Good advice on the baby’s eating in the early days

This booklet is intended to help you read your baby’s signals in relation to feeding. When your baby feeds, it is a social event, just like it is when everyone else eats. Feeding is an active act that is necessary for your baby to thrive and develop. It is an interaction between the baby and the person giving the food, regardless of whether the food is offered via breast, tube, bottle or cup.

Your baby needs to have a certain level of maturity to be able to coordinate their breathing while sucking and swallowing.

By the time your baby learns to eat, the nervous system and brain are developing rapidly. The baby's experiences and influences help to influence their development. It is therefore important that you are close to your baby as often as possible when they eat. Your baby's ability to feed is strengthened when you become better at reading their signals and acting on them.

Light, sound and activity around your baby before, during and after they feed can affect how your baby manages to both feed and digest their food. It matters whether your baby is supported or possibly swaddled so that they have support for their feet and body, and are warm, comfortable and well positioned.

Below you can read more about how to best support your baby when they are feeding. The values are based on NIDCAP principles. You can read about NIDCAP on the last page.

It is important that you are around your baby so you can see their signals before they are about to feed. Be mindful that your baby does not use their energy unnecessarily on staying awake, sucking, searching, being restless or crying. Think about if or when your baby needs to be changed in relation to feeding. Your baby will request food on demand to the extent that they are able and mature for.

Your baby may show some of these signs when they are hungry and ready to eat:

• They may take their hand to their mouth, search, suck on their hand, tongue or pacifier.
• They may be awake or sleeping lightly, i.e. have facial expressions and move lightly in sleep.
• They may cry, whine or be restless.
• They may stick out its tongue.

When considering whether your baby is ready to feed, you should also look at the following.

• Does your baby have calm breathing and their usual colour?
• Is the baby well positioned, lying in the foetal position with bent arms and support for the feet and with good power in the muscles?

Your baby can show that they are comfortable and in balance in the following ways:

• They have calm, unchanged and effective breathing and colour.
• They lie calmly in the foetal position and may be holding onto your finger.
• They can coordinate breathing, sucking and swallowing at the same time if offered a breast, bottle, or cup.
• They may be awake or sleeping lightly. If your baby is doing well, it can suck whilst awake or half-asleep state. If your baby is given milk through a feeding tube, they can sleep in the meantime.
• They may have their eyes open and seek contact with you while eating, depending on their maturity and strength.

Your baby may show some of these signs if they are struggling and need a break:

• The baby pauses in their breathing, or the rate of their breathing changes, i.e. it becomes shallow, fast, slow or laboured.
• The baby's colour, oxygen saturation and/or heartbeat changes several times.
• The baby hiccups, regurgitates or strains.
• The baby’s body or face becomes limp.
• The baby becomes restless or tense. They may grimace, writhe and/or stretch out their fingers, arms, legs or body repeatedly.
• The baby stops sucking or the sucking power changes.
• The baby has difficulty coordinating sucking and swallowing whilst breathing. It munches on the breast, the bottle teat or gets the milk down the wrong passage. Your baby may also try to spit out the breast or teat or clamp their mouth closed.
• If your baby falls asleep during breastfeeding or while bottle-feeding, it could be a sign that they are tired, need a break or cannot take it anymore. They may also protest by whimpering or crying.
• The baby may find it difficult or be unable to face contact or interaction whilst eating. Maybe they can only do one thing at a time. This may be shown by the baby turning its gaze away, having a staring, unfocused gaze, becoming dull in expression or falling asleep.

Based on your baby's signals, these tips can be a support:

• Dim the lights, sound and activity around your baby so that they can concentrate on feeding.
• Make sure your baby is well supported with bent arms and legs or possibly be swaddled as when your baby is calm, they can concentrate on sucking. If necessary, place them on their side or at the breast, where you sit back, and your baby lies tummy to tummy.
• Lie down skin-to-skin with your baby.
• Offer the baby something to hold on to, such as your finger. This helps your baby to be able to calm down and possibly suck better. At the same time, it provides the sense of closeness and togetherness whilst feeding.
• Offer the breast or a pacifier with milk on it if your baby feeds via a tube. By doing this, the baby's need to suck is met, and they get the experience of a connection between sucking and being full.
• If necessary, lay the baby on its side when they are given a bottle. It can be less strenuous for the baby to lie on their side with good support in your lap or on your arm. When your baby is lying on their side, it can more easily coordinate to breathe while sucking and swallowing.
• Give your baby a break if they give you signs that they are struggling, and if necessary, assist them to burp.
• If your baby is showing repeated signs of a struggle, think about whether they are able to take any more milk. You can give the rest of the meal in a different way or consider whether the volume is correct.

Your baby has used effort and energy to feed, so it is therefore important that you observe them after they have finished feeding. Make an overall assessment of your baby, how did they behave before and during the feed? How were they in the subsequent time while digesting their milk?

For some babies, feeding can be particularly challenging. The signs may vary but are the same as described under the earlier section "How your baby can show that they are facing difficulties while eating". The signs may be apparent immediately after eating or over time.

The above is meant for guidance and good advice. All babies are different, and their signs can be different, depending on the context, the baby’s maturity and any illness. Talk to the staff about your baby 's signals.

If you have any questions, please feel free to ask us.

The content of this booklet has been prepared by NIDCAP professionals from Rigshospitalet, Hillerød, Herlev, Roskilde, Hvidovre, Skejby, Randers and Aalborg Neonatal departments.