Medela SNS User manual

Article #00901S (US)
Produit #20901 (Canada)
The SNS™
Supplemental Nursing System For Breastfeeding Assistance
Sistema de lactancia complementario para dar el pecho
Système d’allaitement supplémentaire
Instructions for Use
Instrucciones de uso
Mode d’emploi
Medela Logo CMYK

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TO THE NEW MOTHER
Dear Mother,
Congratulations! We at Medela wish many years of
health and happiness for you and your baby. We are
happy that you have chosen to breastfeed your baby and
are pleased to be of help in providing the best nutrition
for your baby. The Medela SNS™ breastfeeding assistance
kit can help in nursing your adopted baby or in overcom-
ing temporary breastfeeding difficulties, and will allow
you and your baby to enjoy that special feeling of love,
warmth, and trust that makes nursing so special. Please
read the following instructions for use carefully.
Caution
You are using your SNS to help assist you in breastfeed-
ing your baby. Baby should easily be making weight gains
each week. If for some reason, your baby is not gaining
weight, or if baby loses weight, consult with your health-
care professional immediately. Consult with your health-
care professional throughout the time you use your SNS to
determine how often your baby should be checked and per-
haps weighed. Please make sure you read this manual well,
for it contains important information you need to know.
Your Doctor
Your physician and other health care providers should
be made aware that you are using the SNS. Consult with
them before you use the SNS as this will enable them to
provide you with the best possible care. Follow your
physician’s recommendation as to the type of supplement
to use, how much to use, what size tubing to use and any
other suggestions they may have.

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Table of Contents
To the New Mother . . . . . . . . . . . . . . . . . . 1
Your SNS™. . . . . . . . . . . . . . . . . . . . . . . . 2
Additional Ordering Information. . . . . . . . 3
Getting Started. . . . . . . . . . . . . . . . . . . 4-7
Cleaning and Sterilization . . . . . . . . . . . . 7
Specific Problems . . . . . . . . . . . . . . . . . 12
Decreasing Supplements. . . . . . . . . . . . . 16
Breastpumps . . . . . . . . . . . . . . . . . . . . . 17
A la nueva mamá . . . . . . . . . . . . . . . . . . 18
El SNS™. . . . . . . . . . . . . . . . . . . . . . . . . 19
Información adicional de pedido . . . . . . . 20
El comienzo . . . . . . . . . . . . . . . . . . . 21-24
Limpieza y esterilización . . . . . . . . . . . . 24
Problemas específicos . . . . . . . . . . . . . . 29
Disminuir los suplementos . . . . . . . . . . . 33
Extractoras de leche. . . . . . . . . . . . . . . . 34
À la nouvelle maman. . . . . . . . . . . . . . . . 35
Le SNS™. . . . . . . . . . . . . . . . . . . . . . . . . 36
Renseignements supplémentaires
pour les commandes. . . . . . . . . . . . . . . . 37
Installation. . . . . . . . . . . . . . . . . . . . 38-41
Nettoyage et stérilisation . . . . . . . . . . . . 41
Problèmes spécifiques . . . . . . . . . . . . . . 46
Diminution des suppléments. . . . . . . . . . 50
Tire-lait. . . . . . . . . . . . . . . . . . . . . . . . . 51
ESPAÑOL
ENGLISH
FRANÇAIS

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YOUR SNS
The SNS is designed to stimulate the mother’s milk sup-
ply by providing the baby with the motivation needed to
suck well.
Your SNS should include the following items:
1. Neck Cord
2. Feeding bottle
3. Three sizes of tubing
4. Valve holder
5. Attachment ring
6. Cover
7. Two rolls of hypoallergenic papertape
8. Instructions for use
1
2
4
5
6
7
3

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ADDITIONAL ORDERING
INFORMATION
To order parts for your SNS contact your local
authorized Medela Rental or Retail Station.
Part # Item
00901S(US) Complete SNS
20901(Canada) Complete SNS
8000794 Container with lid
8000041 Valve (white) with medium tubing
8000042 Valve (red) with small tubing
8000044 Valve (clear) with large tubing
8100084 Valve holder
8100085 Attachment ring
6000155 Neck Cord
8100086 Cover
8990007 Hypoallergenic papertape
1/2” x 10 meter
1907208 Instructions
Parts may also be ordered by calling 1-800-435-8316 and
ordering with Discover Card, Mastercard, Visa, or
American Express.
Call customer service for current pricing
and shipping charges.

