There are times when baby must be fed away from the breast and it is not desirable to use a bottle. In these situations, either you or another caregiver can finger-feed.
Finger-feeding uses a device attached to a caregiver’s finger to give the baby supplemental milk. This allows you to avoid giving your baby an artificial nipple while still allowing him to suck, which is important to babies for both physiological and psychological reasons. Finger-feeding (with special training) may also be suggested by some lactation consultants for babies who have certain types of problems with sucking. At the very least, finger-feeding allows the baby to have the special feeling of contact with human skin during his feeding, which can be very comforting. During finger-feeding, baby must suck in a way that is similar to breastfeeding, keeping his tongue down and forward over his lower gum, with his mouth wide and jaw forward. As with using a bottle, it is important to encourage him to open his mouth widely before the finger is given so that he learns the same skills he needs for breastfeeding. Some lactation consultants also recommend using a larger finger or thumb that is closer to the approximate diameter of mother’s nipple. A man’s finger may work better than mother’s.
One type of finger-feeder can be made at home using a narrow feeding tube and a regular baby bottle with a nipple whose opening has been enlarged just enough to accept the feeding tube. The end of the tube should be completely submerged in the milk.
Hygeia also markets a commercially manufactured finger-feeding device called the Hazelbaker FingerFeeder. Other options are using the Medela Starter SNS, the full-size SNS, or the Lact-Aid at-breast supplementer as a finger-feeder. The container of these at-breast supplementers can be clipped to your clothing or hung around the neck as usual, while the tubing is attached to a finger and given to the baby as described below.
How to Finger-Feed
First, wash your hands thoroughly, and, if necessary, trim the nail of the finger you will be using as short as possible. Next, assemble the finger-feeder and put the tubing onto your finger, allowing it to extend just to the end of your finger. Use your index finger, middle finger, or thumb, depending on the position of your baby and your desire to imitate the size of mother’s nipple or a mouthful of breast. You can tape the tube to the upper portion of your finger with medical-grade tape if you prefer (or you can use a Band-Aid, slipping the tube under the gauze), but this is not necessary as the tube can also be held securely with your thumb or finger.
Now, pick up your baby and sit in a chair that is comfortable for both of you. There are two good positions for finger feeding, although any position that feels right to you is fine. One position is to hold your baby in your lap in a half-seated position, facing you. Support his head, neck, and upper back with the hand that will not be feeding him. The container filled with supplement needs to be held or suspended in some way at the height of the baby’s head or just a bit above it; some mothers tuck it into their armpit. The other position is to have baby so that his head is in the crook of your arm and you can use other hand to give him the finger-feeder.
With baby facing you and the pad side of your finger turned toward you, point your finger upward and lay it across the baby's lips, stroking downward, encouraging him to open widely for the finger. Be sure to ”wait for the gape,” as this helps to preserve the wide open gape baby needs for a good latch at the breast. When he opens widely, lay your finger on top of his tongue. Keep your finger straight and let him begin sucking on your finger and drawing it more deeply into his mouth. Avoid allowing the weight of your hand to rest on baby’s lower jaw. If you see him sucking in his upper or lower lip, either gently flip them out or withdraw your finger and start the process again to allow him to relatch properly. If he persists in drawing in his lower lip as he sucks, gently pressing downward on his chin may teach him to rely more on the action of his tongue to get milk than on suction.
If you find that the baby seems to be working hard to get milk, or if the feeding seems to be taking a very long time, you can raise the container of supplement a bit higher to improve the rate of milk flow, but not so far that the supplement flows too quickly and the baby gags and chokes. Another remedy is to tape two tubes together and open them both for doubled flow.
To clean the finger-feeding device, wash the container with hot, soapy water. Occasionally, you may need to run vinegar through the tubing to clean it thoroughly.
Finger-Feeding with a Periodontal Syringe
Periodontal syringes can also be used for finger-feeding. Finger-feeding with a syringe is “parent-led” rather than “baby-led.” It allows more flexibility in controlling the flow of milk. This can be an advantage for babies who are having trouble drawing the milk out of feeding tubes, especially if their suck is weak. Consult a lactation consultant to learn the best technique for your situation.
Periodontal syringes are inexpensive (about $1.00 US). The Lactation Institute markets a soft tip for periodontal syringes that can be used for finger-feeding. See “Resources” for information on obtaining periodontal syringes.
To finger-feed your baby with the periodontal syringe, begin by washing your hands thoroughly and trimming the nail of the finger you will be using. Baby can be cradled upright in the crook of your arm, allowing your hand to come around and hold the syringe while you use a finger on your free hand for baby to suck on. Or, baby can be laid in your lap, with his head toward your elevated knees. This frees both hands for feeding. (This position is a favorite for dads.)
Use either your index finger or your middle finger. Turn your feeding finger so that the pad is turned up toward the ceiling. Gently lay the finger across baby’s lips, drawing downward, to prompt him to open his mouth for the feeding. You can gently insert your finger a short distance, but allow him to open his mouth to accept it. Keep your finger straight and allow him to begin sucking on your finger and pulling it deeply into his mouth.
Slip the syringe 1/8 inch (3.175 mm) into the corner of baby’s mouth, taking care not to allow it to slip in deeper during the feeding. (Pulling the syringe out periodically to see the tip can help you visualize where it is in baby’s mouth.) As baby sucks, depress the plunger slightly to give him “taps” of milk (a bolus, or swallow’s worth) timed with the dropping of his jaw as he is sucking. It is important not to push too much milk into baby’s mouth with each suck; rushing the feeding can make it hard for baby to breathe between sucks. Some babies do best with taps of milk given every other suck. Watch your baby to know what the best pace for him is.
Successful feeding by periodontal syringe depends on following baby’s feeding rhythm. Giving a little milk with the syringe can encourage baby to start sucking, but once baby gets going, milk should be given as the jaw drops; if you miss this part of the rhythm, the milk may come right back out and down baby’s chin. Short “taps” of the plunger can help regulate the amount of milk (bolus) baby gets each time. Some babies do well with a little milk each suck, while others do better when given milk every other suck. The size of the bolus needed will vary with each baby.
Periodontal and other similar syringes are cheap, but they also wear out quickly. With frequent use, they usually last for five to seven days before becoming “sticky” and difficult to use. When washing, do not use regular or grease-cutting dish soap, which will strip the lubricated surface and shorten the life of the syringe. Simply wash the syringe promptly with warm water and a little anti-bacterial soap, then rinse and air dry.
Mothers who use syringes often buy four to six or even more of them and load them all up in advance rather than re-filling the same one over and over. To make cleaning easier, fill a bowl with warm water in advance, then toss the used syringes in as you go.
There are other types of syringes with blunt openings that parents sometimes use for finger-feeding. Those with large barrels usually give too much milk with even a small push, while smaller ones simply may not hold enough milk. Any syringe that can be controlled well is a possible option for finger-feeding, but these are usually difficult to find outside of hospitals. Eye droppers have also been used to finger-feed, but do not offer as much control over how much milk is coming out.