policy No
Effective Date:
6/07
Page 1 of 3
APPROVAL:
SUBJECT: Alternate Feeding Methods for Breastfeeding Infants
APPLICABLE DEPT: NICU, Couplet Care, Nursery, Pediatrics
PURPOSE:
To provide guidelines for safe feeding of infants by methods other than at the breast.
POLICY:
1.0
Any method other than direct breastfeeding is an “alternate” feeding
method.
2.0
Mothers may request, or a lactation consultant may recommend,
alternate methods of feeding for breastfeeding infants in order to limit
exposure to the rapid flow through a bottle nipple, or to facilitate long
term breastfeeding.
PROCEDURE:
1.0
Ask the mother of the baby if she has any preference regarding
feeding method when she is unavailable to breastfeed, or if
supplementary oral feeding is needed.
2.0
Document the mother’s preferences.
3.0
Cup (short or long term use)
3.1
Assess infant for alertness. Do not attempt to cup feed an infant who is
not alert.
3.2
Swaddle infant and hold in semi-upright position
3.3
Fill the 30mL medicine cup at least 1/2 full and place cup up to infant’s mouth
touching upper lip (and not pushing down on lower lip)
3.4
Use expressed breastmilk when available. Otherwise use the formula of
mother’s choice or what is medically indicated.
Policy No
Effective Date
6/07
Page 2 of 3
4.0
5.0
3.5
Tip cup so supplement just touches infant’s lips
3.6
Infant usually laps or sips it (do not pour into baby’s mouth)
3.7
Allow the infant time to swallow, to pace the feedings, and stop
to burp from time to time
Spoon (short term use)
4.1
Swaddle infant and hold in semi-upright position
4.2
Place expressed colostrum on the spoon and place spoon up to
infant’s mouth touching upper lip (and not pushing down on
lower lip)
4.3
Tip spoon so supplement just touches infant’s lips
4.4
Infant usually laps or sips it (do not pour into baby’s mouth)
4.5
Allow the infant time to swallow, to pace the feedings, and stop
to burp from time to time
At the breast with a feeding tube, syringe or Supplemental Nursing
System (longer term use)
5.1
Gather supplies (20 mL syringe and #5 Fr.
Feeding tube or SNS, and tape)
5.2
Fill appropriate container with supplement and prime tubing
5.3
If using tubing, place tubing on the nipple making sure it extends about
1/2 inch beyond nipple and secure it with a piece of tape.
5.4
Position and properly latch baby at breast. You may need to
adjust placement of tubing for infant comfort and optimal milk flow.
5.5
If using syringe, place the tip of the syringe in the corner of infant’s
mouth and insert about ½ inch along the side of the breast. Slowly
depress plunger only while infant is sucking.
PATIENT/FAMILY EDUCATION:
Policy No
Effective Date
6/07
Page 3 of 3
1.0 Educate family on the techniques used, amount of supplement, duration of use,
and follow-up.
DOCUMENTATION:
1.0 Document the volume and feeding technique used, including
estimates of spillage.
2.0 Document how well the infant tolerated the procedure.
3.0 Document all education and referrals for further support provided to the mother.
REFERENCES:
Nutritional Support of the VLBW Infant: Part II Appendix Q.a.
Biancuzzo M. Creating and Implementing a Protocol for Cup Feeding.
Mother Baby Journal May 1997; 2(3): 27-33
Lang, S., Lawrence C. J., L’eorme, R. Cup feeding: An alternative method of infant
feeding. Arch Dis Child 1994; 71: 365-9.
Nyqvist KH, Strandell E. A cup feeding protocol for neonates:
Evaluation of nurses’ and parents’ use of two cups. J Neonatal
Nurs 1999; 5(2):31-36
REVIEW DATE:
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REVISED DATE:
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