Alberts, J. R., & Ronca, A. E. (2012). The Experience of Being Born: A Natural Context for Learning to Suckle. International Journal of Pediatrics, 1–11. https://doi.org/10.1155/2012/129328
Hodges, E. A., Johnson, S. L., Hughes, S. O., Hopkinson, J. M., Butte, N. F., & Fisher, J. O. (2013). Development of the responsiveness to child feeding cues scale. Appetite, 65, 210–219. https://doi.org/10.1016/j.appet.2013.02.010
McMeekin, S., Jansen, E., Mallan, K., Nicholson, J., Magarey, A., & Daniels, L. (2013). Associations between infant temperament and early feeding practices. A cross-sectional study of Australian mother-infant dyads from the NOURISH randomised controlled trial. Appetite, 60, 239–245. https://doi.org/10.1016/j.appet.2012.10.005
Ep. 131 – Confusing Feeding Cues
This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way. So join us for another episode.
Hello. Welcome back to the Milk Minute podcast. We have a lot to get into today, so we’re just gonna dive in. All right. Okay. Sounds good. No chit chat. Noted. All right, buckle up. We are talking about confusing feeding cues. Ooh, that’s good cuz we get questions about that a lot.
Yeah, and it’s also really hard to answer those questions unless you see those babies in person. Oh yeah, absolutely. They kind of differ from baby to baby at a certain point. Uhhuh. Well, that’s actually highly debatable. Ooh, is it innate? I’m interested. Or is it highly variable? So, okay, we shall see.
But yeah, today we’re talking about how to read your baby’s cues, mm-hmm, as they grow and develop neurologically. And we know it can be very frustrating, especially for first time parents to feel insecure about whether or not you’re actually reading your baby’s cues correctly when everyone around you keeps telling you to feed on demand. Absolutely. So what if you don’t know what they’re demanding or if they are demanding at all.
What if your baby is actually full and you’re stressed all the time thinking they’re hungry? So that sucks. Mm-hmm. And this anxiety plays into the fear that we will misread them and then we alone will be the reason that they don’t thrive, which is like. It’s a lot of responsibility and it’s like raising children in isolation.
It’s hard. Yeah. And also not to mention the pressure of setting your baby up for feeding as an infant, that will prevent them from childhood obesity later on, which I was surprised about all of the research basically points to that. Yeah. Interesting. Well, before we get deeper into that let’s thank a few patrons.
Yeah. Yeah. I would like to thank Ashley H and Anne Marie Hext, who are some new patrons of ours, and we’re so, so happy to have them. Welcome, welcome, and thank you for your support of our crazy project. Okay. And I’ve got a question from a listener quick, so let’s do that as well.
This question is from Valerie in our Facebook group, which is Breastfeeding for Busy Moms, and she said, Would progesterone be fine to take while breastfeeding? I’m currently pregnant, and progesterone levels are like non-existent. Has anyone continued to breastfeed through their pregnancy on progesterone supplements or did you end up weaning? Heather! I’m tapping in. So I actually had very low progesterone with Heidi, and of course I went down the deep dark rabbit hole of it and my midwife did prescribe me progesterone supplements to take.
But when I started looking at the research, it’s very debatable about whether or not it works. And actually the most evidence we have is if you have a long history of miscarriages, the best time to take progesterone is right before you’re pregnant, when you’re in the luteal phase. So really getting that progesterone amped up before we even have implantation.
Right. And so they basically started to say, and the research kind of curved more towards, don’t take progesterone while you’re pregnant to keep the pregnancy, like tablet wise. Mm-hmm. Because it doesn’t make that much of a difference. And also you’re adding an extra hormone, which for me, I was like, It’s there anyway.
Right. But the synthetic form of it, they were like, We don’t know. So like, don’t take anything extra that you don’t know about because what if it affects their gender structure and like it was too much for me. So I actually opted not to take it. I opted not to take it because I have never had a miscarriage to my knowledge.
So for me, I was just kind of like, you know what, I’m just gonna see what my body does. Right. I don’t, I don’t particularly like taking medication, but technically is it safe to take while breastfeeding? Yes. Yeah. Except in super large doses where sometimes anecdotally we do see a dip in supply, which is usually recoverable.
Yeah. And you know, this is not exactly the same as birth control, and it’s a very different dose. Right. If we’re using progesterone only birth control. But research is saying it’s pretty safe. We just don’t have a lot of data about it. And the progesterone supplementation that I’m talking about is for first trimester stuff.
There are people that have a history of preterm labor that have to take like Makena injections or you know, intravaginal progesterone later on to maintain their pregnancy. That we have good research on. Like that’s a thing. We do that. But like for keeping an early, early miscarriage in the first trimester.
Not really great data on that. Right. So I don’t know, but you’re welcome to look into it. Yeah. And there’s, there’s a little bit on infant risk and LactMed you can look into too, but if that is the route you’re choosing, it should be totally fine. Yep. Okay. Let’s take a little break and think a sponsor and then you’re gonna tell me about feeding cues.
All right. It’s Maureen here, and I want to tell you that I have finally set up a link so you can instantly book virtual lactation consults with me. Oh, thank the Lord . I know Heather. It took me a long time to take the leap from in person visits to virtual, but I did it. You’re gonna love it. I love doing virtual consults.
They are the best. It serves more people. I’m so glad you took the plunge. Thank you. And if you guys out there wanna book some time with me, you can go to HighlandBirthSupport.com and then click on my lactation services tab. Is that H I G H L A N D? Yes. Okay. . I will see you on Zoom, everybody.
All right. Feeding cues. Let’s start with what they are, because a lot of people have no clue what feeding cues actually are. So infants communicate using these subtle cues that become increasingly active and overt until a caregiver responds in some way. Right? They escalate. Yes, they escalate. So these cues are initially available based on reflexes that babies are born with.
