Connecticut Childrens Medical Center - Policy and Procedure Manual

Provision of Care, Treatment and Services

Date Effective:

April 19, 2012

Alternative Feeding Techniques

Date of Origin:

March 01, 2000

Approved By: Clinical Council

Date Approved:

April 03, 2012

I.Purpose
The purpose of this policy is to describe the steps involved in safely and effectively cup
feeding, finger feeding and syringe feeding human milk or formula to an infant.
II.Policy
It is the policy of Connecticut Childrens Medical Center (Connecticut Childrens) to
support breastfeeding and oral feeding by offering alternative feeding methods like cup,
finger or syringe feeding for times when the mother is not available and/or the infant is
unable to take an entire feeding at breast or bottle. These methods are appropriate for
nursing infants and infants diagnosed with oral-motor/developmental feeding problems.
These techniques may be used by Occupational Therapists, Speech and Language
Pathologists, Registered Nurses, Patient Care Assistants, Mid-level Practitioners,
physicians and parents trained in its use.
III.Procedure
A. Cup Feeding/Preparation and Feeding
1. Wash hands thoroughly.
2. Observe the infant as being awake and showing feeding readiness cues in
preparation for the feeding.
3. Fill a 30-ml medicine cup at least half full with breast milk or formula.
4. Wrap the infant in a blanket to minimize stimulation and to protect the cup from
being knocked loose.
5. Use a pre-weighed drip cloth to aid in calculating lost intake.
B. Position Baby/Initiate Feeding
1. Position the infant upright, with good support for body and head.
2. Place the edge of the cup gently on the infants lower lip.
3. Tip the cup so the milk or formula just touches the infants lip. Do not pour it into
the infants mouth.
4. Allow the infant to sip or lap at his/her own pace.
5. Leave the cup in position during the feeding to make milk or formula available to
the infant as he/she paces the feeding.
6. Limit the cup feeding to 30 minutes or less, according to the infants interest and
tolerance.
C. Finger Feeding
1.Wash hands thoroughly.
2. Prepare breast milk or formula and pour amount into a volu-feed.

Page 1 of 4

Connecticut Childrens Medical Center - Policy and Procedure Manual

Provision of Care, Treatment and Services

Date Effective:

April 19, 2012

Alternative Feeding Techniques

Date of Origin:

March 01, 2000

Approved By: Clinical Council

Date Approved:

April 03, 2012

3.Assemble the supplemental nursing system (SNS) according to the package

instructions, using the volu-feed containing expressed breast milk or formula.
4.Attach SNS, with the tubing clamped, to the shoulder of the caregivers clothing.
5.Prepare infant for feeding outside of crib or isolette.
6.Place clean, snug-fitting glove on the hand to be used for finger feeding.
7.Position feeding tube on the soft-pad of the finger so the tip of the tube ends
where the finger pad curves. Do not allow the tube to extend beyond the tip of the
finger.
8.Use tape placed at the second joint of the finger to secure the tube in place.
D. Position Baby/ Intimate Feeding
1.Position baby comfortably, with baby on caregivers lap. Infant should be held in
an upright position with the head and neck supported by the caregivers nonfeeding hand.
2.Using finger with tube attached, stroke babys lips gently to elicit a rooting reflex
and mouth opening. If baby opens mouth only slightly, rub gums gently to
stimulate wider mouth opening. It may be necessary to press gently on babys
chin.
3.With mouth sufficiently opened, slide finger (pad side up) with feeding tube into
babys mouth.
4.The finger pad should be positioned at the juncture of the hard and soft palates
(S spot) before unclamping the tube and releasing the breast milk/formula.
5.The feeding hand should be held level, with wrist slightly elevated to prevent any
downward pressure on the babys tongue. The finger should be maintained in this
position throughout the feeding
6.It is best to allow the baby to suck on the finger before releasing the milk or
formula to help the babys suck become organized. However, some babies require
a taste of milk before they will begin to suck.
F. Feeding process
1. Once baby starts sucking unclamp the tube to allow the breast milk/formula to
flow.
2. Height of the volu-feed should be adjusted to control the rate of milk flow
according to the babys suck/swallow skills.
3. If the baby stops sucking for longer than a normal pause, apply gentle pressure
upward on the S spot to elicit the sucking reflex again.
4. Avoid tickling or aggressively stroking the S spot. Avoid any in-and-out
movement of the feeding finger.
5. Clamp the tube and remove the finger from the babys mouth if he/she shows
signs of needing to burp or take a rest.
Page 2 of 4

