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Practical experiences and lessons learned in using supplemental suckling technique

Breastfeeding in Sierra Leone

Following on from the article on infant feeding in emergencies, which appeared in the March 2000 issue of Field Exchange, we wish to add our thoughts on the use of the supplemental suckling technique, drawing on our experience from the therapeutic feeding centre in Kabaya district hospital, in Gisenyi, Rwanda, which Save the Children (UK) was supporting.

The recommended suckling technique involves attaching a naso-gastric tube to the mother's breast at one end and a cup of milk at the other end, below the level of the baby's mouth (see M. Corbett, Field Exchange, issue no. 9). This procedure aims to re-establish the mother's breastmilk supply and to ensure that her milk doesn't dry up while the baby is recuperating in the feeding centre. Therefore when the baby is discharged, she should have a normal milk supply to continue to feed the baby normally.

Feeding centre staff can become discouraged if they face unexpected obstacles when using a new technique, so it is important to be aware of potential difficulties in advance, as shown in the table on the right. With patience and perseverance we were able to overcome the problems. Advance planning also helps for example in anticipating and meeting material, training and staffing needs.

Potential problem Points for consideration
High staff-patient ratio required Mothers need a lot of help, encouragement and reassurance in the beginning, especially first-time mothers. Also feeds are very frequent.
Cultural difficulties The nursing staff need to handle the mother's breasts while attaching tubes etc. This may be culturally inappropriate for males, even in the nursing environment. Here in Rwanda, it is even unusual for female nurses to have such intimate contact with a patient.
Large Supply of materials required Each baby will need at least 8-12 tubes per day. Each feed requires a new tube to avoid risk of contamination, because the tubes cannot be sterilised. In standard emergency feeding kits for example, there would not be sufficient sterile naso-gastric feeding tubes to cope with a large number of babies for whom you wanted to use this technique.
Latching on Some babies find it difficult to latch onto the breast when there is a tube present because they can feel it. If the tube is fixed in place AFTER the baby has latched on, the older ones in particular notice it coming towards them and get disturbed. Also some babies are so weak when they arrive in an emergency feeding centre that they cannot suck easily. For babies that refuse the breast, for whatever reason, a possible solution is to use a manual breast pump or to hand express into a small sterile medicine pot and then to cup-feed the baby. These pots are easier to use than normal size cups which are often too big for the baby's mouth.
Breastfeeding position Often in an emergency setting, the mother is obliged to perch on the edge of the bed, which isn't conducive to maintaining the best position. This was particularly a problem with first-time mothers who are not used to holding the baby in the right position for breastfeeding. However if the mother lies on her side, this helps to keep the baby at right angles to the breast.

 

Yours etc.

Judith Cowley, now Health Programme Advisor, Swiss Development Co-operation, Rwanda
Jeanne d'Arc Nyirajyambereba, Nurse Nutritionist, SC-UK, Rwanda
Sonya LeJeune, Nutritionist / Food Security Officer, SC-UK, Rwanda

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Judith Cowley; Jeanne d’Arc; Sonya LeJeune (2001). Practical experiences and lessons learned in using supplemental suckling technique. Field Exchange 13, August 2001. p22. www.ennonline.net/fex/13/practical

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