Podcast: Ep 24 - The lasagne effect

Breastfeeding, snacks and meals

Does your baby snack feed? The duration and scheduling of breastfeeds is a hot topic both for mums having questions and others giving advice. Jess and Simone chat about feed timing, and what Simone likes to call the lasagne effect.

Links to resources and information discussed in this episode:

• Information on feeding patterns, including how long feeds take and routine or timing of feeds. 
• How breasts make milk information (supply and demand principle). 
• Is my baby is getting enough breastmilk? 
• Information on waking sleepy newborns for feeds. 
• Breast compressions information. 
• Breastfeeding and hot weather information. 
• Paced bottle-feeding information.
• A caregiver's guide to the breastfed baby leaflet, including paced bottle-feeding.

Credits: This episode is presented by Jessica Leonard and Simone Casey. Audio editing by Jessica Leonard. Show notes by Belinda Chambers. Transcription by Jessica Pressland-Black. Produced by Belinda Chambers, Jessica Leonard and Eleanor Kippen.

[Music in background]

SIMONE: There's a concept that's been thrown around and you hear it a lot: don't let your baby snack feed. And it actually infuriates me, because everyone has snacks! They're human babies, we are human, we all have snacks sometimes, and we all have big meals sometimes.

JESSICA: Welcome to Breastfeeding… with ABA, a podcast brought to you by volunteers from the Australian Breastfeeding Association. Breastfeeding… with ABA is a podcast about breastfeeding, made by parents for parents. In this episode we'll be talking about timing feeds and what Simone likes to call the lasagne effect.

This podcast records in different parts of Australia. We acknowledge the traditional custodians of the lands we're recording on, and the lands you're listening on. We pay our respects to elders past, present and emerging and to any indigenous people listening. We also acknowledge the long history of oral storytelling on this country and of women supporting each other to learn to feed their babies.

My name is Jessica and I'm a breastfeeding counsellor with the Australian Breastfeeding Association.

SIMONE: And my name is Simone and I'm a breastfeeding counsellor with the Australian Breastfeeding Association, and an International Board Certified Lactation Consultant, working on the maternity ward in a hospital setting and in private practice in women’s homes.

JESSICA: And today we're recording on the lands of the Wurundjeri people of the Kulin nation.

[Music begins to fade out]

So, Simone today we're talking about timing feeds, so lots of mums are told to schedule the amount of time between breastfeeds. So, what do we know about this?

SIMONE: So, one of the things that we know about breastfeeding is that it works on a supply and demand basis. So that means, however much your baby takes from the breast is how much you'll make. It doesn't work so much on a time basis. Babies don't know what clocks are, so… and even just how long a baby spends on the breast, it could be different from baby to baby and mother to mother. You know, some babies take longer to feed, some babies take a quick time to feed. Some women’s milk comes out quickly, some women’s milk comes out a bit more slowly. So, all the different combinations mean that a baby could feed for a short time or a long time, or they might want a small feed or a large feed, so there's so many different combinations of that.

JESSICA: Yeah, I definitely had that experience with, I've got two children and my first would be at the breast for a good sort of between 30 and 45 minutes, until she was at least a couple of months old. But my second was quite a big baby and he was always very efficient at feeding, so by the time he was about six weeks old he would spend 5 minutes on the breast. So, to start with that was something that I wondered a little bit whether he was getting enough milk, but then I was very reassured by the fact that he was getting lots of wet and dirty nappies and certainly putting on a lot of weight and meeting his milestones. He was just a very quick feeder.

SIMONE: I've seen babies that are pretty much done in five minutes, and even newborns, that can be quite quick. I've also seen babies that, you know, are very sleepy, very slow. Sometimes we have to prod them along a little bit, so, in the early days, a feed could take up to an hour for those babies. Sometimes they need even to be woken up and switch sides and all those sorts of things and then you'll get the ones that are done quite quickly. 

