At birth, babies have so many skills. Connect with them, as they teach you. Many babies recognise their caregivers by four weeks and health texts encourage examination of the baby’s vision, if not smiling at a care- giver by six-to-eight weeks. We know they hiccup regularly in the womb. This means that by the time they are born they have strength in their diaphragm and chest wall, so they can take deep breaths and maintain breathing for the rest of their lives. They practice regular breathing, to have a rhythm but need that extra strength. Babies keep hiccupping for several months after birth, at any time.
In the womb, they swallow liquor, but not feed, and have a gut full of meconium but do not pass it in utero, hopefully. They don’t practice strengthening their abdominals in-utero; they do that for the next three months with all that pushing and squirming to pass liquid stools. They move their little limbs in utero, but the main strength develops from birth. We try to stop them head-banging against our chests, but this too, is helping them strengthen neck muscles.
From the time they are born, they will look at and follow anyone who looks at them. Even if their focus level is at the distance of their mother’s face when feeding, which we are taught, they take in much more of their surroundings. They startle with noise, are already learning to distinguish smells and are soothed with cuddling and singing. They can crawl to the breast and they are born with a strong rooting reflex to help them attach. Every time we pick them up and talk or sing to them, we are teaching them speech and language. This repetition is important. They sleep to their own internal needs and need support for this. In the first month of life many babies feed for an hour and sleep for 1-2 hours, around the clock.
This is around 15 hours sleep in total. This is an average and the range is much wider. Thankfully, many babies settle more as they grow. They will have hours of wakefulness as they develop and will, with some gas, be very demanding in these hours. This is normal. Most healthy babies move out of this unsettledness around three months and move on to other life skills. At six months they can semi-sit, are watching everything, reaching for everything and are trying to chew things.
From birth, they are regulating their intake and by around six weeks, they will have decided their total daily intake and not change this, until well into the second half of their first year. They will not take more than they want. They will scream, arch and display many other signs of refusal, if they are forced to feed when not hungry. They all have different feeding patterns, regardless of how they are fed. We do need to be a little more careful of the bottle-fed baby, who may not know how to stop, but many refuse to finish their bottle and want more at another time of day. Total daily volume is over 24 hours and does not need to be the same at every feed.
Newborns have small, frequent feeds and over time they get faster and can spread their feeds. Breast and bottle-fed babies will, by six weeks, be taking about 800mls per day. The range is about 500mls to 1300mls per day, in a growing baby.
The baby will not take more milk than they want, regardless of how it is delivered and forcing more may lead to aversion to feeding. As they mature from being a neonate (first four weeks), they develop enough muscle skills to arch and push away from the breast or bottle if they are full. Some babies will bottle-refuse in the first week, but especially around four months, even if they are regularly bottle-fed. They are learning how to manipulate their tongue to take solids and preparing to chew and swallow, by around six months.
At three-to-four months, they start dribbling as they need more saliva to help the breakdown of food and protect their teeth. The baby controls the flow of milk with his tongue from birth. He uses a tongue thrust to help him suck. Having teeth does not stop the baby feeding at the breast, though some may bite, with or without teeth and a few at the end of the feed.
Solids start gently at around six months. Initially, they are practicing eating, but somewhere around the 9-12 months’ mark, milk alone no longer has sufficient nutrients and babies need solid food. They can continue breastfeeding until two years old and beyond.
When they crawl, walk, talk etc., is strongly genetic, but also is helped by being encouraged to move and being responded to. Some breastfeed babies will jump up growth centiles in the early days then not gain for months, as they slim down while continuing to get longer. Some babies lose up to 10% of birth weight at day four and then start gaining. Some babies get back to birth weight quickly, some slowly. Some have lost the extra fluid they carried at birth, like their mother who had excess fluid when she birthed. This fluid she may have been carrying for weeks, as well as from the multiple intravenous fluids given with inductions, epidurals and caesarean sections.
After the first weighs, it might be better to work on the growth since the baby’s last weight, not where a chart expects babies to be. Some would need to gain 500 – 1000gms overnight to get back to a graph we want the baby to be on.
‘Responsive feeding’ is the new and broader term replacing ‘demand feeding’. It describes the baby and breast responding to each other, day and night and over time. Feeding a newborn as you would a six-month-old baby would mean not enough milk for the newborn. If one breast is not used it will dry up, even if the other is still making milk and when there is a preference for one breast, it will have more milk. Sometimes one breast will always work better than the other.
Responsive feeding encompasses the wider family and how much it supports and positively responds to mother and baby. As baby grows, feeding patterns change and somehow, our breasts know how to adapt to their needs. If mum responsively feeds, her breasts and baby will continue to work together.
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