Mm-hmm. And I guess these innate behaviors are debatable and variable, just like you said in the intro, where it’s like, are all babies the same? Uhhuh. You know? And so a lot of researchers go back and forth. That’s about 50 50 on that. Okay. However, for the purpose of keeping this simple, ha ha, Because I think we’re going to get a little bit complicated, I can tell you that we typically see that the sucking reflex doesn’t appear until about 34 weeks of gestation.
So that’s one of the reasons why NICU babies are fed on a schedule, because they’re not telling you like, we can’t rely on them neurologically to tell us when they’re hungry, and also they can’t tap into that sucking reflex to produce the outcome they want, which is ingesting food. Mm-hmm. So we have to help them along the way.
But also we have to be really careful developmentally to preserve their sucking reflex as it comes, especially if they’re getting fed with a tube. So this is where like we’ll direct you back to the speech language pathology occupational therapy episode that we did for those two providers that work with NICU baby specifically.
Right? So that’s where providers like that come into play to help their reflexes continue to develop, even if they’re not actively using them for feeding. So babies are growing and changing every day, obviously, and it’s very important to keep checking in with them and facilitating their development as they come online neurologically.
Yeah, and you know, we know that those newborn reflexes fade. We get different reflexes coming in, and if those are the root of a lot of the feeding cues, they’re gonna change as baby gets older and integrates purposeful movement. Right. And you know, most of the research, which may not be surprising is in relation to childhood obesity later in life.
That seems like what? Right? That’s looking at the wrong thing. I’m like, how does that help us with actually learning about our babies? I don’t know. That seems weird to me. Mm-hmm. Well, that’s where the money is. Yeah. Okay. So you gotta follow the money in the research. So sure. If we can cure childhood obesity, you know, we could cure chronic disease and sure.
Right. Uhhuh. Maybe we should just give people free nutritious food? Maybe. Maybe so. But also the research was largely focused on the mother’s responsiveness to the infants queues, of course. Yeah. So not a lot of stuff on partners, not a lot of stuff on other caregivers. Daycares. Day, Right. Daycares, which feed on schedules most of the time.
Yeah. Lots of the questions about whether mom’s BMI has the association with the feeding practices. Like if your mom has a high bmi, are her cues off and she’s actually giving you bad cues. What? Yeah. What? I know. I was like, baffled by this. Maureen is gonna be so mad about that. I just don’t like, I, I’m just wondering like, what was the thought process that led a researcher to be like, We need to learn about infant feeding cues so let’s look at how fat the moms are.
Yeah, because it in their minds, easier to control that. And it’s just one more way that they can be like, Here’s another incentive for you to lose weight. Because if you’re overweight, you won’t understand feeding cues and you won’t know when your baby is full.
And then you’ll just keep overfeeding them. I’m sorry, why couldn’t we just have like, 2000 mothers come and feed their babies in a clinic and videotape their babies’ feeding cues and then compare them to each other and compile a list of the most common ones? They did that. Okay. Yeah, they did that too.
But this is more, that study was also more about the mom and what, how they respond. So it’s more about the responsiveness than the actual infant. I feel like it’s like a chicken egg situation. Yeah. Here, and we’re looking at maybe the wrong side of it. Mm-hmm. Like what if we taught parents about the feeding cues first instead of then studying their responses to like, criticize them on it?
What is the point of that? I don’t understand. I’m not really sure, but just so you know, there was no real evidence to show a correlation with BMI and. Oh, good. I’m so shocked. Also there many studies disproved the gender influence on cues and responsiveness. You know, which is nice, like, yeah, how mom favors the boy, you know?
Or like, Oh, well the boy just needs you to like bring it to him, whereas the girl will work for it. You know? That weird. So that was disproven. So a couple of things that we did see for sure is that maternal depression status was correlated with a decrease in responsiveness to infant cues. I’m sure maternal stress too.
Yeah. And you know, your, your whole body is depressed and you are probably not responding to anybody’s cues. Yeah. If your husband walks in the room and he’s like, Hey, would you like a cup of tea? And you just can’t even answer him, You know what I mean. Yeah, there’s this trending sound on TikTok right now, which I’ll give a quick trigger warning for.
But it’s like, someone’s like, Oh my God, people’s depression gets so bad they don’t brush their teeth, and then someone’s like, People’s depression gets bad enough they kill themselves, Karen. Yeah. Yes. Yes. It’s bad. Yeah, it can be really bad.
You know, if you have a baby that’s losing weight and a parent that’s really struggling with depression, it’s definitely worth it to look at the whole picture, not just one side, and get the parents some help and pull in other family members to educate them on infant feeding cues.
Do we have research that tells us like how long it takes for feeding, if feeding cues are ignored for them to stop showing up? I didn’t see any of it, but I included a whole thing about what I’ve seen. Okay, good. Because I feel like that, like why are, why are we wasting time on how fat the moms are and maybe their babies will be one day.
We should be looking at that kind of stuff. Well, there’s no like hard line, right? For like when that happens. But we’ll get into it. Okay. We’ll definitely talk about that. Gosh, I’m already infuriated. I didn’t expect to be. This is a surprise, Heather. I know. So we do have research that does suggest infants have the capacity to self-regulate intake in response to caloric needs.
And infant self-regulatory abilities are best fostered by feeding practices that are infant led. Mm-hmm. So basically the more control you give your baby about eating, the better their self-regulation is in their brain development, and the more efficiently they’re responding to their caloric needs.
Makes sense. So, you know, no pressure in addition to keeping your baby actually alive with breast milk, you are also developing their regulatory centers in your baby’s brain. So this is where we get the feeding on demand situation. And by the way, feeding on demand, they really do highlight as bottle feedings included with that, formula bottle feedings included with that.
