Feeding Safely

A Guide to Mealtime Mastery

Welcome to our comprehensive guide on baby feeding safety, where we dive into the essential practices and considerations every caregiver should know. At Tidal Therapy our Speech-Language Pathologists not only have expertise with speech but also expertise in feeding. We understand that introducing solids and managing mealtimes can be both exciting and overwhelming for new parents. Ensuring the safety and well-being of your little one is paramount, and understanding the ins and outs of baby feeding is crucial in preventing potential hazards. In this blog, we will explore the important aspects of feeding safety, from selecting the right foods and textures to recognizing signs of readiness and addressing common concerns. Let’s embark on this journey together to make feeding a safe, enjoyable, and nurturing experience for both you and your baby.

Feeding Safety:

Here are common questions we receive from our patients and issues we face as parents.

What if my baby starts choking/coughing during feeds?

If breastfeeding, some tips to reduce occasional choking/coughing during feeds include:

• Place your baby in side-lying or down under positions–this offers your

  baby more control over feeding pace.

• If you have an overactive letdown, you can try pumping until you feel the

  letdown (typically 1-2 minutes), then bring your baby to the breast.

If bottle feeding, some tips to reduce occasional choking/coughing during feeds include:

• Sometimes the flow rate may be too fast, causing your baby to have trouble coordinating their swallow and/or coordinating a functional suck-

  swallow-breathe (SSB) rate.

• It is important to practice paced-bottle feeding in which you present the bottle to your baby horizontally (rather than at an angle or vertically). This offers your baby more control over feeding pace.

• Try a slower flow nipple–if your baby is growing more fatigued, frustrated, and/or sleepy during feeds with a slower flow nipple but is consistently choking/coughing during feeds, you should consult with your baby’s pediatrician and seek a referral for an evaluation from a pediatric speech-language pathologist for an individualized approach.

• Feed your baby on his/her side or in an upright position.

For both breastfeeding and bottle feeding, it is important to break your baby’s seal to the breast/bottle as soon as he/she begins coughing, then regroup and

attempt a re-latch once your baby has stopped coughing/choking. It is important to follow your baby’s cues and never force your baby onto the breast/bottle

if he/she is not ready.

Be sure to burp your baby frequently during feeds. If your baby begins to present with the following stress cues during a feeding, then your baby is probably

ready for a break or needs a change to occur to continue feeding comfortably. Stress cues may include:

• Finger-splaying

• Grimacing

• Visible Color Change (e.g. flushed, blue color)

• Crying

• Gaze aversion

• Flailing arms/legs

• Extending arms/legs with tension

• Yawning

• Gagging/vomiting

• Hiccups

• Sneezing

Coughing/choking during feeds can be multifaceted, if occurring consistently across feeds, we recommend a visit to your baby’s pediatrician to discuss concerns and to obtain a referral for a pediatric speech-language pathologist for a formal, individualized assessment and treatment plan, as well as an International Board Certified Lactation Consultant (IBCLC) if breastfeeding.

Is My Baby Getting Enough?

One of the common questions that many parents frequently worry about is weight gain. They often wonder how to accurately determine if their baby is getting enough nourishment, and they grapple with the concern of whether their breastfeeding supply is adequate to meet their infant's needs.

Supply concerns are one of the most common concerns while breastfeeding. Here are some basic pointers to establish, maintain, and monitor supply:

• Feed on demand whenever your baby is hungry using cue-based feeding—common feeding cues include: rooting, hand(s) to mouth, mouthing/suckling motions, body movements, crying

• Feed 8-12x/day to establish and maintain supply

• Monitor your baby’s stools/voids- your baby should have at least 3 stools per day (this may reduce in frequency after the first 6-8 weeks) and 6+ wet diapers per day.

• Take your baby to all recommended pediatrician appointments and monitor height/weight gain.

• If you offer your baby a bottle, be sure to pump as well in order to maintain your supply.

• Ensure appropriate flange size/fit if pumping.

• Ensure your baby is in an appropriate state of alertness for feeds

• Quiet alert is the optimal state of alertness for feeding

• If your baby is consistently too sleepy to latch or maintain a latch during feedings, it is important to plan a visit with your child’s pediatrician as well as a pediatric speech-language pathologist and/or IBCLC to formally assess these concerns. We

Bottle Feeding Tips

• Feed on demand whenever your baby is hungry using cue-based feeding–common feeding cues include: rooting, hands to mouth, mouthing/suckling motions, body movement, crying

• According to Healthy Children Project, babies typically consume approximately 2.5 oz of formula per lb of body weight each day with a cap

  at 32 oz

• Monitor your baby’s stools/voids– your baby should have 1 stool per day (this may reduce in frequency after the first 6-8 weeks) and 6+ wet

  diapers per day.

• Take your baby to all recommended pediatrician appointments and monitor height/weight gain

  • If you and/or your pediatrician have concerns for your baby’s weight and suspect feeding difficulties (e.g. difficulty and/or painful latching, difficulty maintaining a latch, coughing/choking consistently during meals, milk spillage from your baby’s mouth during feeds, labored breathing during feeds, etc.), then you should seek a consult with a pediatric speech-language pathologist and, if breastfeeding, an IBCLC for further assessment.

Introducing Solid Textures

• It is recommended to gradually introduce age-appropriate solid foods, in addition to breastmilk or formula, into your baby’s diet starting at 6 months of age if developmentally appropriate. Keep in mind that breastmilk/formula should remain your baby’s primary source of nutrition at the 6 month mark as solid textures at this age are generally introduced for skill development and food exploration.

• Postural stability (e.g. sitting up with some support or independently, functional head and neck control) is a key prerequisite to the introduction of solid foods.

• It is important to start slowly, introducing 1 new food every 3-5 days. You should start with thin consistency purees, gradually working towards thicker consistency purees in the first month or two if safely tolerated. If your baby is safely tolerating thicker consistency purees after the first month, then you can gradually introduce soft mashed textures. Towards the end of the first year, as long as your baby is comfortably and safely tolerating pureed and mashed textures, you can begin to introduce finely chopped/minced soft textures (e.g. scrambled/hard boiled eggs, muffins, cooked and chopped fruits/vegetables, etc.) and meltable solids (e.g. Gerber Cereal Square, Pirate Booty, etc.)

• While introducing solid foods to your baby, be sure to avoid these choking hazards:

  • Try to limit distractions during meals.

  • Place your child in a high chair for support and stability during feeds.

  • Most importantly–be sure to incorporate plenty of fun, play, and exploration with a variety of foods during your baby’s mealtimes!

In conclusion, ensuring baby feeding safety involves a delicate balance of knowledge, patience, and attentiveness. By understanding your baby's developmental cues, selecting appropriate foods, and practicing safe feeding techniques, you can create a positive mealtime environment that fosters growth and development. Remember, every baby is unique, and what works for one may not work for another. Trust your instincts, seek guidance when needed, and stay informed about the latest feeding practices. As speech-language pathologist’s specializing in feeding, we are here to support you on this journey, helping you navigate the often-challenging landscape of baby feeding with confidence. Together, let's make feeding a joyful and safe experience, laying the foundation for a lifetime of healthy eating habits.