Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Bottle feeders - please stop twisting it.




I am a self confessed people watcher.  I love nothing more than sitting watching the world go by, as all the colourful characters it is filled with wander past - and last Friday was no exception.  Sitting on the terrace of a quaint cafe, window boxes overflowing, sun beaming down, both children occupied, drinks ordered; I sat back watching people mill about.

Before long a couple with a baby arrived and took a seat next to us.  Dad ordered the drinks whilst mum sorted baby's bottle for a feed, and my first thought was what a cute baby; only a few months old and with obviously doting parents. The mum caught my eye and I smiled as she adjusted her position to move baby's face out of the sun, remembering those early months when the world seems to stop and revolve around this tiny being.

Mum started feeding the baby, positioning him in the crook of her knee so she could have her drink and use her mobile - and I went back to the business of watching people passing down the lane.

After a while my attention was drawn back in their direction with the movement of her shifting him for winding. I smiled to myself again as she carefully supported his wobbly young baby head and he produced a burp his dad would have been proud of, before she laid him back down to resume his feed.

Only baby had other ideas. Obviously satiated he turned his head away from the bottle and tried to shift slightly; mum and bottle followed. He turned away again, twisting from side to side to try and prevent the teat re-entering his mouth. Still it followed and as mum finally managed to squeeze it past his lips, she twisted it quickly to release milk. Baby took a few gulps before again releasing the bottle and turning his head. Mum winded baby again, picked up the bottle and examined how much was left - before the game of cat and mouse resumed; the baby unable to make it any more obvious he didn't want more (after all two or three month olds can't physically push someone away) the mum ever determined to get more milk in.

I packed up and we left the courtyard, my mind still on the obviously loving mother who I suspect had no idea what the impact of her behaviour could be long term.

It is well documented that non breastfed infants are at higher risk of obesity both in childhood and in later life, and how the feed is delivered appears to play a large part.

A study in May 2010 of over one thousand older infants, found those who had had more than two-thirds of their feedings via bottle in early infancy, were twice as likely to routinely empty their milk cups as toddlers who'd had less than one-third of their feedings via bottle. This was the case regardless of whether it was breastmilk or a substitute in the bottle. Whilst only 27% of toddlers exclusively breastfed in the first six months routinely finished their cup or bottle, this figure sat at 68% for those exclusively bottle fed.

Losing the ability to self regulate intake has life-long impact, as a popular adult diet book now highlights. Paul Mckenna's "I can make you thin", is based upon re-learning what your body's sated cues are. Focusing on consuming each mouthful s-l-o-w-l-y (for exactly the same reason - to give your body chance to recognise it's full) and stopped when you are full (even if it's scrummy chocolate cake!).  In fact he claims there is no need to calorie count (or live off salad), providing you only eat what your body requires and stop when full - you will obtain and maintain a healthy weight.

So why is bottle feeding linked to reduced appetite self-regulation?

Firstly, bottle fed infants receive a later satiated cue than their breastfed counterparts. Breastmilk isn't released in one constant stream like a bottle, mum has multiple let-downs during a feed, resulting in regular pauses. These "breaks" slow the feed down, and allow baby to recognise satiety and stop feeding, long before the stomach is over full. As soon as a breastfed baby stops sucking, milk ceases immediately.

In a bottle fed baby, the feed is more parent led - once the bottle is upturned, milk is released and each suck swallow pattern causes the teat to refill and more milk to be released. Baby can have finished the bottle, long before their system has had chance to recognise they are full.

Secondly, as observed in the cafe, before an infant can physically push the bottle away, the only thing they can do is turn their head and try and prevent it entering their mouth. Eventually mum will often manage to get the teat in, milk flows and baby is forced to swallow, usually at least a couple of times before they manage to force the teat out with their tongue and again turn their head.

