A Quiet Lunch: Baby-feeding May Not Go Well at Parties

A friend was recently telling me about her new grandbaby, a plump but hungry little girl born by Caesarean section not long ago. The grandmother described how the young mother was worried about breastfeeding and fretting that the baby was not getting enough milk. She also told me of the scene at the new baby’s house when both grandmothers, friends, and various other visitors were all there, and the mother tried-- without much success-- to nurse the baby while socializing with the company.

Naturally, the difficulty she had with this nursing was disturbing to the mother. Like most mothers inexperienced with breastfeeding, she was afraid she wasn’t making enough milk and that the baby was starving. And the tenser she was, the more difficult it was for her to nurse the baby. Breastfeeding requires not only the “manufacture” of milk in the breasts, but a reflexive response to the baby’s sucking, the let-down or ejection reflex, that actually squirts milk out of the nipples. (This water-pistol effect is definitely part of the humorous side of breastfeeding!) Babies don’t just draw milk out of the breast as you’d suck lemonade through a straw, and if milk is not ejected, the baby will get only a few drops at a time rather than a mouthful. First-time mothers, especially, may find their milk does not “let down” easily when there is a lot of commotion or tension to deal with. Whether you’re particularly modest or not, you may find it awkward to nurse the baby when a lot is going on around you. From that point of view, it’s not surprising that my friend’s daughter-in-law had trouble breastfeeding while visitors were there.

But there’s another important point about this situation. The other half of the breastfeeding team, the baby, can also have trouble with exciting surroundings. This is so much the case that bottle-fed babies, too, may have trouble feeding when there are visitors-- and the bottle does not share the mother’s problems with letting down milk, of course.

Some years ago I was at a large party where a young mother had brought her toddler son and 6-week-old baby girl. The mother was longing to talk to all the people, many of them her cousins and friends she hadn’t seen for some time. She was trying to give the baby a bottle while she conversed, but guess what, the baby wasn’t having any; she would suck for a minute or so and then let go of the nipple, fretting. I guessed that everything was too exciting for this baby and offered to have a try. We went to a quiet room, sat down and snuggled and talked for a few minutes, then I offered the bottle and the baby slurped up every drop.

What was this all about? Did I have some kind of experienced-mother magic that I applied to this baby? No, but I was aware that even at the advanced age of six weeks, babies may have trouble organizing their feeding if there is something to distract them. In order to suck from breast or bottle, a baby needs to time properly her sucking, which brings milk into the mouth, and her swallowing. This seems simple to adults-- we even have the ability to swallow voluntarily, as in taking pills, or to take food into the mouth and hold it there without swallowing. But for the young baby sucking and swallowing are still primarily reflexive, and they have to occur at the right times and in the right order. Otherwise, the baby will choke on an excessive amount of milk, or the milk will run out of the sides of the mouth rather than going down.

So, what is the connection? Why should hearing people talk interfere with the baby’s coordination of sucking and swallowing? The problem is that a baby’s movements, breathing, sucking, and so on, are easily “entrained” to events in the environment. Entrainment means that the rhythm of actions begins to follow the rhythm of other things that are going on. It’s like adults dancing to music-- the movements of our feet follow the rhythms of the music. As adults, we can decide not to dance, or we can even dance to a different rhythm than the music that’s playing (though it’s hard to do that). Babies don’t seem to have any choice about entrainment. The rhythms of speech and movements around them can take over the rhythms of sucking and swallowing and make it difficult or impossible to do these things in the necessary pattern.

Young mothers may feel very out of things when they need to go away and be alone with the baby in order to nurse. But this may be exactly what’s needed for both parties. The mother may feel hassled and tense in a group of people, even though she wants to be there. The young baby is quite likely to be disorganized when talk, laughter, and movement take over her rhythms. A quiet place gives mother and child their best situation for feeding by breast or by bottle.

Eye contact with babies-- how important is it?

