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Baby slow feeder


Why You Should Not Label Babies "Slow Feeders"

Marcy M. invites me into her home for a lactation consultation.

Her 2-week-old baby, Porter, has regained his birth weight and is healthy. At a recent visit to his pediatrician she asked for advice about feedings that were lasting more than an hour.

Marcy was told that she “had a slow feeder.” Any advice that she might have been given after that went unheard. The first negative label had been applied and now it was stuck in her brain.

I asked many questions and was able to get a picture of Marcy’s dilemma. Now overwhelmed with screen after screen of conflicting Internet research, she felt unsure of herself and was ready to supplement her exclusively breastfed infant with formula to “speed things up.”

First you have to ask yourself... is an hour long feeding a problem? Marcy said “Sometimes yes, sometimes no. The feeding right before I’m ready to go to bed for the night lasts an hour and I love it. During the day? Not so much. Too many things I have to get done.”

As I watch Marcy feed her son I am able to adjust their positioning and alignment and after relatching, Marcy is able to achieve a deeper latch... more breast tissue in his mouth means more milk into Porter. Effective sucking = less time at breast.

After 3-4 minutes he stops, still holding on to her nipple. Marcy jiggles him, strokes him, he semi-dozes.

Now is the time for deep breathing to stimulate more milk to flow. Porter is not a slow feeder or any other kind of negative label. He is happy to have a half full belly if it comes along with Marcy by his side. Remove mom’s warmth, heartbeat, voice and he remembers his ½ full belly. Let’s get more milk into Porter in a timely manner, at this point in Marcy’s day.

Breathing slowly and mindfully will activate the hypothalamus, which is connected to the pituitary gland in the brain. It sends out chemicals that inhibit stress-producing hormones and trigger a milk let-down response in the body.

After 8 deep breaths, with Marcy’s breast swelling against his face as she inhaled and then retreating a bit with each expiration, Porter began sucking but with decreasing rate of swallowing.

Now is the time for breast compression to move more milk to the front of Marcy’s breast and begin to squirt or drip milk into Porter’s mouth. That’ll arouse his interest!

Here’s how to do it:

1) The first step is to hold your breast with one hand with your thumb on one side and four fingers on the other side of your breast, supporting most of the breast should in your hand. Your other arm should pull the baby firmly against you.

2) Next the thumb and the fingers are brought together, firmly compressing the breast. If it hurts, you’re doing it too hard.

3) Once your breast is compressed your baby may start to actively suck and swallow again. The pressure on the breast should be maintained as long as the baby is actively sucking. Gently release your fingers when your baby stops sucking/swallowing and more milk will flow from other areas of the breast, stimulating renewed sucking.

4)  Your baby may stop drinking when the compression is stopped. After around 10 seconds compression may be started again. A different area of the breast should be compressed next to ensure complete emptying of the breast.  

Using deep breathing and a simple breast compression technique, Porter lost his “slow feeder” label as Marcy gained confidence in her ability to adjust and accommodate slower and faster breastfeeding sessions into her everyday life. 

No labeling required.

Paula Zindler
RN IBCLC

How to Do It and Why You'd Want To

Paced bottle feeding is a method of feeding your baby that mimics breastfeeding. Find out why it’s so beneficial to feed baby this way, plus get step-by-step guidance.

If you’re planning to go back to work after baby, you’ve probably started pumping, storing milk, and have chosen a good bottle for breastfed babies. Now, you need to know how to properly feed baby with a bottle. Paced bottle feeding is the answer.

Paced bottle feeding can help reduce some of the drawbacks of bottle feeding and keep baby and mama happy and healthy.

What is paced bottle feeding?

Paced bottle feeding is a method of feeding your baby that mimics breastfeeding. As the name suggests, it involves pacing your feedings to allow baby to be in “control” of, process, and recognize his own “satiety,” or feeling of fullness. Baby is going to eat more slowly and work harder to get the milk (like he would with breast-feeding) as opposed to typical bottle feeding.

Video of paced bottle feeding

The best way to really “describe” paced bottle feeding is to show you how it’s done…

In this video by Emerald Doulas you’ll notice that the:

  1. Baby is sitting more upright
  2. Caregiver tickles baby’s lips with bottle
  3. Nipple is then put into baby’s mouth
  4. The bottle is held horizontally, which slows the flow significantly
  5. After 20–30 seconds of feeding, the bottle is tipped downward or removed from baby’s mouth to stop the flow of milk (creating a similar pattern as in breastfeeding)

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How to bottle feed the breast-fed baby: Paced bottle feeding

These tips are designed to replicate breast-feeding for breast-fed babies while mom’s away, but they can absolutely be helpful for formula-fed babies too!