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GETTING STARTED
Before using the SNS, it may help if you get acquainted
with the device. Practice assembling and disassembling
your SNS as this will give you familiarity with the system.
11Connect proper sized tub-
ing (see Tubing Size).
Generally, the middle size
will be most appropriate.
The smaller size is used
for a slower flow or a thin-
ner fluid. Consult with
your health care profes-
sional for your proper size.
22Push valve with attached
tubings over valve holder.
Caution: Do not pull on
tubing. Tubings are not
very strong and could break.
33Slide tubing through
attachment ring and push
valve holder with the valve
into the ring until it snaps.
44Fill bottle with supplement
recommended by physician.
There is normally no need to warm the supplement.
The tubing is very thin. Your body will heat the sup-
plement as it passes through the tubing because the
tubing is close to your skin. When taken from the

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refrigerator or when supplement was stored in cold
weather, warm the supplement to approximately body
temperature.
55Screw attachment ring onto feeding bottle, clamp both
tubings into attachment ring to avoid milk flow as you
place system around your neck. To avoid stretching
make sure that the tubing has a loop.
66Hang the SNS around your neck.

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77Place tubing on the top of the nipple making sure it
extends about 1/4 inch beyond nipple and secure verti-
cally with a piece of tape down to the base of the areo-
la. Another piece of tape may be placed horizontally at
base of areola. Put tape on breast and areola but not
on the nipple itself. Most babies are not bothered by
the tape.
88Position baby at breast and
release just the tubing on
the breast you are about to
nurse. Place all your fingers
underneath the breast and
off the areola. Place your
thumb on top of the breast
and gently on the tube
(don’t press hard with your
thumb or the tube will point
upward). Tickle baby’s lower
lip with your nipple and
wait till the baby opens
wide. Position the tube
under the baby’s upper lip
as you pull baby close to
the breast so that baby
accepts both the breast and
the tube. The tip of the
baby’s nose should just touch
the breast. This should help baby accept both your
breast and the tube at the same time. If you have diffi-
culty, don’t worry as this may take a little practice.
Remove baby and start again.

99It may be necessary to prime the system by squeezing
gently on bottle. This will cause the tubing to be filled
with supplement and prevent the infant from swallow-
ing air.
1100After use, wind tubing
around attachment ring
and close system with
cover.
CLEANING & STERILIZATION
1. Hospital Sterilization
All disassembled parts can be auto-
claved to a maximum of 272°F for 3
minutes at 29 PSIG or 250°F for 15
minutes at 15 PSIG.
To avoid damage during sterilization
-Sterilize parts without applying
external pressure on parts.
If gas sterilization is used, residual test-
ing is recommended to determine the
proper length of aeration.
7
AUTO-
CLAVE
GAS

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2. Home Use
Prior to first use:
1. Wash and rinse parts.
2. Place parts in a 4- to 5-quart saucepan.
3. Fill to within 1 inch of rim with
cold water.
4. Cover and boil for 20 minutes.
5. Drain water off, allow parts to cool in
open pan.
6. Remove all parts and allow to air-dry.
After each use:
1. Fill SNS full of warm soapy water, replace
attachment ring and tubing and force
water through tubing.
2. Refill with clean water and again force
water through tubing.
3. Squeeze the empty bottle a few times to
remove water droplets from the tubings.
4. Completely disassemble and clean
remaining parts with soapy water.
5. Rinse well and drain dry on a clean towel.
6. Reassemble.
7. It is not necessary to boil parts after
each feeding unless your health care
professional specifically directs you to
do so.
8. If you find mineral deposits building up,
try rinsing with vinegar and then thor-
oughly rinsing out. Alternatively, you
can boil with distilled water only.
BOIL
WASH
RINSE
AIR-DRY

