Heather, a very dear friend, wrote
to me asking if it was likely that she isn’t making enough milk at night
because her baby fusses in the evening, won’t take the breast, and then takes 2
ounces of formula by bottle and falls asleep.
Her pediatrician suggested introducing solids as a means of solving the
night time fussiness. It got me thinking
about this topic, and why that is such a terrible thing to do to mom. Here is what I came up with in answer to her
problem.
The first thing we have to
understand is that the breasts are an organ.
They work as well as the heart, the lungs, the kidneys, and the brain. Even better, they are two mutually redundant
organs so that one can compensate for the other if needed. That redundancy is there for a reason, to help
make sure that nothing bad will happen. Breasts,
like every other organ system, tend to work all the time. They don’t function well from 9 am to noon
and then suddenly and inexplicably fail for a few hours and then start back up
again the next morning. It is possible
(but VERY unlikely) for them to slow down or even fail over time, but they
wouldn’t work fine during the day and then fail at night. As a matter of fact, we know that pregnancy, breasts,
and infants are nocturnal. They all work
best at night, which is why contractions come from dinner to 2-3 AM, why babies
are usually born in the early morning hours after a night of labor, and why
babies are most awake from 9 pm to 3 am.
They aren’t hungry, they are alert and awake and frustrated that mom and
dad want to sleep. The problem isn’t the
baby, it is the mom and dad that want to go to sleep and get frustrated because
baby doesn’t want to go to sleep. If you
don’t want him to be awake all night, then don’t encourage him to take naps all
day. He has to sleep, but he won’t sleep
24/7. Sooner or later he has to wake
up. I seriously doubt that night time
fussiness has much to do with hunger.
Now, let’s talk about why a baby
will always take a bottle. Babies take
bottles because gravity force feeds the baby and he has to take what is in the
bottle, even if he doesn’t want it. They don't do it because they like it. Have
you ever tasted formula? It is a rather nasty flavor and I seriously doubt a
child will choose that over his mother’s breastmilk, which is incredibly sweet.
To help us figure this out, I’m going to
pose a few questions that my families ask me all the time.
1) “Why do babies refuse the breast
if they are hungry?” First, I always say
that if they refuse the breast, they are probably NOT hungry, they just want to
suck. You have to understand that babies
are in charge of breastfeeding, they ONLY
breastfeed when they are hungry. That
doesn’t mean that they won’t suckle at the breast if they aren’t hungry. Any lactation consultant who practices pre
and post weights knows that sometimes babies take the breast for 15-30 minutes
and take almost no breastmilk at all, this is called “non-nutritive sucking”. Babies suck for comfort and somehow control
the flow of milk. Another thing that
babies will do is refuse the breast when the first let down happens. They take the breasts, suck for a little bit
and they pull away and cry. Then they
take the breast, suck for a bit, and pull away and cry. It has always seemed to me that they realize
that food is coming and they aren’t hungry, so they let go of the breast and
cry because whatever is causing them to be uncomfortable is still there. Their need to suckle hasn’t been met, so they
cry.
2) “But if they can refuse the breast, why can’t
they refuse the bottle?” Or “Why do they
always take the bottle when I offer it?” It goes back to infant development. You may remember that all infants are born
with a suck reflex. It is instinctual,
pleasurable, comforting, and helps to ensure survival. Babies suckle EVERY TIME they are
uncomfortable for any reason. They suck
when they are hungry, cold, lonely, frightened, frustrated, in pain, have a
dirty diaper, they suckle EVERY TIME they are uncomfortable. Suckling isn’t a “hunger sign” it is a “stress
sign”. Any time you put something long
and hard in a baby’s mouth, they are forced to suck (fingers, pacifiers,
bottles, breasts, etc...) so they will suck a pacifier or a bottle even if they
aren't hungry, because it feels good, not because they are hungry. But with a bottle filled with liquid, they
have to drink because liquid is running out of it and into their mouth.
Let me explain, if you hold a bottle
at more than a horizontal angle it will leak, and if you touch it the milk will
squirt out all over the place. Imagine
what that does in his mouth? Let’s combine those two factors (the
uncontrollable urge to suck and a readily flowing device) you get a baby who
will over eat, even if he isn’t hungry. Often he will simply push it back out and let
the milk or formula drip down his chin, which is why you always need a cloth
under his chin while bottle feeding to keep him from “making as mess”, but have
you ever noticed that you don’t need to do that when you breastfeed? Again, it is because he is in charge of the
breastfeeding and can just let go if he isn’t interested. But I digress, back to over eating. When we over eat we fall asleep. This is why
lions sleep on the Savannah after eating a zebra, why we sleep after our Thanksgiving
feast, and why babies sleep when they are over fed. It has to do with the
release of pleasurable and sedating hormones that comes with a full tummy
(Gastrin and CCK, I think).
3) “So what is the problem with over
feeding him if it makes him stop crying and fall asleep?” The real problem, is what it does to the
mother, it is why this mother is writing to me in the first place. She is convinced that SHE is the problem. There could be no other explanation for why
her baby is fussy at night. Obviously
her organ systems just intermittently stop working after dark and then start working
again the next morning. That is why her
pediatrician suggested adding solid foods or offering a bottle…. REALLY PEDIATRICIAN? REALLY?
It makes me angry to think that there is such ignorance out there coming
from a health care provider. What did
her pediatrician do? She took a mother who
believes that fussiness is related to feeding and led her down the wrong
path. The mother has a baby who is fussy
and offers the breast. But if the baby isn't
hungry, he won't take the breast for very long.
He suckles and then lets go and fusses, then suckles, and fusses, over
and over again. Mom, who is tired
because it is 10 pm and she wants to sleep, gets frustrated and desperate. Since her health care provider convinced her
that she isn’t making enough milk (but only at night), and because people tend
to trust physicians, mom offers a bottle and he drinks it and goes to sleep. What
does that tell mom? It re-enforces the idea that he was obviously hungry and
that she is just another inadequate mother who can’t do what her baby needs her
to do.
It is a terrible and frustrating
myth that we in the health care field continue to spread every time we teach
the mother “Hunger Signs”. We don’t
bother to explain newborn stress signs, we don’t teach a father that there is
more to pleasing a baby than just feeding.
We simply suggest that every problem is a feeding problem and blame mom
for not doing a good enough job. Nonsense! You are perfect, your breasts are perfect,
your baby is perfect! Have confidence in
your body, it got you this far. It
amazes me that people, especially physicians, believe that the human body can
take two cells, combine them, multiply them a couple billion times and create
the most complex living system on the planet, and then for some inexplicable
reason suddenly fail and not be capable of supporting that baby when they are
born. And for some reason, the fault is
never the ignorant health care provider, but rather it is the helpless
mother. Okay, I have to stop or I will
rant for another 100 pages.
Hope that helps,
Sage Homme
