Time to feed the babies

Translation by Irina Slukina
Editing of the translation by Natalia Gerbeda-Wilson
Proofreaders Dina Sabitova and Aliya Vasilchenko

The feeding routine, like the kissing routine, will complicate life for you and your baby.
“The Art of Breastfeeding” (2010)

“How often should I feed my baby?” Almost all young parents puzzle over this question in the first days of a baby's life. They have not yet learned to distinguish the nuances of his behavior and doubt their ability to care for him. Depending on who they turn to for advice or what book they look for information in, new moms and dads get different answers to this seemingly simple question.

Some sources advise feeding at fixed hours, such as stating that children should eat every four hours. Feeding by the hour promises parents predictability. They feel confident because they are following recommendations from trusted sources. “We don’t have much experience with children and it’s important for us to do everything right,” one father explained the reason why his wife was breastfeeding a child on a schedule.

Other books recommend "feeding on demand", "feeding on demand", or "feeding in response to signs of readiness to suckle". (editor's note. Feeding on demand - why so many terms?) Supporters of feeding on demand believe that a child should be fed when he is hungry. This means that the mother must learn to recognize the special behavior of the baby when he wants to suckle. The child, as it were, sends signals to the mother that he already wants to suckle the breast - the baby’s eyelids tremble in a dream, you can notice the rapid movement of the eyeballs under the eyelids, then the baby begins to toss and turn, fidget, he looks for the breast, starts to squeak, and if he is not fed starts crying loudly. For some, recognizing signs of readiness to suckle is easier, for some it is more difficult. This ability depends on previous experience with children, self-confidence and how clearly the child can show by his behavior that he wants to suckle, and how vividly he responds to the actions of the mother. Some parents will need from several days to several weeks before they learn to understand the behavior and needs of their child.

Which approach to feeding is best? Which approach is best for breastfeeding? Why do parents choose one way or the other? Parents' actions depend on culture, individual preferences and values. If you break away from the influence of culture and look at the process of breastfeeding, the biology of a woman and a child, it turns out that abstract feeding very often does not work: children cry, women are nervous, and milk runs out.

In industrialized cultures, adults often have no idea how children actually behave, although everyone has illusory ideas about how children should behave. Adults do not realize that a child comes into this world with the same biological needs for food, protection, affection and attention as children thousands of years ago, throughout human history. Humanity has survived and thrived because mothers have met the needs of their children, responding to their signals and behaviors, in particular, signs of readiness to suckle.

Breastfeeding is normal for mother and child. It has been scientifically proven that bottle feeding with formula will not replace the emotional and physiological process of breastfeeding, and no artificial milk formula will replace the nutrients and immune factors of breast milk that protect the baby from disease. Scientific studies of successful breastfeeding have shown that, from the point of view of biology, both mothers and children are suitable for feeding not according to the regimen, but taking into account the behavior of the child.

The capacity of a baby's stomach is small and breast milk is digested quickly. By themselves, these two physiological facts confirm that the newborn will be calmer if he suckles frequently, and not only every three or four hours according to the regimen. In the first two or three days after birth, the mother produces a small amount of colostrum, an easily digestible, protein-rich fluid that contains immune bodies and prepares the baby's digestive system for more food. Another biological fact has appeared in our body of evidence, which confirms that newborns need to suckle often and suck out small portions of milk. And, of course, it is not at all accidental that frequent attachments to the breast guarantee the baby enough affection, the feeling that he has not been abandoned, i.e. a sense of security, tactile contact and communication with mom.

But that's not all. Frequent feedings in the first days of life help the newborn learn to suck on relatively soft breasts, so that later, when there is more milk, the baby can confidently take the breast. For a mother, frequent feeding in the first days after childbirth means a sufficient and stable amount of milk in the following months. And importantly, women who hold babies for long periods of time quickly learn to recognize what their babies need.

Studies have shown that healthy full-term infants regulate their milk intake remarkably if they are breastfed when mothers recognize behaviors that indicate a desire to breastfeed. The amount of milk the mother has in such cases exactly matches the needs of the baby. Regardless of the size of the mother's breasts and the weight of the child, a mother who feeds her child in proportion to his appetite has exactly as much milk as the baby needs. Babies suck when they are hungry, then suck more slowly until they stop sucking when they are full. Some babies suckle little and often, others suck longer and less often. In both cases, you can be sure that a healthy baby will regulate how much milk he sucks, and, therefore, adjust the mother's milk production so that he always has enough.