Sometimes too, if they've had a really long feed, they might last a bit longer asleep and then other times if they've had a short feed, they might last a shorter amount of time. I always say to the parents we can't choose what length of feed they're gonna have, they really choose that. I guess we can encourage a newborn by prompting them and maybe doing some breast compressions and things like that, but not always, you know. Sometimes they just want a small amount of food, sometimes they want a large one, and that's how we come up with the lasagne effect!

JESSICA: So, what is the lasagne effect?

SIMONE: So, [laughs] this is something I sort of made-up one day when I was giving a talk to a whole lot of women. It was actually a meeting with the Australian Breastfeeding Association with a whole lot of mums and we're all sitting around in a circle, and everyone was talking about how long do you keep them on the breast for? How long between feeds? Is it 3 hours? Is it 4 hours? Is it 2 hours? What is it? And so, I just sort of started to explain it like, do you always want a lasagne and a crème brûlée for dessert every single time you eat throughout the day? And of course, everyone’s going no, of course, I don't. Sometimes we'll have a full three course meal, maybe at dinner time, but when you think about how many other times you eat during the day, that could be a cup of tea and a biscuit. It could be just a sandwich. It could be a sip of water, sometimes you're thirsty. So, if you look at how many times you're actually putting food or drink to your lips throughout the day, it's quite often, but it's also various amounts and it can be large amounts or small amounts and it’s exactly the same with a baby. And when I was telling this to the mums, they're all just going oh yeah, of course.

And there's a concept that's been thrown around and you hear it a lot: don't let your baby snack feed. And it actually infuriates me, because everyone has snacks! They're human babies, we are human, we all have snacks sometimes, and we all have big meals sometimes. And that if we can give that baby the luxury of what we have, is being able to decide whether they have a main meal or a snack, then that's OK, and if they have a snack, well, maybe they might want to feed only an hour later, but if they have the lasagne and the crème brûlée, maybe they'll have a nice big four hours gap between feeds. But we don't get to choose that, they do.

JESSICA: I used to use exactly that phrase when my children would just have a quick snack feed, I say oh, just a cup of tea and a biscuit this time.

SIMONE: Yeah.

JESSICA: And that was fine, and especially on days when it's really, really hot as well, I would find that they would have that really quick snack feed because they were thirsty. Just feed for a couple of minutes and off they’d go in the same way that I would be drinking more water on that day to keep myself hydrated.

SIMONE: Yeah, the other thing I’d hear a lot is 20 minutes each side. I just hear that so often now. I don't know exactly where that exact amount of time came from, but over the years I have heard it so many times. Mums will say to me so, what about, about 20 minutes each side? And like, I just always answer like, I don't like to put a number to it. Let's just look at the baby sucking. Let's look at the baby swallowing. If the baby is continuing to swallow, well, we know they want more. If you can encourage a newborn to keep swallowing, great, but if you can't and they're finished, take them off, you know. Don't look at whether it's 20 minutes or not. 

And I actually had a mum once that I went and saw her and she… her baby was very quick at feeding. In fact, she had a lot of milk. It was coming out fast. And her baby would only feed for, I think she timed it, 7 minutes each side. But because she'd heard about this 20 minutes from somewhere, she used to pump her breast until she got to the 20. Then she’d give the baby the other side. If it only took 3 minutes on that side, then she'd pump for exactly 17 minutes. So, she would have all this expressed milk, which the baby actually didn't even want. Plus, just because of this 20 minutes thing so, [laughs] I think it's a little bit of an extreme example, but it was a true story. And yeah, she thought it had to be 20 minutes.

I also had a neighbour who did the same thing when her baby was a bit older. I think she was about four months old and um, yeah, thought that her baby had to have 20 minutes each side, and the baby was actually just refusing and crying a lot, so when we had a chat about it, we realized that she was trying to go to the 20 minute mark and it, just the baby was finished after like 5 minutes or something. So, once we listened to what the baby wanted and actually stopped when they were finished, everyone was much happier.

JESSICA: Yeah, it'd be like you offering me a crème brûlée after a lasagne.  I just don't think I could manage it.

SIMONE: [laughs] That's right.

JESSICA: So, what is the satiety response?

