Sunday, November 11, 2012

Crying: "a LATE sign of hunger"

What exactly does the American Academy of Pediatrics statement on breastfeeding mean when it says, "Crying is a late sign of hunger."?

Establishing a pattern of feedings does not mean setting a rigid timetable and insisting that your baby breastfeed for a set amount of time or eat a full 4 ounces (120 ml) at each feeding. It’s much more important to pay attention to your baby’s signals and work around her needs.
During the first month, breastfed babies indicate interest in feeding when they begin to root (reflexively turn toward the breast) or place their fist in their mouth and start sucking. Crying is a late sign of hunger. It is easier to get the baby to latch on and feed when she is showing the early signs of rooting or lip smacking.
1. A feeding pattern is not a timetable.
2. Pay attention to your baby's signals.
3. Typical signals include: rooting, putting a fist in the mouth, sucking fist/other things, lip-smacking
4. Crying is a LATE signal.
5. Lip smacking, rooting, sucking a fist etc. are early signals.
6. Late signal - that means you somehow overlooked the early signals.
Your job as your baby's mother is to pay attention to YOUR baby. Not most babies. Not the schedule that works in institutional settings. Not the advice written by the parent of a different baby. Your baby.
In watching your baby, you will begin to see a pattern of behaviours suggesting that he may be hungry.  The hard part of course, is that you can't tell when another person feels hunger! This is important because a newborn can't tell when he is hungry either!
There was no hunger or thirst in the womb.  After his startling transition to the world of bright lights, loud noises, air-filled lungs and the surprising sound of his own voice, he is soon calmed by a familiar sound: his mother's voice. She holds him close and he feels her warmth and her heartbeat. He instinctively seeks her nipple and begins nursing. A little later, he becomes aware of a gnawing discomfort within him. What is it? He doesn't think "I'm hungry," because he's never experienced it before. His cry is therefore a cry of helplessness, not 'hunger'. Something's wrong in his world, and he doesn't know what to do about it! He cannot do anything about it! Nursing the baby at the first signs of fussiness, calms and soothes the baby.

Scheduled feedings can lead to fussy, irritable babies. Feeling discomfort, baby squirms. He becomes restless. He grunts. Where's my mother? She picks him up. He smacks his lips, and his fist goes to his mouth. Mom's here, but it's not it's not getting better. He fusses and she talks soothingly to him, telling him it's not time to eat yet. It's not helping! He finds his fist and sucks it. I don't feel right! Mom bounces him on her knee. She gives him a pacifier, trying to make him wait just a little longer. Now he's getting frantic.  Something's wrong! He starts crying so she finally feeds him.

That crying is a late signal. LATE, because mother did not PAY ATTENTION when he first began signalling. Late, because when he was instinctively rooting, he didn't even know he was looking for a breast. But if a breast were readily available before he became frantic, he would have found it and settled very quickly.
 Some babies are so upset by this time, they  have difficulty latching on to the breast. They arch their backs and flail their little arms. With his repeated latching on / coming off frustration, Mother becomes frustrated too. Why he just doesn't  eat? She concludes this means he is just having a fussy time, and isn't really hungry. Following a rigid feeding routine in this manner is actually establishing a pattern of confusion and dysfunction in the mother/baby dyad. The mother feels the baby is rejecting her in his refusal to latch on to the breast.

If mother will pay attention to her baby in those early days and weeks,  nursing at the first signs instead of trying to fit him into a timetable, she will find her baby rarely cries. This is partly because she can read his early cues, and partly because he can trust her to always come. He knows she will come quickly, so he never needs to escalate to crying. This establishing a sense of trust and security.

Unfortunately this is known as demand feeding. It's unfortunate because it implies a bossy little baby ruling the household, demanding his mother's attention. What about a mother who demands her baby can eat only on an assigned schedule instead of when he feels thirsty or hungry?

Nursing "on demand" is harmonious and empathetic, building on the communication and relationship. Far from being demanding, a baby actually asks to nurse very respectfully: since he is unable to speak, he roots, smacks his lips,  or puts his fist in his mouth! If he has to fuss and cry to get fed, it's because he was ignored when he was asking politely!