What is a Supplemental Nursing System?
Supplemental Nursing Systems can be game changing tools to help you meet your breastfeeding goals. They are available easily without a prescription and can be used without the guidance of a medical professional or lactation consultant as parents wish. It is important to note, though, that these tools work best as part of a long-term plan for breastfeeding management under the care of a skilled lactation consultant. There are many types of SNS set-ups, and choosing the right one is based on an analysis of your milk production, your baby’s feeding abilities, your feeding goals, and your lifestyle. Like all breastfeeding management solutions and tools, it has to be a good fit in all of these areas to make it the right tool for you. A good lactation consultant can help you evaluate your options and determine what might work for you.
What is a Supplemental Nursing System?
A supplemental nursing system, often referred to as an SNS, is a way to feed a baby at the breast when supplemental milk is needed to meet baby’s feeding needs. A tube is fed into the baby’s mouth with the other end either attached to a bottle containing the supplemental milk that the baby will draw through the tube when they generate suction with nursing. Alternatively, the tube may be connected to a syringe where the milk will be pushed through the tube for a baby who may not be able to regulate the feeding or generate enough suction to remove milk from the bottle independently.
Why would we recommend a Supplemental Nursing System?
Supplemental nursing systems are used for a variety of reasons. Here are some of the most common scenarios in which we would want to consider using an SNS:
Long term low supply concerns to allow a breastfeeding dyad to primarily nurse at the breast despite the parent not having an adequate milk supply to meet all of baby’s nutritional needs.
To entice a baby back to the breast after a period of not-nursing by allowing more rapid and continuous flow at the breast.
As an alternative to triple feeding: The SNS provides baby’s supplemental feedings at the breast while providing increased breast stimulation to increase the parent’s milk supply.
Preventing rejection of the nursing relationship by keeping feeding at the breast is a common motivation for a parent to consider the SNS over other means of infant feeding.
What considerations do we have with a Supplemental Nursing System?
Supplemental nursing systems are only appropriate when the baby is able to safely and effectively feed at the breast. Using an SNS can be a great way to manage a complicated breastfeeding situation but only when it’s actually addressing the issue of a particular parent and baby together. While SNS set-ups can be purchased over the counter, I highly recommend only using one under the supervision of a highly skilled IBCLC, and only after a comprehensive assessment of your milk supply situation and your baby’s ability to safely and effectively feed at the breast. The IBCLC should be able to explain how the SNS meets your individual infant feeding needs and goals.
How does a Supplemental Nursing System work?
Supplemental nursing systems work by providing a means to feed a baby at the breast when either the milk supply is not available to meet the baby’s needs or the baby is unable to transfer enough milk independently. The basic mechanics of the system are a reservoir to hold supplemental milk combined with a tube to allow milk to be fed at the breast. In some cases, the baby has to generate suction to transfer the milk, while in others, the system allows passive feeding to maintain the nursing relationship despite baby lacking the ability to independently breastfeed.
How do you hold the SNS tube in place at the breast?
Option A: Medical tape.
You may choose to use medical tape to hold the tube to the breast. This is an easy solution and perhaps the most common method taught. Risk of reaction to the tape adhesive are a concern as well as discomfort from removing the tape multiple times a day.
Option B: A small band-aid.
You may choose to place a small bandaid on the breast to create a pass through tunnel for the SNS tube. You may have to trim the adhesive of the bandaid next to the pad to allow the tube to pass through. This can reduce set-up and prep for usage. This also reduces discomfort from removing medical tape repeatedly.
Option C: A-frame nursing bras or tanks.
If your nursing bra or tank has an A-frame set-up, you can tuck the tubing through the fabric of the bra to hold it in place. This article explains the differences in types of nursing bras: A-Frame Vs Side Sling Nursing Bras. Whats the difference? | Hotmilk Lingerie
What brands of Supplemental Nursing Systems are good?
