I thought in a previous discussion on this topic the decision had been made to call this method of feeding something OTHER than "paced bottle feeding" because that term is used by OT, ST, and NICU staff to describe a FEEDER pacing the feeding for a baby with difficulty - either breathing, immature, whatever...

The feeder is usually a nurse trying to get as much into the baby as possible with as little stress as possible - but the alternative is to tube feed, and many want to avoid this (let's not go into a discussion about THAT topic right now!).

I understood that the feeding method we were trying to describe in handouts to parents and child care workers, etc. was a method that allowed the baby to cue interest, hunger, pauses, and satiation.  The presentation of the nipple when the BABY gave indications of hunger, the allowing the nipple to go deeply in and the avoiding of tipping the bottle so that the nipple was so full of milk that the baby would have no choice but to "swallow or be flooded" were some of the things to include in a handout on this topic.

As I recently wrote in another listserve: 


I would recommend that we consider the wording "cue-based feeding" instead of
"paced bottle feeding" when it comes to feeding infants and children who are
healthy, well and being fed mother's milk or formula by bottle.

This is because nurses in the NICU use the term "paced bottle feeding," as do
Occupational and Speech Therapists who work in those areas, as "pacing the
feeding" to avoid stressing (low oxygen levels, high cortisol levels, difficulty
breathing or needing to "catch their breath) the child - but the FEEDER is in
control, trying to get more food into the baby, who may or may not be interested
at the time...but who needs to be fed "or else we'll have to tube feed him"
nurses tell parents as they teach this method of feeding.

In "cue-based" or "responsive" or whatever term someone will eventually come up
with - the BABY is in control of the timing, speed and amount of the freeding.
- The feeder is taught to offer the nipple because the baby has given some sign
of hunger, then the nipple is placed in a way that the BABY gives signs of
readiness.
- The nipple goes into the baby's mouth when and as deeply as the baby wants it.
- Milk is in (and not in) the nipple during the feedings to allow for baby's
cues to control the speed of the feeding (rather than "I have to swallow, or
I'll drown" which happens with the usual bottle feeding style).
- Feeding is paused whenever baby gives signs of disinterest.
- Feeding ends when baby shows signs of satiation.
- The NEXT feeding is based not on the clock but on baby's cues...and this may
be in 1 hour or 3, not on schedule as it is in most hospitals.

By the way, as can be seen in the latest ILCA Globe
(http://www.ilca.org/files/eGlobe/2011eGlobe/012011_eGlobe.pdf), IBCLCs were
able to be part of the revision done to: Preventing Childhood Obesity in Early
Care and Education Programs,
http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf.

We weren't able to get in EVERYTHING we wanted, but cue-based feeding is in
there!

Jeanette Panchula, RN, PHN, IBCLC
Vacaville, CA

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