Maggie’s Feeding Guide: Cue-Based Strategy
Context: For a NICU graduate recovering from respiratory fatigue.
Current Status: No set schedule. Feeding on demand (fussiness) with safety guardrails.
The Golden Rule: Because Maggie is recovering from Magnesium exposure and lung fatigue, we cannot rely 100% on her hunger cues (she might sleep through a meal). We feed when she asks, BUT we never let her go too long without eating.
1. The "Rule of Thumb" Numbers
| Metric | Target | Why? |
|---|---|---|
| Volume per Feed | 1.5 oz – 2.5 oz (45 – 75 mL) | Large volumes (4oz) bloat the stomach and push on the diaphragm, making it harder to breathe. Smaller meals = easier breathing. |
| Frequency | Every 2 – 3 Hours (8 – 12 times a day) | Frequent, small meals keep her energy up without exhausting her lungs. |
| The "Must Wake" Alarm | 4 HOURS | Strict Safety Limit. If she sleeps 4 hours from the start of the last feed, wake her up. Low blood sugar makes her lethargic and harder to feed. |
2. Daily Breakdown: What to Expect
Since we are following her cues, these are "Phases," not strict times.
| Time Phase | Typical Behavior | Strategy for Parents |
|---|---|---|
| Morning (6 AM – 11 AM) | "The Best Feeds" She is rested. Likely to take full bottles (2.5 oz). | Fill the Tank. If she is alert, encourage a full feed here to get calories in early while her energy is high. |
| Mid-Day (11 AM – 5 PM) | "Snack & Nap" She may wake frequently but only eat 1 oz before dozing off. | Watch for Fatigue. If she stops at 1 oz and is breathing fast, let her rest. Don't force it. It is okay if she "snacks" every 90 mins instead of a full meal. |
| Evening (5 PM – 9 PM) | "The Witching Hour" Fussy. Might want tiny amounts every 45 mins. | Check Retractions. If she is crying and eating, she might swallow air. keep her upright. If she is struggling to breathe, stop. |
| Late Night (9 PM – 6 AM) | "Strict Business" Goal: Eat, Burp, Sleep. | Minimize Stimulation. Keep lights low. If the 4-Hour Alarm goes off, change her diaper to wake her, feed, and put her back down. |
3. Reading Her Cues (The "Stop" Signs)
Maggie communicates via her hands and her chest. Watch these closely.
| Sign | Translation | Action Required |
|---|---|---|
| Hands to Mouth / Rooting | "I'm Hungry" | Feed immediately. Try to catch this before she cries (crying wastes oxygen). |
| Splayed Fingers / Furrowed Brow | "I'm Stressed" | Pause. Tilt the bottle down so milk stops flowing, but keep the nipple in her mouth. Let her reorganize. |
| Chest Sinking (Retractions) | "I Can't Breathe" | STOP IMMEDIATELY. Remove bottle. Burp her. Wait 5 mins. If she is still retracting, the feed is over. |
| Milk Dribbling / Open Palms | "I'm Done" | Stop. She has lost the seal or fallen asleep. Do not force the last 0.5 oz. |
4. Critical Feeding Technique (Paced Feeding)
- Bottle Position: Hold the bottle horizontal (parallel to the floor).
- Why: This prevents gravity from pouring milk down her throat. She must actively suck to get milk. If she needs a break to breathe, she just stops sucking, and the flow stops. This gives her control and protects her airway.