Recently, a group of Australian scientists conducted a study that clearly showed the relationship between a child's appetite and the amount of milk a mother has. Very often this relationship is described as a supply-demand system. According to these studies, milk is produced in the breast more slowly or faster, depending on how full or empty it is. Full breasts produce milk more slowly, empty breasts faster. This means that when the baby has emptied the breast as much as possible, milk is produced most quickly. If the baby does not suck out all the milk from the breast, there will be less milk. The baby's appetite controls the mother's milk supply. Therefore, if the baby is always breastfed when it wants to suckle, the baby will regulate its own milk production. If the baby is hungry and empties the breast, milk will be produced faster. If the child is full and does not eat for several hours, slow down.

It follows that the question “How often should I feed my baby?” there can be no single answer. Feeding on a strict schedule will disrupt the complex interaction between an infant's suckling and feeding needs and the mother's ability to produce enough milk. For example, if a baby wants to suckle, but he is not given a breast, because the time for feeding has not yet come up according to the regimen, the breast overflows, and milk production slows down. If this happens from time to time, the amount of milk the mother has will not meet the needs of the child. Some proponents of the regimen approach believe that one should wait until the breast is "full" before feeding the baby, and that the baby will not be full if he suckles on a relatively empty breast. However, studies on the rate of milk production leave no doubt that in response to the suckling of a child in an empty breast, milk is produced faster and that such milk is high in fat.

Changes in the fat content of breast milk is another important factor that influences the relationship between a baby's feeling of fullness, the amount of milk the baby sucks, and the amount of milk the mother produces. The amount of fat in breast milk increases as the breasts are emptied. A not-so-hungry baby sucks out a small amount of low-fat milk. A hungry baby sucks out more milk with a high fat content, and the longer he sucks, the fatter the milk. Higher fat milk gives the baby a feeling of satiety at the end of feeding. If an infant is allowed to suckle one breast for only a few minutes and then the breast is voluntarily changed, he suckles only a full breast in both cases, which means that he fills his stomach with a lot of low-fat milk and does not receive the “cream” that would make him feel full and satisfied.

American editor's note. Please note that this article is about healthy babies who suckle and empty their breasts well, suckle enough milk and gain weight well. Babies who suckle poorly and do not empty their breasts may not always be able to set the pace of milk production and suck out enough milk for growth and development. If the newborn sleeps too much, he should be awakened and breastfed more often.

Scientists have also determined that the fat content of mother's milk decreases as the time between feedings increases. In other words, the more frequent feedings, the higher the fat content of milk. An infant who is breastfed 30 to 40 minutes after he has emptied his breast will suck out more fatty milk than if he were breastfed two to three hours before.

American editor's note. Do not rush to come up with new rules for breastfeeding based on this article. No need to think about which breasts are full and which are empty, how much milk is in the breast or how much fat is in the milk. Look at the baby, give him the breast when he shows his behavior that he wants to suckle, and everything will be all right.

Babies change their personal “mode” of suckling depending on various circumstances: whether they are hungry, or hot and thirsty, or upset and need to be pitied. There are times when babies grow very fastmonths), which means they suckle very often and thus increase the amount of mother's milk to meet the increasing needs for further growth (there was enough milk and even more!). When children eat more and more adult food, complementary foods, they breastfeed less often, and there is less milk. A well-oiled system works great because of natural behavior: the mother adapts to the child, and the child adapts to the mother. A strict feeding regime breaks this harmonious system. Nature has made it so that babies decide when to breastfeed.

Understanding a child's behavior requires effort and time to acquire new skills. It's much easier to look at your watch or listen to an "authoritative opinion" about when and how often to feed your baby. If parents aren't sure they can figure out when a baby is "telling" them that it's time to breastfeed, they may find it easier to feed on a schedule. Some parents believe that feeding according to the regimen is good for the child - they themselves live according to a clear schedule and rely on the children's regimen to guarantee them the stable and predictable life they are so used to. There is also an opinion that the regime imposed by parents will help raise an obedient child.