I agree. And solids. I’m glad to hear that because I, I feel like we have so many people who are being told to formula feed on a schedule. When it’s just like, this makes a lot more sense and I get the practicality side of it and daycare and blah, blah, blah, but they’re also not like mutually exclusive.
Right? You could feed on demand at home and on a schedule at daycare. Right. And also, you know, You waste a lot more that way. Mm-hmm. But you have to educate people ahead of time. I mean, I think babies typically do fall into their own schedule over time, and they become a little bit more predictable. But in the beginning, I always educate my patients that are bottle feeding.
Yeah. I’m like, Listen, you’re gonna waste some formula and it’s okay. Like this is just part of the process and it’s fine. You know, like I, I’m sorry that it’s wasteful, but really there’s no way around it. Like we don’t wanna save it long term and make it unsafe to drink, but also like we don’t wanna over feed a baby.
I’ve had a lot of people with that do a pitcher method for formula and they prepare like what they expect to use in the day. And then just do small bottles that they add to, which usually wastes a little bit less, but it’s still tricky. Mm-hmm. It’s tricky, but also, you know, to a point, and then baby’s very predictable.
Yeah. You know, it’s like that first five months where you’re just like, What are you doing? I just, it’s every day. Every day. I’m still there 18 months. So you know what I always tell my patients? If you have a medically well term baby, so greater than 37 weeks, yes. Then we can trust them neurologically to tell us what they need.
So this means, let me just quick note if your baby has jaundice, blood sugar issues, greater than 10%, weight loss from their birth weight, they’re premature, or they were born low birth weight, any of that, they are not in the medically well category. Sure. And we cannot trust them as much neurologically in the beginning to let us know what they want.
Makes sense. Okay. So, I kind of unofficially go by the two week timeframe, first two weeks of life mm-hmm to let those initial issues resolve, and then I start trusting them again if they’re back to their birth weight. Yeah. And the boulder is now rolling down the other side of the hill. Yeah. Are you the same?
Yeah. I, I mean case by case, but that’s like, feels comfortable usually. Mm-hmm. I’ll have to tell you I just got a text from one of my aunts, so one of my aunts and I have the same name, Maureen Farrell, Aunt Maureen Farrell is a party. And I get texts meant for her a lot. Apparently there are, They’re, they’re at some kind of beer party with my other aunt, and it was like, Sorry, couldn’t hear you.
Happy Octoberfest. I’m like, Y’all, Woo. Her life is so much more exciting than mine. Someday you’ll be the cool Aunt Maureen Ferrell. She is definitely the cool aunt who brings like flashy tchotchkes to weddings for all the kids and stuff. And what? She’s crazy. I love her. I wanna be that cool too.
Yeah. Anyway, I’m so sorry to interrupt, but No, that was, No, you’re good. I think we need that here. Yeah. I just had a little fun fact that I had to pull out. Okay. Out of these love those, out of these little crazy research that I found. I did find a study with rats in 2012 that showed that a lack of intrauterine compressions like contractions actually led to poor sucking onset.
I believe this. Okay, so this is the thing with livestock where when babies come out, especially horses, but cows and sheep and stuff too, sometimes they come out and they’re just like, they’re not getting it together. Yeah. You know, you expect them to walk, right? You expect human babies to breathe. That’s it.
Yeah. We expect livestock to get up and use their feet, and when they don’t, sometimes you have to literally squeeze them like you swaddle them and squeeze them for a certain amount of time to reset them neurologically and then when you’re done they like get up and walk away. No way. Yeah. Is this kind of like how you can squeeze someone who’s having like an episode who’s maybe on the spectrum and you hold them real tight and like a compression suit sounds nice to calm them down?
Or like they squeeze the cows before they slaughter them to release the oxytocin. Oxytocin. Yeah. Is it oxytocin? I don’t know. I assume so. I’m not a livestock person, guys, but I don’t know. I can’t remember the maneuver. There’s like a spur particular name. You know some guy who developed that maneuver for FOLs. But it’s really common in horses cuz they suck at having babies.
But that’s the theory is like they didn’t get enough in utero compressions to like neurologically set them up for extra uterine. Yeah. Yeah. Well, it makes sense. And also I’ve seen so many scheduled C-section babies. Mm-hmm. that just need a minute. Or the one, the like precipitous labor babies where they come out and they’re like bug eyed.
Yeah. And guppy gaping their mouths and you’re like, bro, Just like chill out , we we’re just gonna wipe you down a little. Just some. Some, yeah. Maybe we should start squeezing them honestly, like it doesn’t sound like a bad idea, but they’re the ones who usually perk up with a lot of like stimulation. Yeah.
You know where like, we’re gonna rub your back. Really nice. Yeah. But what if instead of rubbing their back on a very gentle skin, you just put them on our chest and we. Squeeze them. I don’t know. , I’m gonna have to look and see if there’s research about it now. I know. Isn’t that cool though? Fascinating.
Fascinating. Cause I was more interested in like what’s affecting the late onset of these and you know, are there risk factors that we can tell people about that like your baby might have a little bit of a delay if, and I would say I’d put a C-section on. For sure, because especially if we don’t have the spontaneous initiation of labor, Nuhu,
Yep. Because they don’t get them, they don’t get the squeeze. Mm-hmm. . But we’re talking, whenever we say that, it’s usually more like they’re still full of fluid. Yeah. And you know, when I, I also talk to people a lot about that with lactation, because part of setting the stage for lactation is that whole hormonal cascade in labor that like you.
Travels down to placental ejection and blah, blah, blah. And without that, sometimes it’s a little bit difficult. Yeah, exactly. So obviously everyone wants to know when their baby is hungry. Yeah. How do I know when my baby’s hungry? Okay. So we looked at that. Okay. And it much like how you described earlier, people were recording themselves, you know, they had like cameras set up for cool, I think they even did it in their homes.
