Introduction

A Supplemental Nursing System (SNS) can be used to administer supplemental nutrition to babies while they are being fed at the breast.

This helps to maintain skin to skin contact with mother/feeding parent and baby and can increase a parent’s milk supply.

It may also reduce the negative practical and psychological impact of a triple feeding regime.

How to use an SNS safely

Wash your hands thoroughly before preparing the supply line.

Fill your bottle with the right amount of milk that is needed for this feed. The health professional will decide how much is required.

The baby should breastfeed on both breasts first or until the baby is feeding less vigorously, before introducing a supply line.

Offering the breast before using the supply line in these circumstances can stimulate a better milk supply.

The supply line can be set up in 2 ways:

• Allow the baby to attach to the breast, then insert one end of the tubing into the corner of the baby’s mouth, pointing it slightly towards the roof of their mouth. The tube may also be effective when inserted under the nipple, so that it is directly over the baby’s tongue. https://youtu.be/UCVJjCMzx98
• Alternatively, the tubing can be taped to the mother’s breast before the baby attaches.

When you are ready to use the supply line, place the tubing into the container of milk.

A hole in the top of the disposable teat can be made to insert the tubing to help keep the tube in place.

If using tubing with an opening at the end it only needs to go just past the baby’s gums.

If using tubing with openings on the side, it should be inserted far enough that all openings are in the baby’s mouth.

• The tube should never be cut down.

The baby will suck on the breast and the tube at the same time, drawing extra milk through the tube into their mouth (like sucking on a straw).

Initially hold the bottle of milk at the same level as the nipple. If you need to slow or increase the flow you can do so by changing the level of the bottle.

If the bottle is too high the flow will be too fast, and the baby may swallow too quickly.

If the container is held too low the flow may be too slow, and your baby may become frustrated and tired.

If your baby is breathing regularly and sucking in a relaxed and rhythmic way (1 to 3 sucks per swallow) the milk flow will be working well.

How to clean your SNS

Trial systems provided in clinic are made with an Naso-Gastric (NG) tube which is a single use item.

This type of tube is not designed to be sterilised but discarded after one use.

NG tubes are often used for up to 72 hours as a naso-gastric tube.

This is because once they are placed they are not regularly handled or exposed to dirt and bacteria from the outside environment.

However, when used at the breast, the tube is exposed to the environment and handled much more regularly.

• Always inspect the NG tube for damage or discoloration before a feed and always discard the tube after a maximum of 72 hours. Babies more vulnerable to infection, such as premature babies, should have a new tube every 24 hours.
• The feeding tube must be cleaned thoroughly as soon as the feed is finished. Rinse the tube using a syringe to remove any milk from the tubing and to avoid the growth of bacteria – this is particularly important when infant formula is used as it grows bacteria more quickly than breastmilk.
• Use a 10ml syringe to flush 10mls of just boiled water through the tube if breastmilk has been used. Flush through with sterilising solution if formula has been used.
• Flush the tube at least 3 times, more if there is any milk still visible in the tube. Always store the cleaned tube in a clean sealed container or plastic bag in the fridge.
• The demonstration tube used in clinic should be disposed of and not reused as it has been tested in a public environment and cannot immediately be cleaned
• If using a purchased kit parents should refer to the manufacturer’s guidelines for use and cleaning instructions.

How to decrease use of the SNS

Some families will need to consider long term use of an SNS; however, some may find this is a short-term solution.

Your health professional will discuss how to do this safely by gradually reducing the volume in the SNS, while looking out for signs that the baby is still getting enough milk, based on behaviour, urine and stool output appropriate to age, and adequate weight gain.