In both the above scenarios, the ability to only eat to satiation is being overridden from a very young age - instead infants are used to finishing the lot and feeling overfull. The over feeding stretches their stomach to accommodate the larger amount of milk, so next time after consuming the same amount - they may no longer feel sated.  At the "worst case" end of the spectrum you end up with a baby consuming vast amounts of milk, yet still not settling or appearing full - maybe even suffering colic from his distended stomach.  An older report found found bottle fed babies consumed approximate 30,000 more calories per year than a breastfed infant - which the authors felt was due to a combination of incorrect preparation and tactics to encourage infant to drink more or finish each bottle.

Many babies prefer small, more frequent feedings as they have small stomachs and again this mimics the breastfed baby; however, bottles shouldn't be used as the primary way to comfort baby - if he appears hungry shortly after a feed and weight gain is good, consider offering a clean finger or pacifier (Sears)  If your baby is taking above the guidelines on the tin per 24 hours, contact your health care provider for advice.

The risks increase again with the introduction of solids - which may account for at least some of the 27% of breastfed infants who has diminished appetite regulation. Mums tend to spoon feed purees much faster than a baby could feed themselves (ie baby led weaning) and again, this gives the system little chance to recognise satiation and encourages over-eating.  As with bottles, mums often employ all sorts of tactics to encourage their child to consume more - from distracting with a toy whilst they shovel it in, to playing aeroplanes.

Can a bottlefeeding mum do anything to reduce the risks?
  • An average bottle feed should take approximately ten to twenty minutes. Regularly pausing to slow the feed down and mimic a breastfed pattern, can help baby recognise sated cues earlier. It also prevents guzzling!
  • Hold baby regularly when not feeding, to prevent baby asking for food in order to be held. 
  • Non nutritive sucking (ie comfort sucking) is important to babies. If not breasfeeding, consider offering a finger/thumb or pacifier between feeds, so baby doesn't have to feed to meet this need. 
  • Watch baby closely for his cues. If he turns, twists or pushes the teat out with his tongue - he's finished. He may need winding and will perhaps then take more, or he may repeat his behaviour to indicate he is satiated. 
  • Some sources suggest that mums may confuse signs of overfeeding with an intolerance to a particular breastmilk substitute, and may try swapping brands to reduce symptoms. Watching your baby closely and observing for any of the following behaviours can help to reduce the risks of overfeeding.
 Is baby getting too much formula?

Signs that your baby may be consuming too much at each feeding are:

  • a lot of spitting up or profuse vomiting immediately after the feeding  
  • colicky abdominal pain (baby draws his legs up onto a tense abdomen) immediately after feeding  
  • excessive weight gain
 If these signs of overfeeding occur, offer smaller-volume feedings more frequently, burp baby once or twice during the feeding, and occasionally offer a bottle of water instead of formula.  (Sears)

16 comments:

  1. Reading this I am grateful for breastfeeding as I never had to force feed my children nor worry if they were getting enough (since they take after myself and my husband they are both relatively slim and tall for their age so no Dr. pestered us re: "getting enough"). Bottle- and formula-feeders have many challenges and I appreciate you taking time to talk about some of them.

    I wonder how one would know if a baby has "excessive weight gain", given weight is a factor of genetics and not just calories in/out. Also, obesity and poor health are not the same thing, so one should be careful in reading too much into obesity scares (I don't know about the UK, but obesity scaremongering is at a high in the US).

    Thanks for a great article!

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  2. QUOTE I wonder how one would know if a baby has "excessive weight gain", given weight is a factor of genetics and not just calories in/out.

    Hi Kelly
    In the UK infants are measured on a growth chart which compares both weight and height. These charts are often misused and as you say - only weight is considered which is not reliable.

    My own daughter was at the top of these charts for weight, but was also at the same place for height - thus making her in proportion. At 6 she is now very long and of athletic build (very slim, not skinny)

    When the new charts (issued only this year and not all mums have them yet!) are used correctly, the vast majority of healthy children will sit somewhere on here.

    Children that should flag up as worth checking are those off the charts in only one area, or those that are sitting at very different places ie top for weight but bottom for height, and also the other way round to pick up those not thriving ie very tall but off the bottom for weight.

