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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