Connecticut Childrens Medical Center - Policy and Procedure Manual

Provision of Care, Treatment and Services

Date Effective:

April 19, 2012

Alternative Feeding Techniques

Date of Origin:

March 01, 2000

Approved By: Clinical Council

Date Approved:

April 03, 2012

6. Resume the feeding process until the breast milk/formula is consumed, or the
infant is no longer interested.
C. Syringe Feeding
A. Preparation/Equipment
1. Wash hands thoroughly
2. Observe the infant as being awake and showing feeding
readiness cues in preparation for the feeding.
3. Prepare breast milk or formula and draw desired amount into a
1, 3 or 6 ml syringe. May use a short (2-3mm) length of feeding
tubing on the end of syringe.
B. Position Baby/Initiate Feeding
1. Position baby comfortably, with baby on caregivers lap. Infant
should be held in an upright position with the head and neck
supported by the caregivers non-feeding hand.
2. Using the syringe, stroke babys lips gently to elicit a rooting
reflex and mouth opening. If baby opens mouth only slightly, rub
gums gently to stimulate wider mouth opening. It may be
necessary to press gently on babys chin.
3. With mouth sufficiently opened, slide syringe into babys mouth.
Be sure to aim syringe at the side of the mouth toward the
infants cheek.
4. The syringe may be used to gently tap the S (suck) spot on the
infants palate to stimulate sucking but the feeding should not be
delivered while the syringe is in this position. Avoid tickling or
aggressively stroking the S spot. DO NOT use this
presentation for facial plastics or oral-maxillofacial post
operative patients. For these patients present only to the buccal
cavity.
C. Feeding Process
1. Once the infants starts sucking, gently depress the plunger of
the syringe to deliver small aliquots of the feeing into the side of
the infants mouth. Avoid pushing large amounts into the
infants mouth and stop depressing the plunger whenever the
infant stops sucking.
2. Repeat this process until desired amount of breastmilk/formula
has been delivered
3. Syringe feeding should NOT be used to deliver large feeding
volumes (>50% full feeding) or for long term supplementation.
Page 3 of 4

Connecticut Childrens Medical Center - Policy and Procedure Manual

Provision of Care, Treatment and Services

Date Effective:

April 19, 2012

Alternative Feeding Techniques

Date of Origin:

March 01, 2000

Approved By: Clinical Council

Date Approved:

April 03, 2012

IV. Documentation
1. Record breast milk/formula intake on the flowsheet.
2. Record length of feeding.
3. Record tolerance of this feeding method in the progress notes.
4. Document the occurrence of any of the following during the feeding: color changes,
change in HR, RR, or O2 saturation, or biting the cup.
V. References
Mohrbacher, N. and Stock, J. The Breast Feeding Answer Book, Revised Edition,
Schamburg Illinois, La Leche League International, 1997, pp 540-541
Dowling, D., et al. Cup Feeding for Pre-term Infants: Effect on Oxygen Saturation,
Weight Gain, and Breast Feeding, Journal of Human Lactation 2002; 18 (2)
Rocha, M.N., et al. A Comparison of the Safety of Cupfeedings and Bottlefeedings in
Premature Infants Whose Mothers Intend to Breastfeed, Journal of Perinatology 2001 ;
21 :350-355
Oddy, W.H. and Glenn, K. Implementing the Baby Friendly Hospital Initiative: the role of
finger feeding, Breastfeeding Review 2003, 11(1): 5-10
Flint, A, et al Cup feeding versus other forms of supplemental enteral feeding for
newborn infants unable to fully breastfeed, Cochrane Database of Systematic Reviews,
2007 Issue 2, ART No. CD005092DOI:10.1002/14651858.CD005092.pub2.
Collins CT, Makrides M, Gillis J, McPhee AJ. Avoidance of bottles during the
establishment of breast feeds in preterm infants. Cochrane Database of Systematic
Reviews 2008, Issue 4. Art. No.: CD005252. DOI: 10.1002/14651858.CD005252.pub2.
Hargreaves, K. and Harris, A. Nipple confusion in neonates. British Journal of
Midwifery, 2009, 17(2) 97-103
VI. Related Documents
Alternative Feeding Guidelines in the NICU

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