Dr ravari finger feeding, dropper, spoon, syringe and bottle feeding

Alternative feeding methods in Breastfeeding

1. ردامريش اب هيذغت جيورت يملع نمجنا هريدم تئيه وضع
ردامريش یروشک هتيمک وضع
Alternative Feeding Methods Related to Breastfeeding

3. Dr.Ravari, Newborn Skyroom1 Dec 2020
Positioning of tube for Finger Feeding

4. Dr.Ravari, Newborn Skyroom1 Dec 2020
Finger Feeding (best learned by watching and doing)
The use of finger feeding with a
syringe to push milk into the
baby's mouth is too difficult and
not more effective
Is “parent led” rather than “baby
led,” allowing more parental
control over milk flow.
This can be an advantage for
babies who have trouble drawing
the milk out of feeding tubes.

5. Dr.Ravari, Newborn Skyroom1 Dec 2020
Finger Feeding
Finger-feeding with a periodontal syringe (glove optional)Finger-feeding with a Finger Feeder

6. Dr.Ravari, Newborn Skyroom1 Dec 2020
Finger feeding involves a baby receiving breast milk or
formulavia a very fine feeding tube while they suck an
adult finger.
Sometimes a curved tip syringe or finger feeder is used to
dripmilk into a baby ’s mouth alongside the finger instead
of a tube.
Finger feeding a baby can be an alternative to using a bottle
if a baby isn’t breastfeeding yet and itcan also be used as a
suck training technique.
What is FingerFeeding?

7. Dr.Ravari, Newborn Skyroom1 Dec 2020
When a baby won’t latch
If the baby refused the breast or was too tiredto nurse, did not
latch well and therefore did not get milk well
Can be used as suck training to improve breastfeeding technique
Avoiding bottle preference
Sore nipples(although proper positioning and good latch help
sore nipples more often than finger feeding)
Separationfrom mother, butwon’t take a bottle (short term
alternatives such as cup feeding or syringe feeding are possible)
When is finger feeding useful?

8. Dr.Ravari, Newborn Skyroom1 Dec 2020
Helps to learn to latch-on and suck the breast .
◦More like a breastfeed thancup feeding or bottle feeding, so can
helpa baby usethe correctsucking technique for breastfeeding
To evaluate sucking and tongue movements
Avoids nipple confusionor bottle preferencebefore breastfeeding is
well established
Maintainsskin-to-skin contactwhile baby feeds
Finger feeding for Oral Motor Facilitation
Help to improve coordination of feeding behaviorsversus exercises
done with a fingerwithout milk or a pacifiersince finger feeding is
more task-specific.
Advantages of finger feeding

9. Dr.Ravari, Newborn Skyroom1 Dec 2020
Bringing the tongue forward
Relaxing the tongue
Finger feeding variations for suck training

10. Dr.Ravari, Newborn Skyroom1 Dec 2020
If Tongue Tip Elevation Obstructs Attachment
◦In facilitative strategies:
Tickle down the tongue tip with an adult finger immediately before attachment
Finger feeding can be useful for habitual tongue-tip elevation by teaching the infant that milk
belongs on top of the tongue.
If the Tongue Is Retracted or Unable to Grasp the Breast
◦Facilitative strategy:
Massage the tongue with a fingertip until it extends over the lower gum. Fingerfeedfor one or
more feedings.
If the Tongue Is Humped or Blocking the Infant’s Oral Cavity
◦Facilitative strategy:
Massage the posterior tongue, drawing gently forward in the baby’s mouth.
Fingerfeed withgentle counterpressureto the humpedareaof the tongue.
Advantages of finger feeding

11. Dr.Ravari, Newborn Skyroom1 Dec 2020
Baby hasto keep his tongue down
and forward in his mouth to cover
his gums
Baby uses a wide open mouth on the
finger to recreate a deep latch
◦use your largest finger
Baby can control the flow of milk, if
he doesn’t suck there will be a pause
in milk low
How is a finger feed like a breastfeed?

