Bring On the Taties, Bring on the Bread: Feeding, Eye Contact, and All That

“Bring on the taties, bring on the bread-- Won’t somebody get this baby fed!” Feeding hungry babies is a universal task of childrearing. Before they reach the toddler period, babies get frantically hungry and seem to think that only desperate crying will bring them anything to eat. Parents and other caregivers sometimes feel that they spend most of their time in feeding, and sympathize with mother and father birds confronted with wide-open beaks every time they return to the nest.

Obviously, feeding enough of the right things, in the right amounts and at the right times, is essentially to babies’ very survival, as well as to normal physical growth and development. The physical effects of feeding are so important and so obvious that it’s easy to forget that much happens during feeding other than transferring food from the outside of the baby to the inside. Studies of preterm infants have shown a number of factors that affect feeding and digestion even in very tiny babies who cannot suck and must be tube-fed-- these include the experience of smelling the mother’s milk, the experience of sucking a pacifier while being tube-fed, and the experience of being fed during a period of activity rather than when deeply asleep (all of these increase growth rate).

Even the youngest babies are actively engaged in the experience of feeding and are paying attention to events that they connect with being fed. This is a simple but powerful type of learning-- the kind Pavlov called classical conditioning-- in which the babies learn to expect one event to follow another one. More and more complicated learning builds on these early feeding experiences, until the hungry one-month-old who quieted when Mother began to undo her blouse becomes the one-year-old who tries to unbutton those buttons herself.

All those moments of learning are closely connected with social and emotional development. Except for the unlucky baby who has to make do with a propped bottle or pureed food in a bottle with a big hole in the nipple, infants almost always experience feeding as an interaction with another person. It’s an interactive experience of communication with a caregiver who does a lot of the physical work of providing food-- but who ideally does this in response to the baby’s communications of wanting to eat or wanting to stop. Both parent and baby use their best communicative skills to do this job. They both use their eyes to gaze at or look away from the other person or the food being offered, as well as putting out their hands to control a spoon or a bottle and their voices to show approval or protest. The baby wants food but may like some foods better than others, and prefers certain feeding rhythms; as he or she experiences a more satisfied appetite, there may be changes toward slower consumption or stronger preferences or avoidances.

These facts mean that ideally babies and caregivers have many sessions of practicing communicating with each other about a topic that is of great interest to both of them. It’s fun to eat when you’re hungry, and it’s fun to see your healthy baby consuming the food you’ve offered, so both of them are likely to find feeding time pleasurable and to associate that pleasure with their communication and social interaction. However, if a baby is sick or developmentally delayed, and if the caregiver is worried, depressed, afraid of wasting food, frightened, or exhausted, neither of them will have much fun in the feeding situation, and they will miss a major chance to learn to enjoy their interactions. They may not advance well in their abilities to communicate with each other, either about feeding or about other important things.

When parents and babies are not doing well together, they need support that pays attention to both adult and child needs and abilities, but they do not always get this even when intentions are good. A few years ago, I observed a program for adolescent mothers and their babies. There had been some concerns about neglect in the case of each participant, and the babies were receiving intervention in the form of supportive day care, while the mothers attended classes and discussion groups. The highlight of the day was supposed to be lunch, with each mother feeding her baby. The babies had high chairs and plenty of food provided. BUT--- nobody had remembered that it was important for the mothers and babies to be able to look at each other’s faces in order to communicate. There were no chairs for the mothers! Each young woman stood in front of her baby and bent over awkwardly to spoon the food into the baby’s mouth. The babies had to look up and away from the spoon to see their mothers’ faces, and even then saw only a tense-looking expression on a face held at an odd angle. What appeared to be a tiny detail actually caused a major impediment to the social and emotional interaction that’s a critical part of feeding.

It’s popular nowadays to emphasize early interactions, “skin-to-skin” experience, and so on, and I don’t dismiss those. But if we want to see how relationships, communication, and understanding of other people develop, I suggest we look at the thousands of feeding experiences that occur in the first year or so of a baby’s life. If someone invented feeding as a brand-new intervention, parents would rush to take workshops and learn how to do it. It doesn’t need to be invented, but parents need to understand its importance, and so do those who “coach” or support parents in other ways.

Adoptive Parents Feeding Survey

The SPOON Foundation has asked me to invite any readers who are adoptive parents to take a quick survey about foods you used to help the transition from your child's past experience to your ordinary family diet. It's at http://www.surveymonkey.com/s/LZYBK9C.