I like that. And then sent the videos in, I wanna see 10,000 of those . I know, right? And then so they had to like train people on what to look for, but they never really. Said in the study what they were actually looking for. Mm-hmm. , they just classified it as early active or late cues. Okay. So whatever we can get into that.
Yeah. But in this study it was 146 individuals. Okay. Small but Okay. Small but also significant. Many. Feeds for each of those. Yeah, yeah. Looking at feeding Q responsiveness, so this is about how responsive the parent is. Like are they reading the cues correctly? There were greater maternal response to hunger cues seen among mothers of older children.
Does greater mean faster? Yes. Okay, so, More and faster uhhuh more and faster for older children than infants. So this makes sense to me because toddlers are a giant pain in the ass, and they’re gonna ask you for a snack. Point seconds until about it. Yes. And also those moms are probably sleeping through the night potentially.
Mm-hmm. and neur them neurologically. Like they neurologically can respond a little bit like, I don’t know about you, but when Lira’s hungry, she literally goes to the fridge and points to the shelf that has the food she wants. Yeah. So it’s like pretty clear to her feeding cues. Exactly. pretty clear. So let’s talk about what they’re classifying here.
Okay, so we have these early feeding cues, which everyone with breastfeeding has. I’m pretty sure if you’re on social media, you have heard these before. Yeah. And this is what I educate every first time parent on, cuz these are not obvious if you’ve never been around a baby. Right. Because they are relatively.
And primarily oral in nature. So when you have this baby doing things with their mouth trying to tell you, I’m thinking about getting hungry. And your grandma is going, That baby just needs a pacifier. Yeah. And they’re trying to tell you, Oh, that baby’s using you as a pacifier. You just need to put the pacifier in their mouth.
You just, you know, there’s just a few words in this world that piss me off like that. Right. Or you need to swaddle them with their arms down. To keep them asleep and it’s like, well, they can’t really show you their hand to mouth movements. Mm-hmm. . To be hungry, you know? Yeah. So these are the early feeding cues are like increased alertness.
Mm-hmm. Okay. Like really, if you have a brand new baby and they’re awake, they’re probably hungry. They’re hungry. . Yes. Cause they’re only gonna be awake like one time a day. Yeah. They sleep like 18 hours a day. So if your baby’s awake Yeah. That’s a good time to latch ’em. sucking on their hands. Mm-hmm.
opening and closing their mouth. Yep. Subtle. Okay. Very little. Yeah. And just like they, for, for most babies, these early feeding cues, they’re not frantic. They’re very slow. And they just kind of look like exploratory movement. Right. You’re like, Oh, you’re learning about your tongue. Look, it’s coming in and out of your mouth.
It’s so cute. But they’re actually like, I am hungry. Yeah. Mother, please. So then we have active feeding cues. Mm-hmm. , And this is where we have more overt. Behaviors and it involves more full body movements. Yeah. Most people notice these without being told. Right, So this is like excitatory limb movements, leaning towards the food, Also turning their head to look for the breast.
So if they’re lying in their bassinet, they’re turning their head, trying to bite the blanket. We call that rooting as well, where they’re like open mouth, just like look to the side. Also squirming and fussing. Yes. And I call this being oy, like, Oh, this baby’s just oy. Yeah. And that’s like, you know, when you’re like, Oh, you’re just a little bit upset.
Okay. You know, and that’s actually not, that’s not their first feeding cue for most babies. You’ve probably missed the early ones, which is okay. Just, you know, it’s an escalation. . Right. And so then we have the late sign of hunger, which is very overt and involves a negative effect. And this is crying. Yes.
So let’s talk about crying for a minute. . Okay. Is food always the answer? No. No. It might have been the answer 20 minutes ago. . Mm-hmm. , you know, when they were doing their early cues, but now baby is pissed and the new priority is to neurologically get that baby back online. I mean, I get it cuz when I get to a certain point of hunger, I get to the hanger point.
Mm-hmm. and then sometimes I just need like a nap or something. Right. I just need like everybody to leave me the F alone. Mm-hmm. and I need to calm down. So I could think straight and then like maybe I can put food in my mouth. Right. And you know, you gotta think like the infant’s first developmental stage that they’re trying to accomplish is a sense of safety.
Yeah. So crying equals distress. All right. And I know that sucks for a lot of you guys to hear that right now, and I apologize if that is upsetting, but this is what we know for sure. They are either happy. or they are distressed . Yeah. There’s not a lot of in between for newborns and that’s not your fault in any way.
And they don’t take it personally. They have like an on switch and an off switch. Mm-hmm. . And there’s not a lot in between because their brains are not complex enough to put things together. They don’t have any building blocks to like build a story about neglect or Yeah. You know what mom didn’t do for me?
We’ve done an episode on this before, but I just wanna remind you that you cannot spoil a baby. A crying baby is a baby who has an unmet need. Spoiling would necessitate a manipulative capacity. Manipulation necessitates being able to actually understand your emotions, somebody else’s emotions, predicting them, et cetera, which babies, toddlers, children, just they.
They can’t do that. can’t do it. They don’t understand. So if they are crying, we either missed the early hunger cue or they’re upset about something else. Sure. Poopy, diaper cold, hot, whatever, Overtired. Yeah. Sometimes they just need to go to sleep. Mm-hmm. . So that’s a problem. And you know how they can calm down, sucking on a boob.
Yeah. , you know, in my opinion, it’s, it’s off. It’s an answer that is just it’s, it’s, it’s adaptable to many situations. so many. So many. So we do have some results of the Norish study from Australia in 2012 that showed that mothers of infants with a more difficult temperament reported a lower awareness of infant cues and were more likely to use food to calm.