When should baby be fed?

Whenever baby is hungry.   A schedule can be helpful as a loose guideline (for example, feeding baby every 2–3 hours), but look for feeding cues first and foremost instead of going by the clock.

Some signs baby is hungry include:

  • Smaking lips
  • Sucking fists
  • Rooting (baby turning with mouth wide open toward any object that touches her cheek)
  • Acting fussy or restless

Baby position

Hold baby in an upright position, as opposed to laying down. This helps baby to control the flow of milk better. He doesn’t have to be at an uncomfortable 90-degree angle, but only slightly reclined so that the bottle isn’t pouring down into baby’s mouth.

Offer the bottle horizontally

Lay the bottle nipple across baby’s lips (nipple pointed up) when baby starts rooting and opening his mouth. Let baby draw the nipple into his mouth and close his lips on the base of the nipple. Baby essentially is going to “latch” on the bottle nipple like he would a breast.

Once he’s latched on, keep the bottle horizontal. This allows baby to control the flow of milk better. This also helps the bottle to last the entire length of a normal feeding, usually 10–20 minutes, rather than baby gulping a bottle down in 5 minutes.

Baby learns to recognize when he’s full because he is not filling his belly before the signals of satiety can reach his brain.

You may also consider not allowing the milk to reach the nipple of the bottle for a few minutes while baby sucks. This mimics the letdown of breast-feeding and can help reduce the chances of nipple preference.

One caveat would be if you have a really fast letdown. If your baby only nurses for 5 minutes per feeding, holding bottle at a horizontal angle is not quite as important. And frankly, paced bottle feeding probably won’t be a necessity for you since your baby is already used to a fast flow.

Pausing

Babies at the breast will pause and take breaks often throughout a feeding. Baby’s caregiver should encourage pausing while bottle-feeding as well. If baby gets tense or starts gulping, lean him forward to allow the milk to flow away from the nipple to give him a break. If he pauses on his own, great!

Switch sides

Just as mom does while breast-feeding, move baby from one side to the other halfway through the feeding. This helps baby avoid a side preference, and allows for new views and eye contact, which is excellent for his development.

Ending the feeding

One big drawback of bottle feeding is the risk of over-feeding. Look for cues that baby may be getting full, such as:

  • Slower sucking
  • Eyes wandering
  • Falling asleep
  • Hands are open and relaxed

When you think baby’s getting close to being full, remove the nipple from his mouth by gently twisting. Offer it again, and if he accepts, give him about 10 sucks, and repeat until he refuses. This will help teach him the feelings of satiety and reduce the chance of over-feeding.

Likewise, don’t coerce baby into drinking the last few drops of milk in the bottle. If he falls asleep, he is finished (an exception being newborns who may need to be awakened in the first few days to feed).

Benefits of paced bottle feeding

Breast-feeding is the biological design, so it makes sense that we would want to recreate this dynamic as best we can when bottle feeding. Paced bottle feeding has many benefits, which will help your child both in the short and long-term.

Baby avoids being under- or over-fed

If the caregiver is in charge of when and how much baby eats, baby is not likely to get the correct amount of milk. Paced bottle feeding helps baby be in charge, just like when he’s at the breast.

Less stressful for baby

Babies can become very stressed when laid on their backs to eat from a bottle. When baby swallows milk from a bottle, the negative pressure forces more milk out of the bottle. Baby has to keep gulping to avoid choking. Paced feeding gives baby the time and space to eat at his or her own pace.

Avoid colic

Proper feeding techniques and a good bottle can minimize colic-like symptoms. When milk pours into baby’s mouth, as happens with conventional bottle feeding, baby gulps to keep up, ingesting air in the process, which can cause gas.

Easier pumping for mom

If baby is being over-fed, mom needs to continually pump extra milk to replace the milk that’s being fed. Sometimes this leads to mama believing she has low milk supply. When baby is in charge, it’s much more likely that the amount mom pumps is exactly what baby needs. (Need more pumping tips? Check out this post!)

