Celebrating Step 8!

Skipping from Step 1 all the way to Step 8 for a little celebration!
Here is our self assessment:

 STEP 8. Encourage breastfeeding on demand.

 8.1  Are all mothers, regardless of feeding choice, taught how to recognize the cues
that indicate when their babies are hungry? Yes

8.2  Are breastfeeding mothers encouraged to feed their babies as often and for as long
as they want? Yes

There is nothing I love more than checking things off a list!  Well, that and teaching new families about their fascinating newborns!

Teachable Moments
Breastfeeding is a skill that babies and mothers learn. I don’t know about you, but when I’m hungry, I am not in the mood to learn a new trick. Babies are no different. If we wait until a baby is crying, we have missed this teachable moment. Babies show us they are hungry by smacking their lips, opening their mouths, rooting and bringing their fists to their mouths. Crying is the last sign of hunger.

Bottle fed babies give us the same cues, and these little ones require teaching too. It is tempting to mistake that a bottle fed newborn can feed with no assistance, but they have their own challenges. While a breastfed baby needs the most help with latching on, a bottle fed baby needs more help coordinating suck-swallow-breath.

Paced Bottle Feeding
Colostrum produced by mothers in the first 2 to 5 days after delivery comes out just a teaspoon or two at a time. This matches her baby’s shooter marble sized belly which holds 5-7 milliliters (an ounce is about 30 ml). The small amount of colostrum comes out at a slow pace, allowing baby the time to learn the intricate skill we take for granted: suck-swallow-breath.

Contrast this with common bottle feeding practices. The bottle is placed in a baby’s mouth, and the milk flows freely. A baby has two choices: eat or drown. Without the ability to stop the flow, babies are forced to drink. Bottles in the hospital are 60 ml which is up to 12 times the size of a newborn’s stomach! Without instruction, new parents will feed their baby an entire bottle and remark, “Wow! Look how hungry she is! She drank the whole bottle!” This may be one reason formula feeding is correlated with later obesity.  We are inadvertently overfeeding our children beginning on day one.

Paced bottle feeding is a method to help babies learn to coordinate their feedings without being overfed. Here’s how it’s done:

  1. Rest the bottle nipple on baby’s lower lip
  2. Wait for baby to open mouth to pull the nipple in
  3. Tip the bottle nipple into baby’s mouth and allow baby to take up to 10 sucks
  4. Gently pull the bottle from baby’s mouth and rest it on lower lip, tipping the bottle so that milk does not flow
  5. Allow a few moments for baby to swallow and breathe
  6. Wait for baby to open mouth again
  7. Repeat steps until baby stops opening mouth or turns head

Besides avoiding drowning babies in formula, paced bottle feeding allows time for us to observe when a baby is satiated. Babies will stop opening their mouths after swallowing and even turn their heads when they are satisfied.

More than Breastfeeding
Baby-Friendly hospitals are more than breastfeeding-friendly; they are family friendly places where all informed choices are honored and respected. Families who choose bottle feeding deserve the most up-to-date, evidence-based methods and information regarding their feeding choice. Teaching paced bottle feeding is one way to demonstrate our commitment to the health and well-being of all our patients.

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About blogtobabyfriendly

blogtobabyfriendly is written by Amy Murray, a Childbirth Unit nurse with a touch of earth muffin crunch. A childbirth educator and IBCLC, she's been a breastfeeding advocate all her adult life, believing that if our bodies make milk, it just makes good sense to feed it to our babies. blogtobabyfriendly is her hospital's journey to Baby-Friendly designation. Click to get email updates on new blog posts. Our desire is to learn, share, and learn more.
This entry was posted in Celebrations, Our Self-Assessment Tool. Bookmark the permalink.

9 Responses to Celebrating Step 8!

  1. Gemma Regan says:

    Amy, THANK YOU! For this simple explanation of paced bottle feeding! I plan to use this info in my next class. Working together to inform our families of the most up-to-date, evidence-based methods of infant feeding, we are even helping to prevent future obesity in these children! Thank you especially for the comment regarding that “Baby-Friendly hospitals are more than breastfeeding-friendly; they are family friendly places where all informed choices are honored and respected.”

  2. You’re welcome Gemma. I have to give my WIC friends credit though. They are the ones who taught me. I learned a couple years ago that if you want to be in the know about all things infant feeding, you need to be connected with Indiana WIC!

    • Gemma Regan says:

      YES! They do amazing work! For anyone reading this who needs WIC information in our South Bend area: Call 574-647-2100. You may visit the office at 325 N. Lafayette in Downtown South Bend.
      (PLEASE NOTE: The Ireland Road location is no more! A new additional WIC office location will open soon at 201 Lincolnway West in Mishawaka, Indiana. Phone 647-2175)

  3. Emmy says:

    Thanks for the info on pace feeding. I found it very interesting. Small steps can make a big difference in fighting childhood obesity!

  4. Marie says:

    The paced bottle feeding idea was definitely something I had to learn as a new mom. When family came to help with my newborn, I would let them take one of the night feedings and feed her a bottle of pumped breastmilk. I would wake up to find all my bags (that I had worked hard to build up) were gone! Amy and Cindy asked me if perhaps she was being overfed. Especially since she was used to breastfeeding not bottle feeding and now that I look back I totally see how she had to drink or drown!

  5. Jerri Lynn Simmons says:

    We were honored to have our second grandchild born at a baby friendly hospital. It was amazing. I can not say enough about how caring and supportive the staff was. The best thing was the consistency of care. Everyone was on the same page. To a new mom I think this is one of the most important part of the bonding experience.

  6. leah says:

    I’ve never thought about the drink or drown idea, that sounds awful! So glad your team will be better educating new parents.

  7. Theresa Visocky says:

    The tips for paced bottle feeding are great. In NICU practice with preemies and late preterms we also practice paced bottle feeding; we refer to it as cue based feedings. The baby can communicate very subtle cues that they need a break such as raising their eyebrows, wrinkling their forehead, sneezing, yawning, falling asleep. It is important to observe for these cues and respond appropriately. Preemies and late preterms also struggle with maintaining the energy required to get through a feeding. We suggest parents count to 4 or 5 sucks and then tilt the bottle downward to allow the baby to do some catch up breathing before resuming feeding. As the baby matures with their feeding skills they will be able to pace the feeding on their own. Kangaroo care before a feeding and swaddling with hands midline during a feeding are also very useful tools in helping the baby develop the skills that are necessary to have a safe, enjoyable feeding.

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