12. Dr.Ravari, Newborn Skyroom1 Dec 2020
A baby with some oral-motor competency can use
the HazelbakerFingerFeeder.
Its container rests in the feeder’s hand, and a soft,
flexible tube can be held to the finger with the
thumb or taped to the finger .
The top of the container contains a valve, so the
infant needs to draw milk from the tube by forming
negative pressure in the mouth.
The container is soft enough to allow the feeder to
squeeze it to supplement the infant’s efforts, if
needed.
HazelbakerFingerFeeder

13. Dr.Ravari, Newborn Skyroom1 Dec 2020
Trim long finger nails and wash your hands prior to finger feeding
Hold your baby comfortably , with the baby’s head supported with one hand behind the shoulders
Hold the rounded end of a smallfeeding tube (e.g. 5fr or 6fr) along the side of your finger, make a
gentle curve between the thumb and middle finger , or tape it in position if preferred, the end of
the tube should not extend past your finger tip
Encourage a wide gape—ticklethe baby’s mouth gently or brushingyour finger against your
baby’s lips
Slide your finger gently along the baby’s hard palate so that the sot pad of your finger tip is
uppermostand resting against the roof of your baby ’s mouth
◦at the junction of the hard and sot palates
◦avoidgoing too far to cause gaggingor discomfort
Check your baby’s lips are not folded in
◦Pull down the baby's chin, if his lower lip is sucked in
Try to keep your finger as much as possible straight or flat
The technique is working if the baby is drinking. If slow, raise bottle above baby’s head.
A step by step guide to finger feeding

14. Dr.Ravari, Newborn Skyroom1 Dec 2020
When the infant sucks, a small bolus (0.5–1.0 ml) is delivered to the
infant.
If milk spills from the corner of the baby’s lips, the respiratory rate
increases markedly; if the baby shows any stress signs (splayed fingers
or widened eyes), the milk flow is slowed.
Ideally, feeding should proceed at a pace that allows a 1:1 suck–
swallow ratio during sucking bursts, particularly at the beginning of a
feeding.
Feeding should follow the normal burst–pause pattern of a 3–5 second
respiratory break after a sucking burst of 5–20 sucks, depending on
the infant’s maturity and aerobic capacity.
Finger feeding

15. Dr.Ravari, Newborn Skyroom1 Dec 2020
Is not appropriate for all babies
Cleaningthetubes properly is difficult
The flow of milkmay be too fast or too slow
A sore mouth
A finger is not the same as a breast
◦Pushing afinger too far into baby ’s mouth, or the tube extending further than
afinger tip could cause gagging or discomfort.
◦It’s important to watchyour baby closely for signs of stressor they could start to
resist anything entering their mouth (oral aversion) including a breast.
Infants can become addicted to this type of feeding and weaning them to the breast
can be difficult.
Some healthcare professionals consider the placement of a finger inside the infant’s
mouth to be an invasive procedure and are reluctantto implement this method
Disadvantages of finger feeding(some concerns )

16. Please Note:
If the baby is taking the breast, it is far better to use the
lactation aid tube at the breast(SNS),
If supplementation is truly necessary Again, finger feeding is
not a good method of supplementation in the latching baby

17. Dr.Ravari, Newborn Skyroom1 Dec 2020
Recommended steps to implementation of the Baby Friendly Hospital Initiative
Implementing the Baby Friendly Hospital Initiative:
The role of finger feeding
Breastfeeding Review 2003; 11(1): 5–9

18. Dr.Ravari, Newborn Skyroom1 Dec 2020
The aim of our study was to assess the effectiveness of the finger
feeding method in encouraging a breastfeeding-type suck, in preterm
infantswho were commencing oral feeding.
Through identification of a developing faulty suck or correction of a
faulty sucking technique, we hypothesisedthat it would be practicable
to improve the number of infants exclusively breastfeeding on
discharge from NICU.
Substitution of finger feeding for bottle feeding in preterm infants with
developing or faulty sucking techniques in a hospital in Perth, Australia,
increased the rate of breastfeeding on discharge from 44% to 71%
Implementing the Baby Friendly Hospital Initiative:
The role of finger feeding
Supporting Sucking Skills in Breastfeeding Infants, Third Edition2017

