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Parenting
with Gary & Anne Marie: Infant
What's Behind Modern Infant - Feeding Philosophies?
Demand-feeding. Hyperscheduling. Cry feeding. Breast-feeding and bottle. Feeding baby should be easy. Your baby needs food and you have it. So why all the confusion? One reason might be the overabundance of parenting theories. With so many options it is no wonder parents get confused. For example, during pregnancy you may have been encouraged to demand-feed your baby and warned not to follow a schedule, especially if you intend to breast-feed. Maybe you heard about a demand schedule or a self-regulating schedule.
Perhaps you were told to consider natural feeding for the baby or to avoid hyperscheduling. Of course, hyperscheduling is rigid, and rigid feeding is not as good as cry feeding. However, the latter is less desirable than cue feeding, which is similar to responsive feeding. And last but not least, is bottle-feeding. Where in the process might this fit in?
When it comes to feeding baby, it isn’t any wonder many moms resort to simply winging it. Who can decipher all the terms and techniques? Certainly, establishing good feeding habits should be the easiest feature of child training. That’s because the drive to obtain nourishment is one of the strongest drives in all living beings. However, much more is happening during feeding time than just filling up a little tummy. How you choose to feed your baby will have a profound effect on your child’s hunger patterns, sleep patterns, and basic disposition.
Defining the Terms
Prior to this century, common sense, not theoretical concepts, was most critical in raising children. Mothers nursed babies when they were hungry, having pre-established guidelines for babies’ hunger patterns. A mother shaped her baby’s hunger cycles to match her need to care for the entire family. A mom had no cause for clock-watching to know feeding time was at hand. Her schedule was set by domestic duties which ruled her day. Thus, routine feedings fit into her schedule in a way orchestrated to meet her baby’s needs alongside those of her entire family.
As the industrial revolution progressed, new infant-management theories evolved. During this century, two theories have dominated American parenting. In the early years, the first theory was introduced by a group of scientists called behaviorists. Their belief was that a child was molded by his or her environment. The infant’s developing emotions and feelings went unrecognized, over-ruled by specific and controlled care. Such outward structure, behaviorists believed, produced in the child controlled emotions. This was considered desirable.
Based on this theory, American mothers in the 1920s were introduced to a feeding practice called hyperscheduling or clock feeding the baby. A strict four-hour feeding schedule was established. Every good mother followed it to the minute. If baby seemed hungry after three hours, too bad. No feeding would occur until that fourth hour had passed. The clock was the final authority with no regard for the baby’s, and certainly not the mother’s, needs. 1
By the mid-1940s, a second theory, an adaptation of Sigmund Freud’s child-rearing theories, started to nudge out the rigidity of behaviorism. Freud’s twentieth-century followers stressed the instinctive, animal-like qualities of infancy as the starting point for child management. Structure was not as important to those theorists as were the child’s developing emotions. With revisions made to Freud’s theories, the American parent was pulled to the other extreme. Now, the baby was fed at the first indication of fussiness whether or not the baby was actually hungry. Under this theory, nursing the baby satisfied both nutritional needs as well as presumed psychological needs.
To what type of psychological need were these theorists referring? Psychoanalysts attempted to locate the origin and nature of adult neuroses by discovering, through psychoanalysis, significant traumatic experiences in early childhood. Originally, the quest into the past ended in the preschool years (two or three years of age). When no traumatic experiences were found in the average patient, analysts were forced to either abandon their theory or, by faith, move to the conclusion that the original source of traumatic experience was the birthing process itself, as postulated by Austrian psychoanalyst Otto Rank in 1929. Even Freud greeted such a notion with skepticism.
That belief inspired the neoprimitivistic school of child care, supported by Ribble (1944); Aldrich (1945); Trainham, Pilafian, and Kraft (1945); and Frank (1945). The title “neoprimitivistic” is not name-calling, but a specific school of thought. This theory postulates that the separation at birth momentarily interrupts the mother-child in utero harmony. Therefore, the goal of early parenting is to reestablish that harmony. How is this supposed to be achieved? Only by the constant day-and-night presence and availability of the mother to the child. New mothers are instructed to do whatever it takes to neutralize the supposed trauma of birth and offset its effect. By 1949, the birth-trauma theory, lacking objective verifiable data, was dismissed as a nonsensical theory. But that was not the end of it. Twenty-five years later, it resurfaced again disguised under a new name—attachment parenting.
It is important to note that the modern attachment parenting theory and the theories of attachment are not the same. The first is a parenting philosophy driven by an interesting but unproven philosophical assumption—birth trauma. The second is a generally accepted truth that infants are born with both the capacity and need for warm, loving, and intimate relationships. When these relationships are secured from loving parents, the foundation for all future emotional bonds is established. On Becoming Babywise will help you connect with your baby and meet his attachment needs and more.
