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Supporting Responsive Feeding as Part of Nurturing Care
Ms Miranda H.S. LEUNG, Mrs Francis AU, Ms Theresa T. T. NG and Ms Iris H. H. CHAN (Clinical Psychologists)
There is strong evidence showing that breastfeeding offers many benefits to both mothers and babies. Supporting sustained breastfeeding is hence, a public health priority. In 2018, the World Health Organization revised the Baby-friendly Hospital Initiative with updates on the Ten Steps to reflect the latest evidence-based guidelines and global public health policy.1 Step 8 affirms the requisite to support mothers to practise responsive feeding as part of nurturing care. Regardless of whether they breastfeed or not, mothers should be supported to recognise their babies’ behavioural cues for feeding, closeness or comfort, and respond accordingly. Mothers’ practice of responsive feeding facilitates bonding and parent-child attachment that underpins healthy growth and development of children.
Responsive feeding refers to parents feeding their child in response to her cues “in a prompt, contingent, emotionally supportive and developmentally appropriate manner”.4 Every child has her unique temperament, feeding skills and limitations. Moreover, her state of hunger or satiety also varies from day to day and between different times of a day. When feeding the child, parents must, therefore, attend to her needs and attune to her rhythm and pacing.
Responsive feeding applies not only to breastfeeding, but also bottle feeding, transitional feeding (introduction of solid food) and feeding thereafter. In the antenatal and early postnatal period, through educational materials and guidance provided by health professionals, parents are introduced to the principles and practices of responsive feeding. The aim is to help parents be aware of, trust and rely on the cues given by their child for the amount and preference of feeding. When the child’s hunger or satiety cues are consistently recognised and met with prompt, emotionally supportive and contingent responses, over time, she will learn to regulate her feeding according to her internal signals. During transitional feeding, parents’ positive responses to their child’s attempts to self-feed with fingers and gradually use a spoon, as well as to taste different flavours, textures and varieties of food not only help her master self-feeding, but also support her lifelong responsibility for healthy eating.
Through the introduction to responsive feeding, parents are also made aware of the baby’s cues for various other physical and emotional needs. Apart from hunger and satiety cues, they learn to observe when their baby feels tired, sleepy, irritated and happy, and then respond accordingly. Indeed, responsive feeding is but one aspect of responsive parenting.
Responsive parenting is characterized by mutual and synchronised interactions between the parent and child, where the parent recognises the child’s cues (sensitivity) and responds contingently and promptly in a way that is emotionally supportive and appropriate to her developmental level (responsiveness). Parent’s responsiveness facilitates subsequent responses of the child which allow the dyad to engage in back-and-forth or “serve and return” interactions.6 Through this mutual interactivity in daily life, the child finds her needs being satisfied and gradually develops a sense of safety and trust towards the parents. Thus, responsive parenting helps to build a secure parent-child attachment. Besides, it also gives a sense of predictability, safety and connectedness with the environment that support the child’s development of self-regulation.
Self-regulation is the ability to monitor and manage one’s attention, thinking, feelings, and behaviours to accomplish goals.7 Very young children have limited self-regulation ability. They depend on their parents for co-regulation, i.e. the warm and responsive interactions that provide the support, coaching and modelling children need to “understand, express, and modulate their thoughts, feelings, and behaviours”.8 With sensitive and supportive parenting, children move on to their different developmental readiness to gradually master self-soothing, waiting, staying in seat to do tasks, etc. and, in due course, achieving the not-so-easy task of self-regulation, signifying the progress from complete dependence to gradual independence.
Common Challenges in Responsive Parenting
Committed mothers may be adept at practising responsive breastfeeding but tend to overlook the need for their baby to move on to the next developmental stage.
Mothers should be supported to let solid food gradually take over the majority of breastfeeding when the child’s nutritional needs can no longer be solely met by breastfeeding. In parallel, breastfeeding as a way to meet the child’s emotional needs of intimacy should also gradually give way to other forms of intimate parent-child interactions. As there are individual variations in developmental characteristics including temperaments and abilities, parents have to be sensitive in recognising their child’s characteristics and nature of needs so as to help her develop self-regulation skills appropriate to her developmental level. There is no hard and fast rule. Other aspects of care, such as night feeding and learning to self-care, also involve parental responsiveness to the specific developmental needs of the child.
Balancing between the child’s needs and parental needs
In order to bring up a healthy and well-adapted child, parents have to observe their child closely and adjust their level of guidance to match her developmental level. When a child wants to do something on her own or indicates she does not want the close proximity of parents, as long as it is safe, it is the moment for parents to let go and observe from a distance. This is a good opportunity for the child to explore as a way to learn and be independent. When a child goes to the parents for comfort and intimacy, parents should put aside what is in hand and be with her to satisfy her emotional needs. When re-charged, the child will feel secure and energised to go out to the world and explore again. It is like having numerous circles of going out to explore and coming back to the parents’ side for emotional re-charging in a day.9
However, parents’ responsiveness can be impeded by daily hassles, stresses and other factors including parental expectations, which may undermine their capacity and motivation to tune in with their child’s needs. Parents brought up in different family backgrounds may have different needs to be close to their child. Some may not feel comfortable and safe to let go of their child to try new things even though it may be developmentally appropriate. Such parents may need more professional guidance in helping them to see how their past experiences have hindered their practice of responsive parenting.
Children need repeated opportunities in daily activities to gradually pick up the repertoire of self-regulation, such as self-soothing, waiting, focusing on a task, connecting own feelings with those of others, etc. Learning self-regulation skills from early childhood is important as it predicts academic attainment and is associated with social competence, healthy behaviours and physical conditions, as well as work achievement in adulthood.10 Responsive parenting lays the foundation for children to learn self-regulation skills. Helping parents to feed responsively, as they learn to observe sensitively and respond to their baby’ cues, is a good way to introduce them to the comprehensive concept of responsive parenting that supports the long-term development and wellbeing of the child.
- Introduce responsive breastfeeding to parents in the wider context of responsive parenting so that parents can have a comprehensive understanding of the latter.
- Guide parents to be sensitive to their baby’s cues and respond accordingly.
- Inform parents about the different developmental needs of children.
- Emotional support to parents is always important to help them alleviate their stresses and attend psychologically to their child’s needs.
- Some parents may benefit from attending parenting programmes to help them reflect on their role as parents and learn skills to support and form secure bonding with their child.
For the note of References, please refer to the PDF version.
Views expressed in this article are the author's and do not necessarily reflect the opinion or position of the BFHIHKA.
Editor-in-Chief: Dr Shirley Leung
All rights reserved by Baby Friendly Hospital Initiative Hong Kong Association.