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Other feeding methods
For the newborn baby to survive and thrive it must make a successful transition to enteral feeding after birth. Most babies achieve this smoothly and continue to feed well, either at the breast or from a bottle. However, some need support to maintain adequate nutrition and hydration. These babies may be small and relatively weaker, such as preterm infants, or may have a congenital anomaly that makes feeding more difficult, such as an orofacial cleft. Midwives will need to work with parents to ensure the infant’s nutritional needs are supported. The following are common strategies to provide additional milk for the baby and, if the mother is breast feeding, are preferable to using a bottle and teat. Breastfeeding mothers should be encouraged to give expressed breastmilk rather than formula.
Basic principles of cup and syringe feeding
- Use only when clinically indicated.
- Discuss with, obtain the consent of, and involve the parents.
- Wash hands before and after.
- Use sterile, single-use equipment.
- Discard unused milk.
- Document all supplementary feeds.
- Used in addition to, not instead of, breast feeds.
- After feeds remove bib and make baby comfortable.
Cup feeding
Used when additional feeds of 3–5 mL or more are required (Figure 45.1).
- Wrap baby in a blanket and place a bib under the chin.
- Hold baby in an upright position.
- Rest the edge of the cup on the baby’s lower lip, tilted to allow milk to touch the lip.
- Allow baby to lap or drink the milk.
- Feed at the baby’s pace.
- Do not move the cup until the baby has finished.
- The baby will indicate when it has had enough, usually by turning the head away.
Syringe feeding
Used when additional feeds of 3–5 mL or less are required (Figure 45.2).
- Wrap baby in a blanket and place a bib under the chin.
- Hold baby in an upright position.
- Place the nozzle of the syringe between the gum and the cheek.
- Syringe no more than 0.2 mL of milk into the mouth at a time.
- Allow baby to swallow the milk before delivering another bolus of 0.2 mL.
- Continue until feed has finished or baby rejects more feed.
Tube feeding
Babies who are unable to suck and swallow adequate amounts of milk may need supplementary feeding by nasogastric tube. This is only undertaken by staff who have been trained and demonstrated competence in the procedure. Parents will be trained to insert and feed by tube if the baby is discharged while still being tube fed. The tube must be inserted correctly and the position in the stomach confirmed. The position is confirmed before every feed or medicine is given, after any vomiting episode and at least once every shift. An incorrectly placed tube may lead to inadvertent instillation of milk into the airways, with possibly fatal consequences. Tube size is usually 6FG.
When inserting a nasogastric tube the type and size must be based on individual needs. It is essential that the midwife refer to local evidence-based policy and procedure in order to ensure the safety and comfort of the child. During insertion of the tube there will be a need for two people to pass the tube; one carrying out the procedure and the other supporting the baby and parent(s).
The type of tube passed, size, method used to secure the tube and the tube feeding regimen must be documented.
Feeds may be given as slow boluses from a syringe, with the flow rate controlled by gravity (raising or lowering the syringe; Figure 45.3). The tube is flushed with water before and after every use and should be removed as soon as it is no longer required.
Infants with orofacial clefts
Infants born with an orofacial cleft may need some assistance to feed. Many are able to breastfeed with appropriate assistance in the early days. For those who cannot, or whose mothers do not wish to, special teats are available.
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