Young parents often rely on the opinions of other people (grandmothers, doctors, “authoritative books”, friends) about how to properly care for a child. When an authoritative person in the eyes of a mother claims that if the feeding regimen is followed, the baby will sleep better and sleep longer and that she will “accumulate” milk for feeding, the woman is most likely to try to feed by the hour..

However, the reasons why parents Deciding to feed according to a schedule may go deeper than just personal preference. If the culture of parents is in control of children's behavior, parents are more likely to feed at fixed hours. If it is not customary in society to pay attention to the needs of the child, parents will be condemned if they respond to every change in the behavior of the child. long intervals between feedings) may become the norm, and parents of an infant will try to extend the time between feedings and avoid frequent attachment to the breast. Young parents are more likely to conform to cultural dictates than to listen to their own parental instinct.

Feeding infants according to a strict schedule and limiting the duration of suckling often does not go unnoticed either for parents or for the child. Most babies cry and demand to eat “too fast” and off schedule. But you can get a “good” baby who can handle hourly feedings, but as a result, such a baby may not gain weight well. When parents look at the clock, deciding it's time for a baby to breastfeed, and don't consider the baby's desire to suckle, the baby's growth and the mother's milk supply are at risk. If the baby is not gaining weight well, this can be mistakenly attributed to the mother's "non-dairy" ability to produce enough milk. And if you know that there may be little milk due to the fact that a woman simply rarely feeds, the imaginary “non-dairy” can be easily corrected by frequent applications. But if you believe in congenital, family, genetic “non-milkness”, which is so often unreasonably attributed to women who feed by the hour, then it is easy to agree that it is no longer in our power to correct the trouble. In this case, women often give up and stop feeding so as not to starve the child.

Most babies are very indignant and protest if they are not fed enough and they are hungry. If parents persist and feed the child at regular intervals, the baby will rarely be calm, satisfied and satisfied with life. When a child desperately demands (simply cries loudly) that the parents meet his normal and healthy needs, the parents become nervous and do not know what to do. The confrontation between a parent who tries to fit a child's needs into an abstract schedule and a child who struggles to get everything they need to survive, grow, and develop exhausts both parents and children. In a senseless struggle, the emotional and physical state of the child suffers, the trusting relationship between the parent and the baby is undermined.

Parents of a baby who is always dissatisfied between feedings involuntarily begin to think that he is unbearable, “difficult” or even unhealthy, spoiled and spoiled. People around are sure that parents are slow and negligent, because they cannot cope with their child. In this situation, parents are no longer able to trust their own feelings, whether they react correctly to the child's behavior. The natural, instinctive reaction is to do everything possible to calm their beloved helpless child. Most often, one has only to take the child in his arms and give him the breast, as he calms down. But what kind of mother would risk taking the child in her arms once again if she was frightened that such “connivance” in upbringing would spoil the child for life?!

A similar conflict between what most parents want and try to do for the peace and happiness of the baby, and what “authoritative” advisers are trying to convince them of, leads to a situation where parents do not believe in themselves and artificially suppress the natural reaction to restless baby behavior. The inner feeling of insecurity of parents leads to stiffness in communication with the child, and children immediately feel it. Parents not only do not trust their feelings, but also to some extent deny the child's ability to express their experiences and feelings. And since children learn the world through the prism of an adult, the baby may lose confidence in himself.

When a mother understands a newborn's behavior and notices the signs of readiness to suckle (see table on page 129 [below]), she easily anticipates all of his basic biological needs. For a mother who responds quickly and consistently to a change in her child's behavior, the baby does not need to cry to be noticed. As a result, the child trusts the world around and grows up healthy, calm and complacent. The calmer the baby, the more confident the parents, because they manage to live in peace and harmony with the child. When the baby does not cry, parents are pleased to be with him.

How can a mother learn to tell when to breastfeed and when to do something else? For simplicity, consider: if a child needs something, he needs a mother and a breast. Sometimes babies need breasts because they're hungry, sometimes because they're restless, and sometimes because they want to socialize. Breastfeeding satisfies all these needs of the child, so new parents do not need to try to determine what exactly the child needs at this moment. Over time, parents will learn to discern the nuances of a child's behavior. With experience comes an understanding of how a child behaves when hungry, bored, overexcited or tired; when to offer the breast and when to find another way to soothe the baby.