And reported high concern about overweight and underweight. So that’s interesting and that’s a lot to unpack there and it kind of sucks to hear that, but it also might be good to know. So if No, no, that makes sense though. It does. It does. A more, a difficult to care for baby is going to increase your stress in cortisol levels and make you probably hypervigilant and then simultaneously less responsive because you’re taking in so much stimuli.
and you’re exhausted. Right. And this is where I see people asking me when they can start bottle feeding. Yeah. And I start to see partners chiming in being like, What can I do to help? Mm-hmm. , you know, this is where partners start feeling absolutely useless. Sure. And this is where we have to like really intervene and be like, We got this, let’s figure.
And neurologically, it’s hard for the parents because your brains have changed so that they are more responsive to cries. And if you, he are hearing this cry all day every day. It’s frying your little brain. Yeah, it really is. I had that with you. Yeah. And it, I did with Griffin too. Oh, what is this first baby nonsense?
I don’t know. It’d be better if you and I had different experiences, but our kids are the same ages apart. I know genders. I know same things. So what do we do? If you have a baby that’s super fussy all the time, quote unquote colicky, we number one, go see a lactation professional. Period. First stop period.
First stop. We have an hour to spend with you. Your doctor is probably just going to try to diagnose your baby with reflux and kick you out after 15 minutes because they just don’t have enough time to dig into the details about what’s happening. So number two, you’re going to try to observe your baby for early feeding cues and try offering the breast prior to them crying and see if that does the trick.
Yeah. And you know, sometimes for people who are struggling with this, I have had them set up like some kind of visual reminder of how often they’ve fed, cuz it’s really easy to lose track of time and feedings and all of that when you are so stressed out and you haven’t slept in like four weeks possibly.
Yeah. You know. So I’m like, especially if this is your first baby, which I swear it always is. Mm-hmm. , I’m like, Why don’t you put like a bowl of m and ms and there’s 10 of them, and I want you to get through one every time you feed and do all 10 before 3:00 PM. You know, and then you’re like, Oh yeah, okay, that’s a lot of feeding.
Great. And then that means you are definitely feeding before the baby cries. You’re possibly like, you know, every time, as soon as they wake up, you’re like, Oh yeah, I’m gonna sit, I’m gonna have an m I’m gonna feed the baby . Right, Exactly. So, and you know, we do shoot for like eight to 10 times in a 24 hour period, but in the beginning, especially before your milk comes in fully.
Well, and when we’re trying to. Almost like neurologically reset a baby. Yes. Like this. Sometimes we have to just start over and we’re like, Skin to skin. Literally feed nonstop. Yep. Get the baby to essentially stop crying all the time. Get your brain to calm down. and then you can try to, then it’s like then you might be in a head space to actually observe
Yeah. You literally have to pull the rug out from under that baby and be like, All right, start from scratch. Mm-hmm. . And I find the best way, in addition to skin, to skin is to just try the next feeding when they’re happy. Yeah. You know, and then just start from there. And now we have to also remember that breast milk is digested in about 90 minutes.
Mm-hmm. . So if your baby requests to feed again in 60 minutes, it’s not because you’re failing. It’s because that makes sense. Mm-hmm. , and you have just thrown all the monopoly pieces across the board and we’re starting over. Yeah. So the schedule that you used to have is gone. It’s on fire. Okay. Yeah. You know, I’ve heard an interesting one from some parents that I was trying to get to feed more often, and they were like, Well, every time we feed the baby, they go to sleep.
And I really enjoy the wake time with them, so I don’t wanna feed them when they’re awake. And that’s a really tough one, right? Cause I’m like, I understand that, right? You wanna have this precious awake time with your baby, but you have their whole life to do that. Yeah. And it’s really just the first four weeks, right?
That it’s like this. Right. And also I see issues with, maybe they had a little NICU stay and they were fed on a schedule, and then you pumped on a schedule and then your baby came home and you’re trying to clasp onto any semblance of order in your life. So you’re like, It was working in the NICU to the point where they got discharged.
So we’re just gonna keep doing that. But your baby graduated from the nicu? Mm-hmm. for a reason. Haha. Because neurologically stable. Yes. They’re now neurologically stable, so that means we need to trust them again. And I have had to work with so many parents of NICU babies and I’ve had to hold them by the hands and say, I trust your baby now and I need you to trust your baby too.
And they’re like, Oh my God, it’s so hard, . I get it. I, yeah, I understand that. It’s, It’s like you, I mean, , it’s just like that first day home from the hospital all over again. . Yeah. Yeah. And basically just let it happen. Yeah. You know, let it happen. Have grace with yourself. It’s fine.
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So yeah. So we go. We have had a little discussion about what it looks like to have a hungry baby. What does it look like when baby’s full? So when baby is full. Now this is important because a lot of people don’t even think about this. Mm-hmm. . When your baby is full, they will release or fall off the breast.
Sometimes , sometimes baby will turn away from the nipple, and this doesn’t mean popping on and off. That’s a whole other situation. Mm-hmm. , I mean, literally the baby turns away from the nipple and is looking elsewhere and has moved on with their baby agenda. Mm-hmm. and then also the one that drives me crazy.
Baby relaxes their body and opens their fists. I really feel like this is more related to sleeping, though. I feel like that isn’t strictly like. Two weeks. I don’t know. I, I feel like I never saw that after the really, really initial newborn phase, but I, I mean, I don’t know babies. All different, but Yeah.
But I mean, you lose the tone in your body when you finally pass out. Right. You know, like when you go to sleep, your arms go to the side and your hands open. And I have seen people who are obsessed with looking at their baby’s fists as the only sign that they’re full. Mm-hmm. , you know? And so they come to me thinking they have low supply because their baby always.
Is making a fist and I’m like, Oh God, I don’t know. Let’s Interesting. So that one for me, I’ve seen, I’m kind of like not as obsessed with that one. Yeah. It’s something to keep in mind. And I think too, you know, when you say baby turns away from the breasts, whatever, not every baby’s gonna do that, right?
