Originally published on Sept. 2, 2018.

When a baby is learning how to feed, it is important not only that we respect their feeding cues, but also that we understand when they are telling us that they need a break.

Feeding is a complex set of skills that require a high level of coordination. If our babies are finding learning to co-ordinate difficult, or finding it tiring, then they will experience feeding as stressful. Stressful feeding experiences are more likely to lead to aspiration (milk going down into babies’ airway and/or lungs), and to lay the groundwork for feeding tube dependency or feeding aversions. These difficulties can be difficult to remediate, and are often easily avoided if we ‘read the feed’ well.

So what can we look out for when feeding our babies at this stage?

Firstly, it is a good idea to observe your baby before each feed. You need to get a feel for what your baby looks like before the feed, because looking for some signs, such as colour changes, will be relative to whatever they looked like when they started.

Look at your baby’s colour, and general happiness being handled and alertness before you start. This should all be taken into account, alongside their feeding cues. If your baby appears sleepy or irritable before a feed, it might be that an oral feed is not the best idea.

Specific things to look out for:

  • Becoming irritable whilst feeding
  • Grimacing or signs of stress in the face. This can be quite subtle in a small baby, just a forehead wrinkle or similar.
  • Crying whilst feeding
  • Colour changes when feeding- this might be going pale, or getting red in the face. This can eb quite subtle
  • Desaturations which may set off the machine monitoring your baby.
  • Appearing to be tiring
  • Splaying out fingers or arching their body (this is a ‘startle’ response)
  • Hiccups

Desaturations on the monitor are a late sign. If you are watching your baby carefully, you will usually see the signs of stress before the monitor picks them up, so watch your baby more carefully than the monitor.

A baby who is regularly setting off the monitors whilst feeding may well require a Speech and Language Therapy assessment.

Signs of stress during a feed may indicate that a baby is struggling to co-ordinate all their feeding skills, or that milk is ‘going down the wrong way’ (being aspirated). These are signs that a baby need a bit more help from you, and you will find some ideas on how to help coming up in future posts.

However, signs of stress during a feed may not necessarily suggest that it is the feeding that is not going well. Many babies have the basic idea of feeding, but may not be able to co-ordinate at the beginning of a feed when really hungry or may tire over a feed. In addition, oral feeding may trigger reflux, or make them fill their nappy. They may have taken in some excess air that they need to bring up. They may not be able to coordinate all these things as well as their emerging feeding skills. With time and maturity, these things will improve, and it is our job to make sure that the baby gets enough practise, but is not overwhelmed by the task of oral feeding.

It is important to respect a child’s stress cues by giving them a break from feeding, or even by stopping the feed and completing it with a tube feed. Whatever the underlying cause of the stress cue, if we continue to feed then we are likely to be teaching them that feeding is unpleasant, and that we don’t listen when they communicate.

Posts from Find the Key Speech Therapy are intended for information. They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language therapist who knows your child. Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance.