Baby continuous feeding

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How to survive your newborn's cluster feeding

Photo: @lamamanpoule via Instagram

So you have a newborn, and lately your evenings have been hijacked by non-stop nursing sessions. If this sounds familiar, you’re probably dealing with the common breastfeeding phenomenon known as cluster feeding.

What is cluster feeding?

Infants nurse frequently (at least eight to 12 times in a 24-hour period), but sometimes it’s even more often, and they may bunch up those feedings—especially in the evening. This is frustrating for both the parent who’s been home with the baby all day and the parent who may only get to see the baby after work.

But cluster feeding is perfectly normal, says Attie Sandink, a lactation consultant in Burlington, Ont. “Babies instinctively know how much milk they need. If they’re not getting enough, they just want to feed and feed,” she says. This doesn’t mean your milk supply is tanking or you need to supplement with formula. And letting newborns nurse as often as they like doesn’t mean you are spoiling them.

“I remember thinking, Is this how life is going to be?” recalls first-time mom Alison Pearce of Toronto. “It was like looking down a tunnel with no light at the end of it.” From two to eight weeks old, her daughter, Simone, spent most evenings nursing non-stop. But once Pearce and her family noticed the pattern, they came up with a plan. Each night, before the intensive breastfeeding session began, Pearce’s mom (who stayed with them for the first month) made an early dinner while Pearce took a bath. Then, armed with snacks, they all settled in with a movie while Simone nursed and dozed, and everyone took turns holding her.

Cathy Wegiel, a mom of four in Airdrie, Alta., knew to expect a cluster-feeding phase, because all of her babies had spent their evenings attached to her boobs. But her son, Parker, was particularly enthusiastic. For two months, he was latched from 5 p.m. until 10 p.m. Wegiel suspects Parker—who had needed heart surgery at three weeks old—was trying to pack on the weight he’d lost before his operation. Parker’s need to feed became part of the family routine. “I always nursed in the armchair in the living room, and the other kids would snuggle with me and read stories,” Wegiel explains. “And if he was hungry during dinner, I nursed at the table and tried not to spill my food on him.”

Why is my baby breastfeeding all the time?

Babies cluster-feed for many reasons. One theory is that a mother’s prolactin levels drop toward the end of the day, which means her milk supply decreases and the flow is slower, so babies may nurse for a longer time to fill up, says Taya Griffin, a lactation consultant in Toronto. They could be frustrated by the slow flow and go on and off the breast more often. Mastering breast compressions—pressing down on your boob while the baby sucks—can help, because it expresses the milk faster and more efficiently. Babies can also cluster-feed at any time of day if they’re feeling out of sorts and need comfort, adds Sandink. Sometimes babies who seem ravenous are having a growth spurt (which lasts a few days).

To make cluster feeding more manageable, get things done earlier in the day and lean on your partner for meals. Wegiel would make dinner while her older kids were at school and then reheat it. Also be prepared to lower your household standards. “I really let things slide,” she says. “It was a disaster for quite a while.” Keep a basket of filling snacks (like energy bars or almonds) and a water bottle near where you nurse most often.

Feeling marooned on the couch? Wearing your baby in a sling or carrier so you can multi-task (or even nurse!) can save your sanity. Or forget about your to-do list and spend the time catching up on TV shows, scrolling through social media or reading a book with one hand. Cluster feeding is temporary—so settle in and make the most of it.

Should I be worried my baby isn't getting enough to eat? 

When a baby is eating all the time, almost every mom wonders, Do I have a milk-supply issue? Just remember that this pattern is normal for a newborn. You should only worry if your baby is not gaining weight well (something your doctor or midwife will keep track of) or is not producing enough wet diapers (typically six per day for newborns six days old and up). If you are in pain while breastfeeding, reach out to a lactation consultant for help.

This article was originally published online in February 2016.

This article was originally published on Apr 11, 2021

Enteral nutrition (tube feeding)

What is enteral nutrition?

Sometimes during treatment and recovery, children with cancer cannot get the calories and nutrients they need orally. Tube feeding, or enteral nutrition, provides nutrition in the form of a liquid or mixture given through a tube that is inserted into the stomach or intestines. Some medications may also be delivered through such a tube (probe).

Typically, the tube is inserted in two ways:

1. Through the nose (non-surgical method)
2. Through a small incision in the abdomen (surgical method)

Most commonly used are nasogastric tubes and gastrostomy tubes. But there are several types of enteral feeding tubes that differ in the method of insertion and location in the digestive tract.

Sometimes the patient is simply not able to eat enough calories or protein. There is no fault in this. It is important to help your child understand that nutritional support is not a punishment. Most children get used to the enteral feeding tube quickly. It is important that the child does not touch or pull the phone. Follow skin care instructions at the insertion site to avoid irritation or infection.

A nasogastric tube is inserted into the stomach or small intestine through the nose and throat.

Enteral feeding tube types

Enteral feeding tube connects to the stomach or small intestine. The location depends on how the patient tolerates the formula and how well their body is able to digest the nutrients. If possible, they try to place the probe in the stomach so that digestion occurs naturally.

There are 5 types of enteral feeding tubes:

Nasogastric Tube . A nasogastric tube is inserted into the stomach through the nose. It passes through the throat, esophagus and into the stomach.

Nasojejunal Probe . A nasojejunal tube is similar to a nasogastric tube but passes through the entire stomach into the small intestine.

Gastrostomy Tube (Gastrostomy Probe) . A gastrostomy tube is inserted through a small incision in the skin. The probe in this case passes through the wall of the abdominal cavity directly into the stomach.

Gastrojejunostomy tube (gastrojejunostomy probe) . The gastrojejunostomy tube is inserted into the stomach like a gastrostomy tube, but passes through the stomach into the small intestine.

Jejunostomy Probe . A jejunostomy tube is inserted through a small incision in the skin and passed through the abdominal wall into the small intestine.

Nasal tubes, including nasogastric and nasojejunal tubes, are generally used for short-term enteral feeding, usually not more than 6 weeks. The probe comes out of the nostril and is attached to the skin with adhesive tape. Nasogastric and nasojejunal tubes have a number of advantages, such as a low risk of infection and a simple insertion procedure. However, the probe must be attached to the face, and this worries some children. Other children may have problems with the nasogastric tube due to chemotherapy, which irritates the skin and mucous membranes.

Surgical insertion tubes - gastrostomy tube, gastrojejunostomy tube and jejunostomy tube - are used for longer periods of time or if a nasal tube cannot be placed in the child. The opening in the abdominal wall through which the probe is inserted is called the stoma. A long tube or a "button" (low profile) probe may be visible on the patient's body. After healing, the stoma is usually pain free and the child can perform most daily activities.

• Insertion of nasogastric and nasojejunal tubes

• Gastrostomy, gastrojejunostomy and jejunostomy insertion

After healing, the stoma usually does not hurt. The child can perform most daily activities.

Side effects of enteral nutrition

The most common side effects of enteral nutrition are nausea, vomiting, stomach cramps, diarrhoea, constipation and bloating.

There may be other side effects:

• Infection and irritation at the insertion site
• Probe misaligned or falling out
• Lung ingestion of formula

Most side effects can be avoided by following the care and nutrition instructions.

Feeding babies with tubes in place

It is the responsibility of the nutritionist to provide the baby with all the necessary nutrients. In children with cancer, an enteral feeding tube is often used in addition to what the child can eat normally. However, some patients have to enter all the nutrients through a tube.

The patient is prescribed a mixture containing:

• Calories
• Fluid
• Carbohydrates
• Fats
• Protein
• Vitamins and minerals

Standard formulas are suitable for many patients. For babies, it is preferable to use breast milk. Some children need special formulas that take into account their characteristics: the presence of allergies, diabetes or digestive problems.

