Responsive feeding is the practice of listening to a baby's communication about hunger or being full, then responding warmly and consistently by offering food or stopping the feeding. This includes offering food when baby "tells" you he or she is hungry (even if it's not "feeding time") and also stopping the meal when baby indicates he or she is full (even if the bottle is not empty or baby "usually" eats more.)
Sounds fairly straight forward, right? It's actually not. Many, many parents and medical professionals get tripped up with implementing responsive feeding.
Who's at risk for struggling with responsive feeding?
First time parents and those of us who have a baby who does not gain weight initially as expected tend to be at higher risk for struggling with responsive feeding practices. Feeding an infant can be more challenging than it looks! And when you are not familiar with how often a newborn baby might need to eat, or what the signs are of hunger or fullness, or even why it would be so important to feed according to cues instead of on a parent-driven schedule... well we get it! It's challenging.
My (Kary’s) daughter was jaundiced shortly after birth and a little sleepy in those first few days. This meant I needed to try to wake her to eat fairly regularly. I remember on our first day home from the hospital she slept for 5 hours straight and I tried unsuccessfully to wake her every hour or two. I recall how stressed I felt and how impossible it was to actually wake her up! It wasn’t responsive feeding and getting to a place where we could practice responsive feeding took a few days. Not ideal but so much easier to navigate than many of my peers’ experiences (such as a friend whose baby had a week + NICU stay, one friend whose baby had more severe jaundice who had to be re-admitted to the hospital, or another friend whose premature baby was very sleepy, disorganized, and small and who needed several weeks to mature and grow before he woke consistently to eat).
Responsive feeding can take time and there may be times where it’s actually not wise to feed responsively. Generally though- those times where we aren’t feeding responsively should be brief and ideally society/the medical system should be giving active support to parents during those times. (We can dream!)
Responsive feeding is recommended by the American Academy of Pediatrics (AAP) and is built on the theoretical foundation that nearly all infants are born with the internal ability to feel hunger and satiety and to respond to those internal cues in order to eat "the right amount" for their body and brain to grow at the rate it's meant to grow. The parent who feeds responsively practices an essential skill of carefully watching their baby for communication of hunger and fullness in order to help their infant follow those natural internal cues. In doing this, the parent allows her baby to maintain that innate ability to rely on internal hunger and fullness cues rather than learning to eat based on what someone else decides is the "right" amount or the right time. Listening and responding promptly to what baby is telling you about food can also be foundational for helping baby understand the power of communication—developing the belief that he or she can impact the world.
How to practice responsive feeding
The first step is understanding and responding to an infant's feeding cues, which include the signs that the infant is ready to eat and the signs the infant is done.
In order to feed responsively, you must be able to understand your baby's, "I'm hungry" and "I'm all done" cues.
Typical newborn "I'm hungry" cues:
Waking up
Licking the lips
Opening and closing the mouth
"Rooting" or opening the mouth, turning the head, and searching for food
Making sucking noises
Bringing hands to mouth
Moving around or being more active
Fussing
Active crying
Typical newborn "I'm full" cues
Stopping sucking
Starting and stopping sucking
Falling asleep
Letting go of the breast or bottle
Pushing nipple out of the mouth
Turning away
Keeping lips closed
Sucking with little "flutter" sucks rather than big sucks
Remember- babies are not meant to eat the exact same amount at every meal. If your baby is acting full after less milk than expected, THAT’S OK--give him a break or stop the meal all together. That’s what Responsive Feeding is all about. Our appetites fluctuate throughout the day and so does an infant's. When we respect "I'm full" cues, baby learns to trust and respond to their own internal cues.
But, we get it. It's stressful (and natural) to worry about your baby's growth. Did I feed him enough? Is she growing well? Am I doing this right? If you're feeding responsively, listening to your baby's communication, it's possible at first you might misread those cues. It happens to the best of us because babies can be confusing and sometimes you get a *little tired* as a new parent which can make it hard to be your most pulled together self (or basically function). Thankfully we check-in with our baby's pediatrician regularly in those first few weeks of our baby's life. At those check-ins, the pediatrician can check your baby's weight and growth which can give you feedback to know if they way you are responding to baby's feeding cues is on target or needs some adjustments. If it needs adjustments, that's OK (join the club.) We're all learning and the more feedback you get, the more you learn, the quicker you become a total pro.
Past your baby's first month of life, you're checking in less frequently with your pediatrician. Also, even when you are checking in regularly, it's nice to know what you can look for to tell you feeding is going well. Here are the signs that you're reading those feeding cues correctly:
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Lots of wet and poopy diapers everyday. LOTS. Like 6-10 wet and around 3 poopy diapers in 24 hours at first. As they get a bit older they may poop once per day or less.
The poop will change from black and sticky in the first day or so, to green, to yellow and seedy looking (really, it will look kind of like chia seeds in there. It's 👌🏽.)
Baby is waking to feed every few hours. Newbies- especially under 36 weeks can be challenging and sleepy. Couple that with a nice hospital-grade swaddle, your baby may happily sleep straight through a feed or two and over time start to get even more drowsy because he's not eating enough to have energy. If baby isn't waking to feed every 1-3 hours at first you probably will need some feeding support.
Baby is gaining weight. (Now this isn't the end-all-be-all but it's one sign baby is eating enough. Past the 2 week mark, you're checking in less frequently with your doctor so you can't rely heavily on weight gain to calm your parent-worry. Plus please keep in mind that babies should lose weight in the first few days immediately after birth then regain that weight by around 14 days old.)
Baby has energy for play (by "play" we just mean waking up and looking around).
If your baby seems constantly drowsy check in with your baby's doc or lactation support- don't wait until your next scheduled visit- call and speak with the advice nurse or whoever you can speak with who can either put your mind at ease or make you a sooner appointment.
If it turns out you're not quite reading baby's cues correctly yet, take a deep breath and forgive yourself then use the information to adjust. You'll hit your stride with practice.
What happens to responsive feeding when a baby is underweight? Teetering on the edge of a "failure to thrive" diagnosis? We'll explore this in a future post! We're also going to explore responsive feeding from the lens of a feeding therapist next!