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.

Stop Weighing Babies Like Stranded Beetles!

Imagine the scene - you're a tiny baby and not long ago your home was warm and cosy, cushioned in every sense from the outside world.  Suddenly you're shunted into a bright environment, noises are no longer muffled and food is no longer delivered around the clock.

But it's OK, you're snuggled up with mum and her familiar voice, her skin and now her scent help you adjust as she tends your every need.  You've just settled down for a nap when out of the blue someone strips you starkers, then plonks you on a thin piece of paper, on top of cold hard plastic scale like a stranded beetle.  Your startle reflex is triggered, your hands come up to your face and you let out a big shout, WTF is going on?
You might kick your legs and wave your arms, why is nobody moving me you shout? Hello! I'm letting you know I'm really not OK with this!

As a result the numbers on the display dance a Cha Cha up and down as watchful eyes wait to see where it will land (if you lay still long enough).

Why do many insist on weighing babies in this way? I don't get it, especially given we don't use analogue scales for weighing anymore.

When I'm baking I could weigh fluid by tipping it all over my digital dinky number, or I could put a bowl on first - tare the scale and then add the liquid. 
The liquid weighs exactly the same whether it is in a suitable receptacle or not, yet one is far more practical than the other.

Why is weighing a baby different?

Why can't we pop a snuggly blanket on the scale, tare them and then place baby prone, a position they are generally much happier in.  Arms and legs are less likely to flail as the startle reflex isn't triggered - making everything quicker.

In fact do we even have to undress baby at all?

I'm not convinced we do and for some babies this may be even more important.  Premature infants for example need a cardigan, hat and blankets - even in a hospital.  Their skin is thinner and maintaining body temperature is something that can be hard work for them - stripping them off also often prompts lots of crying in these babies too, burning energy and generally stressing their system.

So, back to the baking analogy above.  If I put a bowl on the scale, a cup inside that, an egg cup inside that - tare them and then add fluid; the reading is just as accurate as it would be just with the bowl.

Applied to babies, if parents are aware their baby will be weighed why can't they dress baby in a vest and/or babygrow and/or hat depending on the weather/baby's age, and have a spare set of identical items on hand (as per multipacks)

Place the above along with a new identical nappy and a snuggly blanket on the scale and then tare   Remove the vest, romper and nappy and they will tip to a negative balance.

If you then place baby dressed in a clean nappy (ie change it immediately before weighing), vest and romper as above on top of the blanket prone - tada, you have the same reading as if you stripped baby butt naked and laid him flailing on his back.

Even if you do want to strip baby down, placing a young baby on his tummy on a soft surface, tucking his arms and legs underneath him if he is still quite fetal and curled can help lots.

Really, the stranded beetle is not an essential part of weighing your baby - remember, tummy to the scale if you don't want them to flail...

Slumber Bear - Depriving Newborns Of Contact?

I stumbled upon a forum the other day where "baby essentials" were being discussed. As you know I think there are very few things that are truly essential when baby is small - and as the discussion following the above entry highlighted, essential varies widely parent to parent, baby to baby.

But I did notice the "Slumber Bear" was mentioned several times so I went to check it out.

The description from Amazon:
"Designed by a doctor and used successfully in maternity wards for over 30 years, the Prince Lionheart Slumber Bear Plus has helped millions of newborns (and their parents) get a good night's sleep. The Slumber Bear Plus features a multi-function sound box playing womb sounds, lullabies, ocean waves and white noise. There is also a recordable feature allowing you to save your own unique message for baby. Comforting sounds lull baby to sleep in minutes and sound and motion sensors reactivate the recording when your baby cries or jostles the bear.
Each Slumber Bear Plus arrives with its own silkie. Parents can bond with baby by keeping silkie close to their skin, transferring their scent to the blanket. The scent then comforts and reassures baby when parents are out of reach and the soft, smooth texture provides beneficial tactile stimulation."

