Everything you need to know about a supplemental nursing system (SNS)

If breastfeeding isn’t going as well as you hoped it would, you may be told to consider using a feeding tube while you breastfeed your baby. This is often known as using a supplemental nursing system (SNS). Read on to learn the ins and outs of breastfeeding with a feeding tube.

What is a supplemental nursing system?

A supplemental nursing system allows you to supplement your baby at the breast with breast milk or formula. “Essentially, the baby is breastfeeding at the same time as they are receiving the supplement,” explains international board certified lactation consultant (IBCLC) Taya Griffin.

How does SNS work?

One end of a very thin, flexible tube is placed in a container, such as a bottle, that contains the milk. The other end is either inserted into the baby’s mouth after she has latched on to mom’s breast, or is attached to the breast with medical tape ahead of time so it’s ready to go. The result is that the baby may get some breastmilk from the breast as well as the supplemental food.

What supplies will I need for SNS?

You’ll need a No. 5 French feeding tube, which usually costs around $2, and is available at most medical supply stores (lactation consultants almost always have them on hand), as well as a container like a bottle, plus medical tape. Or, you can purchase a supplemental nursing system kit for around $50. This system comes with a syringe or a small bottle connected to silicone tubing, which hangs around the neck like a necklace.

Which one you go with depends on how long, or often, you plan to supplement with a tube, Griffin explains. Because they’re not made of silicone, the No. 5 French feeding tubes shouldn’t be reused, so they’re best for moms who will be tube feeding only occasionally. She recommends an SNS kit for longer-term users because its tubes can be sterilized.

When to use SNS

Using a tube to supplement can help whenever there is low milk supply, says Griffin. Sometimes parents may need to do so for the short-term to feed their baby while simultaneously bringing their own supply up to meet her demand (a suckling babe stimulates a breast to make more milk). Other parents may have to supplement with a tube for the long-term, because in their situation, a full supply isn’t possible at the breast alone; this may be the case with some people who’ve had a breast reduction or chest contouring surgery, or those with hormonal or other issues that may affect supply.

Adoptive parents, or those who’ve used a surrogate, can also breastfeed with a tube system, as can a non-lactating partner who wants to connect with her baby by breastfeeding, even if she isn’t trying to stimulate a supply.

Tube feeding can also help get a baby back to the breast since it may help her learn that she can, in fact, be satisfied by nursing. “I've introduced the tube in situations where baby has started refusing the breast because of slow flow, and we actually get them to start latching on and trusting the breast because we give them the tube right away,” explains Griffin.

You may have also heard of parents placing the tube alongside a finger that is inserted into the baby’s mouth. This type of feeding is usually meant to give baby just a bit of milk so they aren’t so ravenous that they can’t latch on; it can also be used for what’s known as suck training. Griffin cautions that a finger feed should not replace a full feed.

What are the advantages of tube feeding?

A tube system can help to boost mom’s milk supply, and may get some breastmilk in your baby at the same time as you supplement. But there is another huge benefit, says Griffin. “The connection between the two of you, the increased use of skin-to-skin contact, all of those kinds of things are increased using the tube,” she explains. “This can be really, really helpful, not just for milk supply, but also for the breastfeeding relationship.” Tube feeding can also cut down on the number of times you need to pump to stimulate supply, since your baby is a natural pump, she notes.

Are there disadvantages to SNS?

While Griffin says most young babies take to tube feeding fairly easily, it can be a tougher sell once they hit three or four months of age, since they’re more aware of how the tube feels in their mouth. But even with an older baby, she says it’s worth trying if your supply is low and they won’t accept anything but the breast. “If you can get one feed into them before they clue in to the fact that there's a tube there, it can still be a win,” she explains.

There’s no doubt that some parents find tube feeding a bit challenging. “It takes practice, and some people find that it starts to get frustrating,” says Griffin, who recommends getting an IBCLC to guide you in the nuances of tube feeding. “It can get a bit demoralizing if it doesn't work right away, so getting someone to help you use it and assure you that your baby is latching well, and that tube feeding is going well, can be quite a powerful thing,” she says.

If you’ve been advised you need to supplement, and tube feeding is not for you, then Griffin says the alternatives are cup feeding or a slow form of bottle feeding. A lactation consultant can help you sort out which of these options would be best for your baby.

How long do you usually need to supplement for?

That depends, says Griffin. If you know you’re never going to have a full supply, then you may need to use an at-the-breast supplementation system for the length of the nursing relationship. Or, it could take only a matter of days to get your baby to trust the breast, or to increase your supply.

Read more: How to use a breast pump Quitting breastfeeding won’t make your kid less smart The best preparation for breastfeeding is accepting it might not happen