As a result of the birth trauma speculation, the 1950s American mother began leaning more towards a nonstructured approach in parenting. During this time, Dr. Benjamin Spock rightly rejected behaviorists’ assumptions of absolute structure and veered parents toward a healthy mix of structure with flexibility. This was a radical idea in the 1950s and a much needed redirection for mothering.
By 1970, Spock’s views were gradually replaced by a nondescript and generic feeding approach commonly referred to as demand-feeding. This practice operated on the simple assumption that a baby should always direct the timing of a feed. This new view sounded good on the surface but had serious short comings, (as we shall discover later in the chapter.) It was in the early 1970’s that unsuspecting mothers began to abandon any parent-guided routine and trusted their baby’s cry to be the exclusive signal for nursing. And that is when weak and sickly babies, and babies who had not learned how to nurse efficiently, began to suffer.
Today, the term demand-feeding carries a variety of meanings depending on who you talk with. For example, Julia, a second-time mom, describes what demand-feeding looked like for her. “I demand-fed my first child every three hours.” For Julia, demand-feeding offered some predictability. In contrast, Barbara, a fourth-time mom, defined her last experience as having some flexibility within defined limits. “I fed my baby on demand whenever he was hungry,” she said, “But never sooner than two hours and never longer than four hours.”
Allicin, a third-time mom and former attachment-parenting follower, describes a more fatiguing experience. “I nursed my babies whenever they cried or began to fuss. On average, I was told that mothering attachment required me to nurse every two hours around the clock for the first six weeks,” says Allicin. “I was exhausted and forced to give up breastfeeding.” 2
Obviously definitions vary from household to household and practitioner to practitioner. For the purpose of this book and because of its extreme nature, Allicin’s definition of attachment parenting will be used when referring to demand-feeding rather than the other two moderate forms described by Julia and Barbara. When attachment parenting, abbreviated AP, is noted, we are implying that the baby’s cry is the primary signal (cue) for nursing. This is true regardless of whether that cry is for food or a presumed psychological need. The baby is offered the breast simply and immediately without regard to assessment of real need, or the amount of time that has elapsed since the last feeding. For the AP mom, the next feeding may be in three hours or in twenty minutes.
By the early 1980s, the neoprimitivistic school of infant care and its attachment theories gained more ground. AP theorists today believe that babies are born with lingering womb attachments and that birth only changes the way the attachment need is met. In order for the baby to get the best start in life, an artificial womb-like environment must be created and maintained after birth. 3 This theory overlooks one all-important consideration. The baby is not in the womb any more because he has developed beyond the need for a womb environment. The theory is in conflict with its most basic assumption.
The updated version of the attachment parenting womb theory requires mothers to carry their babies whenever possible, sleep with them, breastfeed day and night and continue breastfeeding well into their second, even third or fourth year of life. 4 Continuous access to the mother’s breast and immediate gratification are primary parts of the attachment process. The premise suggests that the sensitivity that helps a mother do the right thing at the right time develops more quickly (and to a greater degree) through breastfeeding. That is why you supposedly can never breastfeed too much, too long, too often, but only too little under this philosophy.
Thus, the devout La Leche League mother will respond to her baby’s cry with the breast even if it is the third time in thirty minutes. She is acting on the fearful assumption that every cry is a call for hunger or represents the early signals of attachment failure. Either way, the theory insists that the breast is the primary and often the only form of comfort-relief acceptable. The weary mom moves dutifully toward her child, never realizing that her child’s lack of contentment is more likely the result of her parenting style and beliefs.
It all becomes a vicious cycle. The methods used to manufacture a secure attached child too often produces the symptoms of an emotionally-stressed, high-need, insecure baby. These symptoms often include a combination of excessive fussiness and colic-like symptoms; instability in feeding and sleep cycles; waking for night nursing for up to two years; low tolerance for delayed gratification; underdeveloped self-comforting and coping skills; limited self-play adeptness—and one tired mom.
The weakness of the womb-and-birth-trauma theory is found in its very premise. Does the birthing process really create psychologically fragile children? Does the stability of all future human emotions really hinge on the necessity of recreating a second artificial womb? Dr. William Sears, writes: "Another reason babies fuss is that they miss the womb environment they once had. . . Baby's fussings are pleas to his caregivers to help him learn what makes him feel right, a sort of "Give me my womb back plea. . ." 5
"Babies miss the womb environment they once had?" Wow, how does Dr. Sears know that? What test did he give to determine if newborns miss the womb? To miss something one must contemplate it. The belief that a newborn can cognitively sense "missing" anything represents quite an advance memory system. What does he miss in the womb that according to Sears he wants to return. The moist wet sack? The smells? The sounds? Did the womb really represent paradise to a pre-born child. This type of theoretical conjecture is scary.