Supports breast-feeding relationship

Using a feeding technique that resembles breast-feeding is a great way to support the breast-feeding relationship and avoid a bottle preference. We are learning that babies don’t struggle as much with “nipple confusion” as with “flow preference.” If you are consistently giving a breast-fed baby fast-flowing bottles, they will probably prefer that easier, faster milk versus the breast.

May improve health later in life

One reason that breast-feeding is so great is that it allows baby to eat at his own pace, allowing him to learn his body’s cues for satiety. Studies have found that bottle feeding plays a large part in teaching overeating. Therefore, paced bottle feeding may contribute to healthier eating habits in the future.

Which is the best bottle to use?

Some lactation consultants like a narrower nipple found in traditional bottles versus the more breast-like nipples on some bottles. They prefer this style because baby can “latch” deeply on the narrower nipple, like with a breast. Other lactation consultants say it isn’t the bottle that matters as much as the pace of milk flow.

I like the breast-shaped nippled bottles because they are almost always a slow-flow bottle and the baby has to work for the milk, regardless of how you hold it (horizontal or vertical). Here’s our post on the best bottles for breastfed babies.

Will paced bottle feeding make my baby gassy?

When I first saw demos of this feeding method, I instantly thought of baby getting gassier. However, many lactation consultants say that air isn’t what causes gas. It’s more due to baby’s immature nervous and digestive systems.

If you notice an increase in gas, switch to a breast-shaped nipple bottle, which is slow flow. Also, try holding the bottle more horizontally so that less air interferes with the feeding.

Final word on paced bottle feeding

Whether you’re going back to work full-time, part-time, are exclusively pumping, or feed formula, paced bottle feeding can be a great way to support yourself, and especially, your baby.

How about you?

Have you tried paced feeding? How has it helped your baby?

References

  • https://www.llli.org/docs/0000000000000001WAB/WAB_Tear_sheet_Toolkit/22_bfabreastfedbaby.pdf
  • https://www.emeralddoulas.com/

Solving five breastfeeding problems after the first month

Expert advice on solving the top five breastfeeding problems that may arise after the first month.

Share this information

Cathy Garbin, child health nurse, midwife and lactation consultant:
Cathy, a mother of two, was a research fellow at the renowned Human Lactation Research Institute, founded by Peter Hartmann, for seven years, providing support to breastfeeding mothers in clinics and at home. Today, she still works as a family counselor, and also conducts seminars for attending physicians and speaks at international conferences.

You and your baby have already fully established the process of breastfeeding and know what and how to do. It seems that all difficulties are left behind. However, some more surprises await you. The following are suggestions for dealing with breastfeeding problems that may arise later.

Problem #1. I need to be away from my baby

Whether it's social events, travel or medical treatment, at some point you may need to be away from your baby for a while.

Solutions

  • Express milk so that someone else can feed the baby. Now that breastfeeding is established, you can express and store your breast milk in the refrigerator or freezer. Try different options to find the most convenient time for pumping in your daily routine. Some mothers manage to pump more breast milk in the morning when the baby wakes up after a long night's sleep. For others, it's best to express 60 minutes after feeding. Remember that everyone is different. Don't be discouraged if you don't get enough milk the first time: it's possible that you'll be able to express enough for one feeding in just two or three pumpings. As with feeding, it may take time for your body to adjust to pumping.
  • Take your breast pump with you, if you plan to skip a feed. Even if you leave your baby with expressed milk, but will be absent for more than two hours, you will need to empty your breast. Pump at the same frequency as you would breastfeed your baby. This will support milk production and prevent discomfort. Express milk regularly throughout the day without waiting for your breasts to overflow. 1 Most electronic breast pumps are battery operated, so you don't have to find an outlet nearby.

Problem #2. How to continue breastfeeding after returning to work?

You will likely have to leave your baby more often and for longer when you go to work, so it's especially important to find ways to continue breastfeeding and pumping that work for both of you. As mentioned above, you can build up a supply of breastmilk before you go to work and then pump regularly to support milk production, prevent discomfort, and make sure your baby has enough pumped milk the next day. Many companies now provide dedicated pumping rooms, and modern breast pumps work efficiently and reliably. If you have a regular work schedule or work part-time, you can still breastfeed your baby before and after work and at night.

