A lactation aid is a device that allows a breastfeeding mother to
supplement her baby with expressed breastmilk, formula, glucose water
with added colostrum or plain glucose water without using
a bottle. The early use of artificial nipples may result in the baby
becoming “bottle spoiled” or “nipple confused” especially when the
mother’s breastfeeding is not yet well established or flow from the
breast is slow because of milk supply issues. In fact, the baby is not
confused. The baby knows exactly what the score is. If he goes to the
breast and gets little milk or the flow is slow and then gets a bottle
with rapid or steady flow, especially in the first few days, most can
figure that one out fairly quickly. Bonding is very important, but
hunger comes first.
The better a baby latches on, the easier it is for him to get milk, particularly
if the mother’s supply is low. In the first few days, it may
seem as though the mother may not have much milk; however, the mother
does have the appropriate amount of milk that baby requires (see the
video clip 2 day old baby at the website nbci.ca and watch this
baby drink great guns—compare to the other video clips that show older
babies drinking). Yes, the milk is there even if someone has “proved”
to you with the big pump that there isn’t any. How much does or does
not come out in the pump proves nothing—pumps don’t work that well
either when the milk is there in the small, but normal, quantities of
the first days, as nature intended, incidentally.
Also note, no one who squeezes a mother’s breast can tell whether there
is enough milk in there or not. And a good latch is important to help
the baby get that milk that is available. If the baby does not latch on
well, the mother may get sore nipples, and if the baby does not get
milk well, the baby will want to be on the breast for long periods of
time, worsening the soreness. What we have here is a perfect “vicious
circle”, which can be avoided, actually.
Though artificial nipples do not always cause
problems, their use when things are already going badly will rarely
make things better and usually make things worse. And “newer bottle
nipples” are no better than the old ones; that’s just good marketing.
The lactation aid is by far the best way to supplement, if
the supplement is truly necessary. (However, proper latching
on of the baby usually allows the baby to get more milk, and thus it is
often possible to avoid the supplement). The lactation aid is better
than using a syringe, cup feeding, finger feeding or any other method,
since the baby is on the breast and breastfeeding. Babies, like adults,
learn by doing. Furthermore, the baby supplemented while
latched on to the breast is also getting breastmilk from the
breast. And there is much more to breastfeeding than breastmilk.
Why Is The Lactation Aid Better?
- Babies learn to breastfeed by breastfeeding
- Mothers learn to breastfeed by breastfeeding
- The baby continues to get the mother’s milk even while
- The baby will not reject the breast, which is very possible
if supplementing off the breast
- There is more to breastfeeding than the breastmilk
What Is A Lactation Aid?
A lactation aid consists of a container for the supplement—usually a
feeding bottle with an enlarged nipple hole—and a long, thin tube
leading from this container. Manufactured lactation aids are available
and are easier to use in some situations, but not necessarily.
Manufactured lactation aids are particularly useful when the need for a
lactation aid arises in an older baby, when a mother needs to
supplement twins, when the need for a lactation aid will be long term,
or whenever difficulty arises using the improvised lactation aid.
Though the manufactured lactation aid is not inexpensive, the cost is
about equal to two weeks of the usual milk-based formula. Please
Note: Using a tube with a syringe, with or without a plunger,
instead of the setup mentioned above, seems unnecessarily complicated
and adds nothing to the effectiveness of the
technique. On the contrary, it is more cumbersome and pushing the milk
into the baby’s mouth with the syringe does not teach the baby how to
breastfeed because he gets milk even if he sucks poorly.
Using The Lactation Aid (Improvised). (Use should be
shown by a person experienced in helping mothers with breastfeeding).
See the video clips at nbci.ca.
- The baby may be latched on to the breast first, and the
tube slipped into the baby’s mouth at the appropriate time (after
the baby has breastfed on at least both sides first).