Some babies are like, What if I just stayed on? So in that case, to sometimes I’m like, Okay, if you think your baby’s full, you can take them. And then see how they respond. Mm-hmm. , most of the time, a full baby, they might fuss for a minute, you know, and you can like Pat, Pat and do the little, you know, random rocking motion that specifically calms your baby
And then like they’ll settle down and if they’re truly still hungry, they’re gonna escalate again in feeding cues. Yeah. And so what I usually tell parents is you nurse on one. And then when you don’t see the jaw rocking motion anymore, you don’t see their little ears wiggling. You don’t hear any audible swallows, and it looks like they’ve moved the suck to the front of their mouth, where they’re just kind of like gently, no nodding on the tip of the nipple.
You break the latch. Burp them and offer the other side. I always offer two because some babies are one boob babies and other babies are two boob babies. And this is largely based on milk storage capacity. And we will link that episode in the show notes. Yeah. And it can change. And after, you know, a couple weeks or whatever, when you really get to know your baby, you don’t necessarily have to offer to every time.
Right, right. It’s a good way to start. Yeah. And also, You know, for me, even over the long haul, if you’re looking at your baby and you’re like, But you’ve always been a one boot baby and it looks like it wants more, don’t automatically blame yourself and think that you have a supply issue. Be a two boot baby.
It’s okay. You know, whatever. Let them do their thing, and this is like, I try to say that breastfeeding is a conversation. Yeah. Between your body and your baby’s body. And the more times you put that baby to the breast, the more we’re gonna be on the same page. Mm-hmm. reading the same chapter of the same book.
And I think that, you know, offering that second breast is like the dessert boob. Like we don’t always have dessert, but when we do, isn’t it nice? Yeah. And no one’s like, Oh, you had dessert. What’s wrong with us? You know, it just happens. And that’s good. So, Let me give a quick little caveat. Okay. And this is kind of what we were talking about before.
Mm-hmm. . So I was not able to locate a study specific to what I’m about to say. Okay. I looked professional opinion, it’s not there. Okay? Doesn’t mean it’s not there. I just couldn’t find it. But here’s my 2 cents on some things I’ve observed, and I have seen many patients come in with their baby who is fed on demand with an incredibly attentive mother who describes their baby as content after feedings, and their babies are absolutely falling off the growth curve in a major way.
Okay? And I also typically hear the story about these kids. That they eat frequently and they’re eating every hour to two hours during the day and then several times at night. And that feedings are 30 to 60 minutes each time. And that the baby would stay on the breast forever unless I stopped it. I always think oral dysfunction when I hear that I do, but sometimes it’s just not there.
Yeah. I have, I don’t get it. And it’s usually a supply issue or like an oral, Right? Or both. You know, one that led to the other. Sure. But in this situation, Babies have been snacking on small amounts of milk. Throughout the day, and I suspect that their stomachs have never expanded fully to their capacity that they’re supposed to be at, and their regulatory centers are set at a lower baseline.
Interesting. And so this ties right into that brain development piece. We’re gonna chat about in a minute here a little bit more, but you know, when you eat, It’s a hormonal first. Yeah. So, you know, we have to release enzymes from the pancreas and we have to release stomach enzymes and all of that to start the digestion process.
And we have to, I, I don’t really know the details of the anatomy in physiology. Mm-hmm. of like how many of those hormones have to respond. But I do know that we have in our body a lot of stretch receptors Sure. That activate neurological. Things like even your vagina, when it stretches to a certain point during crowning.
Yeah. It releases natural anesthetic from your neurological system to get you through. Yeah. The pain. You know? So with our stomachs, when it stretches and it expands to a certain level, does that now set the self-regulatory centers? Mm-hmm. that says they’re hungry. And I’m thinking about this, This is terrible.
But you know, and I also hear these babies sleep through the night sometimes. Like, Yeah. He sleeps through the night and I’m like, well there are starving children. I’m suspicious there are starving children all over the world that sleep through the night though. Yeah. Every night, you know, and it’s like, man, And you know, at some point, Little kids that are hungry all the time just quit complaining about it.
Interesting. You know, and so with these babies, I think that they’ve just kind of like you get what you get and you don’t throw a fit. And so whenever we start feeding these babies, obviously if they’re off the growth curve, We introduce a little bit more at a time, a little bit more at a time, and I’m telling you, there is a point in time where they take over three ounces.
This is seeming to be the magic number for me. Mm-hmm. , where we can get them to take about three ounces in a feeding. And if we do that for enough days in a row, it’s like, bam, these babies change neurologically. I see their personalities change. They start queuing a lot more, and then the mom is like, Oh my God, it’s a totally different baby.
I would be really interested to see if there’s any. Studies of that link volume of a feed to. that to like feeding cues or growth curves or, I don’t know. Anyway. Well, it’s very complicated. Yeah. Oh yeah. I don’t know how you would study it in any like controlled mood. It would have to be a NICU study. I and there are NICU studies.
Yeah. You know, so we could reach out to our, Our friends in the nicu. Sure. We could ask them if they have any research on it, and that’s how maybe they determine the volume of feeds. Hmm. I don’t know, but I know that the, Usually they’re more concerned about getting enough calories in in a 24 hour period.
Right. And a lot of the time they are just adding calories to the volume because they can’t over expand a tiny tummy. But if your baby is term. It’s interesting. Let’s, let’s put a pin in it. Pin, think about it. Noodle on it. Okay. Okay. What’s next? So, another little fun tidbit is what does full mean? , Okay?
Mm-hmm. . So in that same study of 146 individuals looking at feeding cue responsiveness, mothers showed greater responsiveness to child hunger cues than to fullness cues. While 75% of mothers were observed to be responsive or highly responsive to the hunger cues, less than half were responsive to the fullness cues.