When it comes to supplemental nursing systems, we have a few options available, each with their own pros and cons:
Option 1: Medela Starter SNS
This is the SNS most likely to be given to a nursing dyad in a health care setting. Technically, this SNS should only be used for 24 hours due to concerns about keeping it clean and durability. This is a temporary SNS and only appropriate for short term usage. A common use for this is to bridge the time period where milk may be low with delayed onset of copious milk production after birth (lactogenesis 2). Some families opt to clean the starter SNS very well and use it for a longer period of time than 24 hours. If you are doing this, like with all infant feeding tools, closely check parts for damage or wear to prevent choking hazards.
Option 2: Medela SNS
This is a more expensive and reusable option for long-term supplementation at the breast. An advantage of this system is that it’s essentially a one time expense, it’s reasonably easy to clean, and it can be used long term.
Option 3: Lact-aid Nursing Trainer
This is a unique system that combines milk bags with a tube device. The advantage of this system over others is that a day’s worth of supplemental nursing set-ups can be pre-prepped for easy use.
Option 4: Haakaa Supplemental Nursing System
This system is compromised of a reusable silicone tube with a dial to control the speed of milk flow. This system was intended for use with Haakaa Gen 3 silicone pumps and feeding bottles, but can be used with any bottle. There is some concern that this tube to too thick for many babies, but other find it to work well.
Option 5: Laally Bridge
This is a hybrid nipple shield and supplemental nursing system combination sns. This can be fantastic for babies who are resistant to using the tube directly or who cannot use an SNS without a shield due to latching issues. This allows for active feeding of the baby with the attached syringe.
Option 6: French Feeding Tubes
French feeding tubes allow for the creation of homemade supplemental feeding systems. These tubes can be inserted through x-cut nipples into bottles, through modified Kiinde bag set-ups or attached to bottles using Volu-feed caps. These homemade supplemental nursing systems are less expensive to acquire and maintain over time. Syringes attached to the feeding tubes allow for easy washing compared to other set-ups.
Supplies for homemade SNS set-ups can be found here:
https://www.lactationconnection.com/Jack-Newman-s-Lactation-Aid-Feeding-Tube-p/54-5036-2.htm
How do you get the tube into the baby’s mouth?
There are three different ways to get the SNS tube into the baby’s mouth.
You line the tube up with the nipple when latching your baby with the end about 1-2 cm past the tip of the nipple before the baby is brought to the breast. You will have to play with tube placement to see what placement allows you to most easily get the hang of latching with the tube in place. This will certainly require practice and can be frustrating in the beginning, but with practice it can become second nature especially with extended use.
You can latch your baby at the breast, then feed the tube into the corner of their mouth. This is done carefully and gently so as not to disrupt the latch. This method may prove easier with babies who really struggle with getting latched as it allows the parent to focus on the latch initially before worrying about the tube for the SNS.
You can use a nipple shield with the tube fed underneath the shield to allow baby to latch without directly being able to feel or move the tube. This can be great in the early days of using the SNS or if the plan is for long-term shield usage.
You may find you need to try each strategy to find what works for you and your baby. Patience and persistence is key to the SNS.
Do you tape the tube to the inside or outside of the breast?
There is no set rules here. As long as the tube is secured to the breast in a way that allows it to smoothly run alongside of the nipple and ends up in the upper corners of your baby’s mouth, it was well placed. Depending on the positions that work best for you, your breast anatomy, and personal preference, you will find one way may work better for you than the other.
What are the Pros and Cons of a Supplemental Nursing System?
The Pros of an SNS:
Allows supplementation to occur at the breast so as not to disrupt the nursing relationship.
Can allow nursing to occur with minimal or no milk supply available.
Can be used with the parent’s own expressed milk, donor milk, or formula.
Provides stimulation to encourage increased milk supply.
Decreases the risk of milk-flow preference associated with bottle usage.
Can facilitate feeding at the breast when baby is unable to feed effectively enough to nurse directly without the aid of the SNS.
The Cons of an SNS:
Some set-ups are expensive with ongoing costs.