The better the latch, the better the baby will get your milk and the
easier the aid will be to use, and the more quickly you will be able to
get rid of it and the supplements. The breast should be gently
eased out of the way so that the corner of the baby's mouth is seen,
and the tube, held between the index finger and thumb, should be
slipped into the corner of the baby’s mouth so that it enters straight
towards the back of the baby’s mouth and at the same
time, slightly upwards towards the roof of the mouth (see the video
clip called Inserting Lactation Aid). The tube is
well placed when the supplemental fluid works its way down the tube at
a rather rapid rate. There is usually no need to fill the tube with
supplemental fluid before putting it into the baby's mouth.
- Or, the baby is latched on to the breast and the tube,
which is run along the mother’s breast and nipple, at the same time.
The better the baby's latch, the easier the lactation aid is to use.
Also, the better the latch, the more likely and the sooner the baby
will be able to do without supplements. Therefore, proper positioning
and latching on of the baby are still very important.
- The tube may be taped to the breast if the mother desires,
though this is not really necessary and not always helpful.
- The tube does not need to pass the end of the nipple and
needs to be only just past the baby’s gums to function properly. It
does seem to function better if the tube is placed in the corner of the
baby’s mouth and enters straight into the baby’s
mouth over the tongue. (Point it slightly to the roof of the baby’s
mouth). It is occasionally helpful for the mother to hold the tube in
place with her finger, as some babies tend to push the tube out of
position with their tongues.
- The bottle containing the supplement should not be higher
than the baby’s head. If the lactation aid functions only when the
bottle is held higher than the baby's head, something is wrong. Keep
the bottle higher only if the doctor or lactation
specialist suggests this (as in the care of breast refusal for
- It is best to use the tube as necessary to keep the
baby drinking at the breast. Follow the Protocol to Increase Breastmilk
Intake. Feed baby from both breasts before adding the supplement. Some
mothers find it easier not to use it during the night. Better eight
supplements a day of 30 ml (1 ounce) per feeding than 2 large
supplements a day of 120 ml (4 ounces) each.
Do not cut off the end of the tube as cutting it makes the
end sharp--it works fine as it is.
- It should not take an hour for the baby to drink an
ounce of milk from the lactation aid. If it is taking this long, the
tube is probably not well positioned, or the baby is poorly latched on,
or both. When the lactation aid is functioning well, it takes 15-20
minutes, usually less, for the baby to take 30 ml (1 ounce) of the
- A trick for easier use: Wear a shirt with pockets, and
put the bottle in the pocket or stick it in your bra strap.
Cleaning the Device
Do not boil the tube of the non-manufactured aid. It is not made to
After using the device, clean the bottle and nipple as usual. Do not
boil the tube. The tube should be emptied after use and then rinsed
through with hot water (suck up hot water into the tube from a cup) and
then hung up to dry. Soap, though not necessary, may be used if
desired, but rinse the tube well. Tubes may become stiff and unsuitable
for use after a few days to a week.
Weaning the Baby from the Lactation Device
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
Maintain contact with the breastfeeding clinic for advice about
weaning the baby from the lactation aid. See the information sheet
Protocol to Manage Breastmilk Intake.
Weaning the baby from the aid may take several weeks or only a short
while. Do not be discouraged and do not try to force the weaning.
Usually, the amount of milk required in the lactation aid increases
over one or two weeks, and then levels out for a variable period of
time before decreasing. The whole process may take two to eight weeks
or longer, although some mothers have used the device only a few days,
whereas others have not been able to stop using it at all until the
baby was well established on solids. Rapid improvement sometimes occurs
after a long period of little change.
Observe the baby’s breastfeeding. If you do not know how to know if
the baby is drinking, see the video clips at nbci.ca. Put the
baby onto the breast, allow the baby to breastfeed as long as he is
suckling and drinking, then use breast compression (see the information
sheet Breast Compression) to keep the baby drinking; then repeat the
process on the second breast. You can return to the first breast and
continue back and forth as long as the baby is drinking. After you have
finished feeding on both breasts, insert the tube into the baby’s
mouth. Allow the baby to breastfeed until satisfied using the lactation
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Lactation Aid, 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC,
Revised Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008,