Abstract
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Background: Infants who cannot feed effectively with standard bottles, including those with cleft lip and/or palate, often require specialized feeders that allow caregivers to assist milk delivery. However, successful feeding with these devices depends heavily on caregiver skill. The Kumagai method, a feeding technique using the silicone long nipple feeder (pigeon corporation, Tokyo, Japan), was developed through clinical practice and described in our previous publication. To date, no practical tool has been available for teaching the method to caregivers and health professionals.
Purpose: To develop an illustrated procedural manual to disseminate the Kumagai method.
Methods: We created a five-page manual in Japanese and English based on the published technique. The first author drafted the manual, and the second author, the originator of the Kumagai method, participated throughout the editing process. She reviewed and revised all steps, photographs, and illustrations to ensure that the manual accurately reflected the original technique. Each step is presented with photographs, illustrations, and a brief rationale. Aspects that are difficult to convey through text alone, such as hand positioning and the angle of the nipple in the mouth, are shown visually so that users with varying levels of experience can easily follow the procedure. The manual is intended for use with infants without swallowing difficulties.
Manual content: The manual comprises five sections: (1) Characteristics of the bottle and how to hold it, (2) Basic feeding posture, (3) Nipple insertion, (4) Maintaining feeding, and (5) End of feeding. A checklist of common errors follows each section. Key points include holding the nipple near its center with the tips of the index and middle fingers; keeping the infants body straight in a slightly upright position so that the angle between the tongue and the nipple is approximately 10° and the angle between the nipple and the horizontal is approximately 30°; moving the bottle horizontally and touching the lower lip with the nipple before insertion; sliding the nipple along the lower lip and the tongue to place it at the midline of the tongue, up to the 3-cm mark on the nipple; compressing the nipple between two fingers in time with the infants sucking, but not during breathing pauses; and completing the feeding within 15 to 20 minutes.
Conclusion: This manual provides a standardized visual guide that may support consistent use of the Kumagai method. Introducing it into educational and clinical settings could increase the number of caregivers and health professionals able to perform the technique. Future studies will evaluate the usability of the manual and its effects on feeding outcomes.
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