19. Dr.Ravari, Newborn Skyroom1 Dec 2020
The control group comprised 27 newborns fed through the cup-feeding
technique, 13 of whom had 32-34 weeks of gestational age and 14 had
34-36 weeks of GA
The experimental group, fed using the finger-feeding technique,
comprised a total of 26 newborns, 12 with 32-34 weeks of GA and 14 with
34-36 weeks of GA.
◦In both GA ranges, the control group showed significantly higher values of milk loss when
compared with the experimental group, with a higher loss in the corrected GA range of 32-34
weeks.
◦The time of feeding in the experimental group was longer than the time of feeding in the control
group
◦Regarding weight gain (during 1-5 days), In the control group, the median weight difference
between the 1st and the last weight assessment was 145.0 g, while in the experimental group, the
median was 85.0 g.
Comparison of the finger-feedingversus cupfeeding methods in
the transition from gastric to oral feeding in preterm infants
J. Pediatr. (Rio J.) vol.93 no.6 Porto Alegre Nov./Dec. 2017

20. Dr.Ravari, Newborn Skyroom1 Dec 2020
Comparison of the finger-feedingversus cupfeeding methods in
the transition from gastric to oral feeding in preterm infants
J. Pediatr. (Rio J.) vol.93 no.6 Porto Alegre Nov./Dec. 2017
Complications occurred significantly more often among neonates with
32-34 weeks of GA in the control group
Complications in the control group (CG) and in the
experimental group (EG) with 32-34 weeks of
gestational age (GA and 34 + 1 to 36 + 6 weeks GA
Presence of complications during the
oral feeding: these complications were
oxygen saturation, cyanosis, respiratory
effort, and gagging. The observation of
these signs of stress was performed by
the nursing team.

21. Dr.Ravari, Newborn Skyroom1 Dec 2020
Materials and Methods: Totally 70 babies were included in this prospective randomized
controlled study. Finger feeding method was applied in Group 1 (n = 35) and syringe
feeding method was applied in Group 2 (n = 35).
Results:
◦Predicted comfort and distress scores of Group 1 were significantly lower than those of Group 2.
This means that babies in the finger feeding group had better comfort than the those in Group 2
(p = 0.000).
◦Time passed for transition to breastfeeding was significantly shorter than that in Group 2
(19.4 ±15.0 days versus 29.7 ±10.2 days,p = 0.000).
◦Group 1 had lower amount of food leakage while feeding and their average weight gainat the
end of 10th day was significantly higher (322.1 ±82.3 g versus 252 ±108.4 g,p = 0.004). They also
were discharged earlier than Group 2 (25.8 ±17.4 days versus 35.9 ±13.0 days,p = 0.001).
Conclusion:Finger feeding method is an effective way for increasing sucking abilities,
accelerating transition to breastfeeding, and shortens duration of hospitalization in
preterm infants.

Comparison of the Finger Feeding Method Versus Syringe Feeding Method in
Supporting Sucking Skills of Preterm Babies
Breastfeeding Medicine VOL. 15, NO. 11 | Clinical Research, 9 Nov 2020
https://doi.org/10.1089/bfm.2020.0043

22. Dr.Ravari, Newborn Skyroom1 Dec 2020
Types
◦10 ml to 50 ml capacity with a gavage tube 5F or tubing
from butterfly needle
◦Periodontal syringe, 10ml with a curved tip
◦Regular syringes (1,2,5.10,20 ml )are usually not used
because the infant have difficulty in complete seal
◦Finger feederattached to syringe
Provide milk incentives at the breast in order to achieve latch-on
Complementary feeding
Syringes