I feel like I can see this a hundred percent. Is this like your grandma who’s like, Yeah, hungry, have a sandwich, and you’re like, I just ate. And she goes, I’ll make you a sandwich. And you’re like, What? You know, . And so I have patients all the time who are like, I know he just ate, but like, how do you know he got enough?
And I’m like, Well, look at him. Yeah, he’s got milk running down. His looks really nice. Super, like milk drunk and he’s passed out. He, That’s not a hungry baby. And they’re like, Okay, but they need, Yeah. This is where the socialization comes into play, where we’re supposed to be sitting around congratulating each other on full babies.
Mm-hmm. . So then we know like, this is what a full baby looks like. Like look what you did. He’s so full. You know, don’t you think? Yeah, I hear that. Okay. So why are these feeding cues important? You know, why do we care? Obviously milk supply. Sure. So the more times you have that breastfeeding conversation, baby demands it, you supply it, your milk supply is gonna be right where your baby is.
Mm-hmm. or more if you’re, you know, doing a little bit extra. And that way you’re never at a deficit. . We also want to stay on the same page with your baby as they grow. Yes. And change example would be like illness. Okay. So if you’re feeding on demand and like randomly your baby is like queuing to feed all the time.
All the time. All the time. They might be heading into a viral illness or a bacterial illness and they might be trying to like bolster themselves against it and you don’t want to limit that makes sense. And then regulating the full centers of the brain. Okay. And that’s like setting up for lifelong development stuff?
Yes. Okay. Why are you so mad? ? No, no. I, I’m not mad. I’m just like, I’m thinking about a lot of things. I know it’s hard to not reflect and be like, What did I do? Did I do anything wrong? Yeah, I’m like, did my mom do anything wrong? Oh my. I’m sure that’s not a question. So I hear this question a lot. So can a breastfed baby overeat?
Ooh, yeah. This is a good question. Yeah. So the short answer is no. At the breast if they’re direct breastfeeding, on demand, exclusively breastfeeding. Are there any caveats to that? No, not that I found. Okay. Because we have all seen in all of these studies that infant led, like the more infant led it is, the better they are at regulating.
Dude, I have. Heard so many stories of pediatricians, fat shaming babies. Mm-hmm. , like, they’ll get to six months and the pediatrician’s like, Well, your baby is overweight, so you need to start restricting their food. And I’m like, What? Mm-hmm. . Mm-hmm. , They are exclusively breast fed. Mm-hmm. . So what? Well, with bottles they can overeat.
Yeah. No, but. No bottles. Yeah. At the breast. So your breast, they have to work for it. Like they suck, suck, swallow, sucks. Like that’s a lot of effort. Also, I have seen some people who I could describe more accurately as like waterfall, . Yes. But those babies will back off. Yep. And then also they have shorter feeds.
Okay. Yep. Whereas if you gave them a bottle that with like a zero sample, they’d take 15 minutes sometimes. Yeah. I mean, I agree with you. I’ve definitely. Worked with a lot of people who they’re like, Okay, like they have that kind of what I would think of as a genetic predisposition to oversupply. Mm-hmm.
they’ve got strong let downs. They’re having issues with their baby, eating in a healthy way with that, but it’s not common. It’s not common. I’ve seen it too, and I think a lot of those babies. do you get more lactose, which makes them chubbier. Mm-hmm. just because of the oversupply issue, but it’s like good sugar.
Yeah. But it’s like, okay, so block feed, like if your baby is absolutely drowning in your let down Yeah. And you’re engorged all the time, but you’re an exclusive breast feeder, you block feed two on two, boobs on the right, two boobs on the left. Mm-hmm. . And other than that friend, I don’t know what we can do with you.
Other than do some labs after you’re done nursing? Absolutely. So there actually are quite a few screening tools that have been developed over the years to evaluate queue based feeding and interaction. Okay. Okay. Most of these are actually for identifying risks of not feeding. Mm-hmm. or if the relationship between the parent and the child is just not happening and we’re trying to identify them early on for intervention.
Oh, interesting. Like at the hospital. . Huh? Isn’t that interesting? Okay. So very mom focused still like, what are you not doing? How do we identify these weers early feeding cues because we have neurological issues for baby. Are they just assuming we’ll catch it somewhere else, I guess. , or actually, here’s what I think, as long as the baby is gaining weight, even if there is a neurological issue, they’re not gonna do anything about it.
You know? Like it’s because the brain doubles in size in the first six months and it’s so variable. Yeah. Of how it’s gonna shake out that, I swear I’ve seen a lot of babies that definitely have something neuro going on, but the neurologists are like, We’ll see. And they never will tell you what the problem you will never see because they don’t.
Because some babies might go, right? Yes. Some babies might go left and they don’t wanna like stress out the mom. So a lot of it. Eh, well if they start losing weight, we’ll just feed ’em. This is a much more confusing episode than I thought it would be told you. Do we have like concrete useful things to end with
We do. Okay. So let’s talk about like as far as the scale goes, like we know for a fact that we don’t respond as well to the fullness cues, so why don’t we start there. Okay. So if you’re like really confused about where to. Start observing your full baby. You know? And this can mean like if you’re looking at your baby that just ate for 15 minutes and you’re starting to feel like you’re watching the clock all the time, that’s your trigger to stop watching the clock.
Because time does not equal volume. Okay? So I really wanna cross stitch this on a pillow. Time does not equal volume. Okay? So if you just fed your baby, regardless of how long it is, and they are asleep, even though you offered two boobs and they were like, No thank you, and they’re, they’re, maybe their fists are relaxed, maybe they’re not, but they’re, the nipple slipped outta their.
That baby is full. If you still have anxiety about it and you feel like you need to take a wet wipe to your baby to keep them awake, or you’re actually concerned that they’re losing weight, look at the diapers. So, do we have enough diapers in the day? Do we have any signs of dehydration? We need at least six wet diapers in a 24 hour period.
