Amy writes:

Pacing  should match the suck-burst-cycle that naturally occurs at the 
breast.   With the first let down, I usually see 20-25 swallows before a pause.  
 *This* is what needs to be replicated with the bottle.  As a feed goes  
on, suck-burst-cycles decrease.  In my experience, once a healthy baby  gets 
the hang of a nipple that is the correct flow, they will actually pace  
themselves, and usually pacing isn't required.




~~~
Amy makes a good point. For many babies, they only need outside pacing  
because the bottles the mothers were given/are using, are not well designed for 
 the baby. Other babies need help because they are so overly hungry, having 
been  feeding poorly for days or weeks sometimes on the advice of the 
well-meaning MD  who says "just keep nursing", that they just need to be reminded 
they can slow  down, food will be available. Other babies have 
laryngomalacia, or some  condition that makes it harder for them to manage to eat 
efficiently and safely. 
It also seems as if there are widely different populations of babies taking 
 bottles: there is the baby, often a little older, whose mom is going to be 
 leaving him/her for most of the day, and they need to eat in mom's 
absence. They  may be excellent in their breastfeeding skills and now need to learn 
how to  also bottlefeed safely and comfortably as they continue to 
breastfeed  when with their moms.  It was my impression that current practice  
recommendations are that babies do not need early or regular bottles to make  
this transition. ( Though I may be behind the times.)  This is not  usually the 
baby most IBCLCs are meeting. We are meeting  the baby who  cannot show us 
what SSB rhythm or pacing is  normal for them at breast,  because they have 
never latched, or have only latched shallowly and never moved  any normal 
quantity of milk. They may be underfed, low energy, and/or have no  normal 
level of patience. The range of normal is quite wide but these babies are  
still not in range. They have come too early, and/or they have mothers whose  
milk supply is significantly delayed beyond the baby's ability to cope (one  
mom this week told me that her OB told her it's normal to be swollen up to 
her  hips for 12 days) due to any # of issues, but most likely  their 
hospital's labor and delivery, and  post-partum procedures.  They may have an 
undiagnosed or  ignored tongue restriction that affects function. They have been 
speed fed  formula from artificial nipples that make them cough, spit up, or 
reconfigure  their tongues to try and control flow. I sometimes feel like it 
can be days or  weeks, sometimes months, until I see what "normal" feeding 
and self-pacing  might be for these little ones. Number one rule: feed the 
baby (but as safely as  possible and with a continual vision to help them 
breastfeed or keep  breastfeeding.) These are the babies I see. Maybe it's very 
different for  others. One reason I remain a LLLLeader is so I can see 
children  who just  breastfeed normally and happily...:)
 
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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