Terri, from my experience "coaching" new moms by phone at WIC, I would first
rule out overfeeding. It is enlightening to check on the amount that is
being offered in the bottles, in relation to baby's age and size, especially
by the caregiver. It seems very common for babies to be allowed to "eat to
satisfaction" which often means swallowing for dear life so as not to choke,
and getting overfed in the process.


While overfeeding makes some babies fall asleep for longer periods,
others get a tummy ache. Even experienced parents or caregivers may
misinterpret pain as hunger, so more is fed till the baby goes into a torpor
for 4 hours or so. Still other babies, perhaps with some degree of reflux,
spit up the excess. It is well known that babies with reflux do better if
fed smaller amounts more frequently. The same thing can happen if the mom
has a forceful MER and the baby is below the flow. Hence antigravity
positions help some babies, both by slowing the force of the MER but also in
positioning the nasopharynx above the nipple so as to give the baby a chance
to coordinate suck, swallow, breathe without the stress/conditioned reflex
of fear and choking.


The same strategy applied to feeding a bottle is to position the baby in a
fairly upright position with the bottle angled much less perpendicular than
if the baby were lying back in the crook of the arm. All this seems
elementary to many on this list, but many generations in the mom's family or
caregivers, definitely consider themselves "expert" in bottle feeding,
having done it for years. Sometimes I invoke the phrase "new research shows
. .." so neither I, nor the new mother, accidentally "insults" their
capability.


Lastly, I find it helpful to teach the mom how and why the adult should
guide the pace of the flow rate, for several reasons. It's helpful to be
sure she understands what the MER is and that flow rates often slow and/or
pause slightly between MER's. If the adult paces the bottle, the baby is
less likely to get "hooked" on constant rapid flow and eventually reject the
breast due to natural variations in flow rate in the breast.


Another reason is that artificial nipples are often inconsistent, no matter
what the package label says. Two identically labeled packages may have
dissimilar flow rates. Some of them flow faster, especially if the fluid has
been warmed, which was the practice when more mature caregivers were first
learning. Warm temperatures change the resilience of the artificial nipple
temporarily: the warmer the milk, the faster the spray.


I find it pays to go step by step in teaching how to pace the flow with
pauses by leaning the baby forward (with bottle left in the mouth to pacify
on if desired), for a "breathing break" of 15 or so seconds every
one-half ounce for the first half of the feeding. I reassure them that air
in the nipple is not likely to harm the baby as long as he is not struggling
with a feeling of "drowning" (a very illustrative word!) "Breathing breaks"
also stretch out the time so the first milk to go down has a chance to start
digesting and enter the circulation and "register" in the satiety center in
the brain. (Nearly everyone can relate to a holiday meal eaten too rapidly,
but doesn't "register" satiation till well after they've alreay eaten too
much!)


Just another variation on checking for horses before looking for zebras.


K..Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC
Dayton OH

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