By Lucy Lowe IBCLC, October 2022

Using a periodontal syringe can aid breastfeeding in a number of ways. Here we discuss when it might be appropriate to use a periodontal syringe, and how to do so safely. As with many feeding aids, this is a temporary method to enable breastfeeding to continue when additional milk is required or to help a baby and parent to establish breastfeeding.

A periodontal syringe is a plastic syringe with a curved tip.

It can be used to:

Provide extra milk (a supplement) at the breast or via finger feeding (sucking a parents/HCP (Health Care Professional)’s finger)
Avoid bottle use
Help coordinate the suck
Provide an easy-to-use technique but requires care and cleanliness in order to be safe
Give a little milk to help a baby latch, to encourage a baby who does not tend to suckle to start suckling and to help baby keep suckling once a feed is established
Provide a short term method for supplementing a baby
Prefill a nipple shield
- This can help a baby transition from feeding via a shield prefilled with EBM to extracting milk from the breast via a shield. This helps with a happy association with the breast. If a baby has neurological impairments, periodontal syringes can be used to fill a shield with EBM repeatedly (Watson-Genna, 2017)
Supplement an infant with a cleft palate. In this instance, this must only be done if infant is lying prone (Watson-Genna, 2017)

The syringe does not require the baby to be able to create negative pressure. For example, this may therefore help a baby with low energy due to poor weight gain (Watson-Genna, 2017).

How to use a periodontal syringe for finger feeding:

Cut finger nails and clean hands. HCP to use gloved finger
Position baby so he is slightly reclined in his parents arms, ideally skin to skin
Fill periodontal syringe with EBM/DBM/formula
Baby should be alert for syringe feeding
Gently invite the baby to gape widely by stroking his lips and cheeks
Use the largest finger - use the finger most like the circumference of parents' nipples (Core Curriculum, 2019)
When the baby is happy for your finger to enter their mouth, do so gently as you turn your finger so that the pad of the finger is in contact with the palate. The nail bed should be touching the baby's tongue
If the baby is resistant to the finger, then wait a moment before trying again.
As the baby sucks, they will draw your finger to the soft-hard palate junction.
Ensure the baby's lips are flanged outwards and they have a deep ‘latch’
Once baby is sucking, gently move the tip of the syringe into the corner of baby’s mouth, parallel with finger, towards cheek
Hold the shaft of the syringe firmly. www.step2education.com suggests using the thumb on the plunger, with first finger on edge of plunger shaft to enable more control over amount of bolus delivered at each point
When the baby sucks, give small volumes (0.25ml - 0.5ml (Core Curriculum, 2019) of milk
It is important for the person administering the milk via periodontal syringe to do so in response to the baby's sucking: when the baby pauses sucking and swallowing, you pause. If the baby pauses for longer than 10 seconds then give a small volume of milk or try to wake the baby (Core Curriculum, 2019). Do not give any volume whilst the baby has paused for sucking
Monitor baby for stress cues - these include grimaces and splaying their fingers - and can indicate that the bolus is too big. If stress cues are displayed, reduce how much is administered
Some babies may find the flow too slow, therefore you can increase the volume administered slightly
When demonstrating the method to parents, ask them to demonstrate the technique to ensure it is effective and safe
Use up to a total of 10mls of milk in a syringe at a time (Core Curriculum, 2019)
Wash with hot soapy water and use a cold water sterilising method before next use

How to use a periodontal syringe as at at-breast supplementer:

Use cleanliness measures as above
Deeply latch baby, ideally skin to skin
Fill periodontal syringe with EBM/DBM/formula
Baby should be alert for syringe feeding
Once actively sucking, gently move the tip of the syringe into the corner of baby’s mouth, towards cheek
Hold the shaft of the syringe firmly
When the baby sucks, give small volumes (0.25ml - 0.5ml) of milk
It is important for the person administering the milk via periodontal syringe to do so in response to the baby's sucking: when the baby pauses sucking and swallowing, you pause. If the baby pauses for longer than 10 seconds then give a small volume of milk or try to wake the baby (Core Curriculum, 2019). Do not give any volume whilst the baby has paused for sucking. This allows the baby to pace the feed, is more similar to breastfeeding and is safer
Monitor baby for stress cues - these cues (such as grimaces, splaying their fingers) can indicate that the bolus is too big. If stress cues are displayed, reduce how much is administered
Some babies may find the flow too slow, therefore you can increase the volume administered slightly
When demonstrating the method to parents, ask them to demonstrate the technique to ensure it is effective and safe
Use up to a total of 10mls of milk in a syringe at a time (Core Curriculum, 2019)
Wash with hot soapy water and use a cold water sterilising method before next use

Safety:

Don’t use the syringe as a ‘sucking device’ for the baby, eg putting tip into mouth and allowing baby to suck
Aspiration is a risk if the syringe is not carried out properly - watch baby carefully to see if they are coping with the feed
Refill the periodontal syringe as you go along with feed to avoid accidentally providing a too large bolus
Never finger feed when the baby is flat on their back
Don't push the edges of the syringe into the baby’s cheeks/gums/tongue to avoid pain/discomfort/damage

References:

Core Curriculum for Interdisciplinary Lactation Care,Lactation Education Accreditation and Approval Review Committee (LEAARC) (2019)

Supporting Sucking Skills in Breastfeeding Infants, Catherine Watson-Genna (2017)

The Breastfeeding Atlas, Barbara Wilson-Clay and Kay Hoover (2017)