A 3-Step Approach to Responsive Feeding During Infancy and Beyond

Elizabeth L. Adams, PhD; Virginia Commonwealth University
Lisette T. Jacobson, PhD; University of Kansas School of Medicine - Wichita
Melanie K. Bean, PhD; Virginia Commonwealth University

The “how” when it comes to feeding your infant.

Responsive feeding is a reciprocal process between a parent and an infant where infants communicate their hunger and fullness cues, and parents respond to these cues.¹ As a new parent, it can be hard to know what the best approach is when it comes to feeding your infant.

By using responsive feeding, you can²:

• Encourage your infant to regulate their intake by eating when hungry and stopping when full.
• Better understand your infant’s feeding needs.
• Establish routines to reduce parenting battles around mealtimes
• Support healthy growth over time.

The American Academy of Pediatrics, the World Health Organization, and the Dietary Guidelines for Americans recommend exclusive breastfeeding for six months and continued breastfeeding for one year or longer.^3-5 Breastfeeding decreases infants’ risk of infectious diseases, mortality, and sudden infant death syndrome.^6-10

Mothers of breastfed infants also report greater “responsiveness,” or recognition and sensitive reactions to infants hunger and fullness cues, compared to formula- or bottle-feeding mothers, which can contribute to increased health benefits for mother and child.^11,12 Here, we describe this process of feeding responsiveness, as an evidence-based approach on how to feed your infant in a way that supports healthy growth.

Here is a 3-step process to help you implement responsive feeding during infancy and beyond.

Step 1. Infants show signs that they are hungry and full through actions, vocalizations, and expressions.

The first step is recognizing your infants’ hunger and fullness cues. When infants are hungry, they signal in ways such as¹³:

• Putting their hands in or near their mouth.
• Making sucking noises.
• Leaning towards food with an open mouth.
• Looking intently at caregivers’ eyes.
• Turning their head toward anything that touches their face while opening their mouth.

Feeding cues at the start, middle, and end of a meal may be different. More cues occur at the beginning, rather than at the end, of a meal showing cue frequency changes with feeling full.¹³ Breastfed infants may also exhibit more engagement and disengagement cues than formula- or bottle-fed infants, so it is important to become familiar with how your infant communicates.

A common misperception is that “a fussy baby is always a hungry baby.” However, infants cry for many reasons other than hunger, such as when they are tired, cold, need a diaper change, or are not feeling well.

If crying is misinterpreted as a sign of hunger, then infants learn to associate feelings of distress with being fed, which can set the stage for emotional eating as they grow older. In addition to recognizing hunger cues, it is equally important to recognize your infant’s fullness cues, such as closing their mouth, turning their head away, arching their back, and overall immobility.^13,14

Step 2. Caregivers respond to cues in a prompt, emotionally supportive, and developmentally appropriate manner.

It is the caregivers’ role to recognize infants’ hunger and fullness cues as well as respond quickly in a way that is specific to that cue. For example, when infants show signs of hunger, then caregivers should initiate a feeding. When infants show signs of fullness, then caregivers should promptly end that feeding.

Responding to infants’ hunger and fullness cues in an emotionally supportive manner includes expressing warmth, positive affection, and affirmation. Creating a positive feeding environment free from distractions (e.g., television, smartphones) encourages an environment where infants can clearly communicate, and caregivers can appropriately respond. Infants and young children should be fed the appropriate amount of foods to promote quality nutrition and healthy growth.

Step 3. Infants experience a predictable caregiver response.

Providing a consistent and predictable response to infants’ hunger and fullness cues fosters trust and reassurance that caregivers know what they need. This can help foster self-regulation where infants learn to eat when they are hungry and stop when they are full.

Beyond infancy, it becomes increasingly important to establish consistent structure and routines around meals and snacks, so children have clear expectations when it comes to feeding. A consistent schedule can help ensure children are hungry at mealtime and know when the next meal or snack is occurring. As children age, this can also help minimize food requests or battles between planned eating occasions.

Feeding infants can be challenging.

In times of stress when your infant is fussy, it can be appealing to feed your infant right away. This usually works at soothing your infant, but it is important to consider that it may not be the best approach in the long run. Look for hunger cues, and if they are absent, try another soothing strategy to see if that meets your infant’s needs.

Learning how to feed your infant takes time and patience. You won’t always get it right! You and your infant are learning together, so be kind to yourself as you work to provide a healthful and enjoyable feeding experience.  

References:

1. Black MM, Aboud FE. Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr. 2011;141(3):490-494.
2. Pérez-Escamilla R, Segura-Pérez S, Lott M, on behalf of the RWJF HER Expert Panel on Best Practices for Promoting Healthy Nutrition, Feeding Patterns, and Weight Status for Infants and Toddlers from Birth to 24 Months. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Durham, NC: Healthy Eating Research, 2017. Available at http://healthyeatingresearch.org
3. American Academy of Pediatrics. Policy statement breastfeeding and the use of human milk. Pediatrics. 2012;129(3).
4. Saadeh MR. A new global strategy for infant and young child feeding. Forum Nutr. 2003;56:236-238.
5. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.
6. Duijts L, Jaddoe VW, Hofman A, Moll HA. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics. 2010;126(1):e18-25.
7. Ladomenou F, Moschandreas J, Kafatos A, Tselentis Y, Galanakis E. Protective effect of exclusive breastfeeding against infections during infancy: a prospective study. Arch Dis Child. 2010;95(12):1004-1008.
8. Vennemann MM, Bajanowski T, Brinkmann B, et al. Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics. 2009;123(3):e406-410.
9. Horta BL, Bahl R, Martines JC, Victora CG. Evidence on the long-term effects of breastfeeding – Systematic reviews and meta-analyses. 2007.           
10. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490.
11. Ventura AK. Associations between breastfeeding and maternal responsiveness: a systematic review of the literature. Adv Nutr. 2017;8(3):495-510.
12. McNally J, Hugh-Jones S, Caton S, Vereijken C, Weenen H, Hetherington M. Communicating hunger and satiation in the first 2 years of life: a systematic review. Matern & Child Nutr. 2016;12(2):205-228.
13. American Academy of Pediatrics Institute for Healthy Childhood Weight. https://ihcw.aap.org/Documents/Early%20Feeding/Responsive%20Feeding/AAP-Responsive-Feeding_Print-Fact-Sheet.pdf. Accessed September 2020.
14. Shloim N, Vereijken C, Blundell P, Hetherington MM. Looking for cues - infant communication of hunger and satiation during milk feeding. Appetite. 2017;108:74-82.

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