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This may involve discussions aimed at increasing the parents understanding of:

• The feeding relationship including the importance of establishing trust, feeding in response to Nina’s cues and sharing feeding tasks.
• Typical child growth. Unrealistic expectations for Nina’s growth are contributing to Nina’s feeding difficulties.  Provide reassurance that 5% of healthy children grow below the 5th percentile without concerns.

Once goals have been prioritised choose one or two strategies that will assist in achieving goals. Choose strategies that parents feel confident they can achieve and that build on Nina’s strengths.  As these are implemented further strategies can be added.

Suggested strategies may include:

• Establish between Nina and her parents.

• Separate periods of feeding, sleeping and wakefulness. Feeds are not offered when Nina is sleeping or playing.
• Offer feeds at regular intervals in response to Nina’s hunger cues. Explain to parents that children vary in the volume they will take at any one time and that the volumes on the can of infant formula are only a guide.  Smaller babies will require less. 
• Cease feeds when Nina indicates she is no longer interested. 
• Allow Nina to pauses with feeding rest and then decide if she wants more. Bottle may be removed and offered again but not forced back into the mouth.  Further attempts to get her to take a little more are not used.  Coercion and force feeding are not used. See video Breast and Formula Feeding.

Nina:

• Gives cues to indicate hunger and satiety.

Reassure parents that Nina has the ability to do this. She was doing this when you observed her feeding. If she only drinks a small amount at one feed she will get hungry again in a few hours and have more at the next feed.   

• Encourage parents to consider feeding from Nina’s perspective.  “Every time I try to go to sleep I get woken with ‘that bottle’ the only way I can get it to stop is to cry.”

Resources:

Follow-up:

Regular follow up is recommended to monitor progress and provide support.  Mum is isolated and anxious and may find it difficult to implement strategies consistently without support. Phone review may be a valuable support that also reduces mum’s feelings of isolation.

With a consistent approach over a few days Nina’s feeding should begin to show signs of improving.  However it may take a little longer for mum to trust that this will continue and for feeding to get back on track.  Ongoing support may be needed to maintain strategies.

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