    Whereas with breasfed infants we can be confident that even if larger as babies, they are purely fitting their genetic potential (Tam Fry, Infant Growth Foundation)and whilst undoubtedly there will also be some AF infants who follow a similar pattern - when not fed breastmilk it's worth Health Professionals having a chat with parents to check all is ok, we can't be confident it's genetics like with BM

    As you say gentics also influence who is likely to be predisposed - but with regard to appetite self-regulation, I think it can only be a good thing for infants to retain this?

    I don't know about in US, but in UK I have seen some worryingly large AF infants, my mum describes it as looking like they've been "inflated" to have a balloon head! This is by no means ALL - and these babes may even go on to become skinny children! But what longterm of not being able to self-regulate?
    When I've spoken to parents of such infants, a very large proportion have been having huge amounts of hungry baby milk.

    It's also worth noting that even the manufacturers don't endorse using over their recommended amounts without speaking to a HP. As nobody has researched what the impact is of much larger amounts of breastmilk substitute - it's a bit of a gamble imho. There are large amounts of minerals in a different form to breastmilk or in very different quantities - larger amounts of substitute may well impact negatively on health.

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  3. My DD was exclusively given expressed breastmilk (bar a month of ff top ups) due to difficulties with bf. I really tried to mimic bf as I have weight problems that I wanted to avoid and one of the benefits of ebm is that you don't have to throw it away so she snacked on 2-4oz at a time frequently over the day. I often had comments from ff that she seemed to want milk a lot. She followed a bf pattern of weightgain (according to my HV at a bf group) and we BLW. I stopped giving her ebm at a year.

    Now as per many bf children, she's a 2 1/2 year old and seems to be very good at regulating her food intake. I've been careful not to force her to finish eating what's on her plate or to finish her cow's milk.

    BTW, can I point you towards www.beyondchocolate.co.uk that encourages intuitve eating and is right behind you with support of bf and BLW in children and in learning hunger signals and satiation as an adult? You might find some of it interesting. (Similar to Paul McKenna but without the hypnosis!)

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  4. Hi Liquorice, thanks for taking the time to comment :)

    Firstly HUGE admiration for you. Providing expressed breastmilk for a year, especially it today's society is AMAZING! (shame you can't add bold on comments)

    Your post suggests you are a very informed, responsive mamma, so I think one lucky 2 1/2 year old all round!

    I will check out the site now - thanks for the recommendation :)

    ps I don't think theres hypnosis in the diet book? apart from perhaps stuff you can do at home - visualising yourself thing etc but it's a good few years since I read it, so could be wrong.

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  5. Oh gosh, the bit of the little baby effectively being force fed made me very sad :(

    That aside, I am very much enjoying this blog, thank you!

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  6. I'm really thin and my husband is overweight. Our baby was born at 5lbs 13oz and at our last appointment the doctor said she was concerned the baby isn't gaining enough weight. She asked how much we were feeding her and were told she needs way more. I was told to feed her 4 to 5 Tbsp of rice cereal per meal plus 2 to 4 tbsp of vegetables and 1 to 2 of fruit. Presently she is able to eat 2 tbsp of rice cereal and 2 tbsp of vegetable or fruit per meal and she currently only gets 2 meals. She is also breast fed between meals. I'm concerned because I was told she's too thin but I also don't want to stuff the poor girl. She has doubled her birth weight and now seemed to have slowed down immensely in gaining. She didn't gain any weight between her 4 month and 6 month appointments which is why the concern. Thoughts?

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  7. Hi Culinary

    Without more details it's very difficult to establish a clear overall picture regarding your daughters gain etc. If you wanted to email me some further details including; full weight history, full feeding history ie how frequently, whether exclusive or mix fed - whether breast or bottle delivered etc, when solids were introduced and whether anything occured between 4-6 months ie illness etc that could have influenced growth.

    Regarding food - if there is a genuine issue with weight gain, milk is the most calorific food an infant consumes, and so looking at why baby isn't gaining is the starting point. Baby rice is a white, refined and IMO pointless food lol which was designed for introducing food early ie pre 5/6 mths whilst minimising allergy risks (have u tasted it!?). Again most fruit and veg contain less calories and fat than milk.