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Tube Position
When first using your SNS, you will want to know just
how the tubing should be placed. Make sure the baby
keeps the tube in the center of its upper lip and not in the
corner of its mouth.
Tubing Size
Babies using SNS may need different tubing sizes
depending on the exact nature of the problem. The larger
the diameter of the tubing, the faster the flow and the less
work that the baby has to do. Generally, you will want to
begin with the Middle size tubing (see flow regulation).
You can judge if you have the correct sized tubing by
observing the baby’s sucking and swallowing pattern.
Some babies may not swallow with every suck or even
every other suck. You want to achieve swallowing with
every 1-3 suckles. If baby doesn’t swallow consistently
make sure the tube is positioned properly or try a larger
tube. You may have to experiment in order to find the cor-
rect size tubing. Your health care professional will proba-
bly select the tube size based on the baby’s and mother’s
exact problem. Please read the flow regulation on specific
problems for more information. Some general recommen-
dations:
Small Size Suggestions (red valve):
1. Baby gaining well but sucking needs to be improved.
2. Thinner fluids such as water. (Water would be used
when the baby does not use supplement but needs a
better flow to improve sucking.)

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Middle Size Suggestions (white valve):
1. Beginning Use
2. Adoptive Nursing
3. Slow Gaining Babies
4. Most Sucking Problems
5. Premature Babies
Large Size Suggestions (transparent valve):
1. Cleft Palate Babies
2. Sucking Problems characterized by a tight mouth.
(Faster flow prevents tightening of mouth.)
3. Severe Hypotonia that results in poor action
by the mouth.
4. Weak, Lazy Sucking Babies
However, the exact size of tubing needed will depend on
several factors, including strength of baby’s suck, reason
for SNS use, etc. It will probably be necessary for you to
experiment with several sizes of tubing. Try the middle
size first. If the baby is not swallowing on every third
suck, try the larger size. If you aren’t sure what swallows
sound like, ask your health care professional to help you.
Flow Regulation
The Medela SNS is a very versatile device. It allows the
flow to be regulated in a number of different ways. The
easiest way to adjust the flow is by the size tubing used
(see previous section on tubing size). The larger the tub-
ing the faster the supplement will flow. Three sizes of
tubing are included. This will enable you to adjust the
flow to the baby’s need and the particular problem
encountered.

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Another way to adjust the flow is by the height of the
device. When the bottom of the SNS bottle is above the
level of the nipple, the supplement will flow more quickly
and will continue to flow into the baby’s mouth even when
sucking has topped. Such a non-stop flow can be uncom-
fortable so use extreme caution when the device is above
the level of your nipple, especially if the baby seems to
loudly gulp or choke. (Most babies will stop and pull away
if this should happen.)
Similarly, when the SNS is placed below the level of the
nipple, the baby must suck against the flow of gravity. It
could be difficult for the baby to suck the supplement in
this case. If your health care professional suggests the
technique, make sure the baby swallows with every suck
or every other suck.
The flow can also be increased by squeezing the bottle
in some cases. Place the heel of the hand against bottle
while supporting the breast and gently compress the SNS
to force more supplement through the device. This could
be used when the infant has a very weak suck or needs
that extra assistance, such as with the reluctant nurser.
Some mothers have found that warming the supplement
in the SNS will increase the flow. It is usually not neces-
sary to do this. However, it is an additional way to
increase flow.
The versatility of the Medela SNS allows you to vary the
rate of flow: To summarize
Increase Flow Decrease flow
1. Use larger tubing 1. Smaller size tubing
2. Raise device 2. Lower device
3. Squeeze bottle
4. Lengthen tube
5. Warm supplement

