Supplementary nursing systems, topping up at the breast

When a baby needs topping up, the usual question is how to do it without losing breastfeeding along the way. A supplementary nursing system is one answer, and it is the one people have usually heard least about. It is not right for everyone, but for the right situation it does something no bottle can, which is to give the extra milk and stimulate your supply at the same time.

What it is

A small container of milk, either a bottle worn on a cord round your neck or a syringe, with a very fine tube running from it. The tube is taped to your breast so that it sits alongside your nipple and enters your baby's mouth with it. When your baby feeds, they get milk from you and milk from the tube together.

The milk in the container can be your own expressed milk, donor milk or formula.

Why it can be worth the effort

• Your baby feeds at the breast, which is what maintains and builds your supply. Every suck is still a signal to your body.
• The top-up does not replace a breastfeed, it happens inside one.
• Your baby is rewarded at the breast, rather than learning that the milk they really want comes from a bottle. This matters for babies who are becoming reluctant to feed because the flow is slow.
• It keeps you in the feeding relationship while whatever needs fixing is being fixed.

Who it tends to suit

• A baby who latches but is not transferring enough, for example while waiting for a tongue tie division.
• Low supply that you are actively working on, where the top-ups are wanted but so is the stimulation.
• Relactation, where someone is building supply back up after a gap.
• Induced lactation, including adoptive breastfeeding and non-gestational parents.
• A baby refusing the breast because of slow flow, where an immediate reward can bring them back.

Who it does not suit

I would rather be honest about this, because it gets recommended too widely.

• A baby who is not latching at all. The tube does not help if there is nothing to attach it to.
• A very short term top-up, for example one or two feeds while waiting for milk to come in. A syringe or cup is far quicker.
• Anyone at the end of their rope. It takes practice and patience, and adding a fiddly device to an already desperate situation sometimes makes things worse rather than better.

The honest downsides

• It is fiddly. Taping a fine tube in place one handed while a hungry baby roots at you takes practice. The first few attempts are usually awful, and that is normal.
• Cleaning. Fine tubing needs washing and drying thoroughly after every use.
• It is visible, which some people mind when feeding outside the house.
• Flow can be temperamental. Too slow and your baby gets frustrated, too fast and they gulp. Raising or lowering the container adjusts it.
• Cost. They are not cheap, and some are single patient use.

How it compares with the alternatives

• Cup or syringe. Quick, cheap and easy to clean, and good for small top-ups in the early days. No breast stimulation.
• Bottle with paced feeding. Practical, easy for other people to give, and fine for many families. Some babies come to prefer the faster flow. There is more in Paced bottle feeding.
• A supplementer. More work, but keeps the top-up at the breast where it is also doing something for your supply.

There is no correct answer. The right one depends on why your baby needs topping up, how long it is likely to last, and what you can realistically manage.

How a consultation helps

The main thing I can do is tell you honestly whether this is the right tool for your situation, because it often is not and it is a lot of effort to discover that alone. If it is, the practical set-up is much easier learnt with someone doing it with you than from a video, and getting the flow right takes a bit of trial with another pair of hands. We also agree in advance what the plan is for coming off it, because a supplementer should be a bridge to somewhere rather than a permanent arrangement, and knowing what we are aiming for makes the effort feel worth it.