Responsive Breast and Formula Feeding
This is a blog topic I’ve wanted to address for AGES. About the topic of responsively feeding” when breastfeeding. It’s not a topic that’ll be relevant to everyone, but I do think it’ one that is a source of quite a lot of confusion in the world of infant feeding. For this reason, I’ve teamed up with Charlie Blyth who is a Specialist Public Health Nurse, a Health Visitor and founder of The Healthy Child co. Charlie has written this incredibly detailed and thought-provoking blog about breast and formula feeding. I really hope you like it.
There are two types of feeding approaches pre-weaning; breast or bottle. I am not a fan of the term ‘bottle’ feeding as it doesn’t describe the food being received (breast milk or formula). However, for the content of the blog ‘bottle feeding’ needs to be used to describe the approach to feeding.
In this blog, I will be explaining the terminology around feeding babies under six months, how your baby communicates their feeding cues as well as the topic of “responsive feeding” for both breast and bottle. This blog will hopefully alleviate any confusion or anxieties around feeding pre-weaning!
Feeding Terminology – What exactly does that mean?
Feeding on demand
‘Feeding on-demand’ is a term used by many health professionals, and was originally encouraged by UNICEF, The World Health Organisation and the NHS. When researching for this blog I found the phrase ‘feeding on demand’ a commonly used term concerning breast and formula feeding, but without much clarity from the literature to what this exactly means. Which, understandably can lead to confusion, anxiety and stress for parents when it comes to feeding babies. Having a new baby is stressful enough without added feeding anxieties and lack of clarity.
Feeding on demand is the simple idea of feeding your baby when they are communicating to you they are hungry. The feed-on-demand system was originally encouraged for breastfeeding mothers to establish a good milk supply and move away from the prescribed feeding routines set in the 80’s. The positive connection between demand feeding and better appetite regulation were noted by health professionals, and parents who were formula feeding were encouraged not to have strict routines but to feed formula on demand.
Whilst ‘feeding on-demand’ is still a commonly used term it is considered misleading and does not accurately or adequately describe successful feeding interactions. Healthcare professionals have been encouraged to begin to use the term ‘responsive feeding’ as a more appropriate alternative, as the best way to feed a baby is more intricate than simply ‘on-demand’. .
This concept focuses on positive shared interactions between a baby and a parent, which is essential for a baby’s neurological development. Responsive feeding moves away from being focused on the mechanical process of feeding and, crucially, recognises that feeds are not just for nutrition, but also love, comfort and reassurance between baby and parent.
Responsive feeding is understanding when your baby is hungry and when they have had enough. Responsive feeding promotes being engaged in feeding, and in feeding your baby intuitively. It focuses on making eye contact, on taking time, on it being an enjoyable bonding experience. Treating each feed like a sit-down meal where baby takes breaks, you engage in conversation and intuitively respond to babies’ communications which promotes healthy brain development.
Responsive feeding moves away from prescribed routines, counting hours or ounces. It recognizes babies will have hungrier days and nights than others, just like adults. It acknowledges on some days they may get hungry after only two hours instead of three. Which, is perfectly natural, especially if they are growing.
Responsive feeding can be broken down in simple terms; observing a feeding cue from your child, interpreting if they are hungry or full and acting on it.
Realistically as busy parents you are not going to catch every single cue your baby throws at you. You need to eat, use the toilet, yawn and miss a cue every now and then. It is about learning over time how your baby communicates their needs with you and trying to respond appropriately.
As you are getting to know your baby it is also likely you might misinterpret a cue and that’s ok, they will let you know when you have the right one! The early days especially are for learning, you are just getting to know them.
Common Feeding Cues
Baby behavior has been observed by many experts and the following cues have been commonly recorded and documented, however, this list not exhaustive and it is important for parents to observe and understand their own baby’s individual cues, which may not be listed.
Why is responsive feeding recommended?
Responsive feeding is well recognized as an important factor in child health and development. It is therefore recommended by worldwide health organizations. Responsive feeding is thought to reduce the risk of malnutrition from underfeeding and reduce risk of obesity from overfeeding. As well as building feelings of trust and security which improves infant emotional wellbeing.
It is known that babies are born with the ability to self-regulate their energy intake. Research suggests babies regulate their appetite from birth as a survival instinct and by six weeks of age, regulation is well established. Although some newborn babies will need encouragement to feed initially if they are not waking for food, around eight feeds in 24 hours is considered ideal because they only have tiny stomachs.
