Finger Feeding Vs Syringe Feeding in the NICU
by Anne Eglash MD, IBCLC, FABM
Finger feeding is a process of providing nutrition to an infant by attaching a small feeding tube to a finger and allowing the infant to suck on the finger, thereby drawing milk. Finger feeding is used as a strategy for infant feeding when there is difficulty nursing at the breast for a variety of reasons. It is most helpful when supplementing small volumes of milk. However, there is little evidence that infants who finger feed are more successful in their transition to the breast as compared to other types of supplemental feeding such as bottle, cup, or syringe feeding.
The study for this week’s question took place in a NICU in Turkey. The researchers were interested in comparing finger feeding and syringe feeding as strategies to successfully transition gavage-fed premature infants to breastfeeding.
The infants were 30-35 weeks gestational age, on room air, clinically stable, and previously fed breastmilk thru an orogastric tube. The infants had never used nipples or baby bottles, nor had they been to the breast yet.
Thirty-five infants were fed via the finger feeding method 4 times a day, using a 5-french 36-inch feeding tube inserted in a bottle of expressed breastmilk, attached to a nurse’s 5th finger.
The other 35 infants were fed via syringe feeding 4 times a day, using a 1 or 2-ml syringe to drip breastmilk into the inner side of the infants’ cheek.
For both groups, the feeding methods were limited to 20 minutes after which time feedings were finished via orogastric tube.
The infants were fed this way until they transitioned to full breastfeeding, before NICU discharge.
They found that infants in the finger feeding group were fully breastfeeding by 19.4 +/- 15 days, versus infants in the syringe fed group who were fully breastfeeding by 29.7 +/- 10.2 days.
What else? Check the question!
- The infants who were finger fed left the hospital earlier than the syringe fed infants.
- The infants who were finger fed gained significantly more weight by day 10 of the feeding intervention as compared to the syringe fed infants.
- Leakage of milk was higher with finger feeding than syringe feeding.
- Babies fed via finger feeding displayed less physiologic stress as compared to syringe feeding.
nalan karabayir
Finger feeding method firstly used by Dr. Newman is an important method in the process of relactation and / or induced lactation. An alternative feeding method needs to be used in the breastfeeding counseling clinic, I observe that the finger feeding method, which I use as the first option, is an important factor in providing breastfeeding in term babies.
Prof Nalan Karabayir, PhD, IBCLC
Istanbul Medipol Univercity
Annette
Thank you for these CQs!
What about sending parents home on finger feeding. Is this ever appropriate – with the goal transitioning to direct breastfeeding?.
Also , how long is acceptable to use the same 5 Fr tube?
Anne Eglash
Many term infants leave the hospital while being supplemented via finger feeding. Once higher volumes are needed, after 5-6 days, finger feeding is difficult since it is so slow. I don’t know of evidence based info on how long to use a 5 french feeding tube. My practice is to give syringes to clean the feeding tube after each use, and toss after 3 days of use.
Chris Sheppard
In view of my understanding of the “period of imprinting” and cases I have had with well term infants first given a finger to suck on before the breast, I think this practice is very risky. Placing baby skin/skin with mother for as long as possible after birth and remain cocooned with mother, except of course, in exceptional circumstances, should be the norm. Babies can be monitored while there and if not latching given frequent doses of mothers expressed milk increasing amounts especially thru baby’s normal active times throughout the 24 hr day. Many preterm babies are stable enough for this procedure.
Bob Monteverde
I have used the finger feeding method since the mid 80’s to encourage sucking and teach sucking to babies in both the newborn and NICU settings. Odd that it was described as new. I also have taught it to parents as more efficient and effective than simple syringe or cup feeding because the baby uses more natural reflexes of sucking and swallowing. Use of a feeding tube or a 1-3 ml oral syringe has been equally effective from casual observation and monitoring of vital signs
Rima Strassman
My concern wit this is using a syringe at the end of the feeding tube, rather than putting the tube in a container with the milk. The person feeding the baby can still squeeze the syringe and we are back to a variation of syringe feeding but called finger feeding.