Solutions

  • Express as often as you would feed your baby. This will help maintain milk production and prevent discomfort, as well as reduce the risk of clogged milk ducts, mastitis and breast swelling. 1
  • Try double pumping. Double pumping not only takes half the time, but also produces an average of 18% more milk than pumping from each breast in sequence. Milk is more nutritious and has a higher fat content. 2
  • Assemble and bring to work the set, which includes a breast pump, milk storage bags and, if desired, a bustier top for hands-free pumping. You will also need a cooler bag to carry your expressed milk.
  • Know your rights. In many countries, the law allows women to express and safely store breast milk at work. Discuss these options with your employer before returning to work. This will get you both ready.

Problem #3. It seems to me that the baby suckles only for pleasure

Sometimes you may feel that the baby takes your breast in order to calm down, and not to eat. However, do not forget that breastfeeding is not only nutrition, it is also comfort for your baby. "Soothing suckling" (when the baby suckles but does not eat milk) helps the baby to calm down and relax. Remember that a sudden increase in the frequency or duration of feedings may indicate insufficient milk production. However, if the baby continues to gain weight and you use enough diapers a day, this is unlikely.

Solution

  • Be patient. The baby needs your care - listen to his needs and support him. Usually, the period of soothing suckling does not last too long, but it allows the child to feel your love and protection - and this is the best thing you can give him.

Problem #4. I want to switch from mixed to exclusive breastfeeding

Breastfeeding is so good for you and your baby that it's worth trying to fight for it. However, if you have rarely fed lately, your milk production may have been reduced. If your baby has only been mixed-fed for a couple of weeks, you will most likely be able to restore enough milk. Contact a lactation consultant or medical specialist who will help you and give you the necessary advice. This is a very individual process that depends on many factors. In any case, do not despair, because every drop of your milk is important for the child.

Solutions 1.3

  • Increase milk production. Try to put the baby to the breast more often, because the more milk the baby consumes, the more milk is produced. You can also express milk additionally. As mentioned earlier, double pumping in particular helps increase milk production.
  • Be in physical contact with your baby as much as possible. As in the first days after childbirth, close physical contact with the baby promotes the production of the hormone oxytocin, which in turn triggers milk production. It will also make both of you feel more calm and relaxed.
  • Reduce the number of formula feedings gradually. Resist the urge to stop supplementing with formula right away. If you gave your baby formula after each breastfeed, start giving it every other time until milk production rises. Keep a close eye on the number of soiled diapers and weight gain during this transition period. It is likely that at first the child will ask for the breast more often, and this is absolutely normal.
  • Speak with a lactation consultant or healthcare professional. He will be able to help you and strengthen your confidence that your baby gets everything he needs.

Problem #5. My child has lost interest in the breast

If your child, who always ate with appetite, suddenly began to refuse the breast for no apparent reason, this is a false refusal, the so-called "strike". You may assume that he is ready to switch to solid foods, or that he does not like your milk anymore, but this is most likely not the case. It's just that the child develops vision, and now he is more distracted by the world around him. Or maybe something frightened the child during feeding, or he reacts to a violation of the regimen, perhaps he has a stuffy nose or teething. What you take for lack of interest may actually mean that your baby has simply learned to breastfeed more effectively and therefore takes less time to suckle.

Solutions

  • Be patient. False rejection is usually temporary and goes away after a few days. To provide the baby with the necessary nutrition during this period, give him expressed milk.
  • Find a quieter feeding area with as few distractions as possible. Baby is more likely to eat better if he can relax and focus on his chest.
  • Check in which position you feed. The baby may refuse to breastfeed if he is uncomfortable or unable to move his head to breathe during feeding.
  • Express milk to keep it flowing . You can try feeding your baby with expressed breast milk using the Medela Calma smart pacifier.
  • Do not start formula or solid foods. Supplementing with formula can lead to reduced milk production and will only make matters worse. If your baby is regularly fed with expressed milk and is growing well, and the number of soiled diapers is normal, try not to worry. If the baby is less than six months old, you should not give him solid food: his digestive system is not yet strong and may not be ready for such a load.
  • Do not force-feed. Try to relax and be in skin-to-skin contact with your baby as much as possible, hug him and often offer the breast so that he can take it on his own. The release of oxytocin that body contact triggers will also help you pump. 4

Related content: Breastfeeding: what to expect after the first month

Literature

1 Kent JC et al. Principles for maintaining or increasing breast milk production. J Obstet , Gynecol , & Neonatal Nurs . 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Breast Milk Production". G Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.