Responsive feeding encourages babies to tap into their instincts to regulate their appetite and their intake, which can disappear if continuously overridden by parents. This can also help them to feed responsively when they are offered solid foods at a later date too, as they learn to recognise their own internal cues of hunger and fullness. Feeding when hungry and stopping when full helps baby to maintain and strengthen this neurological pathway in the brain. Responsive feeding, therefore, enables and establishes longer-term positive eating habits.
Responsive feeding is also thought to improve parental wellbeing by increasing parental autonomy, increasing parent self-esteem and self-confidence.
Responsively Breast Feeding
Responsive breastfeeding involves a mother responding to her baby’s cues, as well her bodily desire to feed her baby if breasts are full. Responding to babies’ natural cues and patterns is considered crucial in establishing a good milk supply. This is due to the supply-demand mechanism. The body replaces the milk that has been taken (either from feeding or expressing).
As well as be a crucial element of milk supply, responsive breastfeeding has been shown to promote the self- regulatory ability of infants as they can control the speed they are drinking, the amount, and will communicate when they have had enough.
Responsive breast feeding can also be used to meet a mum’s needs. Feeding can be offered if a mum breasts are full, if she needs a nap, if she needs to go out as is unable to feed, and if she would like just to sit and have a cuddle. Breastfed babies cannot be spoiled by too much feeding.
Research also suggests responsively breastfeeding mothers are more likely to breastfeed for longer compared with a routine led feeding schedule, as this may lead to a reduced milk supply due to the supply-demand system not being utilised effectively.
A common reason mothers move on from breastfeeding to formula is anxieties around babies getting enough milk. Accurate signs babies are feeding effectively;
- Parents can see and hear they are swallowing
- Their cheeks are full when feeding and they are moving their chin and jaw
- Communicating full cues
- At least 6 wet nappies in 24 hours once a baby is a week old
- Steadily following their growth centile.
Responsively Formula Feeding
Responsive formula is considered just as important as responsive breast feeding even though breast milk supply is not a factor. Responsive formula feeding involves a parent responding to their baby’s cues in the same way, observing and responding to early signs of hunger and signs of satisfaction. Responsive formula feeding guidelines recommend; not focusing on ounces, or on hours but tuning into cues and communications.
It is particularly important for parents to notice when their baby wishes to stop feeding, this is because a bottle-fed baby has less control over the feed than a baby at the breast. Sometimes parents can encourage babies to finish bottles, but this isn’t necessary if baby has communicated they are full. Making smaller feeds will help stop the urge to encourage further feeding to avoid wasting milk.
Babies do not have to suck as hard on bottles to receive milk and parents are more in control of speed, therefore it is also import parents recognise their baby’s subtle signals like needing to pause or take the feed more slowly. This will help reduce air intake and indigestion. Recommendations are to hold the bottle at a horizonal angle and wait for a cue from baby to start the feed e.g. their mouth opening, moving head towards the bottle and then to place the bottle in baby’s mouth for a feed.
Formula packaging recommends age appropriate amounts. It is important to highlight these are guidelines and to trust your own intuition to help avoid over feeding. Accurate signs a baby is feeding effectively include;
- 6 wet nappies in 24 hours once baby is a week old
- Following their centile growth line
- Fullness cues (see table above)
Sometimes babies can refuse formula or are fussy formula drinkers. This can sometimes be an early indication of an intolerance, if this behaviour is paired with falling from their centile line, an eczema rash, vomiting, colic, constipation or loose mucus stools please speak to your health visitor or GP.
Therefore, to summarise…
- Feeding on demand is an outdated term.
- Responsive feeding is thought to improve baby’s health, wellbeing and development.
- Responsive feeding promotes parental intuition and moves away from strict routines.
- It enables babies to regulate their appetite creating long term positive food habits.
- It fosters empathy and compassion which builds feelings of trust and safety making babies feel more secure.
- It increases parent’s confidence and autonomy and overall feelings of wellbeing.
- It can be used to fit around a mum’s activities making life easier, and hopefully simpler.
I hope this blog has alleviated some anxieties around pre-weaning feeding. If you are struggling with feeding please contact your local health visiting team, visit local feeding support groups, or national helplines.
National Breastfeeding Helpline: 0300 100 0212
Association of Breastfeeding Mothers 0300 330 5453
La Leche League 0345 120 2918
Written by Charlie Blyth, Specialist Public Health Nurse (Health Visitor) and founder of The Healthy Child co. You can follow @thehealthychildco for more tips, advice and support or visit www.thehealthychildco.com for online health and parenting courses and workshops.
Some good resources;