Also - don't forget about recent info regarding extrinsic vs intrinsic cuing on appetite. Adults who respond to extrinsic cuing (external cues - a full plate must be finished) tend to have more weight issues than those who respond to intrinsic cues (internal cues of fullness and they push away the unempty plate). What does that remind you of? Also the research which shows that babies that have to be pushed to finish a bottle are NOT more overweight than those that are interminable eaters. I would LOVE to know if babies of moms that use upright positioning and have high supplies tend to have more weight issues than mothers with average supplies. Wouldn't that be a study!
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Linda Hill
Sent: Tuesday, December 02, 2008 10:24 AM
Subject: paced bottle feeding
I am forwarding this message from Barbara Wilson-Clay. I sent it yesterday, but it seemed to get lost in cyberspace somewhere. So my apologies if it suddenly reappears and this gets posted twice! ;-) -Linda Hill
Hi Everyone,
Just responding to the comments on paced bottle (or cup or spoon) feeding which someone forwarded. Paced feeding or "pacing" is a term already in use in the OT literature (article cited below). Therefore, using an established term with a specific clinical definition has much to recommend it in terms of inter-disciplinary clarity and communication.
Pacing techniques simply refer to a feeder's responsibility to allow the eater to have a moment to pause between swallows in order to take a breath.
The pace at which babies are fed can contribute, in fragile infants, to feeding problems that materialize later (e.g. when they start solids). And yet, remarkably little attention has been paid to old traditions with regard to bottle feeding. For instance, if you hold a bottle so there is no air in the teat/nipple, the upshot is the gravity drop is so severe the baby is forced to chug the fast flowing liquid. It is better to hold the bottle parallel with the flow with lots of air in the teat so the flow rate is lots slower. Never mind air swallowing-just burp after feeding.
The speed of eating is also implicated in obesity, if we are to believe the diet books.
I hope we will adopt the concepts borrowed from other disciplines on how to ensure the humane feeding of people who cannot feed themselves. It doesn't matter what tool we use to deliver the food; only that it be done respectfully and with attention paid to maintenance of stable respiration in the patient. To put the conversation into perspective, consider how in the movies, for example, a director may show someone rapidly shoveling food into the mouth of someone who is very young, very old, or helpless. We are meant to see this as insensitive behavior.
I wrote a CE module for Dr. Hale on the subject of pacing, and we talk a lot about it in The Breastfeeding Atlas. For an article that describes infant outcomes of pacing vs not pacing, see:
Law-Morstatt L, Judd D, Snyder P, Baier RJ, Dhanireddy R: Pacing as a Treatment Technique for Transitional Sucking Patterns, J Perinatol 2003;23:483-488.
A few other good articles:
Dowling D, Meier P, DiFiore J, et al: Cup-Feeding for Preterm Infants:
Mechanics and Safety, JHL 2002: 18(1):13-20.
Kelly B, Huckabee M, Jones R, et al: The early impact of feeding on infant breathing-swallowing coordination. Respir Physiol Neurobiol 2006; Epub in advance of publication doi:10.1016/j.resp.2006.09.007
<http://dx.doi.org/10.1016/j.resp.2006.09.007>
Palmer M. Identification and management of the transitional suck pattern in premature infants, J Perinat Neonatal Nurs 1993; 7(1):66-75.
Barbara Wilson-Clay, BSEd, IBCLC, FILCA
12710 Burson Dr.
Manchaca, TX 78652
Ph: 512-292-7227 Fax: 512-292-7228
www.lactnews.com <http://www.lactnews.com/>
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