Caring for a breastfed baby: feeding, soothing and settling
For the non-breastfeeding parent, grandparents, baby-sitters and other caregivers
Too often, breastfeeding mothers are unable to get the physical and mental breaks they need because it is presumed that only they can help their baby fall asleep. While it is true that the easiest way to calm or settle a breastfed child is at the breast, this needn’t mean it is the only way to do so. Over the years, I have not only cared for three breastfed grandchildren but also settled other people’s babies on an occasional or regular basis as a paid caregiver or as a friend.
There are many ways people identify today. For ease of description, here I will refer to “the mother” as the person who is breastfeeding, “the carer” as the person temporarily looking after her child and “the baby” as the infant being cared for. Feel free to apply these to your own situation using whatever language describes it best.
When a baby is on the way, everyone offers to babysit. Yet the reality is, most offers fade away once the baby arrives and even those well-intended feel blocked by the way the mother chooses to feed and settle her child. An exclusively breastfed baby, whose mother frequently baby-wears and bed-shares her child can seem “too hard” for anyone else to care for - even the child’s father or other parent might baulk at the idea of being left alone with the baby for any period of time.
Unplanned circumstances where mother and baby are separated without time to prepare are different to what we will look at here. The following information is to help everyone involved plan for and prepare for occasional or regular periods of looking after a breastfed baby when the breasts are elsewhere!
When the baby is very young, its best to stay close by to their mother, letting her nap, take a shower, go for a walk or rest while you look after the baby between feeds. Follow her lead about being ready to leave the baby with you while she is in another location. The mother-baby dyad should not be separated too soon or too often while they establish breastfeeding and the baby adjusts to life outside the womb. If the mother needs to attend an appointment, shop for clothes to suit her new body or visit the hairdresser, go along with her and the baby and stay in the vicinity while she has some space but knows he baby is safe nearby.
Spend time with the mother and baby, watching how she responds, how she interacts with the baby. Involve yourself alongside her when she feeds and settles the baby, adding your voice gently into the process. When the baby is fed, slept, calm and alert, hold them and practice different positions to see what they like and don’t and how they communicate their feelings with you. Aim to be calm and help the baby be calm. Watch her rhythm and beat when she rocks or pats the baby and mimic her to get in sync.
There are three areas of concern people express: feeding the baby, soothing the crying baby and getting the baby to sleep.
Feeding the breastfed baby
Ideally, breastfeeding is established without the baby receiving supplements of the mothers own expressed breastmilk, donor milk or infant formula. If top-ups are advised, it is preferable these are given by cup, spoon or syringe, rather than introducing a bottle and teat to a baby still learning how to attach and feed at the breast. The reality is, for many mothers, that bottles of formula are recommended in hospital, as well as expressing and feeding breastmilk by bottle. Many families continue this approach ongoing - “mixed feeding” a combination of options.
However, for the baby who is exclusively breastfed and whose mother has not added pumping milk to the demands of the early weeks or months, it can come as a shock to discover their baby will not or cannot drink from a bottle and teat. In their quest to avoid nipple confusion, they find themselves faced with bottle refusal! Thankfully, bottles are simply one tool to feed babies and there are other options.
Under 4-6 months, the simplest alternative is usually cup feeding. Even the most committed breastfed baby will lap milk from a small cup (the size of a medicine cup or shot glass) without too much protest, especially if you have everything prepared before they wake so their patience is not tested. Small amounts of expressed breastmilk or formula can be poured into the cup and fed to the baby, perhaps 25mls per refill, until they show signs of satisfaction. A feed of 75mls can take a remarkably short period of time for even a small baby to consume.
Learn more about cup feeding here
From around four months, babies can quickly work out what to do with a straw and baby cups with soft, silicone straws are ideal.
Soothing the crying breastfed baby
When you are a breastfeeding mother, you have a magic solution to everything: the baby cries, signaling it needs something and the mother resolves the something by offering the breast. Rarely does it not work, resolving everything from thirst and hunger to frustration and tiredness. Its a hard act to follow!
So how can the carer deal with the normal crying which babies use to communicate? Well, you need to have a few more tricks up your sleeve. Firstly, you need to connect with the baby who also doesn’t know why they are upset. Babies cry to get our attention but not in the negative way people have thought in the past. Crying is the final signal a baby uses, when all previous efforts have not worked. A breastfeeding mother will often preempt a crying spell by reading the subtle cues her baby gives before they cry.
Cues are physical actions, often very discreet, which babies do when moving from one state to another. A hungry baby will give clear feeding cues while a tired baby will give cues they are coming to the end of a wakeful period and need help to transition to sleep. A baby experiencing discomfort from trapped air in their stomach or digestive system will also behave in particular ways.
Before you spent time alone with the baby, spend time alongside the mother at different times of the day and ask her what made her respond to the baby in different ways or why she offered the breast when she did. Ask about the baby’s individual signals that its time to feed or sleep. Find out what the baby does when overwhelmed by play or surroundings. How does the baby signal boredom or overstimulation? Keep in mind the younger the baby is, the less time the family have had to build an understanding of these cues. Sometime it involves a lot of trial and error.
