Originally published on Sept. 23, 2018.

There are a few ways that we can influence how successful our baby is likely to be when orally feeding. It is important to note that we cannot make a baby feed successfully. Only your baby can tell us when the right time for them will be. What we can do, is:

  • Introduce feeds at the right time for your baby
  • Only fed your baby when they are showing the right cues for this feed
  • Make the task of feeding easier in subtle ways that will make learning to feed a little bit less effortful.

One of the things we can do is by varying our feeding position. I am going to talk here about one of the main positions that we recommend for helping establish oral feeds, but it is important that you take your own baby into account, because each baby is different. Even if you do not end up using this position, you can adapt the principles to support your baby.

The position we are going to talk about is elevated sidelying. This is technically more of a bottle-feeding position, but it is similar to breastfeeding positions, albeit the baby lies in a different orientation to your body.

What does it look like?

In elevated sidelying, you will usually need a pillow for your legs, and a footstool. It is very important that you are comfortable,as well as the baby!

      • Sit yourself comfortably, with your feet up on the footstool. Put the pillow on top of your things.
      • The baby lies away from you on its side, along your legs, with its head towards your knees, and its bottom against your body.
      • You hold the bottle to the baby's mouth with one hand, and use the other hand and arm to support the baby along their back.

Why is elevated side lying a good position?

  1. It gives babies as much support in their body as we can

When we feed orally, it is easy just to focus on the baby's mouth and what is happening there. However, your baby's skills in their mouth are very closely related to what is happening in the rest of their body. If we hold babies in ways that make them work hard to maintain their body position, then they have less ability and energy to concentrate on what is going on in their mouths.

Term babies have fat pads in their cheeks that help them to stabilise around a bottle or breast nipple. Premature babies do not have these, and so their mouths are also more ‘wobbly’ and this will make generating suction more difficult.

Elevated sidelying means that the baby is getting a lot of support from your lap and the cushion. The hand you have at their back is also offering support in ways that will allow you to respond as they need to move and adjust.

2. The position is best to help your baby’s breathing and heart rate.

Compared to other positions, research indicates that this position maintains your baby's oxygen levels more successfully and was associated with less variation in heart rate. This is likely to reduce their chances of becoming stressed during feeding.

3. Keeps them as safe as possible

If your baby gets more milk than they can handle from the bottle, then it is likely to run away out of their mouth to the side. This might not appear to be a good thing, but when we feed in a reclined position, gravity will tend to take the milk to the back of the mouth. If your baby cannot cope with the volume, reclined feeding is more likely to make them feel overwhelmed, to be aspirated and to result in stress cues.

When milk comes out of the side of the mouth, it gives us important information about how well a baby is coping, and we are not increasing their risk.

4. Lets you see the baby

You should always do elevated sidelying in a way that let you see your baby’s face. This is important for observing their cues. The hand behind them also lets you get feedback from what you can feel.

Don't be afraid to talk about different feeding positions, for breast or bottle feeding, with nursing staff, and/or your Physiotherapist or Speech and Language Therapist.

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.