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Common bottle feeding problems HOW WE CAN HELP you to resolve complex bottle feeding problems. 1. Is your baby well? A sudden change in feeding behavior often occurs when a child is unwell. See your doctor if your child is unwell, if she has any unusual symptoms OR if she's not drinking enough formula in a 24 hour period. 2. Check weight gains Mapping your baby's weight gains on a growth chart can tell you a lot about where to begin to look for the cause of a bottle feeding problem. If your baby is NOT gaining enough weight or is losing weight, she needs to be seen by a doctor to rule out any illness or physical problem. However... where a child is gaining weight, feeding difficulties are rarely due to a medical problem. There are many reasons why a baby may develop bottle feeding difficulties. Most are easily corrected with minor changes to feeding management. More complex feeding problems are often the result of a combination of different causes and therefore may require a number of different strategies to bring about a resolution. Reasons for common bottle feeding difficulties 1. Feeding nipple The most important piece of feeding equipment is the nipple. The nipple needs to be the right size and speed for your baby's size and age. If the nipple is too long, too short, too fast or too slow for your baby, then she may experience feeding difficulties as a result. RECOMMENDATIONS:
2. The nipple ring is attached too tightly! Air needs to enter the bottle to replace the milk your baby has taken in order to balance the pressure in the bottle. Air enters the bottle either between the nipple ring and bottle OR through the holes in the end of the nipple*. Feeding difficulties can develop if air cannot enter the bottle e.g. if the nipple ring is screwed on too tight and your baby also maintains a seal over the holes of the nipple with her tongue. *Some orthodontic nipples have an extra hole at the base of the nipple, near the nipple ring, for this purpose. When air can't get in to replace the milk your baby drinks, a negative pressure* begins to build within the bottle and this will start to hold the milk back. The greater the negative pressure in the bottle, the more effort it will require for your baby to suck against this pressure to get more milk. The extra work may mean she will 'wear out' before she has completed her feed. * To explain this, picture how the sides of a small juice box collapses when you drink the juice through the straw. This is because of the change in pressure. This change in pressure can also occur when your baby is bottle feeding. You won't see the sides of a hard plastic or glass bottle collapse, but when the pressure is strong enough you will see the nipple collapse. Even prior to the nipple collapsing, it's becoming hard work for your baby to suck against this pressure. You will know this could be causing more work for your baby if ...
If you deliberately want to slow her feeding down, then tightening the nipple ring will assist you to achieve this. If your baby has a strong suck, it can be helpful to start feeding with the nipple ring tightened, thereby using the pressure to slow her down. If she slows too much, loosen the nipple ring to make the feed easier for her. (as air can then enter the bottle between the nipple ring and bottle and maintain an even pressure throughout the feed). RECOMMENDATIONS:
* A common myth is that a baby will swallow these bubbles and will get gas or colic as a result. This is not true. 3. Feeding management Some feeding problems can be related to what can appear like insignificant things. For example, how you hold your baby and the bottle during feeding. RECOMMENDATIONS:
4. Feeding patterns Some babies develop a feeding pattern where they will only drink small amounts of formula at a time but want to be fed very frequently, sometimes every hour or two. Although this will not cause any problems for your baby, provided she drinks enough formula in total over a 24 hour period, this can become very tiring for you tying to keep up with the constant demand for feeding. RECOMMENDATIONS:
5. Misinterpreting baby's cues as signs of hunger Babies are born with reflexes, such as the rooting reflex and sucking reflex, that help them to feed instinctively. (A reflex is an automatic or involuntary response.) Often these reflexes are misinterpreted as signs of hunger and a formula may be offered. If your baby was not actually hungry, she may take only a small amount and refuse the rest. RECOMMENDATION:
6. Tiredness For babies, sleeping and feeding are closely connected it's impossible to deal with one and not the other. If a child doesn't feed well, she won't sleep well. However, tiredness can be the cause fussy, unsettled feeding behavior or falling asleep before the feed is completed. To deal with any feeding problem, first ask yourself - "Is my baby getting enough sleep?" If the answer is no, look for ways to improve her sleep pattern. Often feeding difficulties improve automatically, simply because sleep has improved. RECOMMENDATIONS:
7. Prolonged night feeding Unless your baby was born prematurely or is very small for her age, she no longer needs feeding overnight after the age 6 months. If night time feeding continues past this age it can begin to affect day time feeding patterns and feeding behavior. Your child only needs a certain amount of calories in her day (24 hours) to provide for her growth and energy needs. If after 6 months of age, she continues to receive calories from night time feeds, she will not need to drink as much formula during the day, and she may either fuss or refuse some of her daytime formula feeds. Night time feeding causes no harm and if you're happy to continue feeding her overnight, there's no reason to change a thing. However, you need to take into account that what she drinks overnight will also add to her daily intake, so you can't expect her to take as much during the day as she would otherwise. Many babies will give up night time feeding on their own accord, but others will hang on to the overnight feedings for months (possibly years). These babies may require a little "encouragement" from parents to stop. RECOMMENDATION:
8. Early introduction of solids Around 6 months of age is now the recommended time for starting solid foods, for both bottle and breast fed babies. Although a small number of babies may benefit from solids prior to this age, it's not recommended that babies start solids before the age of 4 months. An early start on solids can potentially cause feeding problems because solid foods may decrease a child appetite for milk (breast or formula). RECOMMENDATIONS:
9. Solids eaten before or in-between formula feeds If solids are offered prior to formula feeds, either directly before or mid way between feeds, when it's time for her formula she may feel full from the solids, in which case she may not take as much formula. RECOMMENDATIONS:
10. Too much solid foods In these early stages of learning to eat solids (4 - 7 months) solids are not needed to add value to a child diet but are offered to provide learning experiences for the child to discover new tastes and textures and get used to the idea of eating from a spoon. Some babies, particularly very young babies, are not aware when they have had enough and will continue to eat and eat. Other babies love eating solids and would prefer to eat solids rather than drink their formula. However, this does not necessarily provide a balanced diet for your baby and you may need to reduce the amount of solids you offer to encourage a greater appetite for formula. RECOMMENDATION:
11. Milk or food allergies Children can develop an aversion to a food that causes them discomfort, this includes milk. Does your child have any symptoms that could indicate a milk allergy such as wheeze, recurrent cough, eczema, diarrhea, blood in stools, failure to gain weight? RECOMMENDATIONS:
12. Gastro-esophageal reflux (GER) Babies with GER may develop feeding difficulties because they begin to associate feeding with the discomfort of heartburn. Reflux is a treatable condition, if managed correctly it should not cause your baby considerable distress. If feeding difficulties continue after treatment, it may be that reflux is not the ONLY reason for your baby's feeding difficulties. RECOMMENDATIONS:
13. Teething While teething, a baby may fuss with feeding or fail to drink as much formula as normal. Feeding difficulties related to teething generally don't last longer than a couple of days. RECOMMENDATIONS:
14. Oral thrush Feeding difficulties associated with a thrush infection in a baby's mouth are rare, but can occur if the infection is severe. RECOMMENDATION:
15. Distractibility Babies over the age of 3 months can easily become distracted during feeding. They are often much more interested in the activities going on around them than they are in feeding. RECOMMENDATION:
16. Natural slowing of growth An average baby will double her birth weight by around 4 months of age and triple her birth weight by around 12 months or age. The largest weekly weight gains will occur from birth to 5 or 6 months. During this time, the amount of formula she will drink will slowly increase to match her growth. However, around 5 - 6 months* of age, an average baby's rate of growth will start to slow slightly and she will no longer need as much formula as she did before. At this stage she will start to leave some milk in her bottles OR she may stop a feed completely. *Larger babies, who were off to a good start with large weight gains in the early months, will often display a decline in their rate of growth from as early as 3 months. For the average baby, a further slowing in the rate of growth can be seen starting around 9 months of age. At this stage she will once again start to leave some formula in her bottles OR she may not be interested when her bottle is offered. RECOMMENDATION:
17. Unrealistic expectations Influenced by a health professional, who has quoted figures on 'average weight for age' OR 'average daily formula requirements' for age or weight, many parents may begin to worry that their child is not be drinking enough formula. This can result in parents either intentionally or unintentionally pressuring their baby to drink formula the child doesn't want ... or need. Not all babies fit the "average" mold - some are smaller, some larger. It would be unrealistic to expect a small baby to drink what is considered average amounts of formula. Many big babies are either born large or gain very large amounts of weight in the early months of life. Because a child's genetic make-up strongly influences just how big she will ultimately become, her weight may not continue to follow a particular curve of a growth chart, but drop to closer match a similar curve to where her length currently sits. RECOMMENDATION:
17. Weaning difficulties Although some breast fed babies willing accept formula from a bottle many will not, at least not straight away. Difficulty weaning from breast to bottle is rarely resolved by finding the "right" feed nipple, as feed nipples will feel equally foreign to a breast fed baby. Nor does a solution lie in finding a formula with the "right" taste (all formula will taste strange to a breast fed baby). Difficulty with weaning to a bottle most often lies in the fact that bottle feeding requires a very different sucking action to breast feeding. During breast feeding the movement of your baby's tongue milks the breast, where as bottle feeding requires much more of a sucking action. A baby that has been exclusively breast fed for any length of time will often refuse milk from a bottle because it "doesn't feel right". Also using a breast feeding action does not work well on a bottle and is unlikely to provide results. It may take time and practice before your breast fed baby "learns" how to suck on a bottle, before she can effectively feed from a bottle. RECOMMENDATION:
* Many breast fed babies will refuse to accept a bottle while they are still being breastfed at times. For these babies it's one or the other, but not both. Additional tips for bottle feeding difficulties
HOW WE CAN HELP you to resolve complex bottle feeding problems.
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