By Kaya Thorpe IBCLC, November 2022

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Usage and cleaning

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A Nasogastric tube (also called an NG tube) is more commonly used to feed a baby that is unable to consume milk via breast, cup or bottle. The baby is fed through the small soft tube, which is placed in the nose and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach. During tube feeding, breast milk or formula is given through a tube passed into baby’s nose or mouth and into their stomach. However, such tubes can be used as part of a SNS. One end of the tube is placed in a bottle of breastmilk/formula, whilst the other end is tapped to the breast (see above/below for full instructions), where baby latches on, sucks, and receives the extra milk alongside any milk directly from the breast.

The nasogastric tubes are not designed to be used in this way however many families do with no concerns. Please make an informed decision as to whether this is right for you and your family.  

 

If you are using an SNS please ensure that you continue to link with a Breastfeeding Specialist for support and a Health Care Practitioner for regular weighing of baby. 

 

Tubes and systems

There are two ready made systems available for purchase – Medela and Latch Aid. Latch Aid is difficult to acquire in the UK quickly. If using an SNS is going to be a long term plan you may wish to purchase a ready made system as this may work out cheaper. Hakaa have also just bought out a system but the tube is very wide and looks like babies may struggle with it. 

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For a DIY SNS we suggest these two suppliers;
Feeding Tubes - The Vet Store

Feeding Tubes Size 5FG - IMS Euro

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You will need a size 5F tube. The IMS Euro ones are longer which can be easier to use. 

You will also need a syringe for flushing the tube. 5ml or 10ml is often best and can be purchased from a pharmacy or online retailers. 

 

DIY Set up

• You can use a sterilised open bottle, cut the end of a bottle teat  or enlarge the hole with scissors and feed the tubing through the hole

• The open-close valve on the tube can either be cut off or put in the end inserted into the bottle in the open position. 

• Add the supplementary milk into the bottle and, if using, put the bottle teat back on, with the tubing threaded through. 

• The end of the tube should lie alongside your nipple and be taken into babies mouth when they latch. Some breastfeeding families prefer to slip the tube in once baby is latched. If you are using a shield, put the tubing under the shield. 

• The tube end should sit close to your nipple and not cause baby to gag.

• You might want to tape the tube to your breast to ensure it stays in place while you breastfeed.

• The higher the bottle is the faster the flow of milk. Raise the bottle up to speed up milk flow and lower to reduce. 

 

Cleaning the DIY SNS

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• NG tubes are single use items, they are not designed to be sterilised but discarded after one use.

• The NG tubes used for DIY SNS are often used for up to 72 hours as a naso-gastric tube. This is because once they are placed they are not regularly handled or exposed to dirt and bacteria from the outside environment. However, when we use the NG at the breast, we are exposing it to our environment and being handled much more regularly.

• Cleaning can be more of an issue depending on whether you are using formula or breastmilk. If you are using formula as a supplement you may wish to consider more regular replacement of the tubing as formula grows bacteria more quickly than breastmilk.

• Always inspect the tubing for damage or discoloration before a feed and always discard the tube after 72 hours. 

• Next we need to consider the baby who is going to be fed with the tube. A premature or sick baby is far less able to tolerate potential contact with pathogens than a thriving, robust 6 month old. We have got to be especially careful if a baby is considered vulnerable, and we would recommend extreme caution if your baby falls into this category.

• Before touching the tube, ensure your hands are clean and any surfaces that you may place equipment on are clean to reduce any risk of contamination.

• Thorough cleaning of the tubing AS SOON AS POSSIBLE after EVERY use is essential. To do this:

  • flush the tube with a syringe of cold water at least 3 times, before washing in hot soapy water, and flushing again with hot water.

  • Spin the tube around to blow out the water droplets, leave it to dry somewhere very clean, and then store in a clean Ziplock bag. The bag can then be stored in the fridge. 

• NOTE: We recommend that the demonstration tube we used at clinic is disposed of and not reused as it has been tested in a public environment and you cannot immediately clean it. 

 

Tips

• Trying to use an SNS when baby is unhappy and crying can be stressful. It is recommended to use the SNS when baby is calm and not too hungry. You might like to latch baby  to the breast first and then add in the SNS. Alternatively, use the SNS on the second breast when the baby is less hungry and calmer. 

• If using formula milk, ensure that there are no lumps in the milkas these can stick to the inside of the tubes and cause a blockage. 

• Warming breastmilk can also help as this causes the fats to dissolve and not stick to the tubing.

• For older babies, a nursing necklace may be a useful distraction to dissuade them from pulling the tubing.

• Consider practicing while you have a support person with you or when other children are in bed/busy.

• You don’t need to use the SNS at every feed ;find the pattern that works for you and your family. 

 

Weaning from an SNS

• Some families will need to consider long term use of an SNS, however some may find this is a short term solution.

• If baby is feeding effectively, and taking the supplement in a shorter time, this may be the time to consider reducing the supplements. 

• We always suggesting weighing your baby before starting to reduce supplements and ensuring that you continue to weigh baby as the supplements reduce. Ideally this should be done under the supervision of a health care practitioner with appropriate scales. 

• Lowering the bottle can make the flow of milk slower, which can help with reducing the supplement.

• It is possible to clamp the tube with your fingers during the first period of the feed whilst baby is swallowing breastmilk directly from your breast. Once they have stopped swallowing at the breast, release your hold on the tube and allow the supplementary milk to flow. 

• Reducing the amount of feeds you use the supplementer.

• Often breastfeeding parents find that baby is less fussy and feeds better in the morning. It may be easier to drop the supplementer from those feeds first.

 

Links and references

Homemade Supplemental Nursing System - Breastfeeding Support

https://youtu.be/4jBQO0viVvw

Nancy Mohrbacher; Alternative Feeding Methods, taken from Breastfeeding Answers 2nd Edition

Lucy Ruddle (2020) Relactation: A guide to rebuilding your milk supply.