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SPECIFIC PROBLEMS
Adoptive Mother
It is possible for an adoptive mother to induce lactation.
The breasts are quite unique in that if stimulation is
applied, a signal is sent to the brain that helps prepare the
breasts for nursing. This is true even if the mother is not
pregnant or has never been pregnant. It might be easier for
the mother who has been pregnant but can also be used for
someone who has never been pregnant. The same signal
then causes the glands to begin producing milk.
When you first decide that you do want to nurse your
adoptive baby you may choose to begin stimulation with the
aid of a high quality electric breastpump such as the
Medela Lactina®Electric Breastpump. The pump can simu-
late the baby’s sucking stimulation and begin the milk pro-
duction process. (See appendix for referral for electric pumps.)
If your adoptive plans leave no time for this preparation,
don’t worry as it is not vital to your success at adoptive
nursing. Many successful adoptive breastfeeding mothers
have not felt the need to do this, nor have they pumped in
between feedings. Consider this only for extra stimulation.
The longer you use your SNS with your adoptive baby, the
better the chance that the stimulation will help bring in
your milk supply. Most women will not be able to exclu-
sively breastfeed their adoptive infants, so some supple-
mentation is often required especially until 4-6 months or
until solid food is introduced and perhaps beyond that.
Frequent weight checks with your doctor are very reassur-
ing that baby is doing well. As your milk comes in, your
baby will take less from the SNS. Let the baby do this natur-
al weaning from the SNS, and don’t arbitrarily cut down on
the supplement.

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Cleft Palate
Nursing the cleft palate baby can be a most gratifying
experience. However, you may encounter some special
problems. Because of the infant’s difficulty in obtaining a
good suction, it may be necessary to use some techniques
to increase flow. This includes raising the device, using a
larger diameter tubing, and squeezing. See the flow regu-
lation section for more details.
Reluctant Nurser
Some babies have a difficult time learning to breastfeed.
In this case, the SNS can be very useful. By attaching the
SNS, the infant gets immediate gratification and this may
help the baby realize the breast is the sources of milk. Be
sure to prime the tube by squeezing the bottle so that the
supplement is ready at the end of the tube to reward baby
for her first suck. A football hold can offer better control
of baby’s head if baby is confused and moves head rapidly
from side to side. If baby seems frantic, wrap tightly in a
receiving blanket to control babys flailing arms. Return
baby to football hold after calming by rocking.
Building Milk Supply
Occasionally mother-baby separation, breastfeeding
problems, illness, etc., will cause a temporary reduction
in milk supply. The SNS will nourish the baby while at
the same time create frequent sucking stimuli which will
rapidly increase the milk supply. At first, baby will greedi-
ly take the supplement at the breast. At about 48 hours
after you begin to use the SNS (depending on the extent of
milk supply decrease) you will notice a decrease in the
amount of supplement taken. This is an indication that
your supply is increasing especially if baby swallows with

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every suck. Let baby self wean from the SNS by discontin-
uing use if baby takes less than 2-3 ounces from the SNS
every day. Weight checks with your healthcare provider
can be reassuring at this time.
Premature Infant
The SNS can greatly help with breastfeeding as your
baby is weaned from gavage feeding in the NICU.
Premature babies generally do not have a lot of stamina.
If they suck at the breast, premature babies should get
some nutrition. The SNS will allow you to help your
infant learn to suck at the breast while receiving nutrition
that the hospital can monitor. This saves precious energy
over breastfeeding alone followed by bottle supplement.
It’s best to supplement while nursing, rather than let
the infant nurse first and then bring in the SNS. The
baby’s energy requirements must be taken into account.
Short frequent nursing is generally the rule, say at least
10 minutes on one breast, at 1-2 1/2 hour intervals
depending on the size of your baby and how well and how
long it takes to empty baby’s stomach. Premature babies
rest and pause a lot during feeding and need a lot of care-
ful monitoring so they actually feed. Pausing is okay and
necessary but a gentle nudge may be needed if baby’s
pausing lasts more than a minute.
Anytime that the infant can suck on a bottle, she can
also suck at the breast. With the SNS there is no reason
to first feed the infant by bottle and then later transfer
baby to the breast. Transferring the baby from bottle to
breast runs the risk of nipple confusion/preference.