"How it was designed ... By placing a specially designed 8mm microphone inside a pregnant mother's uterus, directly next to the unborn infant's ear. Insertion of the microphone moments before the mother went into labor enabled Dr. Eller to record the major intrauterine sounds that the baby had been hearing for the last four to five months prior to birth. The recorded sounds were then clinically tested on thousands of babies in hospital nurseries, and proved to be a natural audio baby pacifier. Based on the knowledge that the birth experience and transition from the peaceful, quiet existence inside the mother's body is a very traumatic time for the newborn, it has been proved that the recorded intrauterine sounds produce a calming effect on the newborn infant after birth."
  Firstly I wonder how they define a "good night's sleep", is that by the newborn standards or parental norms?   Secondly why on earth do parents need to bond with baby via a piece of cheap cloth?  You can hold the cloth to transfer your scent, then this cloth can be reassuring to the baby?

Seriously how did the human race bond before?

Perhaps (just throwing random ideas out there) they held the baby, he was in turn comforted by the scent, touch and sounds of his mother or father - oxytocin was released all round and thus they bonded?

Now babies can't have free access to their parents, instead they have to learn to soothe themselves to sleep alone - with parent smelling material and a machine making parental sounds?

The trouble is it seems, that newborns need their parents - but that doesn't make money!  As is highlighted above, transition to the outside world can be traumatic for newborns; as a result they are meant to stay close to their mother - her scent, milk, voice all serving to ease that transition.

If a baby needed to hear womb sounds to settle appropriately, wouldn't our bodies make this sound?  Or maybe babies actually only need this if separated from their parents - if they can't have the real thing.  Doesn't it kind of trick babies into thinking they're close?

And is this a risk free plan?

Earlier this year a study by Nils Bergman published in Biological Psychiatry found:
Heart rate variability in 2-day-old sleeping babies for one hour each during skin-to-skin contact with mother and alone in a cot next to mother's bed. Neonatal autonomic activity was 176% higher and quiet sleep 86% lower during maternal separation compared to skin-to-skin contact."
Indeed Dr. John Krystal, Editor of Biological Psychiatry, commented on the study's findings:
"This paper highlights the profound impact of maternal separation on the infant. We knew that this was stressful, but the current study suggests that this is major physiologic stressor for the infant."
 Read more here

From the description above, note how the product was developed and tested in hospital nurseries - places where babies are separated from their mother and placed alone in cots.

Read the reviews on Amazon and it's noted how great that when the baby makes a sound it restarts and soothes them!  No parental effort required, genius.  If the cot is next to you, give it a tap and away it goes.  I don't see any reviews from those sleeping with their baby, only from those having trouble putting their baby down alone or settling/sleeping alone.
"His Mummy wore the snuggle blanket down her top for a night to make it smell of her and now the combination works a treat.  The little man keeps hold of his snuggle blanket while asleep and if ever he wakes with a start the noise machine kicks in and soothes him back to sleep"
"Firstly I should state that this has been absolutely instrumental in getting my baby to sleep in her own bed and I would recommend it to anyone who's baby has trouble self soothing."
"Bought this as a last resort for our baby who would only ever settle in our bed, as soon as we tried to put him down he would scream. Now he falls asleep to the womb noises and also settles very quickly."
"We bought this for our son when he was 4 days old as he wouldn't settle in his crib at night."
"Slumber bear - only thing that got her to sleep in her basket"
Notice the pattern?

Plus some rather worrying ones:
"We had an eight week old baby who wasn't sleeping and thought, what the hell, we will try anything! Within a few nights we could see her settle."
"I credit this with helping my baby learn how to sleep. He is 4 months old now and has slept through the night (12 hours a night without waking up) since he was 2 and a half months old because each time he woke up at the end of his short sleep cycles not for a feed it helped him get straight back to sleep."
8 week old human infants aren't supposed to sleep for 12 hours without waking up - they're meant to wake and rouse (for a whole myriad of reasons).  Using something like this to induce abnormal sleep/wake cycles isn't "natural" or beneficial to the baby - even if it's convenient to parents who want their 12 hours!

Perhaps someone will come up with something so the parents don't even have to faff around feeding baby themselves, the other big newborn need.  Depriving baby of even more contact...