Observing your baby's behavior and recognizing signs of readiness to suckle pays off even with a grown baby. Parents who recognize that their child is an individual with unique, meaningful needs will continue to respect those needs well into the future. They will be able to understand the changing needs of the child and will be confident that they will be able to cope with each new age and stage of development of the child, they will enjoy a rich and multifaceted relationship with their baby.

Trusting your child and yourself is an important skill that is learned from the first minutes of parenthood. If a mother notices that a child wants to suckle and gives him a breast, she lays the foundation for dialogue, two-way communication with the child for the rest of her life. And the ability to listen occupies the most important place in communication.

Bibliography
American Academy of Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk (RE9729). Pediatrics 1997 Dec; 100(6):1035-1039.
Biancuzzo, M. Breastfeeding the Newborn, Clinical Strategies of Nurses. St. Louis, MO: Mosby, 2003.
Cregan, M. and Hartmann, E. Computerized breast measurement from conception to weaning: Clinical implications. J Hum Lact 1999; 15(2):89-96.
Daly, S.E. and Hartmann, P. Infant demand and milk supply. Part 1: Infant demand and milk production in lactating women. J Hum Lact 1995; 11(1):21-26.
Daly, S.E. and Hartmann, P. Infant demand and milk supply. Part 2: The short-term control of milk synthesis in lactating women. J Hum Lact 1995; 11(1):27-37.
Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book. Schaumburg, IL: La Leche League International, 2003.
La La Leche League International. Common Breastfeeding Myths. Schaumburg, IL: La Leche League International, l998.
Marasco, L. and Barger, J. Cue feeding: Wisdom and science. Breastfeeding Abstracts 1999; 18(4):27-28.
McKenna, J. Natural History of Breast Feeding: An Evolutionary and Developmental Perspective. SUNY@Stonybrook School of Nursing Breastfeeding Conference, May 11, 2001.
Woolridge, M. Baby controlled breastfeeding: Biocultural implications. In Breastfeeding: Biocultural Perspectives. New York: De Gruyter, 1995.

A gift to all Russian mothers is a translation of a memo on the signs of readiness to suckle from the latest edition of the legendary book “Women's Art. Breastfeeding” (2010). Download and print

Readiness to suckle behavior

• At first, the baby makes a subtle sign that he wants to suckle. The eyes move quickly under the eyelids, the eyelids tremble before the child opens them. The kid brings his hands to his face, opens his mouth.
• Then there are more obvious signs - the baby is looking for the breast, whimpering and squeaking.
• If you notice this behavior at this stage, the baby will latch on gently and easily.
• As the baby grows hungry or upset, his whole body and mouth tense up. He starts breathing faster or crying.
• When the baby has already started crying, it is more difficult for him to take the breast. Crying - late a sign of hunger or that the child wants to suckle. Reassure your baby before breastfeeding.
• The baby is easy to breastfeed when he "asks" for the breast, and much more difficult when he "demands" it.
• Don't wait for milk to accumulate in your breasts. If the breast is full, milk production in it has already slowed down.
• Even if the baby does not ask, you can let him suckle at the breast at any time convenient for you.

When it's time to stop breastfeeding :: City Polyclinic № 12

There are a lot of opinions on this matter: the time when it's time to wean a child from the breast varies from several months to infinity from the point of view of self-weaning supporters. But this issue has always been considered from the point of view of benefit to the baby. And what does medicine say about what terms of involution will be useful not for a child, but for a woman?

What is lactation involution?

Lactation involution (from Latin involutio - coagulation) is a physiological process that completes the period of breastfeeding. This biological mechanism starts on the 40th day from the moment the baby was last attached to the breast. Since the onset of involution, the mammary glands decrease in size and stop producing breast milk. Usually, the process of involution is recommended to be carried out gradually so that the child can adapt to a new way of getting food, and also learn to calm down without being attached to the mother's breast.

