Why lists of feeding cues can make breastfeeding go worse, not better

Cues that your baby wants milk

Have you been given a list of your baby's feeding cues, or lists of behaviours which are meant to signal their baby wants to feed? In the Possums programs, we don't give parents lists of baby behaviours and what they mean, because these lists can be both misleading and disempowering.

You are the expert on your baby, and the only way any of us work out what a baby is cueing for at any particular time is through experimentation. Experimentation is the key to your resilience as a parent! You can find out about experimentation here.

You'll hear that the oral seeking (or rooting) reflex signals hunger - but babies are hardwired to root when their cheek touches your skin. Quite often baby might be searching with her mouth because of hunger, and it doesn't hurt to offer.

But some parents worry a lot that the baby is hungry because they've seen rooting and bobbing behaviour or the baby sucking on his or her little hand, but then baby won't take the breast! "What's wrong?" you might think, and it can be tempting to pressure the baby to take the breast a little, if you think the baby is always hungry when he or she bobs her head around against your body.

The main communication or cue from your baby that he or she wants to feed is the dialing up. Really there are just two responses to experiment with: your two tools of either milk or sensory motor nourishment. We activate a baby’s breastfeeding reflexes when the lower half of the little one’s face has contact with our breast and body. Since this is a reflex, some babies will begin their oral seeking and bobbling behaviours anytime they are in contact, but then signal when they come onto the breast that this isn’t what they really want at all. The concept of the two tools to experiment with to make the days as easy and as manageable as possible is very helpful here. When your baby dials up, you can offer milk, and you can offer rich and changing sensory nourishment, and see what works.

In the early days you can't go wrong with offering milk, but our baby's sensory motor needs are powerful, and often misunderstood. Sometimes you might go outside for a little walk and look at the world, rather than breastfeed, even if the baby is rooting or sucking on his or her hand, and see what happens.

The newborn who doesn't cue for feeds

This is a particular problem for some babies in the first couple of weeks after birth, especially when baby has some jaundice and be quite sleepy. The baby doesn’t wake and cue for breastfeeds very often, and the lack of calories and poor weight gain causes the baby to sleep more and cue less, until suddenly you might find you're in a crisis situation, or continued weight loss and failure to regain birth weight. Having the baby close to your body a lot of the time helps with this, too.

This is why, in the first couple of weeks, parents might be told to wake their baby to feed every three hours day and night: the baby needs calories to move out of the newborn sleepiness and poor intake cycle.

Outright crying is often a late sign of hunger, and it is best to respond before the baby’s dial has turned up high. You can certainly try offering the breast when the baby is crying hard, but often the little one is too disorganised and distressed to take it, and a change of sensory environment (such as stepping outside the home, if you don’t live in an extreme climate) can reset the dial.

We activate a baby’s breastfeeding reflexes when the lower half of the little one’s face has contact with our breast and body. Since this is a reflex, some babies will begin their oral seeking and bobbling behaviours anytime they are in contact, but then signal when they come onto the breast that this isn’t what they really want at all. The concept of the two tools to experiment with to make the days as easy and as manageable as possible is very helpful here. When your baby dials up, you can offer milk, and you can offer rich and changing sensory nourishment, and see what works.

Outright crying is often a late sign of hunger, and it is best to respond before the baby’s dial has turned up high. You can certainly try offering the breast when the baby is crying hard, but often the little one is too disorganised and distressed to take it, and a change of sensory environment (such as stepping outside the home, if you don’t live in an extreme climate) can reset the dial.

Breastfeeding baby's communication or cue	Popular misinterpretation	Typical cause	Possums or NDC strategies
Difficulty coming onto the breast	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis	Positional instability, breast tissue drag, landing pad encroachment	Optimise fit and hold to optimise positional stability (gestalt breastfeeding)
Back-arching and pulling off at the breast	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis	Positional instability, breast tissue drag, landing pad encroachment	Optimise fit and hold to optimise positional stability (gestalt breastfeeding)
Dialing up at the breast	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis	Positional instability, breast tissue drag, landing pad encroachment	Optimise fit and hold to optimise positional stability (gestalt breastfeeding)
Dialing up whenever approaches breast or during breastfeeding ('oral aversion')	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis	Conditioned hyperarousal (dialling up) of SNS, often secondary to positional instability but persisting once fit and hold are corrected	Comprehensive intervention for conditioned hyperarousal of SNS
Marathon feeds or excessively frequent feeds	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis	Poor milk transfer	Optimise fit and hold to optimise milk transfer (gestalt breastfeeding)
Falls asleep at the end of a breastfeed	Allows bad habits or sleep associations to develop	Normal biological process (parasympathetic nervous system response, oxytocin, cholecystokin)	Parents educated about healthy function of the biological sleep regulators
Repeated turns face downwards towards your tummy or the floor pulling off the breast	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis, Sandifer's syndrome	Breast tissue dragging high in baby's mouth with upper cheek asymmetrically more buried in results in positional instability and tendency to turn downwards	Optimise fit and hold to optimise positional stability (gestalt breastfeeding)

Bottle-feeding baby's cues	Popular misinterpretations	Typical cause	Possums or NDC strategies
Back-arching and fussing	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis	Positional instability	Paced bottle-feeding
Back-arching and fussing	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis	Does not want more milk; pressure on feeds due to spacing	Paced bottle-feeding - cease offering bottle for a time
Back-arching and fussing	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy or intolerance, cranial nerve dysfunctions, weak suck, torticollis	Conditioned hyperarousal of sympathetic nervous system	Paced bottle-feeding, health professional support to build enjoyable feeding associations

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