Oh wait, they did already!

So there may be risks baby will choke, but you know parents are busy nowadays!  Who has time to stop and feed a baby anyway - let alone get up and soothe one when you can kick the cot and have it done for you.  Babies are hardy, they will adapt with lots of gadgets to replace their parents right?

Nappy changing robot anyone?

PS - white noise can be settling to an overtired unsettled infant; vacuum cleaners, untuned radios, hairdryers, white noise machines and white noise phone apps are all available. Sure they wont restart when your baby murmurs, wont play womb noises but if these are more than occasional use items it makes more sense to address the cause of the fussyness and consider whether expectations are realistic.

Bottle Symbols V Breasts

Recently there seems to have been lots of posts on Facebook complaining about the bottle symbol being used to identify something baby related.  From phone apps to feeding rooms, children's TV shows to T shirts it's everywhere.

Without fail the comments that follow include things along the lines of:

"I don't see the problem, there are bigger things to worry about"
"It could be expressed breastmilk in the bottle, what's the big deal?"
"It's no big deal, they can hardly use a a giant breast!"
"Not sure they could pictures of boobs up in department stores..."

Here's the most ironic example I've seen:

Google "Nursing a baby" and the information relates to breastfeeding.  I haven't heard a non breastfeeding mum use the term "nursing" to mean bottle feeding.  It can mean cuddling/holding in some areas, but I'm pretty sure this isn't a designated cuddling room!

So even when advertising a breastfeeding room, we have a picture of a bottle?

I don't get it.  What is a bottle but a replica of a breast, nipple and all?  (although we Brits call them teats not nipples, as that would be a bit too breast like thank you very much!)

So if we can use an icon of a bottle and it not cause offense, is an icon of the real thing really that "out there"?  Let's take a look:

Gosh yes, see how offensive that is?  

I can see why that plastic container bit at the bottom makes it so much more acceptable that a real breast icon, the round fullness of the breast positively perverse compared to the tall sleek container!

Oh but wait we can't use a real breast anyway, because that might make bottle feeding mums feel guilty right?  You can put breastmilk in a bottle but not vice versa so the first is more inclusive?  Because we often see mums hiding their bottles under fancy covers or feeding shut away in dirty rooms with nappy bins...

Perhaps we should introduce the viagra logo as the international symbol for sex so as not to offend those who can't "perform"?

I contacted John Lewis last week, and asked if the bottle picture on the baby feeding room meant the room was just for bottle feeders.  Their reply:
"Although a bottle is used as it is a universally understood symbol for baby feeding, we encourage breastfeeding in all of our stores." 
Is it really universal?  do Norway, Sweden etc use bottles to symbolise a baby feeding room?

The very fact John Lewis feel a bottle is the universal symbol for feeding in itself speaks volumes about the culture we live in.

Then consider we need a special room for mums to go and do it in! If they're lucky we even give them little cubicles so everyone is spared the sight of a human infant feeding:

I don't actually think the logo should be a breast, there is an International breastfeeding symbol shown here on the right which I think is pretty inoffensive all round:

But ultimately the point is that it's only in a bottle feeding culture the above would even be debated or relevant.  As individual stand alone symbols, it seems reasonable to suggest it's not a big deal, but add together all the little things and soon we have a big thing.

Think of it like this - take a child being confrontational.  As one stand alone incident, it's not be a huge deal if your child typically is co-operative and communicates well.  But if the same child was confrontational every time you spoke to him - it becomes a big deal.

The culmination of all the ways bottle feeding is drip fed as normal within our society, is significant, it does matter.  In order to effectively support women who want to breastfeed to do so, we have to create a breastfeeding culture - a society where feeding human infants milk of their own species is normal, not special, best or optimal.  Breastfeeding advocates realised this in the early eighties as this fascinating piece highlights.

It's illogical to say these things don't matter, we need to just focus on helping mothers succeed - because societal norms are ultimately key to this success

If you don't want Health Professionals undermining breastfeeding by suggesting bottles at every turn, if you want them to understand breastfeeding and know how to resolve problems - we need to create a breastfeeding culture.

