Burton Neonatal Unit: Baby-led feeding

Dad sat by his baby holding a syringe of milk in the air slowly tube feeding his baby

The neonatal unit at Queen’s Hospital in Burton on Trent introduced baby-led feeding two years ago, with great success. Instead of prescribing babies specific amounts of fluid for feeds, the unit uses a cue-based approach and has found that babies settle quicker, are more comfortable and still gain weight.

"I couldn’t wish for a better hospital than Queen’s, Burton. I loved every stage of our feeding journey whilst we were there. It’s 100% baby and parent led, which really helped with being in an unnatural environment. It was nice to be in control of my own baby rather than being told what to do. I learned her feeding cues which ultimately helped in our breastfeeding journey."

Lexi, mum of a Burton SCBU baby

Some neonatal units prescribe specific volumes of milk for feeds, with caregivers sometimes having a tendency to feed beyond the infant’s ‘stop signs’ as the focus is volume-driven on achieving an empty bottle.

However, recent research has suggested that using a cue-based approach, feeding babies only as much as they are comfortable taking, can reduce stress and can result in babies settling quicker and still gaining weight. There is also evidence that this approach can reduce feeding problems later on in NNU graduates.

After attending a FINE (Family and Infant Neurodevelopmental Education) course and being inspired by new research into cue-based feeding in neonates, Senior Sister Sarah Roberts led the project to introduce baby-led feeding at Burton neonatal unit.

The unit employs a fully baby-led approach to feeding for all babies, preterm or term, including those who are naso-gastric tube (NGT) fed. In most cases, where full milk feeds are established, there are no set times for feeding; instead, they feed babies using cues.

Feeds are at the baby’s own pace, allowing the baby to take however much milk they want to be comfortable. For NGT fed babies, they will slow down or stop the feed based on the infant’s signals, commencing a feed later on if the baby shows cues that they are ready for more. The unit does not plunge feed via NGT as it is impossible to sense or read when baby has had enough during plunge feeding.

Some staff on the unit were initially concerned about the change, and it has taken a lot of hard work by Sarah and the team to persuade some of the staff to move away from long embedded habits based around fixed feed times and volumes.

Now, the whole team are supportive of the approach, which has become standard practice on the unit. Sarah says “we use the grand doctor’s rounds as a time to discuss feeding and feeding practices, as well as teaching sessions on developmental care including feeding and a competency based around this, too. When new staff start they are invited to a teaching session and then complete the competency."

The feedback from parents has been overwhelming positive, with parents saying they feel happier to read cues, allowing their babies to take however much milk they want to be comfortable. Several parents have said they felt empowered by this approach, and it allows them to look for and respond to cues their baby is giving, encouraging a more baby-centred approach to care.

This practice links to principle 6.2a of the Bliss Baby Charter, which encourages all units to focus on a baby-led approach to feeding, reading cues that the baby is hungry rather than having fixed feeding times.

Research links: