Why you might want to use a Supplemental Nursing System (SNS) for breastfeeding & how to use it

Learning to breastfeed can take time and practice and even a whole bunch of tools you didn’t know existed before your baby was born! Some mama/baby pairs are lucky enough to “get it” immediately but many more of us will need support and some props to get breastfeeding really dialed in.

If you have friends who are new mamas or who will be new mamas soon, share these posts! So often new moms feel blind-sided after birth when feeding issues start. Knowing ahead of time that issues can be common, there are awesome tools to support you if you have trouble breastfeeding and that you can ask for them at the hospital (or sometimes in your pediatrician’s office) if you’re struggling can be enough to reduce or even avoid early anxiety and overwhelm. One of those tools is called the Supplemental Nursing System (SNS) or tube feeding system.

This post isn’t just for parents! If you are an OT, PT, SLP, or other feeding professional definitely stick around because we will be discussing when we recommend the SNS, why, and how we use it.

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We took a poll on our Instagram account (@feedersandgrowers) and the results found that about 34% of responders used an SNS at some point to feed their baby!⠀

What is an SNS and why use one?

A Supplemental Nursing System is a tool with a small tube that you can place on your breast with either a bottle or syringe attached to the other end that can help you deliver additional breast milk or formula to your baby while he or she is breastfeeding. It is used when you do not have enough milk to support breastfeeding. The SNS provides the baby extra milk to encourage him or her to remain latched for longer and be more active at the breast to stimulate your milk supply by emptying the milk that is currently available (in your breast) while also making sure baby gets a full feeding.⠀⠀⠀⠀⠀⠀⠀⠀⠀

🔥Hot tip for OTs, SLPs, or lactation consultants: They are kind of expensive and sometimes hospitals don’t have them in stock but you can ask the nurse to make one using a small nasogastric tube (a 5 French works perfectly) and a 5-10mL syringe.

Why should you use an SNS?

Offering formula or donated breastmilk provided by your birth hospital at your breast using the SNS accomplished 3 goals with 1 intervention!

1. Baby gets fed. This helps your baby to sleep better and be more alert when awake.

2. Mom’s nipples get the stimulation they needs to make milk and feed baby the milk she’s already making.

3. Baby has more motivation to stay latched and practice sucking and swallowing which builds the skills needed for better breastfeeding!

Who can benefit?

Maeve arrived exactly one month early. I was 36 weeks pregnant and 1 day into my maternity leave when I went in for a routine check only to find out that baby was distressed. I was admitted that afternoon and they started the induction by that evening. By the time Maeve arrived, 3 days later, I was exhausted and swollen and holding my baby girl. Thankfully she was healthy and feisty! Unfortunately, trying to calm her down enough to get her to latch at my breast was a big challenge. By the end of day one we were not having much success and Maeve’s blood sugar was too low so her doctor recommended I pump and finger feed her or supplement with some donor breast milk in a bottle.

Thankfully, since I am a lactation consultant, I knew to ask for a SNS. My nurse brought me the equipment so I could make one (for all the OTs, SLPs, PTs out there: use a 5 French nasogastric tube plus a 5-10mL syringe) and I fed Maeve 15mL of donor breast milk at my breast.

The SNS worked well to get baby Maeve latching in the first few days which stimulated my milk supply. Adding 10ml of pumped (or donated breastmilk from the hospital) helped keep her blood sugar stable and this helped her not be so sleepy. Once she was calmer and eating a little bit more than what was available in my breasts, she was able to wake up and be more alert and calm/organized at the next few feeds, which really helped. ♥️

There are many reasons why you might consider using the SNS. One example: When mom has medical complications after birth, it may take a few extra days for milk to “come in.” Mom will have colostrum—nutrient dense early milk—but sometimes there isn’t enough colostrum (or more likely baby isn’t efficient enough yet to get it out,) to keep baby’s blood sugar levels stable or to motivate baby to keep trying to latch and build skills needed for breastfeeding.

They are an incredibly useful tool to use when your milk supply is low or when baby needs a bit more encouragement to latch and stay active at breastfeeding. Also, many adoptive moms find the SNS useful to induce lactation or to just enjoy the bonding that comes from breastfeeding, even though they may not have a milk supply.