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Slow Gaining Breastfed Baby
If you have been nursing frequently (every 2-3 hours
round the clock) and for long feedings (20-60 minutes)
and your baby has not gained well, your doctor may sus-
pect illness in the baby or perhaps a sucking problem.
The SNS will provide the nutrition needed to your baby so
that you can continue to breastfeed, while your healthcare
provider investigates the cause of the problem.
If your baby has a sucking in-coordination or sucking
problem, the baby will often suck better with the SNS in
place for every feeding. Your healthcare provider will
probably explain that most sucking problems are tempo-
rary and usually resolve when a baby’s coordination has a
chance to mature. Your healthcare provider may not be
able to tell you exactly when your baby will outgrow this
in-coordination and when you can discontinue using your
SNS. This may take a few weeks to a few months.
Since you will be using your SNS until baby becomes
more coordinated, it is advisable to let baby wean herself
from the SNS as her suck improves. You should notice an
immediate and gratifying weight gain each week. Even
though baby is doing well, do not remove the SNS or cut
down on supplement at this time. Remember that baby
has a sucking problem and can’t suck well. Removing the
SNS too soon might return the baby to a poor weight gain
situation. When baby gains better sucking coordination,
baby will, on his/her own, take less supplement. You
might try starting the baby at the breast without the SNS.
When the suck-swallow rhythm starts slowing down and
you no longer hear the swallows, you can then add the
SNS to finish the feeding. Remember, do not remove SNS
without consulting with your healthcare provider.
Babies with suckling problems may need different tub-
ing sizes depending on the exact nature of the problem

16
(see flow regulation and tubing size section). Try different
sized tubings. You want to be sure that the baby gets
some supplement with every 1-3 sucks. If baby doesn’t
swallow consistently, try a larger tube. Because baby is
uncoordinated, she/he may not always swallow with every
suck or every other suck.
DECREASING SUPPLEMENTS
One of the goals of using the SNS is to return the moth-
er and baby to as close to a natural nursing situation as
possible. The easiest way to do this is to watch baby
decrease amount of supplement as your body begins pro-
ducing more milk and/or baby’s suck improves. Several
indications are:
Baby gaining weight
— 4-7 ounces per week for breastfed babies
is average
Feelings of milk letdown or leaking
— it can be normal not to notice this and still
produce a sufficient amount of milk
Baby leaving supplement in SNS but being satisfied
with feeding
Noticing yourself being able to pump more milk
Feeling more breast fullness
— but not engorgement

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You should never put less supplement in SNS than baby
can take. Do not attempt to wean baby from SNS by doing
this. Let baby wean naturally from the SNS. As you begin
to produce more milk, baby will naturally need less and
less from the SNS. Let your health care professional
determine when you can discontinue using your SNS.
BREASTPUMPS
If you wish to use breastmilk with your SNS, you may
want to use an electric breastpump. Most women find
this is most convenient and easy because both breasts
can be pumped simultaneously. Using a double pump sys-
tem cuts pumping time in half. In addition, research indi-
cates that double-pumping increases prolactin levels,
which helps maintain your milk.
Medela breastpumps can be rented at thousands of
independent rental stations throughout the United States
and Canada. Call toll free 1-800-TELL YOU (1-800-835-
5968) for a rental station in your area.

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A LA NUEVA MAMÁ
Querida mamá,
¡Enhorabuena! Medela le desea muchos años de salud y
felicidad a usted y su bebé. Nos alegramos de que haya
elegido darle el pecho y nos complace poder ayudarle a dar
la mejor nutrición a su bebé. El sistema de lactancia asisti-
da SNS de Medela puede ayudarle a dar el pecho al recién
nacido o si se le presenta temporalmente alguna dificultad
con la lactancia, además de permitirle a usted y a su bebé
disfrutar de ese sentimiento especial de amor, ternura y con-
fianza que hace tan especial dar el pecho. Lea con dete-
nimiento las instrucciones de uso.
Advertencia
El uso del SNS le ayuda a dar de mamar a su bebé. El
recién nacido debería aumentar de peso cada semana. Si
por alguna razón esto no sucede, o el bebé pierde peso,
consulte con su pediatra inmediatamente. Consulte con
su pediatra mientras esté utilizando el SNS para determi-
nar cada cuánto tiempo tiene que llevar el niño a la con-
sulta y pesarlo. Asegúrese de leer bien este manual por si
contiene información importante que usted necesita
saber.
Su médico
Su doctor y otros especialistas deben ser advertidos de
que está utilizando el SNS. Consúlteles antes de utilizar
el SNS para darles la oportunidad de ofrecerle el mejor
cuidado. Siga las recomendaciones de su médico en cuan-
to al tipo de suplemento que debe utilizar, la cantidad y el
tamaño de los tubos, además de otras sugerencias que
pueda tener.