Feeding your baby is a fierce biological drive which rises in a mother often as soon as the baby is born. It can be extremely worrying when a baby is not making much effort to try and feed or seems more interested in sleeping than feeding.
Let me state at the very beginning that if you have any concerns regarding your baby’s health including feeding you MUST CONSULT A HEALTH PROFESSIONAL IMMEDIATELY! The following suggestions are only suitable for healthy babies born after 37 weeks of pregnancy, who weigh 2.8kg or above (6lbs 3oz). You can use them while you wait for your health professional to see you but do not delay seeking medical advice.
Why does baby seem reluctant to feed?
It can be helpful to consider any possible reasons for the baby being slow to start feeding.
Some mums may have had diamorphine or pethidine during labour to reduce labour pain. These pain-relieving drugs can make labour easier to bear, but they also pass across to the baby. It is not uncommon for babies whose mum had these medications to be more interested in sleeping them off than in feeding for the first 24 hours or so.
Babies can get tired after a long labour. They may also still have quite a lot of mucus and other gunk in their stomach. This is very normal, but it fools the baby into thinking they are full so they don’t look for milk. It’s similar to how you feel after a large Sunday lunch with all the trimmings. You are often keen for an afternoon nap so you can digest everything! The baby thinks the mucus in its stomach is a large meal, so decides to sleep while it digests. Unfortunately, mucus can take time to be digested or coughed up, so babies can delay feeding while they do this.
Getting in the mood for a feed
One of the simplest ways to remind baby that feeding is a good option is to put them close to the breast! Your breasts start producing colostrum or milk as soon as the baby is born, although the amounts may be small to start with. When you cuddle your baby close to your chest they can smell the milk and that may be enough to persuade them to try feeding.
Try some skin to skin contact. Skin to skin contact is brilliant for mums and babies. It helps babies regulate their temperature and breathing. It also calms them down and helps their stress hormones to return to normal levels after rising during labour.
Skin to skin contact is pretty easy to do. Just take off your top and any maternity or nursing bra you might have, and strip your baby down to his or her nappy. Put baby on your chest between your breasts and cover both of you with a blanket or sheet or two to keep warm.
This will often be enough to enable the baby to smell your milk and move across to the breast by themselves! This amazing reflex they have of moving towards the breast can be seen in lots of youtube videos if you are interested. Just try searching for ‘Biological nurturing’.
Secret Midwife’s Tip for Faster Skin to Skin
Skin to skin can be brilliant for getting baby to feed. However, it isn’t always easy or practical when you have guests visiting or have to look after other children. It can also be frustrating to undress a baby every 2-3 hours to get them to feed.
One great tip handed down by generations of midwives working on postnatal wards is to dress baby in a centre fastening babygro without a vest. You might need another layer such as a cardigan or an extra blanket to keep them warm when they are sleeping. When it comes to feeding time, you can just unbutton the cardigan and unfasten the babygro. Keep baby’s arms and legs in the babygro but open the front of the babygro wide. This means there will be a large enough area of the baby’s chest to enable you to do mini skin to skin! It also means baby doesn’t get cold arms and legs and redressing them after the feed is much easier.
One of the most effective techniques for getting a sleepy baby to feed is to remind them what they’re missing. If a baby gets a little milk into their system, they often wake up enough to want to feed. So how do you get milk into a sleeping baby? It’s really very simple.
Hand expression is a key skill for mothers of sleepy babies. I imagine I’ll do a longer blog post with more in-depth technical explanations at some point. At present though, let’s keep it short and simple. After all, there’s a baby to feed!
Make sure you are somewhere that you can relax and not be disturbed. Oxytocin is a key hormone in producing milk and it isn’t going to flow so easily in a room full of friends, family, a screaming toddler and the postie dropping off baby gifts! You need to feel safe and comfortable.
Make a C shape with your thumb and forefinger. It’s a bit like miming a crab’s claw! Using that C shape, put your fingers around the edge of your areola. That’s the pigmented part of the skin that surrounds the nipple. Don’t put your fingers directly on the nipple, as there is no breast tissue there for you to stimulate. Placing your fingers further back towards the area where your areola meets the normal skin tissue will help you find more milk ducts to compress.
With your fingers touching your skin, gently press your fingers towards each other, squeezing your breast in the process. Don’t slide your fingers forwards towards your nipple or backwards towards your chest wall. Just keep them pinching directly towards each other.
Getting Milk into a Closed Mouth
It may take a few seconds or more but you should start to see little droplets of colostrum at your nipple within a minute or two. This is the good stuff! Now, all we need to do is give that to the baby and let its sugary goodness wake them up enough to want to try feeding.
You may be shouting at the screen that it’s no good having the milk if the baby is asleep and won’t open their mouth. Don’t worry, I’ve got a midwife’s tip for that too!
