Feeding schedules and demand feeding
Demand feeding has become an overused and misinterpreted phrase. Formula-fed babies are rarely demand fed. It’s mainly breast-fed babies. Whilst this is a good thing in the early months, to establish and increase supply. It’s not necessarily good practice long term.
Many mums are stuck in a demand feeding cycle, thinking it is what they should be doing. Health professionals tell mums to feed to sleep, as it won’t do any harm. In the short term, this is true. However, demand feeding long term, past 4 months, is inviting a whole heap of trouble.
After 3-months stretching out breastfeeds to 3-4 hourly is a good idea. However, you need a baby who not only self-settles but does good day naps. And in this current climate, I'm seeing very few babies who can manage to do this.
Demand feeding a cranky baby
Demand feeding a cranky baby seems such a straightforward task for a parent. Instead, it's potentially a recipe for lifelong eating disorders and obesity. In the 1940's and 50's when babies were fed to a schedule we rarely saw obese children and adults. Current rates of childhood obesity are at proportions increasing the likelihood of parents outliving children.
Feeding a baby relies on a series of cues a baby gives to their caregiver. It depends on how the parent interprets those cues as to whether a baby receives a feed or is soothed and settled using alternative means.
INSIGHT study findings
Intervention Nurses Start Infants Growing on Healthy Trajectories
Their central hypothesis outlines responsive parenting, and specifically responsive feeding promoting self-regulation. And shared parent-child responsibility for feeding, reducing the subsequent risk of overeating and overweight. INSIGHT recognizes feeding is commonly used as a routine first response to infant and toddler distress. INSIGHT offers an alternative, promoting parental responsiveness to their child’s needs. When feeding is responsive to children’s needs, shared responsibility in feeding starts developing. As in other areas of development, this provides opportunities for self-regulation as children assume an increasing role in determining when and how much to consume."
Control patternsDr. Aletha Solter, Ph.D. Psychologist, the author of Tears and Tantrums discusses how demand feeding is a control pattern used to shut down crying and emotions that actually need expressing. Other control patterns include using dummies, patting, rocking and holding to sleep. I'm regularly seeing developed and firmly established control patterns. Breast-feeding to sleep is the predominant control pattern. Feeding and holding to sleep falls at the very bottom of the hierarchy of soothing and is as far away from self-soothing as a baby can get.
Trying to achieve self-settling once this control pattern of feeding to sleep has been imprinted is especially challenging. It will either involve a behavioural approach to sleep training taking 4-6 weeks or a week of active crying and settling techniques to resolve.
Anticipatory guidance is lacking regarding baby feeding
Following birth, mothers are typically instructed to wake their infants to feed at least every 3–4 hours for several weeks or even months. And this is where the pattern of demand feeding and feeding to sleep starts. While this is necessary advice to help newborns regain weight lost after birth, clinicians are less consistent in instructing parents when to stop this practice. This is where things start to fall apart. Also how to identify hunger and satiety cues in babies to guide feeding. Typical anticipatory guidance in obstetric and paediatric healthcare does not discourage the use of feeding to soothe for non-hunger related infant distress. Nor does it advise against feeding as a reward in later infancy and childhood unless obvious obesity develops.
I know this is a hot potato of a topic but it needs addressing if we are to address the current climate of baby and toddler sleep problems and the childhood obesity epidemic. These two go hand in hand.
I'm going to share my own lightbulb moment to this health morbidity epidemic we are currently allowing to happen.
Case studyI recently went to help a mum with a 4.5-year-old girl who was bed sharing with mum and breastfeeding to sleep and feeding 4-5 times in the night to resettle. On night one of sleep training, we had a big discussion about needs and wants to help teach about filling emotions with food. On night one she ran to the kitchen, escaping out of bed, opened the fridge door, sat on the kitchen floor and proclaimed, "I'm hungry". She wasn't hungry she was just unable to manage her emotions without breastfeeding to sleep. My big concern here is she will comfort eat to fill her emotions rather than being able to self-regulate.
The INSIGHT study highlighted a distressed but not particularly hungry baby will calm if given a sweet liquid, which INSIGHT researchers said could lead to problems later on. “Their normal ability to regulate their emotions becomes overridden with a food reward to soothe and projects later into life — when upset or depressed, food becomes the mechanism to soothe these emotions.”
Sobering reading and research. The results of the INSIGHT study have shown when parents were given this training, their babies were less likely to be overweight at 1 year; the babies also slept better than those in the control group, in which parents got safety training rather than responsive parenting guidance.
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