2 Prime DK et al. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breast Med . 2012;7(6):442-447. - Prime D.K. et al., “During the breastfeeding period, pumping both breasts simultaneously is more productive than sequential pumping.” Brest Med (Breastfeeding Medicine). 2012;7(6):442-447.

3 Amir L. Breastfeeding managing ‘supply’ difficulties. Aust fam physician . 2006;35(9):686. - Amir L., "Breastfeeding: Problems of 'Supply'. Aust Fam Physical. 2006;35(9):686.

4 Moberg KU, Prime DK. Oxytocin effects in mothers and infants during breastfeeding. Infant . 2013;9(6):201-206. - Moberg KW, Prime DK, "The effects of oxytocin on mother and child during breastfeeding. " Infant. 2013;9(6):201-206.

Feeding children with special needs

American Academy of Pediatrics and The American College of Obstetricians and Gynecologists. Breastfeeding Handbook for Physicians 2006). - American Academy of Pediatrics and American College of Obstetrics and Gynecology. "Medical Guide to Breastfeeding", 2006.

Lawrence , R . A . & Lawrence , R . M . Breastfeeding : a guide for the medical profession ( Elsevier Mosby , Maryland Heights , MO , 2011). - Lawrence R.A., Lawrence R.M., "Breastfeeding: A guide for healthcare professionals." (Publisher Maryland Heights , Missouri, USA: Elsevier Mosby; 2011.)

Prime, D.K. et al. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med 7, 442-447 (2012). - Prime D.K. et al., “During the breastfeeding period, pumping both breasts simultaneously is more productive than sequential pumping.” Brest Med (Breastfeeding Medicine) 7, 442-447 (2012).

Morton, J., Hall, J.Y., Wong, R.J., Benitz, W.E. & Rhine, W.D. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 29, 757–764 (2009). — Morton J., Hall J.I., Wong R.J., Benitz W.I. and Rhine, W.D., "Manual pumping combined with an electric breast pump increases breast milk production in mothers of preterm infants. " J Perinatol (Journal of Perinatology) 29, 757-764 (2009)

Hill, P.D., Aldag, J.C., Chatterton RT. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact . 2001;17(1):9–13 - Hill P.D., Aldag J.S. and Chatterton, R.T., "Onset and frequency of expression and milk production in mothers who have given birth to premature babies and have not breastfed them." J Hum Lakt (Journal of the International Association of Lactation Consultants) 17, 9-13 (2001).

Hill, P.D., Aldag, J.C., Chatterton RT, Zinaman M. Comparison of Milk Output Between Mothers of Preterm and Term Infants: The First 6 Weeks After Birth. J Hum Lact . 2005 February 1, 2005; 21(1):22–30. - Hill P.D., Aldag J.S., Chatterton R.T., Zinaman M., "Comparison of the amount of milk in mothers of full-term and premature babies in the first 6 weeks after birth. " J Hum Lakt (Journal of the International Association of Lactation Consultants) 2005, 21(1): 22-30.

Parker, L.A., Sullivan, S., Krueger, C. & Mueller, M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med (2015). - Parker L.A., Sullivan S., Kruger S., Kelechi T. and Muller M., "Association of the time of onset of pumping with the amount of milk and the timing of the second stage of lactogenesis in mothers of children who had extremely low birth weight" . Brestfeed Med (Breastfeeding Medicine) (2015)

Meier, P.P., Engstrom, J.L., Janes, J.E., Jegier, B.J. & Loera, F. Breast pump suction patterns that mimic the human infant during breastfeeding: Greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol 32, 103-110 (2012). - Meyer P.P., Engstrom J.L., Jaynes J.I., Jaegier B.J., Loera F. "Pumping patterns that mimic breastfeeding behavior: more milk and less time for constant pumping mothers of premature babies". J Perinatol (Journal of Perinatology) 32, 103-110 (2012).

Torowicz, D.L., Seelhorst, A., Froh, E.B., Spatz, D.L. Human milk and breastfeeding outcomes in infants with congenital heart disease. Breastfeed Med 10, 31–37(2015). - Torowicz DL , Seelhorst A FROH , Spatz DL , "Breast milk and breastfeeding outcomes for children with congenital heart disease", Brestfeed Med (Breastfeeding Medicine) 10, 31-37 (2015).

Reilly, S. et al. ABM clinical protocol #18: Guidelines for breastfeeding infants with cleft lip, cleft palate, or cleft lip and palate, revised 2013.

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