It is true that if a baby doesn’t want to open their mouth, it’s pretty difficult to force them. Parents who give milk via a bottle will have experienced the frustration of a baby crying for milk but refusing to open their gums to allow the teat in! Thankfully, we don’t need to get the milk past their gums.
Have you ever heard the term ‘pet lip’? It’s used to describe a baby or child who has rolled their bottom lip out and down as a sign of unhappiness. It’s actually really useful to practice it yourself so you understand what I mean. Go on. No one is watching! Without opening your teeth, just roll your bottom lip forward and down, almost like it’s inside out. You’ll notice that the lovely pinkish area of tissue that sits between your lips and your teeth is exposed. This is a mucous membrane and it’s all we need to get some calories into a sleeping baby.
So, the next step is to transfer those lovely drops of colostrum to the baby. The simplest way to do this is to run your little finger over the droplet so it transfers to the finger. Take this milk covered finger and run it along the inside of the baby’s bottom or top lip. You don’t need to force the finger in between their gums. Simply coating the mucous membrane will be enough.
Once you’ve done it, go back and hand express another drop and repeat the process. Yes, it’s time-consuming but it works miracles! If you do this for 5 – 10 minutes, the baby will have a crusty milky mouth. More importantly, they will have absorbed the milky goodness and their body will normally wake them up as they decide they want more! That is the time to put your baby to the breast so that they can actively feed themselves.
Making Baby Less Comfortable
Okay, this section shows that I’ve got my midwife hat on, rather than that cuddly mummy hat that keeps babies cozy at all times. The truth is that sometimes babies are just too comfortable sleeping to rouse themselves to feed. A few weeks down the line, I would never encourage you to wake a sleeping baby. During the first couple of days, though, it is helpful in stimulating milk production and establishing breastfeeding to wake babies if they sleep too long.
How long is too long? That depends on many factors and you should be guided by your midwife or health professional. I tend to err on the side of caution and encourage waking to feed if they haven’t done so themselves by 4 hours after the end of the last feed. That’s just until we know that baby has figured out feeding and is putting weight back on after their initial weight loss.
For a baby who hasn’t yet started attaching to the breast, who seems full of mucous or very sleepy, I would encourage you to hand express and finger feed every 2 – 3 hours. Although this is a lot of work, it ensures that even if baby only decides to wake and feed at every other finger feed session, they are still getting enough milk to maintain their health. It also ensures that you are stimulating your milk production in those essential first few days whilst the baby is a little too sleepy to do so.
My ‘Pick them up and let them hang’ technique is often very effective at waking babies, although it does tug at the heartstrings. Holding the baby securely with both hands under their armpits, lift them up into the air so that their legs are no longer supported by the bed or your lap. Although the baby is perfectly safe, they don’t like the sensation of having their bottom half unsupported, so it usually wakes them up and sometimes even makes them a little upset. I don’t recommend doing it for long periods! Just use it as a 2-second thing to wake them up enough to put them on the breast.
The other surefire way to wake a baby is to change their nappy! You’ll probably have noticed that babies do not like getting naked and having their bottom wiped. This makes it an excellent tool for waking them up if you need to. You may just need to open their babygro to wake them. You may need to go all the way to changing the nappy (or opening it then closing it again if it is clean).
Another good way to wake a baby is to have a bath with them. This ticks lots of boxes for waking baby – they get naked and they get skin to skin! Of course, it only works if your house has a bath and if you don’t have lots of other children, pets and partners needing your attention!
A Suggested Feeding Schedule for Sleepy or Reluctant Babies
Every two hours start off by doing skin to skin for at least 30 minutes. Follow this by hand expressing for 5 to 10 minutes. Use your finger to transfer the drops of milk to the baby’s rolled down lips as described above. After finger feeding like this for 10 minutes, you can settle baby back to sleep. Hopefully, they won’t settle and will insist on having a proper active feed.
If the baby has a good feed of 10-15 minutes of active sucking and swallowing with rhythmic pauses, you can let them sleep for another 3 – 3.5 hours before waking them again.
If the baby decides they don’t want to feed after you’ve hand expressed, or if they only actively feed for less than 10 minutes, repeat the process in another 2 hours.
When to Seek Immediate Assistance
Always, always ask for professional advice if you are at all worried about your baby’s feeding or lack of it. Whilst most babies will wake up and start feeding themselves, a slow or reluctant feeder can be a sign that the baby is unwell. If you notice any of the following symptoms, please take your baby to the nearest Emergency Care Centre immediately.
- Jitteriness – this is a repetitive unprovoked movement in one or more limbs
- Excessive sleepiness
- Floppy limbs
- Poor sucking or refusal of the breast or bottle
- Any breathing problems or colour changes
- High pitched crying
- Problems maintaining body temperature
- Unresponsive and/or seizures