23. Dr.Ravari, Newborn Skyroom1 Dec 2020
An alternative is to use periodontal syringe
commonly used by dentists, which has a nicely
curved hard tip instead of a needle.
Baby first latches to the breast, and then the
plastic tip of the syringe is gently sneaked into
the corner of his mouth no more than an eighth
to a quarter of an inch (two and a half to five
millimeters).
As baby sucks, the plunger is depressed with
short taps to deliver small amounts of milk
whenever baby’s jaw drops.
Periodontal syringe

24. Dr.Ravari, Newborn Skyroom1 Dec 2020
Regular syringes
Regular syringes

25. Dr.Ravari, Newborn Skyroom1 Dec 2020
For encourage sucking during breastfeeding
For supplemental feeding
during finger sucking
For minimal enteral feeding
Finger feeder

26. Dr.Ravari, Newborn Skyroom1 Dec 2020
At the breast;
◦insert the tip of the syringe(Periodontal syringe
or Finger feeder) just inside the infant's lips at
the corner of his or her mouth
◦Give a small bolus of milk(.25-.5ml)when the
baby sucks rate initially “ suck: bolus :suck :
bolus” When infant is suckling well the pattern
will be “suck, suck, bolus: suck, suck, bolus” or
“suck, suck, suck, bolus: suck, suck, suck, bolus”
Syringes (Technique)

27. Dr.Ravari, Newborn Skyroom1 Dec 2020
Can be used for very small amounts of
milk, for example colostrum.
Feeding with syringes and droppers is not
faster than cup-feeding.
Place a very small amount (not more than
0.5 ml at a time) in the baby’s cheek
(between the cheek and gums)and let the
baby swallow that before giving more.
Syringe or Dropper

28. Dr.Ravari, Newborn Skyroom1 Dec 2020
Limitations (Syringe or Dropper)
Often needs a second person to help
Is a foreign object in the mouth
Milk Can be improperly injected in to
mouth causing the baby to choke
Syringes and droppers are more
difficult to cleanand more expensive.
Is a slow way to feed baby

29. Dr.Ravari, Newborn Skyroom1 Dec 2020
Advantages
◦Avoids the use of artificial nipples
◦Inexpensive and widely available
◦Easy to use and teach parents
◦Can be used for very small amounts
of milk (colostrum)
◦Baby may be more eager to
breastfeed because suckling need s
are not met
Spoon-feeding

30. Dr.Ravari, Newborn Skyroom1 Dec 2020Dr Ravari
Spoon-feeding (Technique)
The baby should be alertwith a
functioning swallow reflex
Position the baby in a semi-upright
Place the spoon just inside the
infant's lips over the tongue
Allow the infant to pace the feeding
by sipping or lapping
Avoid pouring the milk into the
baby's mouth

31. Dr.Ravari, Newborn Skyroom1 Dec 2020
In addition to the negative physiological effects, bottle
feeding constitutes an obstacle to breastfeeding because
facial muscles are activated in a way that differs from the
oral motor pattern used during breastfeeding.
Bottle feeding promotes the view of feeding as the provision
of fixed volumes at fixed intervals by anybody—it does not
require the mother’s presence. Furthermore, it is mainly a
feeding method, in contrast with breastfeeding, which is also
the newborn infant’s main strategy for self-regulationduring
the process of adaptation to the extra-uterine environment.
Bottle Feeding

32. Electromyography (EMG) studies have
confirmed that muscle activation is
different between breastfeeding and
bottle feeding, with less use of the
mentalisand masseter muscles and more
use of the buccinatorand orbicularis oris
muscles in bottle feeding
Muscle activation in Bottle feeding v/s Breastfeeding

33. Dr.Ravari, Newborn Skyroom1 Dec 2020
The cardiorespiratory system of a preterm infant is immature,
with bradycardia, irregular respiration, and apnea
Difficulty maintaining adequate oxygen saturation is the main
concern during feeding.
Decisions about the choice of a feeding method areprimarily
based on protection of the infant’s physiological stability.
However, these signs of sensitivity or instabilityare observed
in connection with bottle feeding, not breastfeeding.
physiological instability observed in bottle feeding