It is very important for family members to work closely with a nutritionist. Nutritional needs may change due to changes in the child's health or side effects such as vomiting or diarrhea.

Types of enteral feeding

There are three types of enteral feeding - bolus, continuous and gravity.

Bolus feeding - large doses of the mixture are given to the patient by tube several times a day. This species is closest to the usual diet.

Continuous feed - Electronic pump delivers small doses of formula for several hours. Some children may need continuous feeding to reduce nausea and vomiting.

Gravity Feeding - A bag of formula is placed on the IV stand and a predetermined amount of formula is dripped through the tube at a slow rate. The duration of such nutrition depends on the needs of the patient.

Enteral feeding at home

Children can go home with a feeding tube. The doctors will ensure that family members know how to feed and care for the probe. Family members need to pay attention to the following issues:

• Weight gain or loss
• Vomiting or diarrhea
• Dehydration
• Infection

Formulas, Consumables, and Equipment Required:

• Formula: Most enteral formulas are sold ready-made. Some are available as a powder or liquid to mix with water.
• Syringe
• Adapter tube (if the child has a button tube for long-term enteral nutrition)
• Pump (with continuous power)
• Feeding formula bag with tubing (for continuous feeding)
• IV Stand (gravity fed)

General tips for enteral feeding at home:

• Always wash your hands with soap and water before feeding your baby.
• Make sure the baby's head is above the stomach.
• Throw away any ready-made or homemade formulas that have been opened and kept in the refrigerator for 24 hours or more.
• Store mixed formulations in the refrigerator and discard after 24 hours.
• Ready-to-use formulas do not need to be refrigerated.
• Do not empty the syringe completely during feeding.
• Wash the syringe (and transfer tube, if used) with warm water and dishwashing detergent after each use.
• Watch for signs of nausea, vomiting, bloating or irritability while feeding. If you notice these signs, stop feeding and contact your doctor immediately.
• Check the skin around the injection site for signs of irritation or infection.

-
Modified November 2018

Continuous milk feeding by nasogastric tube versus intermittent bolus milk feeding of preterm infants weighing less than 1500 g

Survey question

Is continuous tube feeding through the nose or mouth better than tube feeding every two to three hours in very low birth weight preterm infants?

Relevance

Premature babies born weighing less than 1500 grams are unable to coordinate sucking, swallowing and breathing. Feeding through the gastrointestinal tract (enteral nutrition) promotes the development of the digestive system and the growth of the child. Therefore, in addition to feeding through an intravenous catheter (parenteral nutrition), premature babies can be fed milk through a tube inserted through the nose into the stomach (nasogastric feeding) or through the mouth into the stomach (orogastric feeding). Typically, a predetermined amount of milk is given over 10-20 minutes every two to three hours (intermittent bolus feeding). Some doctors prefer to feed premature babies continuously. Each feeding method has potentially beneficial effects, but can also have harmful effects.

Study profile

We included nine studies with 919 infants. Another study is pending classification. Seven of the nine included studies reported data on infants with a maximum weight of 1000 to 1400 grams. Two of the nine studies included infants weighing up to 1500 grams. The search is current as of July 17, 2020.

Main results

Infants receiving continuous feeding may achieve complete enteral nutrition slightly later than infants receiving intermittent feeding. Total enteral nutrition is defined as the intake of a given volume of breast milk or formula by the infant in the required manner. This promotes the development of the gastrointestinal tract, reduces the risk of infection from intravenous catheters used to provide parenteral nutrition, and may shorten hospital stays.

It is not known whether there is a difference between continuous and intermittent feeding in terms of the number of days needed to regain birth weight, days of feeding interruption, and rate of weight gain.

Continuous feeding may result in little or no difference in rate of increase in body length or head circumference compared to intermittent feeding.

It is not known whether continuous feeding affects the risk of developing necrotizing enterocolitis (a common and serious bowel disease in preterm infants) compared with intermittent feeding.

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