SIMONE: When babies breastfeed, there is a release of a hormone called cholecystokinin which is a hormone that helps a baby feel satisfied. It actually also helps the mother feel that way as well, in that they can actually feel a little bit sleepy when they have that hormone flooding through them. So, when you actually start to breastfeed, some women feel their eyes going a little bit, sort of heavy. But it also is, it, it means that babies know to stop when they're, when they're finished and when they're satisfied and when they're full. So, it's something that I guess they're born with and that we do, you know, need to listen to that. And if they're telling you all these little signs that they're finished, which is things like turning their head away, basically not opening their mouth anymore and just sort of not really looking for the breast … sometimes pushing away, those sorts of things, then we sort of know they're done, and they're satisfied.

JESSICA: So, if there's a caregiver who is maybe giving a baby a bottle, of either expressed breast milk or infant formula, how can they preserve that satiety response?

SIMONE: Yeah, ‘cause I think it is a little bit easier to overfeed, I guess from a bottle, because a baby, when something is in their mouth, they do often just keep sucking and they could just keep be sucking 'cause they've got a sore tummy or they like the comfort of the suck. But then the milk still comes out of it. So, pace feeding is something we talk to parents about then, when we give the bottle, so that we're watching the baby's cues. If milk leaks out the sides of their mouth, for instance, while they're bottle feeding, I would usually just drop the bottle down a bit, making sure the baby is also fairly propped up and their head’s slightly tipped back so their throat is open and just giving that bottle a dip down. You don't have to worry that the baby will suck air or anything, but basically so that the milk is out of the teat and then back up into the teat. So, when you are, it is in the teat it's probably about halfway along, and then you just start and stop as the baby needs it. And I guess once they're sort of not really looking for it anymore and not really searching or rooting, then they probably can stop with that bottle.

JESSICA: Yeah, and there's some more information about paced bottle feeding on our website, if anyone listening is a caregiver who needs to give a bottle to a baby and wants to look into that.

So, to wrap things up, what do you think overall about the idea of babies having very specifically timed feed versus having small meals throughout the day? What are your thoughts?

SIMONE: I just think it's about watching your baby and not the clock. So, looking at whether they're showing hunger cues, have they just woken up from a sleep and that has, there's been a few hours. Understanding what sucking and swallowing looks like versus so what we call nutritive sucking versus non-nutritive sucking. So, whether they're sucking for comfort after, and they've been there and they've done lots of swallowing already and just understanding all that. 
So, demand feeding is something I guess we talk a lot about and it does seem to work really well when babies feed when they want to, rather than being told right, let's see, you have to have milk right now. And I guess as, you know, adults and as human beings, we don't want to be told when to eat and that you have to eat right this very moment. And sometimes too, you know, just for convenience, you're going out and you go, I don't want to feed when I'm out, I'd really like to feed now, before we go, just for my convenience [laughs]. And you try to feed them and they're like no way, man, I don't want this! So, you know, it really is up to them. And demand feeding, I guess, is just trying to be in tune with your baby and understanding when they wanna feed and when they don't.

[Music fades in]

JESSICA: Yeah, I definitely remember trying to do that before things like long car trips. Just be like, oh OK, I don't think baby feels like a feed just yet, but I just want to try and top them up-

SIMONE: Sneak it in

JESSICA: -so they can get a little bit longer throughout the car trip before we have to … and you know, sometimes that was fine, and other times they were just not having a bar of it.

JESSICA: Thanks heaps, Simone, for chatting with me today. You can check out the show notes for a link to Simone's blog and to some other information as well.

If you're in a position to support the work ABA does financially, you can become a member by visiting breastfeeding.asn.au and that'll link you in with your local group as well.

If you need some online support, you can join our Breastfeeding with ABA Facebook group, so you can just search for that and there's three joining questions to get into that group, so make sure you answer those first.

If you want to speak to a breastfeeding counsellor, call the National Breastfeeding helpline on 1800 686 268. So that's open 24 hours a day, every day of the year. Our LiveChat service is another option, so you can check the website to see when that's open.

Thanks heaps for listening. We'd love it if you can rate, review and subscribe to the Breastfeeding… with ABA podcast, wherever you're listening.

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