Jan,

You wrote:
<when you are teaching a mother about feeding her baby if she is bottle
feeding, you don't tell her that the baby has to eat for a certain number
of
minutes or it isn't a good feeding.  . . . . . .   You tell her to feed
the baby until he indicates satiety, whether
that is 7 minutes or 10 minutes or 15 or 20.  You may even tell her about
how
much you would expect the baby to take, but you tell her in ounces or
mls,
not minutes.>

If I may play the devil's advocate (but not really shouting):

I find that in some situations, teaching parents to watch the clock IN
ADDITION TO the baby, when the baby is bottle feeding rapidly, is
something that can solve certain problems.

I feel this is particularly important if parents are using a bottle
because of a vulnerable assumption that the breastfeeding is not
"providing enough" for the baby.

I explain to them that it takes 15-20 minutes for the FIRST DROP of
FORMULA to complete the digestive process, be absorbed, raise the baby's
blood sugar to a level that signals the brain about satiety.

I find that parents (and even experienced professionals and relatives)
often misinterpret the speed at which the baby takes a bottle as a
directly proportionate indicator of the intensity of his hunger and
therefore the quantity of milk he needs.

When I hear a parent talking in this vein, I ask them to describe the
feeding more fully, and ask them how long it takes. All too often, the
baby takes the quantity the parent judges appropriate, in less than 10
minutes time (I call it "chugga-lugging"), and still appears to be hungry
for more.

Some use common sense and refuse to give more. They use a pacifier, walk
the floor, rock, burp, etc. till satiety occurs. Many, especially young
and inexperienced ones, go on and overfeed even more, till satiety
occurs.

I attempt to "disconnect" this misinterpretation about feeding behavior
by offering a different interpretation.

Because a bottle usually delivers milk rapidly at the beginning, and
especially if the baby is lying at less than a 30-45 degree angle, the
baby's struggle to coordinate breathing and swallowing causes sucking
adjustments that just create a vicious cycle of causing more milk to
squirt rapidly, especially if the baby has a strong suck. THAT, and not
ravenous hunger, is more likely why the baby is eating rapidly.

This often results in taking in much more than is required to achieve
satiety, simply because the baby cannot regulate the speed of the milk
flow (as the breast begins to do very early in a feeding.)

I teach them how to WATCH THE BABY while WATCHING THE CLOCK, and how to
slow the feeding down at the first sign of rapid sucking, swallowing
and/or breathing.

Holding the baby more upright, tilting or removing the bottle for a
minute or so till the baby catches his breath, frequent breaks for
burping, gentle reassuring talk to the baby (but really to assuage the
parent's own anxiety too) are ways to do this. (A little like
anti-gravity positions, etc. for OALD!)

I encourage them to be sure the first ounce or two goes in slowly,
spreading the feeding out closer to at least 15-20 minutes, so that
satiety will begin to overtake the baby and regulate the speed and the
amount finally taken.

And then, of course, after that, I see what I can do to help them apply
these insights to the breastfeeding situation and reduce the bottles as
much as they are willing,  in order to "fix" the breastfeeding.

With some of these parents, I catch more flies with honey than with
vinegar!

Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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