Limits the ability of other caregivers to feed the baby which can be essential when helping a parent cope with a difficult feeding situation.
Requires careful planning and confidence to use in public as they are more complicated that other feeding methods.
Can be difficult to clean for some families making this a burden.
Can I make my own Supplemental Nursing System?
You can absolutely create your own supplemental nursing system, and this is a common strategy for parents who opt to use this tool. All you need is a feeding tube and a bottle with some means of holding the tube in the bottle .
Can I use a nipple shield with a Supplemental Nursing System?
Nipple shields can be used with an SNS. The tube can be applied inside the nipple shield so that the baby is unaware of the tube, or alongside the nipple shield, like you would without the shield.
The Laally Bridge is a combined system that you may want to consider if you require both the shield and the SNS to support your feeding goals.
How do I wean off of a Supplemental Nursing System?
How to wean from a supplemental nursing system depends on why you were using it and where you are at in your care plan. If you are using it to bridge the gap while we increase milk supply, you will naturally wean off of it as milk supply increases. If you are using it for long-term supplementation, if can be dropped at any time in favor of other feeding methods. The important part here would be to make sure your care team and lactation consultant know what your goals are so that we wean off the SNS without risking underfeeding your baby or unintentionally harming your milk supply.
How will I know if my baby is ready to wean from the SNS?
If the SNS is being used for low supply with the goal being the additional stimulation at the breast will increase milk supply over time, the baby may slowly take less milk from the SNS. If the baby is consistently taking less milk in the SNS we want to evaluate diaper counts and infant weight to make sure the milk supply has in fact increased, and then work to wean off the SNS. We never want to maintain use of an intervention longer than necessary, but we also don’t want to discontinue the use prematurely and risk undoing all the hard work you put in.
Can I use a Supplemental Nursing System for a Preemie baby?
You can use an SNS with a premature baby, but this should be done under the care of the baby’s medical team collaboratively. Premature babies have unique feeding needs and may necessitate careful consideration for their safety when planning feeding interventions.
Can I use a Supplemental Nursing System for an older baby?
A supplemental nursing system can be used for an older baby. Some babies use the SNS for the entire duration of the nursing relationship well into toddlerhood. A common use of an SNS is to allow quick and ample milk flow to entice a baby who has been disinterested in nursing back to the breast.
How do I clean a Supplemental Nursing System?
Supplemental nursing systems need to be kept clean to prevent contamination of your baby’s food and infection risks. Clean your commercial SNS systems according to the manufacturers directions. This article shares how to properly clean feeding tubes used with homemade SNS systems: International BreastFeeding Centre | How to use a lactation aid at the breast.
Do I have to use an SNS at every feed?
Nope! An SNS is just a tool to support your goals, and it’s only one of several tools available to use. Some families may opt to use an SNS at every feeding, and some may opt to use it part-time. It just depends on why the SNS is being used and how it fits into the overall feeding plan for a particular parent and baby.
What if I hate the SNS?
The SNS is only the right tool for your needs if it meets your needs. If you got set up with an SNS and you hate it even if it’s working well to feed your baby, we can certainly find another option for you! Using an SNS can be a lot of work, and it’s not the right option for everyone. This is where a skilled lactation consultant comes in very handy, we have that whole toolbox of tools and tricks to pull from until we find the right option for you!
What type of milk goes in the SNS?
A huge benefit of the SNS is the ability to feed whatever supplemental milk you are opting to use to feed your baby at the breast. Some parents will opt to pump or hand express milk to feed their baby in the SNS. Some will use donor baby milk. Some will choose to feed formula with the SNS. There is no right or wrong option to feed with the SNS as long as we are assuring your baby gets fed!
What positions are easiest to latch the baby to the supplemental nursing system?
The Koala hold with the flipple technique tends to be the easiest learning position for the SNS. It allows you the opportunity to better control the latch and the best opportunity to help get the tube in with the latch.
If you still aren’t sure about using or needing an SNS, please reach out for a consult so we can help you meet your infant feeding goals.