What are the drawbacks?

Before trying an intervention, it’s important to know what the possible drawbacks might be.

The SNS may overwhelm some babies. When you increase the amount of milk available at the breast and when you increase the flow rate, you may end up causing a new baby (especially premature babies) to suck and swallow repeatedly without actually pausing to breathe. Holding his or her breath can be very stressful for a premature infant and can put him or her into distress, leading to a drop in your baby’s heart rate, respiratory rate, and oxygen levels.

For this reason, it is incredibly important that you work with someone who is familiar with the SNS (and if you’re a therapist, that you are aware this could happen and you should provide pacing and monitoring for your clients the first few times you use an SNS).

Other drawbacks include:

• They are a bit challenging to learn how to use at first

• They can be annoying to clean and it can be difficult to sanitize the tubing in the hospital.

• As we noted above they can be a bit pricy for parents.

What does the research say about Supplemental Nursing Systems (SNS)?

Well, not much, actually.

While the 2018 systematic review by Penny et al found limited research on SNS, what research does exist points to SNS’s being helpful with breastfeeding. We found a 2005 study in The Journal of Human Lactation by Borucki which found that moms believed the SNS was a satisfactory tool & case studies describing use of the SNS as a part of a plan for adoptive mamas to induce lactation, which suggests it might also be helpful for postpartum mamas who need help growing their milk supply and stimulating their breasts.

It’s important to keep in mind though that there isn’t solid evidence yet to indicate when an SNS is useful, who could most benefit from using one, as well as which protocols for use we should follow. Because of this, therapists and lactation consultants are relying on clinical experience and clinical reasoning to guide our recommendations. And on that note, we believe it’s important to report that several mamas have shared with us over the years that they wish their lactation consultant had recommended one to them earlier. We’ve never had a mother report that she felt the SNS harmed her breastfeeding chances or was tried too early.

How to use a Supplemental Nursing System

Mamas let’s be clear, using an SNS takes some practice!

Our number one recommendation is GET HELP! 2 hands aren’t quite enough at first to manage the SNS, the baby, the latch (and possibly a nipple shield and a biliblanket)! Breastfeeding support pillows can also be helpful to make sure you’re not wrecking your neck/ back/ shoulders/ wrists while trying to hold your baby and manage the SNS.

Get your SNS loaded and positioned before positioning the baby. Help your partner help you by asking him/her to hold baby and keep baby calm then hand you baby when you‘re ready.

Some people tape the tube into place before the baby latches, with the end of the tube running down in line with the end of your nipple, then get baby latched on both at once. However, some mamas have difficulty getting a deep latch while also worrying about the tube so another strategy is to get your baby latched as well as you can, then carefully thread the tubing into your baby’s mouth through the corner or their mouth, into their cheek pocket.

Once the tube is in the right place (about 1-1.5” inside your baby’s mouth), you can tape it into place to keep it from sliding around.

If your baby needs the motivation and help getting milk out, you can very lightly press on the syringe to help baby get out a small amount of milk (if it’s the homemade version we described above with a syringe) or just open the clip to allow milk to flow if it’s an actual Medela brand SNS. If your breasts need a bit of extra help, ask your partner to manage the SNS while you focus on baby’s latch plus massaging your breasts. We recommend some hand expression here as well to get your milk flowing. The goal is for your baby to get the milk that’s in the SNS and the milk (or colostrum) in your breasts.

Last step is to take deep breaths, stay calm, and expect there will be a learning curve for both you and your baby. We promise after a few feedings it will get easier to manage it all. And keep working closely with your lactation consultant because the goal is to stimulate your supply and help your baby build efficiency to allow you to not need extra donor milk or formula and to stop using the SNS, and be able to nurse your baby without it!

If you’re feeding journey is looking different than you expected, hang in there. You & baby can get through this. Your journey may look different than you expected but you and baby are resilient and this will be part of your story. Ask for support (lactation consultants, Occupational therapists, and Speech Therapists who specialize in infant feeding are a great resource.)