More likely, newborns have zero memory of birth, let alone the ability to recall anxiety that is specific to the experience. Memory function and synapse development depend on the brain receiving highly oxygenated blood which comes from breathing. Breathing cannot begin until the lungs inflate, which occurs after, not during birth. In addition, higher brain centers are still developing at the time of birth. Even if there is any minimal memory function, enough sophistication for baby to associate birthing with trauma remains highly unlikely.
While behaviorists emphasize outward structure and not the inner person, the neoprimitivistic school emphasizes the inner person at the expense of outward structure. As professionals, we believe both approaches are extreme. We believe they are both wrong and harmful to the healthy development of any baby and soon-to-be toddler. There is a better way.
The Babywise Alternative
Some mothers emotionally thrive on an attachment style of parenting. That is not the case for all women. A more user-friendly, less fatiguing and extreme alternative is available called parent-directed feeding (PDF). Parent-directed feeding is a twenty-four hour infant-management strategy designed to help moms connect with their babies and their babies connect with them. It is a proactive approach to infant care, meeting the needs of the newborn and those of the rest of the family.
It is our experience that both baby and mom do better when a baby’s life is guided by a flexible routine. PDF is the center point between hyperscheduling on one extreme and attachment parenting at the other. It has enough structure to bring security and order to your baby’s world, yet enough flexibility to give mom the freedom to respond to any need at any time.
What Babywise and PDF bring to the table is the single most critical element for all aspects of infant care—parental assessment (PA), an acquired confidence to think, evaluate and respond to real need, not just react moment by moment. The following analysis will demonstrate why parental assessment is absolutely necessary for your baby’s welfare.
Comparative Analysis of Feeding Philosophies
At present, three feeding philosophies dominate Western culture:
• Child-led feeding (also known as cue feeding, demand feeding, response feeding, ad lib, and self-regulating feeding)
• Clock feeding (also known as scheduling)
• Parent-directed feeding (PDF)
Theory in Practice
1. Child-Led Feeding: Feeding times are guided strictly by the single variable of hunger cues. The baby's hunger cue is a variable because feeding times are random. Three hours may pass between feedings, then one hour, followed by twenty minutes, then four hours. The constant of time is not considered, because the theory insists that parents submit to the baby’s hunger cue regardless of the lapse of time.
2. Clock Feeding: Feeding times are guided strictly by the constant of the clock. The clock determines when and how often a baby is fed, usually on fixed intervals. The critical variable of a hunger cue is not considered. The parents’ role is to be submissive to the clock.
3. Parent-Directed Feeding: Both the variable of hunger cues and the constant of time guide parents at each feeding. The parents’ role is that of mediating between the cue and clock, the variable and constant, using parental assessment to decide when to feed based on actual need.
Conflict Between the Variable and Constant
The greatest tension with feeding philosophies centers on which feeding indicator to use—the variable of the hunger cue or the constant of the clock. The standard Attachment Parenting/La Leche League doctrine insists on child-led feedings exclusively, thus, the hunger cue is dominant. The hyper-schedulist sees the fixed segments of time as the final determinant of feeding. Thus, the clock is dominant. Where does the healthy truth rest? Not at either extreme. The weakness in logic of these two views becomes obvious when placed into their respective equations. The child-led feeding equation looks like this:
Hunger Cue + Nothing = Feeding Time
Weakness in practice:
1. The child-led feeding is based on the faulty assumption that the hunger cue is always reliable. It’s not! Hunger cues only work if the hunger cues are present. Weak, sickly, sluggish, or sleepy babies may not signal for food for four, five or six hours. So exclusive cue feeding puts them at risk of not receiving proper nourishment. If the cue is not present, the baby doesn’t get fed.
2. If the cue is consistently less than two hours, it leads to maternal fatigue. Fatigue is recognized as the number one reason for mothers giving up breast-feeding. 5 Exclusive cue-response feeding can easily lead to infant dehydration, low weight gain, failure to thrive, and frustration for both baby and mom. 6
3. The inconsistency of cue feeding also discourages the establishment of healthy sleep patterns as we will demonstrate later.
The Clock-feeding equation looks like this:
Clock + Nothing = Feeding Time
Weakness in practice:
1. Feeding based on fixed times ignores legitimate hunger cues by assuming each previous feeding has been successful. The child who wants to feed after two hours is put off until the next scheduled meal.
