e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Feeding of infants unable to breastfeed directly in care facilities

Intervention | Last updated: 9 August 2023


Breastfeeding has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits such as reducing the risk of overweight and obesity in childhood and adolescence.

While most infants born at term can breastfeed directly following birth, some term infants and many preterm infants may not be able to do so for various reasons, and require feeding by alternative methods. Such methods may include cups, spoons, syringes, parenteral feeding tubes or feeding bottles or teats. The inability to breastfeed directly may only be temporary, and mothers and infants should be supported to resume or initiate breastfeeding as soon as they are able.

Evidence suggests that cups, spoons or feeding bottles and teats may be used to feed term infants expressed breast milk or other feeds* when necessary, while cups or spoons are preferable for preterm infants. For preterm infants, non-nutritive sucking or oral stimulation using pacifiers, a gloved finger or a breast that is not yet producing milk, may also decrease the time necessary to transition to full oral feeding.

* When medically indicated, a combination of expressed breast milk and other fluids, or other fluids alone.

WHO Recommendations


Mothers should be discouraged from giving any food or fluids other than breast milk to their infants unless medically indicated.

If expressed breast milk or other feeds are medically indicated for term infants, use of feeding methods such as cups, spoons or feeding bottles and teats may be used during their stay at the facility.

For preterm infants who are unable to breastfeed directly, non-nutritive sucking and oral stimulation may be beneficial until breastfeeding is established.

If expressed breast milk or other feeds are medically indicated for preterm infants, feeding methods such as cups or spoons are preferable to feeding bottles and teats.



Guidelines and guidance documents Learn More Alternate Text


GRC-approved guidelines


Other guidance documents


Evidence


Systematic reviews used to develop the guidelines


Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding

Jaafar SH, Ho JJ, Jahanfar S, Angolkar M.Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD007202.

Summary of this review Alternate Text

Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed

Flint A, New K, Davies MW.Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD005092.

Summary of this review Alternate Text

Early additional foods and fluids for healthy breastfed full-term infants

Smith HA, Becker GE. Cochrane Database of Systematic Reviews. 2016; Issue 8. Art. No.: CD006462.


Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants

Foster JP, Psaila K, Patterson T.Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD001071.

Summary of this review Alternate Text

Avoidance of bottles and artificial teats during the establishment of breastfeeds in healthy term infants: a systematic review of randomized controlled trials (publication pending)


Avoidance of bottles during the establishment of breast feeds in preterm infants

Collins CT, Gillis J, McPhee AJ, Suganuma H, Makrides M.Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005252.

Summary of this review Alternate Text

Oral stimulation for promoting oral feeding in preterm infants

Greene Z, O’Donnell CPF, Walshe M.Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD009720.

Summary of this review Alternate Text

Cost-effectiveness Learn More Alternate Text


Relevant cost-effectiveness analyses have not yet been identified.