Force feeding

Updated 28-Jun-2024

The force-feeding I am talking about is the force-feeding of babies, not adults. This is actually quite an alarming action taken on the part of moms who are mistaken about their role in feeding babies. There are actually quite a few things that can help a baby feed if they start to get fussy and refuse the breast.

Milk Refusal

But first, let's look at the common potential causes. Unfortunately there are a lot, as in just about everything:

  • Not hungry
  • Burping needed
  • Dirty diaper
  • Sickness of some kind
  • Other stomach issues
    • Reflux (common)
    • Vomiting
    • Diarrhea
    • Constipation
    • Need to defecate
    • Need to urinate
    • Gas, farting
  • Colic (note it is unclear the cause of this, but crying is a symptom) -- there are a few indicators that it may be colic (which is persistent crying):
    • Peak of crying. Your baby may cry more each week, the most at two months, then less at between three months and five months.
    • Unexpected crying. It can come and go and you don't know why.
    • Resists soothing. Unfortunately, your baby may not stop crying, no matter what you try.
    • Pain-like face. Your baby may look as if she is in pain, but it's unlikely that she is.
    • Long-lasting periods of crying. It can last for several hours a day.
    • Evening. Your baby is most likely to cry more in the late afternoon and evening.
  • Teething - oral pain or anticipation of it from the nipple
  • Other pain of some kind (diaper too tight, something poking the baby, being held too tight or limbs not comfortable)
  • Forceful Letdown -- indicative when there is too much milk in a breast and the baby ends up being overwhelmed and chokes on the milk (try block feeding in that case)
  • Just doesn't want to nurse (that is, perhaps wants to play, is otherwise distracted, or not in the mood for whatever reason)
  • Some other reasons

Nursing Strike / Feeding Aversion

A Nursing Strike is when a baby repeatedly (though not necessarily every time) refuses to milk even when verifiably hungry, and in the absence of other causes (granted, this is hard to tell as the litany of possibilities above cast a wide net). This is common with breastfeeding.

Breast Aversion / Feeding Aversion

The heart of the matter is breast aversion, when dealing with breastfeeding, but it could in fact be nipple aversion from a breast and/or a bottle. The key here is in how to feed, which is a source of endless discussion and confusion, from perusing the Internet as well as books by pediatricians. There are a key behavioral changes to make in feeding:

  • For those breast nursing, wear clothing that is easy to access the breasts and not get in the way of feeding (indeed, the baby may become upset very quickly if a breast is not available or clothing keeps getting in the way). Note that many nursing bras and especially nursing blouses are actually quite poorly designed and don't work as they should.
  • Lots of skin-to-skin contact (when the temperature/climate allows)
  • Offer the breast / bottle often
  • Offer the breast / bottle in a very casual way
  • Nurse when baby just wakes up
  • Try favorite positions, or new positions, or at least switch positions if the last time on that position was a refusal
  • Don't hold the back of the baby's head, or force or hold the baby to the breast
    • Note that this might be tricky when their neck muscles are not fully developed and cannot move closer to the breast themselves.
  • Try and warm up or prepare the breast, in the case of breast feeding, or drop expressed milk onto the nipple just before latching
  • Block feeding (divide up feeding equally between two breasts, don't try and empty one of them) if there is a forceful letdown in breastmilk pressure.

Nipple Confusion

Now, it should be stated that there are divided opinions on the subject of the wisdom of a bottle vs. a nipple when trying to exclusively breastfeed. The concern is that a breastfed baby, once provided a bottle now and again (after rejecting the breast, but when willing to drink from a bottle), will learn to reject a breast at all times (or increasingly reject, in any case). One reason for this belief is that it is easier for a baby to drink from a bottle, and so the baby will naturally prefer this method. Bottle advantages include:

  • Easier to drink/suck and faster flow
  • Easier to hold the bottle at an optimal angle for the baby
  • No clothes or other distractions to get in the way
  • Less stress for babies who are experiencing problems with horizontal feeding
  • Nurse can easily reposition the baby for burping and back for drinking, and remove the bottle if it is causing problems with breathing, too much flow, taking a break, etc.
  • Baby can bite on a bottle nipple without the problems caused by biting on a breast nipple
  • etc., etc.

Basically, a myriad of reasons can come up for someone contemplating bottle feeding while breastfeeding. The basic rejection of the breast at some times during which the baby will feed on a bottle, is generally an emotionally distressing event for a mother, and there is a lot of denial about how there might be a problem. The two poles of response are: provide a bottle, on the one hand (with breastmilk or formula), and refuse to provide a bottle of anything. Obviously there are many responses in between these two polar opposites.

While I have heard a doctor say that no baby has died from not being given a bottle when they reject a breast that is a bit ridiculous. Death is not the only negative event to avoid and everything up until death is certainly not acceptable in any case. For those who want a hungry baby to be fed, even in the face of breast rejection, a bottle is the obvious (and simple) solution.

The key to bottle feeding turns out to be mostly the same guidance on breastfeeding, with a few minor differences:

  • Feed upright, but do switch sides
  • Do not force, push the nipple in the mouth, or try to get baby to finish
    • Note this is a bit incomplete, as some babies at some times, need to warm up to the drinking task and a little repeated presentation of the bottle, moving toward, and then away from the baby's mouth, may be helpful in encouraging the drinking process.

It is easy to determine if bottle feeding becomes a problem (simply take note of each feeding, present the breast first, and see if a trend increases in favor of the bottle). If so, and if one feels this is a problem that needs to be eliminated, then do so -- that is, go through the trauma of a hungry, unhappy baby until they cry themselves to sleep, and when they wake up, present the breast.

To my mind it seems a bit ridiculous to be so anti-bottle feeding. The bottle is definitely an improvement over the breast in many ways (though of course the breast is the result of a lot of clever evolution, and should never be despised). It really comes down to whether it is more important for a hungry (and possibly tired and cranky) baby to get a meal, or for the parents to control how the baby will eat. Considering the issue as one of giving-in vs. standing-one's-ground is particularly troubling, especially when dealing with young babies (< 2 years old).

Most babies actually have no problem switching between breast and bottle, and there may be a time-of-day issue with preference that waxes and wanes throughout a day. And in reality, the objective is to have the baby feed. That is the purpose of the breast, not simply to dominate over all feeding mechanisms.

Sources on Coaxing Baby to Nurse / Nursing Strike

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