I prefer the term "baby-led" bottle-feeding because of this very problem of different meanings to paced. And to even try to apply the term "physiological" to a bottle seems like an oxymoron. Remember the Kassing article on the position of the baby also. There is so much difference between how babies are fed bottles and how they breastfeed effectively. Is there ANY bottle out there that works with babies in the prone position? NOOOO! And flow rates in bottles are a relative matter, as we've discussed before - depending on whether babies are compressing or applying vacuum and the strength of the vacuum applied as Karen as demonstrated in her research.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Karen Gromada
Sent: Sunday, November 30, 2008 3:24 PM
Subject: Re: artificial feeding and obesity -- and "pacing"
Sorry -- I hope no one minds if I respond to a couple of different posts in one!
Someone used the subject line re: "paced" feeding. What we (LCs, LLLLs,
etc.) mean by "paced" bottle-feeding is different than what some other disciplines mean by the same term. For other disciplines, "pacing" often refers to clinician-guided/led pauses or interruptions vs. baby-led. For that reason, I steer clear of the term "paced" or "pacing" in ref to a bottle-feeding technique.
I'd like to see us come up with a term that is distinct to our discipline. I tend to use "cue-based," "baby-led" or "physiological" bottle-feeding.
Term newborns through about 3-4 months have reflexive vs. voluntary suck. If a bolus is present, they have to deal with (swallow) it and one suck reflexively sets up the next. Reflexive sucking means a young infant can easily overfeed, so it can matter how many ml/cc/oz are in the feeding bottle. I'm sure that formula companies are very aware of the lit re: size and capacity of the newborn and infant stomach; they have to know that 60ml/2oz is an absurd amount to be placing in newborn disposable bottles supplied to hospitals. Yet they do it, even if much will be wasted. (Who pays for that?) There's a psychological factor for parents seeing that much and coming to believe that's a "normal" amount and there's a physiological factor for newborns with reflexive suck (using bottles with too-fast-flow
delivery.)
To me it is clear that there is a correlation between obesity and artificial
> feeding in the first few days of life. Especially since the industry
> has been supplying the hospitals with bottles and nipples. Our
> hospital works with Ross -Abbot who have generously enlarged the holes
> and added a cross cut to the nipples to produce a tsunami effect which
> causes babies' eyes to bulge out of their heads, and until they figure
> out how to slow down the flow, they drink way more than a human infant
> should consume at that stage of his life.
>
The swallow mechanism is more complex than sucking, and it must coordinate with breathing to protect the infant airway. Leaving everything else by the wayside, please let's start looking at and PROTESTING the "tsunami" effect of enlarged or cross-cut nipples holes for what they are -- a cause of airway distress for newborns and young infants! The more I've reviewed the lit and tested bottle nipples, the more appalled I become at the lack of evidence-based practices when it comes to creating airway distress via bottle-feeding for so many young infants. It's just horrible. No young infant should be forced to develop maladaptive suck-swallow behaviors in order to safeguard the airway! (Research lit has referred to some of these behaviors as "adaptive," but anything that is contrary to BF oral behaviors I consider "maladaptive.") All infants, no matter how fed, deserve to be supported in airway protection during feeding.
--
Karen Gromada
www.karengromada.com/
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