Under normal conditions, each mammary gland will continue to lactate as long as milk is removed from it - and this phenomenon, the same for animals and humans, is used in agriculture. As the volume of milk production decreases, its composition changes: the content of fat, immunoglobulins increases, and the level of lactose decreases. If lactation is not stopped forcibly, it can continue until the baby is weaned from the breast; under natural conditions, this usually occurs in 2 - 2.5 years.

The process starts when the pituitary gland stops producing enough of the hormone prolactin. Milk production continues for some time after the cessation of its suction. As they write in the materials of the WHO, “if in most mammals “drying” occurs on the 5th day after the last feeding, then the period of involution in women lasts an average of 40 days. During this period, it is relatively easy to restore full lactation if the child resumes frequent sucking.

Thus, as soon as attachments to the breast become rare and short, the process of involution begins. This can happen at any time - it is known that sometimes children themselves refuse breastfeeding for a variety of reasons that need to be discussed separately. There is an inhibition of protein synthesis and structural changes in the mammary gland - the reverse replacement of the glandular tissue with adipose tissue begins, which allows the breasts to return to their previous size and shape.

Signs of lactation involution

If involution occurs naturally, it usually begins when the child is two years old. At this time, the frequency of attachment naturally decreases: the child has other interests, including interest in "adult" food. How can a nursing mother understand that involution has begun?

The breasts shrink slightly and do not fill with milk even if you do not feed for more than 12-24 hours. That is why if at this time the child stops breastfeeding, this does not cause any frustration and suffering from excess milk in the mother. Milk, in terms of composition, properties and appearance, is increasingly reminiscent of colostrum.

The baby's sucking activity is markedly increased. This is due to the fact that milk production is reduced, and the child is still trying to suck out the same amount of portion. A child for one feeding can be applied to one breast, then to the other - and so on several times. The period of such sucking activity can last up to several months.

Mother's psychological readiness for weaning. This is a very important sign that should not be ignored. As soon as a nursing mother is tired of breastfeeding, this is a sign that the process is either incorrectly regulated, or, if there have been no problems with lactation so far, it is coming to an end.

Psychological readiness of the child for weaning. Usually, by the age of two, the child is socialized, ceases to experience an urgent need for tactile contact with the mother, and begins to receive the necessary nutrients from other sources. The psychological need for the child gradually disappears

Forced involution

If there is a need to wean the child prematurely, then you need to be prepared for the following consequences:

• pain and discomfort in the mammary glands of varying intensity;
• formation of seals in the area of ​​the mammary glands;
• fever;
• deterioration in general condition;
• purulent-inflammatory complications (breast abscess and mastitis).

If the need to interrupt lactation is associated with medical indications, then it is necessary to carry out involution under the supervision of a physician. What needs to be done first? Reduce the number of feedings by offering the baby a different food source. In addition, strict control of fluid intake with its restriction is necessary, and additional pumping may be required in order to avoid stagnation of milk.

If you are tired of breastfeeding

The psychological state of a breastfeeding mother is a very important criterion that must be paid close attention to. Lactation is a very energy- and resource-intensive project for the female body, and it is not surprising that exhaustion sets in sooner or later. Some nursing mothers can wait for natural involution without any problems, but for many there comes a point when, due to fatigue, continuing to feed is impossible. Unfortunately, this objective situation (the amount of forces and resources is strictly individual) often causes a feeling of guilt in a nursing mother, since the advertising of the need for breastfeeding before self-weaning has reached its maximum in recent years. What needs to be assessed at this moment? On one side of the scale, there is a benefit for the child, and on the other, the psychological and physical comfort of the mother.

Many will choose the comfort of their mother in such a situation, and they will be right. How long breastfeeding will continue is up to her to decide, since only she can assess the degree of her exhaustion. After all, there are now excellent breast milk substitutes, and a calm and rested mother is an irreplaceable resource that cannot be replaced by anything.

Many experts say that breastfeeding up to a year and a half may be optimal. Thus, the well-known pediatrician Dr. Komarovsky recommends starting breastfeeding correction starting at the age of one: at this age it is already time to introduce calming rituals that replace breastfeeding, and also gradually reduce the number of daily feedings. WHO recommendations to breastfeed children for more than two years, according to Komarovsky, are due to high infant mortality rates in Asia and Africa, where a child's life often directly depends on how long his mother breastfeeds.

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