34. Dr.Ravari, Newborn Skyroom1 Dec 2020
Common observations during bottle feeding were
◦Uncoordinated sucking and swallowing;
◦Reduced breathing;
◦Higher incidences of bradycardia,apnea, and
◦Desaturation; lower levels of oxygen saturation;
progressive post feeding decline of transcutaneous
oxygen saturation; and
◦lower temperature, whereas the same infants—also very
preterm infants—remained stable during breastfeeding
Physiological Stability During Breastfeeding

35. Dr.Ravari, Newborn Skyroom1 Dec 2020
Bottles and artificial nipples
Concerns with bottles and artificial nipples interfering with
successful breastfeeding have led UNICEF and WHO to
include strong statements against their use. Concerns
include the following:
◦The breastfed infant may prefer the bottle .
◦Infants may develop a preference for a particular bottle nipple.
◦Bottles and nipples are hard to clean properly.
◦Mothers who are exposed to bottles in the postpartum report that their nipples
are more painful.
◦Bottles are a popular symbol for infants, leading people to believe that bottles
are the normal infant feeding method ?!.

36. Dr.Ravari, Newborn Skyroom1 Dec 2020
Bottles
The upside of bottles is that they are
easy, convenient, and socially
acceptable.
The downside is that there is a risk
of nipple confusion, flow preference
andnipple preference that could
jeopardize your breastfeeding
relationship.

37. Dr.Ravari, Newborn Skyroom1 Dec 2020
Bottle feeding can
separate the
epiglottis/soft palate
connection, elevate the
soft palate, drive the
tongue back and alter
the action of tongue
Bottle Feeding

38. Dr.Ravari, Newborn Skyroom1 Dec 2020
In a feeding policy based on prioritizing breastfeeding, bottle
feeding is considered appropriate when the mother:
◦Is unable to breastfeedfor medical reasons.
◦Is unable to attain a milk production that satisfies her infant’s needs in
spite of her efforts.
◦Intends to use mixed feeding (breast and bottle).
◦Does not intend to breastfeed, which ought to be a result of an
informed decision and can have psychological explanations.
◦Explicitly demands to use a bottle after information about advantages
of cup feeding and reasons for a restrictive attitude toward bottle
feeding.
Bottle Feeding
Ref: Supporting Sucking Skills in Breastfeeding Infants, Third Edition
راوخریش ندیکم یاه تراهم زا تیامح یروار رتکد صیخلن و همجرت2017

39. Dr.Ravari, Newborn SkyroomOct 2020
When using a bottle for a breastfed
infant, or to encourage more
normal feeding skills in an infant
not yet breastfeeding, an artificial
nipple that is cylindrical, with a
rounded end (not orthodontic), a
smooth graduated slope to the
nipple (not indented), and a wider
base is usually preferable
Mixed Breastfeeding and Bottle-feeding

40. Dr.Ravari, Newborn Skyroom1 Dec 2020
Babies may maintain latching skills
better if they are stimulated to latch
onto the bottle more like they attach to
the breast.
The teat can be held across the infant’s
upper lips with the tip at the philtrum
(the ridge between nose and upper lip)
to cue a wide gape, and the infant can
be snuggled onto the bottle as it is
tipped into the mouth.
Bottle-feeding

41. Dr.Ravari, Newborn Skyroom1 Dec 2020
Mixed Breastfeeding and Bottle-feeding
When to Offer the Bottle
◦Christina Smillie, M.D., IBCLC, suggests
an alternative way that she calls the
“Finish at the Breast”method of bottle
supplementation.
◦In her practice, she observed that
babies who quenched their initial
hunger and thirst with a bottle first
tended to have more patience feeding
at the breast.

42. Dr.Ravari, Newborn Skyroom1 Dec 2020