If you want Doctors to have more than a bare bones knowledge of breastfeeding and to consider feeding as more than a "lifestyle choice" - we need to create a breastfeeding culture.

If you want research and media to hold breastfeeding as the normal way to feed a baby, with alternatives compared to this norm rather than vice versa - we need to create a breastfeeding culture.

Still not convinced?  Here is an excerpt from an email I received recently from an amazing young mum trying to establish breastfeeding:
"I went to see my GP because of the pain and she started ranting about how disgusting it was for new mums to feel so guilty they HAD to breastfeed, that there was too much pressure. I said I didn't want to stop I wanted to feed him myself because I knew it was best but I just wanted to know why it hurt so much. She said that he'd had the best stuff and I shouldn't feel bad if I wanted to stop now. Might be because I'm a young mum but she was no help at all."
I wish I was surprised, but look at the quality of information provided by celebrity Doctors and pretty soon you might find yourself overwhelmed by the urge to introduce your head to the nearest hard surface.

We simply can't change this within the current culture, we can't expect quality advice, for people to accept and treat breastfeeding as the norm - if those same people ultimately perceive bottle feeding as the "normal"way to feed an infant - the two clearly are simply not compatible.  The truth is if we want women to succeed at breastfeeding we need a breastfeeding culture - nothing less will cut the mustard.

UPDATE: John Lewis have been in touch to say they are in the process of updating all their store feeding room logos to be an image of a baby, rather than a feeding related icon!

Related Links:
Taking Down The Almighty Bottle
The International Breastfeeding Symbol

AA Answers The Daily Mail Question - How To Keep A Hungry Baby Happy

Health: How to keep a hungry baby happy - Daily Mail

I didn't like Sarah Stacey's answer in the Daily Mail on the link above to the question below
. So I decided to reply myself.

Q: I am a first-time mum and don’t produce enough milk for my hungry six-week-old baby boy at night, which makes us both stressed. I want to avoid using formula if possible so the health visitor advised expressing milk with a pump in the mornings – when I have plenty – but I find a manual pump very difficult to use.

A.  What makes you think you don't produce enough milk at night? During the evening it's very normal for babies of this age to cluster feed, which is when they take multiple feeds with shorter spacings in between, sometimes back to back.

In the early days, hunger is driven partly by a hormone called CCK - the same hormone that induces relaxation and sleep. After a feed baby has a high level of CCK, which tells him he’s full, but it drops after another 10 or 20 minutes, so he thinks he’s hungry again. He may go through this loop several times, in what’s known as cluster feeding, before dropping into a solid, longer sleep. This is thought to allow baby to fill their whole digestive system, so excess hunger doesn't occur during a longer sleep spell.

The other thing to consider is that babies often have something called a "growth spurt" at 5-6 weeks ish (sometimes termed "fussy spell"), which can last anywhere from a couple of days to a week or so. This is when a previously settled baby has a sudden increase in appetite and wants to feed feed feed, sometimes appearing insatiable and generally fussy.  It's a normal developmental step seen in both breast and bottle fed infants and they may have a few days sleeping lots after the spurt, which is when some suggest the growing (physically or mentally) occurs.

Therefore the first thing to ascertain is whether you really are not producing enough, or whether you actually have a perfectly normal supply and your baby is just doing what  babies do (but which many "experts" fail to tell parents about).

You mention you have plenty in the mornings, enough to express - which wouldn't suggest a shortage of milk?  It is though totally normal for milk volume to be greatest in the morning and fall gradually as the day progresses, which can leave mums concerned there isn't enough.  But it's also worth knowing that if we measure the fat content of feeds this increases during the day as volume decreases - magic!

Really you need to look at the big picture.  Does baby pee, poop and gain weight as expected, was he previously settled after feeds and you felt things were going well prior to this point?  Is feeding pain free?  If you answer yes to the above, following your baby's lead and feeding on cue is the quickest way through a fussy spell without using formula (which you mention you would like to avoid using). 

