Katie Angotti: Encouraging responsive feeding in babies

Responsive feeding means recognising what a baby needs and feeding them in response to those needs. Babies are very good at communicating hunger, appetite and satiation (1). Supporting parents and caregivers to recognise the cues that babies give can help them to feed more responsively, regardless of which type of milk feeding they choose to use.   Why feed responsively How often do babies feed? How much milk do babies require? Cues for hunger in babies Fullness cues in babies Tips for bottle feeding responsively Why feed responsively. By feeding responsively, parents are encouraging their baby to listen to their instincts to eat when they are hungry and to stop when they are full. Research suggests that this responsive feeding in infancy sets the foundation for the development of healthy eating behaviours around self-regulation and self-control later in life, by maintaining and strengthening the neurological pathway in the brain (2). When it comes to breastfeeding, responsive feeding recognises that feeds are not just for nutrition but for comfort, love and reassurance between the mother and baby too (3).   How often do babies feed? Feeding responsively, following a baby’s feeding cues, means that all babies are likely to feed slightly differently. With breastfed babies, the first few days and weeks can look very different as the milk supply is established, falling into a pattern of feeding roughly every 2-3 hours. It is a good idea to try and follow a similar pattern with bottle-fed babies, whilst being responsive to the individual babies cues (4).   How much milk do babies require? It’s not possible to know exactly how much milk breastfed babies consume. Instead, parents can look for other signs: feeding regularly, roughly 8-12 times in 24 hours, being able to see and hear baby swallowing, and having at least 6 wet nappies in 24 hours once your baby is a week old (4,5). Most formula-fed babies will consume 150-200ml formula per kg bodyweight per day. All babies are different so monitoring their growth and nappy output can help build a full picture of whether they are getting enough milk (5, 6).   Hunger cues in babies It is recommended that babies are fed after an early hunger cue is noticed, whether they are breast or bottle fed. This can stop the baby from becoming too distressed and not feeding effectively. Some cues will be more apparent in older babies than younger ones. (5)

Early cues	Further cues	Late cues
Mouth opening	Hands in mouth	Squirming
Tongue sticking out	Wriggling	Fussing
Turning head towards chest	Calling	Redness
Lip-smacking		Crying
Head bobbing		Back arching
Sucking and licking sounds
Looking for nipple or teat
Trying to get into feeding position
Pulling at clothes

  Fullness cues in babies Signs that babies are full and coming to the end of a feed are the same for both breast-fed and bottle-fed infants. Not all signs will be apparent at every feed for every baby.

• Their pace of sucking slows down, taking longer pauses between sucks
• Their body relaxes – they might become softer or floppier, often with their hands unclenching
• They fall asleep, letting go of the nipple or teat, and milk may trickle out of their mouth
• The push the nipple or bottle away from them, turn their head away or arch their back in annoyance

  Tips for bottle-feeding responsively Responsive feeding is particularly important with bottle-fed babies, as they have less control over the feed – it can be easy for parents to worry and encourage a baby to finish a feed or drink a certain amount from a bottle. Every baby is different, and the feeding guides suggested are just that- a guide. Responsive feeding is all about following an individual baby’s cues for when they are hungry and paying close attention to them for the signs that they are full. Some tips to share with parents:

• Offer small feeds, every 2-3 hours can help.
• Instead of feeding by the clock, watch your baby for their hunger cues. If they start showing signs of hunger 2 hours after their last feed, then they should be offered milk.
• Allow baby to accept the bottle by bringing it gently to their lips and watching for signs that they are ready for milk. Sit them a little more upright, so that the bottle is more horizontal, and isn’t propped in their mouth.
• Watch them throughout the feed, for signs that they are slowing down or pausing. Gently pull the bottle away and look for signs if they want to continue feeding or are full.
• If baby shows signs of fullness before the end of the bottle, stop feeding, and avoid trying to get them to finish the bottle.

  About the Author: Katie Angotti is a Registered Public Health Nutritionist, specialising in maternal, infant and child health. Katie has worked with children and families in the NHS, in the baby food industry and now works in private practice with pregnant women and parents.   References

1. Hetherington M.M. (2020) Infant Appetite: From Cries to Cues and Responsive Feeding. In: Meiselman H. (eds) Handbook of Eating and Drinking. Springer, Cham.
2. J Harbron & S Booley (2013) Responsive feeding: establishing healthy eating behaviour early on in life. South African Journal of Clinical Nutrition. 26 (Supplement)
3. UNICEF UK (2016). Responsive Feeding. [Online] Accessed at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf
4. NHS (2020) Your breastfeeding questions answered. [online] Accessed at: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/your-questions-answered/
5. Amy Brown. (2021). Let’s Talk About Feeding Your Baby. Pinter & Martin.
6. NHS (2019) Formula milk: common questions. [online] Accessed at: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/formula-milk-questions/