Babies sometimes cry because they are physically uncomfortable. Things you can check are:
The nappy. Is it wet, dirty or uncomfortable? Check if is still in place, fitted comfortably and nothing is digging in.
Clothing. Check tiny toes are not entangled by threads in socks or the feet of onesies. Check singlets haven’t ridden up under garments, making them uncomfortable to lie on.
Are they a comfortable temperature? The back and tummy are the place to check, hands and feet are always cooler than the torso. Do you need to remove or add layers? Is the room overheated?
Are they hungry? Breastmilk is quickly digested and tummies are only the size of their fist. It is typical for breastfed babies to feed frequently and the clock is not a good indicator of feed times. The goal is not to stretch out the time between feeds but allow the baby to take the milk they need, when they need it. Small amounts often is better than large volumes infrequently.
Is their tummy uncomfortable? Trapped wind in the stomach might come up as a burp if you gently hold the baby upright against your chest. There is no need to fiercely pat their back - it is gravity which releases air, not external action. If a burp doesn’t appear or the baby shows no signs of relief, then it is more likely to be gas from digestion distending the bowel. If you have discussed this with the mother previously, apply the techniques the baby is familiar with to help them relax and pass wind. That might be removing the nappy and massaging the tummy, “bicycling the legs” or holding them in a particular position. Never give babies any medications, even over the counter or “natural” therapies without discussion with the parents. Products used in the past (gripe water is one example) are no longer considered suitable or effective. Teas, boiled water and other liquids or foods must not be given to babies who are exclusively breastfed.
Are they ready to sleep? If you have missed the baby’s tired signs or you are not familiar with them, the baby might have gone past the stage of sleep readiness. You might have to help them become calm again and transition to sleep. More about that next.
Supporting the breastfed baby to fall asleep
Breastfeeding mothers will know the simplest way to help their baby transition to sleep is at the breast. They might practice lying down to breastfeed, bed-sharing, babywearing or contact napping as ways to remain in physical contact with their sleeping baby. In preparation for leaving their baby in your care, it can help if they add other sleep prompts to these existing ones, which you can incorporate into your own approach. These might include:
Movement in the form or swaying, bouncing, rocking or walking
Sound in the form of white noise, music, singing or reading a story
Smell in the form of a cloth item they use routinely, like a baby carrier, muslin wrap, comfort toy or piece of clothing.
Touch in the form or patting, stroking, massage or rubbing the back
Here are some ideas to get you started:
It helps to talk about the environment the baby is used to being asleep in. Ideally, babies are exposed to natural daylight and houseold noises during the day, to help their developing body clock. So avoid darkened rooms and silent spaces if baby is not used to them. If going for a walk in a baby carrier or pram is familiar, find out if this is in a quiet park or alongside a busy road and replicate that.
A general pattern you might expect from a baby is to feed upon waking, have their nappy changed, spend some time playing with you or watching as you work alongside them, perhaps take a little extra milk and then sleep close to you for around 40 minutes, perhaps resettling for another sleep cycle if being carried or in the pram.
Never leave the baby alone to cry it out or use controlled crying.
It is very important to follow current guidelines around safe sleep. While the baby might bed-share with their breastfeeding mother, there are known risks to sharing a sleep space without the presence of the mother. Even fathers need to avoid bed-sharing alone with their babies: it is the maternal proximity which is protective, and then only when the baby is breastfed.
Nobody should put themselves in a situation where they might fall asleep holding or alongside a baby on a sofa, armchair or other space not intended for infant sleep. This is the highest risk environment for infant death. If you are caring for a baby, it is important you are not affected by drugs or alcohol, including over the counter medications or remedies which might be sedating. If you ar a smoker, it is important to minimise the infant’s exposure to second-hand smoke and any chemical residue from smoking which might be on your breath, skin or clothing. Cigarette smokers in a household (even if they only smoke outside) is a known risk for Sudden Infant Death Syndrome (SIDS). To avoid exposing the baby to tobacco smoke, don’t let anyone smoke near your baby - not in the house, the car or anywhere else your baby spends time. If you or someone in your household smoke, the baby’s parents might decline your offers to care for the baby in your home or ask you to undertake certain precautions such as changing into fresh clothing. This is not a personal judgement upon you, rather they are following medical advice based on hard evidence on the reduction of risk of SIDS and Sudden Unexpected Death in Infancy (SUDI). You can find out more here:
Using a baby carrier
The next best thing to breastfeeding is a baby carrier. Ask the baby’s mother to show you what type of carrier they use and how to use it. Try it yourself repeatedly before you are on your own with the baby, so you are confident using it when you need to. If neither you or the baby’s mother are familiar or confident with babywearing, get in touch with our community South Eastern Babywearing Group or find a babywearing consultant near you.
If you find yourself stuck when the time comes, this video gives important safety advice:
