Obesity & Infant Overfeeding
by Cynthia Epps, MS, IBCLC
At a recent London meeting between World Health officials and doctors from the International Obesity Task Force, they found target weights on current pediatric growth charts for two to three years olds to be 15% to 20% too high. Since child development growth charts in widespread use are largely based on studies of formula-fed children from more than 20 years ago, the growth tables used to chart your baby's development may be inaccurate. The researchers added that overfeeding of babies could explain in part why childhood obesity is on the rise, and the current generation of adults is the fattest ever. Dr Prakash Shetty, head of nutrition planning at the UN's Food and Agriculture Organization, echoes the WHO concern. "If you look at energy requirements of children who are exclusively breast-fed, they are much lower that those of formula fed infants.
So whats a new mother to do? A simple understanding of how a baby takes milk from the breast can help moms who are breast and/or bottle-feeding. When taking milk from the human breast, the newborn infant stimulates a let-down reflex in the mother. This means the milk is delivered to the infant in a sequence of servings that approximately fit the small size of the babys stomach. Each serving triggers a swallow reflex in the baby. After the mother releases the milk, the flow tapers off to drops, during which time the infant breathes and flutters the tongue, which triggers another let-down or serving. When a baby is introduced to the bottle, the flow of milk falls into his/her mouth continuously, in response to gravity. The babys swallow reflex is stimulated, almost continuously. Observations of this swallow reflex were, and still are, frequently misinterpreted as hunger in newborn infants receiving formula feedings. Hence, bottle fed babies tend toward over-feeding.
Knowing how to recognize when your baby is satisfied can also lower the chances of overfeeding. The breastfed baby will slide off the breast and release the nipple when satisfied, and lie back, in a deeply relaxed pose. When bottle-feeding, the flow is regulated by the caregiver. Counting up to 25 swallows, then withdrawing the nipple, and offering your clean finger for the baby to flutter and breathe, mimics the breastfed pattern of regulating flow. Feeds will take longer, but your baby will have a chance to self-regulate in a similar fashion to the breast fed model.
Most parents, many grandparents, and some doctors still assume all crying to be a feeding cue. But there is a logic concerning crying in relation to the timing of your feeds. Whether on the breast or bottle, if your baby is gaining over 1 ounce/day, fussy anywhere from 30 to 90 minutes after feeds, crying and chewing on his/her hands, and/or sleeping less than 2 hours, this is more commonly a sign of stomach gas, abdominal cramping or relatively normal newborn digestive distress. Your baby will stretch his/her legs straight out, stiffen the abdomen, pull those little hands up close to the face in tight fists, close those tiny eyes and wail, often growing very red in the process. Witnessing such distress in your new infant, without having a clue as to what is causing it, can send even the calmest mother into panic. Yet, rather than feeding in response to this crying, you might try various soothing/comforting techniques, combined with burp holds and swaddling to settle your baby. First, use a good swaddle that keeps your babys hands/arms tucked in. Then hold your baby against your chest, facing out, with the head just under your chin. Anchor your baby across the tummy with one hand, and gently bring those stiff legs up into bent knees with your other hand. Your baby may suck or flutter on your thumb or knuckle. This is a normal response to help release the pressure in his/her abdomen. Bounce up and down, rock side to side, and add a repetitive shush sound. As the stomach spasms release, the suckling will subside, your baby may burp, pass gas or stool, and then melt delightfully in your arms. Happy feeding!
Cynthia Epps, MS, IBCLC, is a metabolic nutritionist and board certified lactation consultant in the Los Angeles area. In her private practice, she specializes in lactation consults, transitioning to solids, and gentle weaning.
2006 Los Angeles Family Magazine