    The risk with spoon feeding very large quantities of solids is one you might have noticed if you read any forums online. The mums are back days/a week later posting baby is dropping milk feeds too fast. Milk and good fats are essential for appropriate brain development and so swapping milk for something less nutritious may often not lead to the gain hoped for. The rice/veg/fruit method is one again designed for infants receiving solids before their systems are really ready - once they are 6 mths, one study in particular found only using these weaning foods potentially compromised nutrition.

    Ensuring appropriate milk intake levels alongside nutritious foods for a post 6 mth old, is in my experience far more beneficial.

    Anyway as I say, happy to chat further if you want to email me? :)

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  8. Love your blog but did want to point out that your advice of giving water in between feeds is actually a very dangerous practice. Babies get the hydration they need from Breastmilk, (or formula if that is the case). Adding water can disrupt the sodium levels in the babies body and lead to seizures and even death.

    http://www.associatedcontent.com/article/931669/infant_water_intoxication_babies_and.html?cat=25

    Otherwise, great post!!! I love reading like-minded Mom's blogs..:)

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  9. Hiya
    Thanks for your comments
    Just to clarify - I didn't give any advice on water. I added a quote from Dr Sears (and quoted it was from him) and his recommendation for non breastfeeding infants.
    The issue of water for non breastfed babies isn't one I've researched - but a quick google shows lots of sources still seem to feel small amounts are appropriate:
    http://www.babycentre.co.uk/baby/formula/extrawaterexpert/
    http://www.wholesomebabyfood.com/babyneedwater.htm

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  10. so very true. David was FF after 2 months and I always felt that he wasn't eating enough because he wasn't eating the "recommended amount for his weight." I constantly looked at how much the bottle had left instead of how he looked. Then... one day at about 3.5 months as I sat there giving myself a guilt trip for giving up on BFing so easily, I realized that it was so much easier to BF him because I had to look for fullness cues, not how much he was getting. After that, I looked at his cues instead of the bottle. He always drank under the "normal" amount of formula, but was still growing like a tumble weed.

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  11. I can't remember if it was a Paul McKenna programme I watched, but I watched a programme which took 2 people to a 'greasy spoon' cafe, gave them a very large cooked breakfast, and asked them to eat it. They ate the lot.
    Next day, same 2 people were taken back, blindfolded, to eat the same cooked breakfast. They couldn't finish the food - because they couldn't see it. They listened to their stomachs telling them they were full, instead of their eyes telling them they hadn't finished.
    Seems the same with the mum forcing the milk down the baby, except of course, the poor baby can't yell at the mum to stop it!

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  12. On the issue of overfeeding I wonder about BF infants with colic. Both of mine have suffered with this and I have used the breast to try to calm them but they have then taken milk rather than just comfort sucking only to sick it up again and so have taken milk they don't "need", although this is not forced on them.

    I often hear that it's not possible to overfeed a breastfed infant as they will be sick if extra milk is taken, but so are FF babies which always confuses me.

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  13. Another issue that can lead to overeating is scheduling feeds. If a baby isn't fed in response to his hunger cues, when he does finally get to eat, he's likely to overeat. After all, he can't be sure that he'll get food next time he's hungry.This sets up a pattern of always eating a bit extra, just in case, and can lead to a lifetime pattern of overeating.

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  14. One thing about eating until full-- some folks think that full means "I can't eat one more bite." I've found that I eat until I am no longer hungry which is easier to tell if you do eat more slowly. This does mean that I tend to eat four times a day and doesn't work well for some workers such as nurses who soetimes work through a set lunch break. Not waiting to eat until you are ravenous helps since it seems to cause you to eat faster sand stuff yourself.

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  15. This whole breast feeding is very good for those that can, there are those parents who desperately want to produce their own child let and when eventually they were gifted with that precious son breastfeeding was not to be. Some children who through no fault of their parents cannot have breast milk and therefore have to have the alternative, but 18years later are not obese and are healthy, handsome and a son to be proud of, not throught the want of trying to breasfeed.

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  16. Yes Anon I agree -which part of the blog post re not twisting bottles did you feel suggested otherwise?

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