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!
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:
- Rest the bottle nipple on baby’s lower lip
- Wait for baby to open mouth to pull the nipple in
- Tip the bottle nipple into baby’s mouth and allow baby to take up to 10 sucks
- Gently pull the bottle from baby’s mouth and rest it on lower lip, tipping the bottle so that milk does not flow
- Allow a few moments for baby to swallow and breathe
- Wait for baby to open mouth again
- 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.