Why it’s Time to Stop Teaching Parents Paced Bottle Feeding and Teach Responsive Feeding As Recommended by the AAP

Paced bottle feeding is a wildly popular bottle feeding technique that is promoted as the best way to feed babies who are breastfed. When I did a google search for paced bottle feeding, there were a whopping 572,000,000 results! What’s more, definitions of paced bottle feeding techniques varied significantly, often contradicting each other,  and there were many unproven claims to promoting paced feeding. 

As a 31-year NICU nurse and lactation consultant, I’m mystified why paced feeding for healthy term babies has become the norm. Pace feeding is a therapeutic feeding technique primarily used for medically complex and premature babies whose suck, swallow, and breathe (SSB) reflex is not coordinated or matured, which is essential to bottle-feed without aspirating milk into the lungs.  

The American Academy of Pediatrics (AAP) and global infant feeding guidelines advocate and promote responsive feeding, which is uniquely different from paced feeding.  Full-term, healthy babies are born with their SSB coordination fully developed and can responsive bottle feed safely.

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Belgian Mother Shares How Her Babies Became Lethargic After Being Denied Supplemental Milk by Hospital Staff

A Letter from Karlyne C. from Belgium

I would like to share my experience in hopes that it can be useful. My name is Karlyne, I am the mother of 3 children and live in Belgium. 

My first daughter, Moïra, was born in 2018. I had not looked up any information about breastfeeding during my pregnancy, I thought that since it is a natural process, it would be easy and that there was nothing more to know than the fact that I should put the baby on breast when she showed signs of hunger. When she was born, that is what I did, I put her on my breast.

But she could not manage to latch on, she would systematically let go of the breast. I asked the midwives who worked in the maternity ward for help. They would crumple my nipples while firmly holding her head to try to shove them in her mouth despite her cries. Hours went by without her being able to feed, and I could tell she was getting weaker; all the while the midwives told me everything was normal. In response to my insistence, I was told to express colostrum in a small spoon and to give it to her if it could reassure me. I produced at most a few drops of colostrum, yet the midwives kept telling me that I had enormous quantities, and that a baby’s stomach is minuscule, that some five halves of those small spoons every 2 to 3 hours would be more than enough. Those few drops, Moïra refused because the spoon in her mouth made her nauseous, so she would not take it.  The midwives refused to bring me a clean spoon for me to try again, telling me that supplementing once was enough. 

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How To Prepare For Supplementing When Breastfeeding Your Baby In The Hospital

Mothers who experienced delayed onset of milk production or experienced low milk supply with their first baby often contact us for support to try breastfeeding again. They typically have anticipatory anxiety because they have lost trust in their lactation professionals and hospital staff and are unwilling to attempt breastfeeding again without supplementation. They want to know how to supplement their baby until their milk supply becomes sufficient to feed them safely while providing proper breastfeeding stimulation for optimal milk production.

The most common concerns expressed:

  • Fear of the pressure to exclusively breastfeed
  • Fear of failing to breastfeed again
  • Fear of advocating for themselves and their babies while in the hospital
  • Fear of being shamed by hospital staff when wanting to supplement until their milk comes in
  • Fear of being denied formula or not receiving it promptly
  • Triggers from the previous negative breastfeeding experience, such as being touched without consent

Monica writes: “I lost confidence in breastfeeding because I didn’t make enough milk for my first son, who required hospitalization for severe jaundice and a 13% weight loss. I was devastated and furious when the neonatologist told me he was starving. In my birth hospital, my son had been forced to cry from hunger, and I was told my body would make enough milk for him by every lactation consultant and nurse in the hospital. I trusted them. They were wrong! I no longer trusted breastfeeding and decided to pump and bottle feed to ensure he got enough milk. I purposely delivered my second baby at a hospital that didn’t force me to breastfeed exclusively. After starving my son,  I was not taking any chances, and I supplemented my daughter after every breastfeeding session. My breastfeeding experience was the opposite of my son’s, and I remember tearing up several times because she was so peaceful and never cried.  Thankfully I supplemented her because it took five days for my milk to come in. Supplementing saved my breastfeeding journey, and we are still breastfeeding 19 months later.”

 

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My Breastfed Baby Starved While Under The Care Of Health Professionals For 5 Weeks

My beautiful baby girl Mary-Kate was delivered by emergency c-section, and although there were complications during labor, she was healthy on arrival. Having done a bit of research and listened to the advice of professionals, as well as the threat of the global pandemic posing a risk, I decided I would breastfeed my daughter, to provide her with passive antibodies for COVID-19 from my milk.

I began exclusively breastfeeding in the hospital and the midwife said Mary-Kate had the perfect latch. I loved being a mummy, I could not stop looking at this beautiful little human me and my partner had created, but Mary-Kate was becoming increasingly unsettled. She was almost always attached to my breast and would fall asleep soon after latching on. I spoke to the health visitors, and we were told her crying was colic.  We began giving Mary-Kate lots of colic-type remedies. 

Each time somebody came to weigh her whether it be the GP, HV, or Midwife, Mary-Kate was not gaining and was in fact losing weight. I could not understand, because she was ALWAYS feeding. Nobody seemed alarmed by this. I was told to just keep trying, she might be a ‘slow starter’. Never once did they check to see what my milk supply was or how much she was getting. The professionals would leave, and I would carry on as normal. Baby attached to the breast, me trying to maintain some sort of order in the home, taking care of my personal needs and sleep. Mary-Kate would just cry and cry and cry unless asleep at my breast.  I was exhausted, I was falling asleep whilst holding my baby and I knew this presented its own risks.  Continue reading

I Supplemented My Baby Until My Milk Came In And We Are Still Breastfeeding At 3 Months

My son will be three months old tomorrow, and I’m reflecting on our nursing journey with gratitude. I had infertility and recurrent pregnancy loss before having him, and (after two rounds of IVF and six embryo transfers), he was born at 35 weeks. So we had a lot working against us for successful breastfeeding, but I wanted to try breastfeeding, and I was ready to advocate for myself and the baby if needed in the hospital since I knew I had significant risk factors for delayed onset of milk. 

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