2. Strict schedules may not promote sufficient stimulation for breast milk production, leading to the second greatest cause for mothers giving up breast-feeding: low milk supply. 7
With both child-led feeding and schedule feeding, a tension exists between the variable and the constant. This tension is both philosophical and physiological. In either case, as parents are trying to serve their underlying parenting philosophy, they become enslaved to a method. To accept either of these feeding indicators as an exclusive guide to feeding is to endanger your child.
The Philosophy of Parent-Directed Feeding
The Babywise Parent-Directed Feeding (PDF) eliminates the tension of relying exclusively on the unreliable variable of a hunger cue or the insufficient constant of the clock. PDF brings into play the critical tool of parental assessment. Parental assessment takes the best of both and weds them together. It frees a mother to utilize the variable of the hunger cue when necessary and the constant of the time when appropriate. Parental Assessment is the mediator. With PDF both the variable and constant are used as companions, backups to each other, not antagonists to be avoided. Consider the PDF equation:
Hunger Cue + Clock + PA = Feeding Time
Notice how the conflict between the variable and constant is eliminated because the parent mediates between both for the well-being of the child. It is Parental Assessment that brings balance to both. Here are some of the benefits of the PDF approach:
1. PDF with Parental Assessment provides tools to recognize and assess two potential problems with infant feeding: a) A child who feeds often, such as every hour, may not be getting the rich hind milk. With PA you not only respond to the cue by feeding the baby, but are alerted to a potential problem with the feedings. b) When the cue is not present, the clock serves as a guide to ensure that too much time does not elapse between feedings. It is also a protective backup for weak and sickly babies who may not demonstrate the necessary hunger cues.
2. When the hunger cue is present, the clock is submissive to the cue, because the hunger cues, not the clock, determine feedings.
3. In the end, PDF promotes breast-feeding, healthy sleep, and healthy infant weight gain. So we ask parents to consider which feeding philosophy makes the most sense? The one where the baby decides? The one that a clock determines? Or the one that parents assess and direct? What will it be for you?
Foot Notes:
1. Dr. Rupert Rogers wrote on the problems of breast-feeding during the 1930s and 1940s. He told mothers to be old-fashioned. What did he mean by that? He said to go back to nursing periods arranged as follows: 6:00 a.m., 9:00 a.m., noon, 3:00 p.m., 6:00 p.m., 10:00 p.m., and once when the baby wakes in the night. Although that type of feeding was a schedule, it wasn’t referred to as such. The term “schedule” referred to a nursing technique more than a routine. Mother’s Encyclopedia (New York: The Parents Institute, Inc., 1951), p. 122.
2. See recommendations by William Sears, M.D., & Martha Sears, R.N., The Baby Book (Boston: Little, Brown & Company, 1993), p. 136.
3. William Sears, M.D., & Martha Sears, R.N., The Baby Book (Boston: Little, Brown & Company, 1993), p. 343.
4. We don’t take issue with a mother who chooses to breast-feed longer than a year because she enjoys that special time. We take issue with the suggestion that the child has a psychological need inherent at birth and if not allowed access to his or her mother’s breast, the child’s future emotional health is put at risk.
5 (William Sears, D.D.k, & Martha Sears, R.N.,The Baby Book (Boston Little, Brown & Company, 1993, p.343-4)
6. Journal of Human Lactation, Volume 14, Number 2, June 1998, p.101].
7. On January 20, 1995, ABC’s 20/20 aired a story dealing with demand-fed, dehydrated infants. This piece showed the American public a child with an amputated leg. The leg was taken because gangrene had set in due to the lack of proper assessment of the real need—adequate nutrition. The mother was feeding on demand but the child wasn’t demanding enough. ABC is not the only major media source that voiced concern. In a front page article in The Wall Street Journal on July 22, 1994, reporter Kevin Helliker told the story of an infant who by the end of the first week had taken in so little food that he suffered irreversible brain damage. The mother kept trying to nurse her newborn on demand, despite initial difficulties. Other cases were documented, including two that resulted in death as a result of mothers not recognizing the signs of inadequate milk production. Similar reports appeared in Time on August 22, 1994, U.S. News & World Report on December 5, 1994, and on the television news magazine Primetime Live, August 4, 1994. According to The Wall Street Journal, nearly 200,000 infants a year are diagnosed with “failure to thrive”—most of which are associated with “just feed more often” advice.
8. Journal of Human Lactation, Volume 14, Number 2, June 1998, p. 101
Article
by Gary Ezzo and Anne Marie Ezzo