If not and your baby remains unsettled or you're experiencing any pain or discomfort,  there is specialist help out there.  From Lactation Consultants to Breastfeeding Counsellors there are lots of options if you know where to look.  Ask your Midwife or Health Visitor for details of local groups and breastfeeding counsellors, find out who is your local Infant Feeding Advisor or call one of the helplines.  If you prefer there are also private Lactation Consultants who charge for their one to one services.  Keep hunting for effective support, with which the vast majority of mums can make enough milk to satisfy even the hungriest of babies.

When The Breastfeeding Baby Bites

Common advice for a biting breastfed baby is to say no firmly, show baby you mean it and sometimes even sternly place them on the floor.  Indeed Babycentre say:
"Say no firmly, look him in the eye with displeasure and stop the feed. He needs to associate biting with losing the breast - most babies will dislike this separation.  If he persists, put him on the floor for a short time immediately after he bites."
Other advice varies, La Leche League say:
"A mother's natural response to pain may discourage further biting. Many babies startle at their mother's loud exclamation and immediately release the nipple. Some may even cry. This negative reinforcement seems to make many babies stop completely."
Although they do acknowledge:
"Such prompt and direct responses occasionally backfire with sensitive babies, who may react by refusing the breast altogether. This sudden disinterest in nursing or outright rejection of the breast is called a nursing strike. A nursing strike can be distinguished from actual weaning by its sudden onset and the fact that the baby seems miserable. It may take lots of coaxing to persuade a baby who has been "on strike" that it's okay to resume nursing. Therefore, it is wise not to exaggerate your response to biting beyond what is natural for you."
but even they add:
"Some mothers may want to take firmer action after a bite and quickly sit baby down on the floor. After a few seconds of distress, baby can then be comforted and should get the message that biting brings negative consequences." sensibly point out:
"Try not to scream. While it will get baby's attention, it may also be a "reward" for that high need baby who likes lots of action. Of course, sometimes, screaming can't be controlled!"
Is being firm and strict the only way?

To me the above all seems a bit Supernanny, the baby equivalent of time out.  Firm, displeasure, forced separation (rejection) distress, negative consequences all feature in the above.  For babies?  Saying no sternly, showing them you "mean it" etc is very different in the context of nursing than it is if you say no for other trivial things.   Some babies as discussed above can seem to think the act of them nursing has caused the displeasure, or simply don't know and become distressed - responding by ceasing nursing rather than stopping biting.

If we work from the basis a baby knows that biting hurts and he shouldn't do it and thus is deliberately causing someone pain - perhaps the above logic makes more sense.  But I've seen these suggestions for babies 3 months and over, not a 2yr old .  If the potential result is a nursing strike, shouldn't we be exploring if there are other ways of solving the problem?

Is the important message we want to convey that biting causes them to "lose the breast"?  Or is it actually that biting hurts and so we shouldn't bite people?  Which message is the baby able to apply to other situations as they grow?  Do we want our children to not do something because they recognise it's the wrong thing to do, or for a self centered reason ie to prevent something they have being taken away?

The age of the baby and the timing of the bite is also key.

If baby bites at the start of a feed, it can indicate the tongue is not moving forward over the gums as required.  When a young baby gets something in their mouth it triggers the clamp and bite reflex - if the tongue is forward as it should be for nursing, this prevents biting.

For this reason we find babies who have a shallow latch are far more likely to bite, as are tongue tied infants.  Some babies with tongue tie will extend their tongue, but it retracts when touched - this means they come to the breast tongue forward, go to latch - the tongue retracts and they inadvertently bite.

Biting mid feed can be an attempt to increase flow of milk, and a baby having difficulty effectively transferring milk can try this trick, particularly if they have a sippy cup that requires biting to release liquid (such as the leak proof ones with a valve).

Just like above, if the baby starts to slip down the nipple when feeding - the bite reflex may again kick in.

End of feed biting may be something baby tries out when he's finished nursing, just to see what it's like or perhaps because they're teething and gums are sore.  Remember though they have no concept that it hurts - they may like the feeling of biting but babies simply aren't capable of maliciously intending to cause pain.

