Responsive Feeding: Why Is It So Difficult?

I’ve just returned from a holiday in Salcombe and aside from the gin and ice-cream, the other thing I found lovely about Salcombe was how many people I saw breastfeeding! I saw breastfeeding on the beach, breastfeeding at the cafes, breastfeeding in beer gardens, breastfeeding at the farm park, breastfeeding at the services. It felt like it was everywhere and it was fantastic.

It was a long time ago now my little girl was a baby but when I saw folks breastfeeding out and about it took me right back.

Let me set the scene. A baby starts crying in a cafe. Parents first start cuddling the baby, jigging about, seeing if baby will settle. They might try to wind the baby. Sometimes baby is passed to someone else instead. A dummy might be offered. Rejected. Offered again. Baby might be taken for a walk around the cafe. A toy might be waved. When the breastfeed begins that comes with moving clothing out of the way, unfastening bras, draping muslins over a disgruntled baby’s head, moving to somewhere more ‘private’. Sound familiar? This was me. It was also something I saw again and again while out and about.

And it isn’t just happening in Salcombe. I sit in support groups weekly and see the same thing. Babies headbutting chests, groping at clothing, quietly agitated. Smaller cues are missed while parents wait for “the demand” of a crying baby.

It’s important for me to say here, this absolutely isn’t a criticism of parents. This is something that has become normal for us all, especially out in public. It is done without question, without thought, it’s just what we have absorbed from the world around us. Breastfeeding in public was for me and still is for many, only done if you absolutely are sure you have to do it. In a culture where breastfeeding is considered time consuming, inconvenient or embarrassing, where it is something that we are told needs a special chair or is supposed to be a ‘special moment to treasure’ this is totally understandable.

I’m not sure the same thing always happens at home in private. I speak to people regularly who say things like “I can’t go out because I know they will need a feed the moment I do” or “I panic if I am out and she needs a feed”. Society is largely to blame for this and it’s a rubbish way to have to feel as a parent. I can’t help but wonder how this impacts on breastfeeding. Like lots of little paper cuts, does it all sometimes build up to a more painful issue? What does it do to milk supply? What does it do to parental confidence?

What is Responsive Feeding?

Responsive feeding is one of the pillars of successful breastfeeding but many parents confuse it with “demand feeding”, a term which is still commonly used. When we say “demand feeding” it feels clear what that means. Responsive feeding doesn’t feel so clear cut. We know a demand is a forceful request, so lots of people think demand feeding is responding to a crying baby. In reality, if we feed responsively, there are lots of subtle cues that come before the cry.

Baby Feeding Cues, Early to Late Stage

Breastfeeding responsively does not mean following a baby’s cues to feed alone either. It also means offering the breast because the parent simply wants to breastfeed or using the breast to comfort and reassure a baby.  

As well as nervousness or reluctance to feed in public, responsive feeding in the UK faces other barriers too. Not long ago our parents were told to feed on a schedule, every 3-4 hours and NEVER to feed for ‘comfort’. “Don’t let baby use you as a dummy” is something else nearly all breastfeeding folks hear. Routine based advice is often passed down today and routine is still something parents often strive for. There are dozens of books and articles out there selling routines to us all. Even up to date advice from the NHS focuses on the baby’s need to breastfeed “8 times or more” every day. While this ‘magic number 8’ may be helpful in some situations, it’s easy to forget the “or more” part of this statement. Sometimes 8 feeds a day becomes a goal, not the minimum.

The reality? Studies following folks feeding responsively tend to find babies breastfeed on average between 8 and 12 times a day, most at the latter end of this range and many breastfeed more than this. My own healthy little chunk breastfed somewhere in the region of 14-16 times a day in the early days. Yes it was exhausting and I worried about it all. the. time. Mostly because people told me that she should be going longer or it meant she wasn’t getting enough. I still remember the sting of another breastfeeding mum asking “Is she really feeding again?!” But if a baby is happy and gaining weight well why do we worry about this? Observational studies of the rural hunter- gatherer tribes show a pattern of very frequent, shorter breastfeeds. There is often a huge difference between what culture says, what routine based books say and what our evolutionary norms suggest.  

So why is responsive feeding important?

Milk Supply: Milk production is tied to frequency of nursing or milk removal.  If milk removal slows down the breast will become fuller. Spacing out feeds and not feeding responsively therefore can send messages to the body that milk production needs to be reduced. This can lead to genuine supply issues.

There needs to be a special mention for the possible impact of reducing night feeds in the early months too. Prolactin levels peak at night so overnight feeds create a fantastic positive feedback loop, helping to build up a really healthy milk supply.

