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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