One of the biggest things that I've come to learn as a clinician and now also as a parent is that there is no such thing as common sense. I'm not talking about that in a derogatory way but in the literal meaning of the phrase. There is no, or very little, common knowledge/understanding of the world, how to raise children or indeed how to feed them.
Once I grasped this concept I became a better therapist (I hope)! I started to be able to look at every baby, child, parent, problem facing me in clinic at face value with no preconceived idea that they don't know what they're doing or that they've somehow missed a beat because they've been switched off to the common sense of society. I was able to be my best, non-judgmental self for every worried parent or carer I came across.
Understanding that there is no common sense when it comes to feeding your baby is pretty fundamental. You'll have heard the phrase 'no two babies are the same'. Well if that were to be true, then no two feeding scenarios can be the same either.
Also, there are training courses and degrees out there that provide that Specialist, in depth, knowledge to support children with feeding difficulties. If there was all this common sense, why would we need to do the training?!
Why am I harping on about this? I want to provide you with some of my knowledge about feeding so that you can understand your baby's feeding presentation. I also think knowledge is power. So if I can impart some of that on to you then you have the power to advocate for your baby if you feel something isn't going well with their feeding. Again, in the multidisciplinary clinical world where you think more of that 'common sense' would exist, it doesn't! Equally, if you feel your baby is feeding well but a health care professional thinks they aren't, you will have the knowledge to advocate for your baby about that too.
If there are any health care professionals reading this, thank you. It's so important to keep growing and building our knowledge about infant feeding as it will be for me to continue to learn about other aspects of infant health.
What makes for a successful milk feed?
Before, I go further let's look at feeding development.
Did you know that a foetus starts practicing their swallow at around 11 weeks gestation?! Mind blowing. They'll start to suck their thumb soon after and some recent research has indicated that they are likely able to taste things their mother has been eating while they are in the womb! Throughout the pregnancy they will harness and practice that skill to process the amniotic fluid, develop their digestive system and to be ready for life outside that cozy little bubble.
Just because a baby has started to practice before they are born, this doesn't mean they are masters at feeding once they are in the world. It's a learning process for all the family. However, you feed your baby you'll need to practice together, again and again and again.
What foundations and systems are involved in infant feeding?
Alertness
Your baby needs to be able to be alert enough to feed. Yes even a brand new newborn needs to be awake and actively ready for a feed, if you try to offer a bottle or the boob when they are sleeping, nothing will happen. Even dream fed babies are stirring a little to engage in their feed. Equally, if your baby is too alert, i.e. really upset they will be too overstimulated to take on a feed successfully.
This leads nicely to communication.
Babies can communicate, it may not be obvious but parents and caregivers need to build their listening skills for this. Responding to their cues in a timely way (when you can) is important to help your baby access what they need in a calm but alert state. Your baby should rouse regularly for feeds. You'll notice: insta post
If they aren't rousing regularly for feeds or you feel they are more drowsy then you'd expect then it may be a good time to speak to your health visitor or family doctor to check your baby over.
If they are constantly or frequently in a state of heightened alertness, ie. Crying a lot and difficult to settle. This isn't typical and a healthcare provider should check over your baby. They may be experiencing some discomfort like colic or reflux that needs to be managed for them. It could also indicate that they are feeling rubbish and again need checking over.
Stamina & breathing
If your baby is difficult to rouse, check their breathing. Are they breathing really quickly or quite shallow? Do you notice a sucking in of their tummy under their ribs? Do you see a dent in their throat every time they breathe? Then they might be having difficulty with their respiratory rate or breathing. Infant feeding is a sustained effort on breathing at the best of times so if you baby is finding that difficult they are likely to find feeding more challenging too.
When we swallow, we reli on our muscles and cranial nerves to block off our airway so that food and drink goes down into our stomach and not into our lungs. This is a brief pause for our airway and the we can recover. Infant feeding, whilst goes through the same process has to do that repeatedly over a period of time until they complete their feed. If stamina or breathing is more tricky for them. They may not be able to continue protecting their airway as effectively because their body is demanding more oxygen to function. This opens up the airway and can allow some of the milk to be aspirated and enter the lungs. This of course is not good and can lead to serious health complications.
Oral skills
In my previous post about dysphagia, we discussed the stages of swallowing. Same applies to infants just the oral skills look a little different.
Infants need to be able to create a firm latch on the teat or breast to feed effectively. They need to have the teat or nipple quite far in to create the right amount of pressure to draw out the milk and coordinate a swallow. If the latch is loose the infant won't be able to draw out enough milk, may get tired too soon or become frustrated and the feed is over.
It looks like lips are involved to squeeze out any milk but in reality its the hard palate, soft palate and tongue that do most of the work.
The process should be rhythmic. While your newborn is a newborn they are likely to start with less coordination as they work things out. They are likely to sink into a more rhythmic, non-nutritive pattern that means a suck that doesn't provide nutrients such as is with a dummy. The rhythmic pattern is likely to look calm and steady and go suck suck suck, swallow, breathe.
As your baby grows and becomes more skilful their sucking pattern should become nutritive - providing nutrition every time. This rhythmic pattern is likely to look calm and steady and go suck, swallow, breathe repeatedly under the feed is finished.
It's normal for babies to take a break every so often but if they are seeking increasingly frequent breaks and looking tired, out of breath, flustered or they are showing signs of aspiration (coughing, choking, changes to colour or breathing) the feed is not going very well and your baby would benefit from some advice from a speech therapy feeding specialist.
So to sum up:
A good feed looks like this:
Cool, calm and collected
Steady and well paced
Takes anything from 5 to 30 minutes
Quiet and cosy
Clean and tidy
Other signs that feeding is going well:
Weight gain along their own percentile curve
Plenty of wet and dirty nappies
A good, healthy colour
Settled baby between feeds
If you aren't seeing some of these things it's a sure fire sign that help might be beneficial, please do get in touch via email or leave a comment and I'll get in touch with you.
If you are seeing these signs and a healthcare professional is pressing for a feeding referral then it's okay to advocate for your baby and decline the referral.
Keep in touch!
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