So let's think about the above again from the perspective of a baby.  Someone who has no idea what being bitten feels like, and even if they have been on the receiving end from another child - still don't make the connection until older that they are causing similar discomfort.

If you accidentally did something that hurt someone, would you prefer them to sternly and curtly reject you with a "no" or would you prefer them to explain that it really hurt and that they really would like you to not to do it again.  Wouldn't the first leave you confused?   What would "no" teach you?  Surely far less than understanding your actions caused pain..

As the second website highlights - baby may find it all a bit bemusing and so try different things he did around that time to provoke a similar response or just repeat the exciting noise he got mummy to make.  That's as far as baby logic goes...

  • Check positioning - if baby is straining slightly to reach the breast, as he tires he can slip back a little prompting his bite reflex (this can also happen if baby falls asleep and starts to fall off).  Holding baby nice and close can help.
  • Feed baby on cue - a schedule fed baby may be more likely to bite if they don't want to feed when offered.
  • Excessive biting is worth checking out with a Lactation Consultant or suchlike, because as discussed above if the tongue is restricted we note baby may be more likely to bite when younger, but also when bigger.  The nipple is more likely to slip causing biting, and some use a compensatory technique to get around the restricted tongue which works until teeth appear!  It can also be a technique to try and increase milk flow.
  • Stop the feed -  but swap stern and showing who is boss, for hurt/pain ie the genuine emotion you feel in that situation.  How you express this depends on the nature and age of your baby.  For some a sad face can suffice, particularly the more sensitive type; some respond better to a pretend cry (as they do to indicate their discomfort).  Some may smile/laugh, although with babies this isn't always genuine amusement - they may instead dislike the emotion you're conveying and so try smiling/laughing in an attempt to encourage you to mimic them.
  • Express it hurts - sadly/genuinely/gently, not angrily.  For a younger baby a simple "ouch, biting hurts mummy", can suffice.  For an older nursling you can explain "biting hurts, please be gentle" or "if you need to bite, you can bite this (giving a teether or suchlike) not mummy" etc
  • Offer something else they can bite - a damp (clean!) facecloth placed in the freezer for a short period can make an instant teether a younger baby can hold on to.  Some mums find something cold before a feed (or applying typical teething remedies if used) can prevent biting during feeding, others find it makes it worse..
  • If they repeat - some may find all the response to the biting so interesting they go straight back for another go.  This isn't your baby being naughty or challenging you, it's normal learning about cause and effect, how/why etc.  Instead of stopping the feed and placing baby elsewhere, again calmly repeat the above and then isntead of re-offering immediately distract with something else or find something else interesting for you both to do. This still sends the message biting hurt and can't continue, without distress and rejection.
"Pain" or "Ouch" 
  • Try baby sign - I believe signing is a fantastic way of babies understanding big concepts like pain.  You can sign it when they bump or hurt themselves, if someone else hurts themselves and shows distress and so when you sign it, it can help them link everything together.
The pain sign is directional so you can move it to the appropriate point of pain ie if it's a painful foot you sign pain over the foot, a hurt breast the same. As a result I've seen preverbal babies able to convey their gums hurt by signing in their mouth or one 13 month old tell the doctor his throat hurt - it can be invaluable in other ways too!
If my youngest nibbled during feeding and I explained it hurt, from around 10/11 months he would sign sorry and reattach super carefully -

  • Hawk eyes - as discussed a baby has to shift from a good attachment to one with his tongue retracted to bite (which he may do by pulling backwards), so watch closely and remove him quickly as soon as he starts to adjust.
How to remove a biting baby from the breast
Simply pulling a baby from the breast can cause damage to the nipple and potentially further clamping

1. Pop your finger in the corner of your baby's mouth between his gums (or teeth!) Keep your finger
there to prevent further clamping whilst you pull nipple away.

2.  When you notice baby starting to slip backwards, pull baby closer to the breast - this can prevent biting and prompt an open mouth to extract your nipple.