13 minute read
Caring for a breastfed baby: feeding, soothing & settling
from MPK Autumn 2024
For the non-breastfeeding parent, grandparents, baby-sitters and other caregivers
By Yvette O'Dowd
Too often, breastfeeding mothers are unable to get the physical and mental breaks they need because it is presumed that only they can help their baby fall asleep. While it is true that the easiest way to calm or settle a breastfed child is at the breast, this needn’t mean that it is the only way to do so. Over the years, I have not only cared for three breastfed grandchildren but also settled other people’s babies on an occasional or regular basis as a paid caregiver or as a friend.
There are many ways people identify today. For ease of description, here I will refer to “the mother” as the person who is breastfeeding, “the carer” as the person temporarily looking after her child and “the baby” as the infant being cared for. Feel free to apply these to your own situation using whatever language describes it best.
When a baby is on the way, everyone offers to babysit. Yet the reality is, most offers fade away once the baby arrives and even those wellintended feel blocked by the way the mother chooses to feed and settle her child. An exclusively breastfed baby, whose mother frequently baby-wears and bed-shares her child can seem “too hard” for anyone else to care for - even the child’s father or other parent might balk at the idea of being left alone with the baby for any period of time.
Unplanned circumstances where mother and baby are separated without time to prepare are different to what we will look at here. The following information is to help everyone involved plan for and prepare for occasional or regular periods of looking after a breastfed baby when the breasts are elsewhere!
When the baby is very young, it's best to have their mother close by, letting them nap, take a shower, go for a walk or rest while you look after the baby between feeds. Follow their lead about being ready to leave the baby with you while they are in another location. The motherbaby dyad should not be separated too soon or too often while they establish breastfeeding and the baby adjusts to life outside the womb. If the mother needs to attend an appointment, shop for clothes to suit their new body or visit the hairdresser, go along with them and the baby and stay in the vicinity while they have some space but know the baby is safe nearby.
Spend time with the mother and baby, watching how they interact with the baby. Involve yourself alongside them while they feed and settle the baby, adding your voice gently into the process. When the baby is fed, slept, calm and alert, hold them and practice different positions to see what they like and don’t and how they communicate their feelings with you. Aim to be calm and help the baby to be calm. Watch their rhythm and beat when they rock or pat the baby, and mimic them to get in sync.
There are three areas of concern people express: feeding the baby, soothing a crying baby and getting the baby to sleep.
Feeding the breastfed baby
Ideally, breastfeeding is established without the baby receiving supplements of the mother's own expressed breastmilk, donor milk or infant formula. If top-ups are advised, it is preferable that these are given by cup, spoon or syringe, rather than introducing a bottle and teat to a baby still learning how to attach and feed at the breast. The reality is, for many mothers, bottles of formula are recommended in hospitals, as well as expressing and feeding breastmilk by bottle. Many families continue this approach ongoing; “mixed feeding”, a combination of options.
However, for the baby who is exclusively breastfed and whose mother has not added pumping milk to the demands of the early weeks or months, it can come as a shock to discover their baby will not or cannot drink from a bottle and teat. In their quest to avoid nipple confusion, they find themselves faced with bottle refusal! Thankfully, bottles are simply one tool to feed babies and there are other options.
Under 4-6 months, the simplest alternative is usually cup feeding. Even the most committed breastfed baby will lap milk from a small cup (the size of a medicine cup or shot glass) without too much protest, especially if you have everything prepared before they wake so their patience is not tested. Small amounts of expressed breastmilk or formula can be poured into the cup and fed to the baby, perhaps 25mls per refill, until they show signs of satisfaction. A feed of 75mls can take a remarkably short period of time for even a small baby to consume.
Soothing the crying breastfed baby
When you are a breastfeeding mother, you have a magic solution to everything: the baby cries, signaling it needs something and the mother resolves the “something” by offering the breast. Rarely does it not work, resolving everything from thirst and hunger to frustration and tiredness. It's a hard act to follow!
So how can the carer deal with the normal crying which babies use to communicate? Well, you need to have a few more tricks up your sleeve. Firstly, you need to connect with the baby which also doesn’t know why it is upset. Babies cry to get our attention but not in the negative way people have thought in the past. Crying is the final signal a baby uses, when all previous efforts have not worked. A breastfeeding mother will often preempt a crying spell by reading the subtle cues her baby gives before they cry.
Cues are physical actions, often very discreet, which babies do when moving from one state to another. A hungry baby will give clear feeding cues while a tired baby will give cues they are coming to the end of a wakeful period and need help to transition to sleep. A baby experiencing discomfort from trapped air in their stomach or digestive system will also behave in particular ways.
Before you spend time alone with the baby, spend time alongside the mother at different times of the day and ask them what made them respond to the baby in different ways or why they offered the breast when they did. Ask about the baby’s individual signals that it's time to feed or sleep. Find out what the baby does when overwhelmed by play or surroundings. How does the baby signal boredom or overstimulation? Keep in mind the younger the baby is, the less time the family has had to build an understanding of these cues. Sometimes it involves a lot of trial and error.
Babies sometimes cry because they are physically uncomfortable. Things you can check are:
THE NAPPY. Is it wet, dirty or uncomfortable? Check if it is still in place, fitted comfortably and nothing is digging in.
CLOTHING. Check tiny toes are not entangled by threads in socks or the feet of onesies. Check singlets haven’t ridden up under garments, making them uncomfortable to lie on.
ARE THEY A COMFORTABLE TEMPERATURE? The back and tummy are the place to check, hands and feet are always cooler than the torso. Do you need to remove or add layers? Is the room overheated?
ARE THEY HUNGRY? Breastmilk is quickly digested and tummies are only the size of their fist. It is typical for breastfed babies to feed frequently and the clock is not a good indicator of feed times. The goal is not to stretch out the time between feeds but allow the baby to take the milk they need, when they need it. Small amounts often are better than large volumes infrequently.
IS THEIR TUMMY UNCOMFORTABLE? Trapped wind in the stomach might come up as a burp if you gently hold the baby upright against your chest. There is no need to fiercely pat their back - it is gravity which releases air, not external action. If a burp doesn’t appear or the baby shows no signs of relief, then it is more likely to be gas from digestion distending the bowel. If you have discussed this with the mother previously, apply the techniques the baby is familiar with to help them relax and pass wind. That might be removing the nappy and massaging the tummy, “bicycling the legs” or holding them in a particular position. Never give babies any medications, even over the counter or “natural” therapies without discussion with the parents.
Products used in the past (gripe water is one example) are no longer considered suitable or effective. Teas, boiled water and other liquids or foods must not be given to babies who are exclusively breastfed.
ARE THEY READY TO SLEEP? If you have missed the baby’s tired signs or you are not familiar with them, the baby might have gone past the stage of sleep readiness. You might have to help them become calm again and transition to sleep. More about that next.
Supporting the breastfed baby to fall asleep
Breastfeeding mothers will know the simplest way to help their baby transition to sleep is at the breast. They might practice lying down to breastfeed, bed-sharing, babywearing or contact napping as ways to remain in physical contact with their sleeping baby. In preparation for leaving their baby in your care, it can help if they add other sleep prompts to these existing ones, which you can incorporate into your own approach. These might include:
Movement in the form or swaying, bouncing, rocking or walking
Sound in the form of white noise, music, singing or reading a story
Smell in the form of a cloth item they use routinely, like a baby carrier, muslin wrap, comfort toy or piece of clothing.
Touch in the form or patting, stroking, massage or rubbing the back
It helps to talk about the environment the baby is used to being asleep in. Ideally, babies are exposed to natural daylight and household noises during the day, to help their developing body clock. So avoid darkened rooms and silent spaces if the baby is not used to them. If going for a walk in a baby carrier or pram is familiar, find out if this is in a quiet park or alongside a busy road and replicate that.
A general pattern you might expect from a baby is to feed upon waking, have their nappy changed, spend some time playing with you or watching as you work alongside them, perhaps take a little extra milk and then sleep close to you for around 40 minutes, perhaps resettling for another sleep cycle if being carried or in the pram.
It is very important to follow current guidelines around safe sleep. While the baby might bed-share with their breastfeeding mother, there are known risks to sharing a sleep space without the presence of the mother. Even fathers need to avoid bed-sharing alone with their babies: it is the maternal proximity which is protective, and then only when the baby is breastfed.
Nobody should put themselves in a situation where they might fall asleep holding or alongside a baby on a sofa, armchair or other space not intended for infant sleep. This is the highest risk environment for infant death. If you are caring for a baby, it is important you are not affected by drugs or alcohol, including over the counter medications or remedies which might be sedating. If you are a smoker, it is important to minimise the infant’s exposure to second-hand smoke and any chemical residue from smoking which might be on your breath, skin or clothing. Cigarette smokers in a household (even if they only smoke outside) is a known risk for Sudden Infant Death Syndrome (SIDS). To avoid exposing the baby to tobacco smoke, don’t let anyone smoke
near your baby - not in the house, the car or anywhere else your baby spends time. If you or someone in your household smokes, the baby’s parents might decline your offers to care for the baby in your home or ask you to undertake certain precautions such as changing into fresh clothing. This is not a personal judgment upon you, rather they are following medical advice based on hard evidence on the reduction of risk of SIDS and Sudden Unexpected Death in Infancy (SUDI).
Using a baby carrier
next best thing to breastfeeding is a baby carrier. Ask the baby’s mother to show you what type of carrier they use and how to use it. Try it yourself repeatedly before you are on your own with the baby, so you are confident using it when you need to. If neither you nor the baby’s mother are familiar or confident with babywearing, get in touch with our community South Eastern Babywearing Group or find a babywearing consultant near you.
Caring for a breastfed baby is a wonderful way for you to support mothers to continue breastfeeding without feeling overwhelmed by responsibility for all their baby’s care.
Why babies under six months do not need water
In the past, when babies were fed strictly four-hourly, mothers were sometimes advised to offer boiled water if the baby was “unsettled” between feeds. Unfortunately, these babies were hungry and showing feeding cues and needed to go to the breast. Filling their tummy with warm water made them think they had been fed but they had received no calories or nutrition and were soon hungry again.
Boiled water was also suggested to bring up wind in unsettled babies. This was totally without evidence and might calm a baby signaling for more time on the breast than the clock allowed, perhaps even leading them to burp the air they swallowed from sucking at a bottle.
However, it is no longer recommended to give young babies water at all.
Both breast milk and infant formula contain the fluid babies require. Additional fluid can stress their system and even lead to water overload in extreme cases, where the kidneys struggle to process the extra fluid and natural electrolytes can become unbalanced.
In hot weather, some people worry that babies need water as well as milk. This is not the case. Breastmilk is 87% water and infant formula is around 85%. A baby who is thirsty will show feeding cues to seek the breast, often for short feeds more often. Even formula fed babies can be offered extra feeds during hot weather.
Human babies survive around the world without bottles of water, as do all the other primates and mammals!
Older babies can begin drinking water as part of their introduction to family foods in the second six months, drinking from a cup. Even then, this isn't required and breastfed babies and toddlers continue to meet their fluid requirements through unrestricted breastfeeds. If mother and toddler are separated, then water from a cup is suitable for thirst. Babies under 12 months shouldn't have water in place of breastfeeds, expressed breastmilk or infant formula should still be used.
