Date of Completion


Embargo Period



Breastfeeding, supplemental feeding, supplemental feeding tube device

Major Advisor

Jacqueline McGrath

Associate Advisor

Michelle Judge

Associate Advisor

Elizabeth Brownell

Field of Study



Doctor of Philosophy

Open Access

Open Access


It is a global understanding that human milk is the ideal and optimal source of nutrition for infants. Human milk provides lifelong health benefits to both infants and mothers. Currently, world and national breastfeeding rates are below the recommendation of the World Health Organization and The Healthy People 2020. When breastfeeding mothers are having difficulty breastfeeding, they may turn to using feeding devices as an alternative means of providing nutrition to the infant with the intent of preserving the breastfeeding relationship. There remains no standard of practice with regard to specific supplementation methods for breastfed infants that result in the best means of support for mothers and infants while also preserving the breastfeeding relationship. The overall goal of this dissertation is to address the gaps in knowledge and practice recommendations of breastfeeding supplementation practices. First is an examination of what evidence already exists to support use of the Supplemental Feeding Tube Device (SFTD) for supplementation purposes. Second, current practices of supplementation by members of the Internationally Board Certified Lactation Consultants are described through the use of an international online survey. Lastly, through a pilot study, use of the SFTD is examined in relation to breastfeeding outcomes and maternal breastfeeding satisfaction. Despite the small sample size, it is shown that the SFTD is a method that could minimize exposure to bottle feeding, at least in the first few days or weeks to help avoid the detrimental effect of bottles on continued breastfeeding. As a complete dissertation, these manuscripts provide evidence for a plan of research concentrated on supplemental practices for breastfed infants in relation to continued and successful breastfeeding.