The birthing parent’s health: Following on from the above, problems can occur if breasts become engorged because of infrequent feeding.  Aside from engorgement being uncomfortable, it can sometimes lead on to blocked ducts, mastitis and in extreme cases, breast abscesses and sepsis. Aside from supporting a robust breastmilk supply, breastfeeding responsively is hugely important for health reasons.

Baby’s weight gain: Research in 2006 by Hartmann and Geddes discovered breasts had differing amounts of milk ducts and different ‘storage capacity’ with some people storing 2oz in their breasts and others storing around 20oz!

This means we now understand that breasts have differences when it comes to producing and storing milk. In order to make adequate milk somebody who has a smaller storage capacity may need to feed more frequently than somebody with a larger one. Research has also shown the composition of human milk can vary from person to person and varies in composition according to the time of day or even the weather! Set feeding times cannot take into account all these factors. This means a baby who isn’t being fed responsively may have some issues with weight gain.

Confidence in parenting and in breastfeeding: Feeding responsively, and using the breast not just for ‘nutrition’ but for nurturing has been shown to help some people to feel more confident about parenting because it usually has better outcomes for breastfeeding and often results in calmer babies and less crying time.

Recent research has suggested that people who read and attempt to follow routine led baby care books are at greater risk of feeling depressed, anxious and inadequate compared with people who were not following book routines.

A baby’s latch: When a baby is fed responsively to early cues, they are usually calmer when coming to the breast. Delaying feeds may lead to small babies becoming quite distressed, so when they get to the breast they can be a little ‘disorganised’. Some babies may struggle to latch on, especially if breasts have become engorged. A taut, full breast and a frantic baby can result in shallower attachment. This can cause pain or injury to nipples and result in an unsatisfying breastfeed for the baby.

In conclusion? Not feeding responsively can lead to all sorts of problems. and supporting people to feed responsively is a critical part of supporting breastfeeding folks.

8 Things We Can Do As Helpers To Support Breastfeeding Responsively:

  • Offer help! Support people with practical, around the house stuff.
  • Don’t offer to take baby for a cuddle to see if you can settle them, unless the parents ask you to first.
  • Signpost parents to images about feeding cues such as the one above.
  • Reassure them that feeding in public gets easier with time, talk about how generally people aren’t paying attention! Encourage them to practise in front of a mirror so they can see how little is seen. Tell them they are doing a great job and how lovely it is to see baby so happy when they do feed in public.
  • Sometimes feeding responsively feels hard because of another breastfeeding issue such as pain. If this is the case can you help by signposting to effective, experienced breastfeeding support?
  • If you have breastfed yourself, why not talk about how breastfeeding is so much more than food and that it is impossible to measure and quantify comfort and love? Offer reassurance that this is a very short phase. Talk about how breastfeeding patterns change and become less demanding as babies grow older.
  • Talk about normal sleep development and be honest about how babies sleep when we talk to other people.
  • Encourage people to reflect on whether that feeding app is really helpful. Unless there is a clinical need to monitor feeds, ditching the tracker can really help boost confidence and encourage parents to watch their baby instead.
  • Reassure parents that their instincts are amazing and that they understand their baby far more than granny, a neighbour, an app or any book! Just telling them they are doing a brilliant job can go a long way.
Brilliant video by Swansea University about how to support breastfeeding people

Ultimately, cultural attitudes need to change so breastfeeding folks feel relaxed about this stuff. I long for a day where nobody feels like they need to use delaying tactics to avoid feeding until they absolutely have to. I long for a day when boobing to comfort a crying baby is seen as the norm rather than something to avoid at all costs. I long for a day when breastfeeding is unremarkable. I am currently loving campaigns like #FeedOn by the Association of Breastfeeding Mothers which help get real life breastfeeding seen on a wider stage and I particularly love the images where they show groups of people breastfeeding together rather than it being a solo activity. I love it when I see a parent wandering the supermarket breastfeeding a baby as they go about their day, or feeding in a cafe while chatting with a friend, or feeding in a sling as they attend to another child. That might not feel possible for everyone, but those moments when breastfeeding becomes a little less special and a little more mundane are magic. Every time this happens it is one step towards being that much easier for the next person to breastfeed without apprehension. We can’t change the culture around us overnight but together we can all play our part in making society breastfeeding and responsive feeding friendly.

ABM #FeedOn Campaign Image © RÅN studio

Further reading on responsive feeding

Prof Amy Brown for Kellymom on the importance of responsive feeding

Unicef repsonsive feeding info sheet

Emma Pickett IBCLC and Breastfeeding Counsellor on feeding intervals

Unicef factsheet “building a happy baby”

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