And usually one of those is very saturated. Mm-hmm. . If you get to know your baby pretty well and you feel like their diapers are decreasing and you don’t trust your baby anymore for whatever reason, that’s a good reason to go get seen by somebody. Yeah. Period. If you’ve got that little funny mom spy sense going on, just go get checked out.
Yeah, absolutely. And if your baby skips more than two feeds, so that means sleeping like four to five hours. Mm-hmm. through and is like very, a very little baby. Right. As a very little baby. Yeah, I would probably go be seen, take the temperature, Are they sick? You know, stuff like that. Right? Or like, did they wake up from that and they were like, I’m gonna have a mega feed.
Then you’re like, Okay. Like you’re responding to what’s happening in your environment, right? So, , once you start with identifying the full cues, and we can get pretty confident in knowing like, Yep, my baby is definitely full. This is what a full baby looks like. Okay. Then I would start watching your baby when they’re not crying, when they’re super happy.
Yeah. And start noticing like, you can take your finger and rub it on baby’s cheek and see if they turn towards your finger. If they do, it could be a boob. Yeah. And you know, if you’re just realizing listening to this like, Oh, I leave my baby SWD all the time, like, Make sure there’s a portion of the day they are unsold so they can show you feeding cues that involve their hands.
Mm-hmm. baby wear. Yes, Baby. Wearing directly against your skin. So baby usually makes roots. Feeding cues very obvious because you’ve, they literally will suction onto any part of you they can reach. Right. And if you are a person that has like a hundred baby apparatus mm-hmm. to put them in in your house like a swing and a bouncer and a maybe spend the day not doing that.
And actually. Wear them so you can identify those cues early. Because most of the time we put ’em in the swing, they’re asleep at the time and we’re like, Awesome. I can go do A, B, and C. But then they start crying and that’s when we go and get them. Right. And we’ve missed that kind of initial escalation.
Yeah, and you know, it’s, it’s okay. Especially like, you know, for a lot of people this is the time they’re still on maternity leave, whatever. Don’t get the, put the other things outta your mind. Don’t do the laundry. It’s okay. Spend a day observing cue. Full cues, feeding cues, wherever stage you’re at. And you can do this anytime if you’re like, I feel like I don’t know my baby anymore.
take a weekend. Reset. Yeah. And I would say the hand to mouth movements are a lot more accurate early on. Yes. After three months they are not . Yeah. Because babies explore their environment with their mouth. Yeah. So if anything grazes past their mouth, they’re gonna try to chew on it and explore it. So really after three months, we’re looking more at like rooting.
Mm-hmm. leaning towards. Being alert and active, just basically at any point in time. Yeah, they could. They could scooch down and latch on. Yeah, and they’re gonna continue developing. So, you know, keep that in mind. It’s not your fault if you feel like you’ve lost track of feeding cues, they changed and you can take that minute to see them again.
Yep. So in conclusion, the more control your healthy medically well term baby has in their eating from zero days of life to two years of life, the better. This includes bottle feeding, which ideally should be done on demand as well, regardless of whether your bottle feeding, breast milk, or formula. If your baby is incredibly fussy, try to notice the feeding cues a bit earlier.
If you are unsure if your baby has feeding cues at all, please go to a lactation professional so we can show you. or maybe point you towards a referral that you need. Yeah, like for neuro and if you’re feeding your baby prior to them showing cues. Example is feeding on a schedule. Mm-hmm. , stop feeding on a schedule because you’re gonna have less efficient feedings if you try to feed them during a time that they’re actually wanting to be asleep.
So if your baby is losing weight or completely off their growth curve, you can’t trust the regulatory centers for sate. And you should definitely seek care from a lactation professional. And if you are struggling with postpartum depression and you are concerned about your baby’s cues or weight gain, please seek help from a lactation professional, or you can call postpartum international for guidance on getting treated for depression, and we will.
So great tip. Yes, and I will put that in the show notes as well. Awesome. . Well, that was a lot to take in, so let’s take a little break to hear from a sponsor and then we will come back for an award, which we’re very excited about.
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Okay everybody, welcome back. I hope you’re feeling more confident about feeding cues and fullness cues. Now I know I am. So today we have an award for one of our patrons, Amanda Kalina. She’s from Ohio, which we love, and she says, after a rocky start emergency C-section at 37 weeks due to D V T preeclampsia.
That sounds rough. Immediate NICU stay for four days, exclusive pumping for eight weeks. Inability of baby to latch, reintroducing body feeding, immense nipple paint, oral ties, literally everything imaginable under the sun to sabotage my breastfeeding journey. I’ve now surpassed the three month mark and I’m hoping to go as long as it works for both of us.
Heck yeah. Shout out to my friend Rachel for her help and support and also introducing me to the podcast. I’ve learned so much from her and from you that it’s helped me continue this journey longer than I initially thought I could, and I am so grateful. Hell yeah. Amanda. Yeah, Amanda, That’s awesome.
And friends gotta stick together like nobody gets through this. Nobody. So shout out to your buddy Rachel, also, who hooked you up with the resources you needed, and we’re so happy to have you as a patron. Thank you so much. And here’s to another three months. Absolutely. And we’re going to give you the formidable Fireball Award.
Because you’re pretty incredible. Yes. And I imagine you are quite the fireball. Absolutely. Well, thank you guys so much for sticking with us through this episode. The way we change this big system, it’s not set up for lactating families, is by educating ourselves, our loved ones, our healthcare providers, and our friends.
And if you liked this episode or literally any other episode we have ever made, you can do us a big favor by telling your friends about it, posting on social media about us, or joining our Patreon. Like Amanda, you can become part of the Cool Kids crew and we will love you forever, . We really will. And we’ll send you merch if you’re in our top tier, and you can hang out with us in a quarterly last q and a.
I mean early episodes. So much. We do so much for you, so much. We love you. So, all right. Okay, till next time, Bye-bye.