People have believed for centuries that the human gaze had remarkable powers. In the distant past, most people thought that rays came out of the eyes and explored the world, carrying information about objects back to the brain. (Some still believe this-- even college freshmen.)

One of the important abilities attributed to gazing involved the mutual gaze, or "eye contact", where two people look into each other's eyes and feel as if they are communicating powerful emotions. "Eye contact" is often said to play a critical role in interactions between adults and babies, and even to help create emotional attachment in early life. A related idea is that breastfeeding mothers and babies gaze intently into each other's eyes and thus establish an emotional connection.

Let's examine some of these ideas. Do babies see well when very young, and do they spend time in mutual gaze with their caregivers?

Newborn babies have vision, but it still has to develop for quite a while before it's as good as an older child's. Newborns (infants in the first month of life) can only see clearly at certain limited distances. They are well adapted to looking at a face from about 10-18 inches from their eyes, which would be a typical distance if an adult held the baby in his or her arms. Babies are more interested in some things they can look at than in others. They like things that are shiny, that move around, and that have patterns rather than just a blank surface. Of course, this set of characteristics describes human eyes-- they are moist and reflect light, they move as we examine something we're looking at, and they have white, colored, and dark parts, as well as eyelashes and lids that move. So, babies with normal vision do look at eyes when they get a chance. What this means to the baby, we can't tell, but it is very exciting and gratifying for the adult when "eye contact" is made.

A curious thing about young babies' eye contact is that blind babies do it too. How? They listen to the adult voice, then move their gaze so they are "looking" in the right direction. It appears to the adult that the baby is looking at him or her, and the adult may not even realize that the baby can't see.

What about the breastfeeding baby? Does he or she gaze into the mother's eyes while nursing? Actually, no; young babies, especially, usually squeeze their eyes tight shut while they nurse. In any case, because the baby has to turn its face toward the breast to take the nipple, it would have to work hard to be able to look up at the face at the same time. Older babies (8 months or so) may have figured out how to hold the nipple in their mouths while turning to look up at the mother or at someone else in the room, and they may let go the nipple and play or babble to the mother for a little while before nursing again. But an intense mutual gaze during breastfeeding is pretty infrequent. (And remember, breastfeeding mothers are not necessarily gazing at the infant. They may be eating, drinking, talking on the phone, or reading to an older child.)

As babies get a few months older, they can see better, and they also begin to use their eyes in a way that gives signals to an adult. For example, suppose you are playing with a baby and the baby gets tired, or maybe you have just come on a little too strong and been too stimulating. The baby turns the gaze away from your face, gets quiet for a moment, and just withdraws to have a little rest. The averted gaze works to tell a sensitive adult that the baby needs to back off for a bit. Then, rested up, the baby looks back at your eyes, smiles, and shows readiness to play some more. This slightly older baby gazes at the adult sometimes, but has the mature capacity to be able to stop looking. A baby who gazed at its caregiver's eyes a great deal of the time would not be showing the level of development we would expect by 3-6 months of age.

In the second half of the first year, babies begin to show a new use of the gaze for communication. They develop the ability for an important skill called "joint attention." The baby sees something interesting like puppies playing-- watches intently-- then turns to "catch the eye" of an adult, and looks back at the puppies again. Babies will do this several times until they get the adult to look at the puppies. Just like an adult, the older baby can use the gaze to point, as a pointing finger would be used. Also like an adult, the older baby wants to share the fun with a loved person, and wants to look at the puppies together with someone else. At the end of the sequence, the two look at each other and smile. (Notice that the baby does not do this in order to get the adult to do anything other than share the interesting sight. This is not a way to get fed, or picked up, or even carried over to see the puppies.) Again, mutual gaze or "eye contact" is only a part of the communication the adult and baby carry out with their eyes.

*** Readers, if you have found this post in your search for current material about eye contact and autism, please look at my post for Nov. 7, 2013,which discusses the Nature article by Warren Jones and Ami Klin.