Do give them a hand, and if you want to talk about it further I'd like to hear your comments.

The Newborn and the Auxiliary Ego

The anthropologist-author Ashley Montagu famously suggested that humans are characterized by “exterogestation”-- a continuation of prenatal development that takes at least the first three months after birth. Montagu held that the early development of human infants actually takes a year from conception before the baby has the minimal ability to cope with the environment. It might well be more appropriate for human pregnancy to last a year, but our large brains and heads, combined with the small pelvic opening needed for upright walking, would make it impossible for a baby to be born after a year’s gestation.

Because they are born at an immature stage of development, there are a lot of important things newborn humans cannot do for themselves. An obvious one is the manufacture of immunoglobulins by the immune system. Caregivers provide an auxiliary immune system that helps out until the baby’s own system begins to mature at about a year of age. Breastfeeding mothers make immunoglobulins that protect against infections that enter through the mouth and gut (gastrointestinal infections, polio, and so on), and these are passed on in their milk. Both breastfeeding and non breastfeeding caregivers also provide auxiliary immune functions by keeping the environment clean, watching what the baby puts into her mouth, making careful choices of clean food and drink for the child, and preventing exposure to contagious disease if possible. (In modern societies, this auxiliary immune function includes providing immunization against disease.)

In addition to their auxiliary immune functions, caregivers also provide the baby with an auxiliary ego. The term “ego” here refers not to pride or self-esteem, but to the ability to carry out reality functions and to deal effectively with the environment. Ego functions include movement, motor skills, learned behavior, problem-solving, and memory. The caregiver acts as an auxiliary ego when doing tasks the infant needs done but cannot do.

It’s obvious that auxiliary ego functions including picking up the young infant, feeding, and cleaning. But a less obvious auxiliary ego function is fostering the infant’s organization of behavior. Newborns have difficulty organizing the timing and sequencing of behavior, and they show this in their disturbed and broken sleep and in the awkwardness they often show in taking the nipple and feeding, sometimes even choking when the milk comes so fast that they cannot co-ordinate sucking and swallowing.

Difficulties in organizing behavior are increased when bright lights, loud noises, or unpredictable movements influence the process. A baby may be very hungry or tired but unable to sleep or eat unless the caregiver’s auxiliary ego functions help to organize the behavior.

How does the caregiver manage to help in organization? One way is to reduce the amount of disturbing sensory stimulation the baby is receiving. Dimming the lights, reducing the noise level, or going to a place where there are fewer people may all be helpful to the baby’s organization of behavior, and they are all things the baby cannot do alone—ego functions that demand more maturity than he or she has.

A second way to help the baby organize behavior like sleeping or eating is to provide the baby with some sensory stimulation that has a predictable rhythm and intensity, like rocking, singing, or patting. The framework of this rhythm helps give the baby a pattern to follow as he or she establishes the rhythm necessary to organize the needed behavior. Sleeping, for instance, is aided by a pattern of slow, regular breathing, and feeding by a regular sequence of sucking and swallowing at given intervals.

When a baby is really distressed and too disorganized to do the sleeping or feeding that is needed, a caregiver may help by an auxiliary ego function known as “overriding the baby’s tempo”. The adult begins with a fairly intense, rapid rhythm of stimulation like fast rocking or singing and then gradually slows and quiets the stimulation. The baby’s rhythm of crying, breathing, and moving slows and regularizes in response, until it is calm and organized enough to sleep or eat.

It’s all too common for parents or their advisers to forget auxiliary ego functions, or to reject them as ways to “spoil” a young baby. It’s often said that parents should start as they mean to go on and should train their babies to independence by demanding that they organize their own behavior from birth. But it’s pointless to demand something a baby is incapable of doing. A better foundation for early development, and a happier household, will result from accepting auxiliary ego functions as an essential part of nurture. Providing such help to very young babies no more ruins their independence than their milk diet will later make them unable to eat pizza.

I would speculate that parents and other caregivers can learn much from helping a young baby organize behavior that will be useful to them when they have older children. Two related tasks of caregivers are buffering (helping older children deal with the impact of environmental problems like bullying) and scaffolding (helping children learn by methods like breaking a problem into parts). Each of these is a type of auxiliary ego function that enables children to do what they can rather than be overwhelmed by difficulty. Parents may be able to do a better job on these tasks if they have learned from seeing the effect of auxiliary ego functions on their young babies. Being an auxiliary ego for the newborn is really starting parenting as it would be a good idea to go on.