MODULE 1

Objectives

Overview

• Goals and Concerns
• Parent/Infant Interactions
• Developmental Surveillance
• Screening

Key Components

• Temperament
• "Goodness of Fit"
• Self-Regulation
  • Feeding
  • Sleep/Waking
  • Emotions
  • Distress
• Family Formation
• Families at Risk
• Attachment
• Cognitive Development
• Communication
• Play
• Mastery
• Stimulating Environments
• Child Care

Developmental Checklist

Office Practices

Community Practices

Feeding

A Special Time for Parents and Baby

Feeding is central to the parent-infant relationship and is a wonderful opportunity for interaction. While feeding their baby, parents strengthen their sense of what it means to be a parent. Their responsiveness to the baby’s cues of hunger and satisfaction and the close physical contact during feeding promote healthy social and emotional development.

Questions to Ask

• How are you feeding your baby? (Breastfeeding or formula feeding)
  
• How do you think feeding is going?
  
• How do you know if your baby is hungry? That he has had enough?
  
• How often are you feeding your baby?
  
• If breastfeeding: Do you need help with any aspects of breastfeeding?

Provider Tips

• Encourage breastfeeding. Be aware that some mothers are unable to breastfeed and others may choose not to breastfeed. Reassure these women that iron-fortified formula is an appropriate substitute for breastmilk.
• Demonstrate how to hold the baby during feedings to help him feel secure during the first 6 months. Help parents find comfortable ways to hold their baby.
• If the mother is having difficulty with breastfeeding, provide information on support groups such as La Leche League or refer her to a lactation consultant.
• Using the guidance below, discuss the benefits of breastfeeding and address other feeding topics including cues, positioning, and routines.

Guidance for Parents

For Breastfeeding Mothers

• Breastfeeding provides many benefits for you and your baby:
  • Breast milk is perfectly suited to nourish your baby and protect her from illness
  • Nursing helps create an early connection between you and your baby
  • Your warmth and presence helps your baby feel secure
  • Breastfeeding can help you feel relaxed and lower your stress levels
  • You will feel good about being able to produce nourishment for your baby
    
• If you are returning to work, you can still breastfeed your baby. Before you return to work, talk to your employer about your plan to breastfeed. Your workplace may have child care on-site where you can breastfeed your baby. If not, some other possible options include:
  • Find a caregiver who may be able to bring your baby to work for feedings
  • Make arrangements with your employer to pump your breasts during the day so your caregiver can bottle-feed your baby the breastmilk you pump
  • If you can’t breastfeed or pump your breasts at work, breastfeed your baby whenever you are with him and have your caregiver give him formula while you are work

For all Parents

In the first 6 months:

• Feedings should be a special time to build love and trust between you and your baby. Look into your baby’s eyes while feeding him and talk to him softly. Imitate the sounds he is making.
  
• Hold your baby close to you when you feed him. The physical contact will help him feel safe and secure. Your heartbeat and breathing can also help regulate his sucking, swallowing, and breathing rhythms.
  
• Be sure to burp your baby about halfway through and at the end of a feeding.
  
• It is time to end a feeding when your baby signals that he is full (straightens his arms; makes no more sucking movements; falls asleep in your arms).
  
• Even though you may be busy and have a lot of things to do, don’t prop a bottle in your baby’s mouth to feed him. Take the time to hold him for each feeding.
  
• Crying is your baby’s form of communicating. Try to determine if he is crying because he is hungry or for other reasons, such as a wet or soiled diaper, loneliness, too much stimulation, or sleepiness.

At 6–12 months:

• Keep your baby company while he is eating. Smile at him, talk to him about the foods he is eating, and respond to what he is doing and the sounds he is making.
  
• Be patient with your baby at mealtimes and allow him to feed himself with his fingers and drink from a cup.
  
• Your baby will enjoy touching and tasting different foods. This can make mealtimes messy, but it is a good way for your baby to “explore” and learn about a variety of foods.

Feeding Schedules

• Regular feeding schedules will help your baby to feel secure and develop regular sleep patterns. Routines are especially helpful for babies who have difficulty dealing with change.
  
• Even when your baby has a minor illness, it is good to keep a regular feeding schedule. If your baby is ill or congested, he may take longer to feed or be less hungry.

Provider Resources

Feeding in the First Year Birth–3 Months Feeding times may be unpredictable. Breastfed infants will eat more frequently, typically 8–12 times in 24 hours. Bottle fed infants will eat as many as 6–8 times in 24 hours. Feedings should coincide with the infant’s hunger cues, which include the following: Increased body activity Nonnutritive sucking Hands circling mouth or stomach area Waking and eventually crying 3–6 Months Breastfed infants may continue to need several night feedings. Bottle fed infants will begin sleeping through the night. 6–12 Months As solid foods are added, encourage parents to introduce self-feeding with safe foods. Instruct parents to introduce one new food at a time during the feeding time when the infant tends to be the most settled and to wait 1 week before offering each new food. Source: Barnard KE. 1999. Beginning Rhythms: The Emerging Process of Sleep Wake Behaviors and Self-Regulation. Seattle, WA: University of Washington, National Child Assessment Satellite Training Programs. Area of Concern: Feeding Difficulties Infants who do not make appropriate weight gains or have fewer than 4-6 feedings per day during the first 6 months should be assessed for physiological and behavioral difficulties. Providers can assess feeding difficulties by: Measuring parents’ discomfort with feeding and scheduling Observing a feeding, focusing on the parent-child interaction Evaluating problems in parent-child relationships Monitoring feeding problems carefully Suggesting alternative, more comfortable positions if parents are uncomfortable holding their infant Determining if feedings are too infrequent or if schedule is overly rigid Investigating too few feedings per day Providing parents with resources (public health nurses and dietitians, La Leche League, WIC, and lactation consultants)