# data[].attributes.body
Back to my Breastfeeding Information Homepage

# data[].attributes.body
Trustworthy, object info about infant formula, follow-on formula and other infant milks

# data[].attributes.attachment_link.title
Infant milks for parents & carers — First Steps Nutrition Trust

# data[].attributes.attachment_link.description
First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

# data[].attributes.body
Practical helpful information if you need to give your baby other milk

# data[].attributes.attachment_link.readable_text
Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don't yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don't have as much milk as their baby needs. It is important that babies get enough milk to be healthy and to grow normally.

La Leche League groups welcome anyone who is breastfeeding or providing their own milk for a baby, or trying to do so. Please don't feel awkward about needing to give your baby extra milk at an LLL meeting! We would love to meet you and your baby!

Get support from LLLGB here.

Why a baby might need extra milk
How to tell if your baby is getting enough milk
Normal growth
Why protecting the milk supply is urgent
Why a mother might not be able to make a full milk supply
Giving extra milk - what kind of milk
Mothers' feelings about using formula milk
Extra milk - how to give it
Extra milk - when to give it
Extra milk - how much to give
Reducing the amount of extra milk
What if you need to keep using formula milk?

Why a baby might need extra milk

The most common reason for a baby to need extra milk is a slow start with breastfeeding, when not enough milk was removed from the mother's breasts in the early days after birth. This can happen when a baby is early, small, unwell, very sleepy, or unable to breastfeed at first. It can also happen when a baby isn't taking a deep enough mouthful of breast tissue to breastfeed effectively. In this case, the mother may get sore, damaged nipples and the baby may seem unhappy and unsatisfied, never wanting to let go of the breast. When not enough milk is removed, the mother's milk supply doesn't get a strong enough signal to increase to the level the baby needs.

You can read more about this here: My baby needs more milk.

How to tell if your baby is getting enough milk

When young babies aren't getting as much milk as they need, the first sign is usually that they don't poo as much as expected. A baby over 3 days old who isn't doing at least 3 yellow poos - the size of a 2p coin or larger - every 24 hours needs to be checked by a healthcare provider. After about 6 weeks, babies find their own pooing pattern, which may be less often. As long as the baby is well and growing normally, it doesn't matter by this stage how often they poo.

Weight loss is another important way to tell whether a baby is getting enough milk. Babies usually lose up to 7% of their birth weight in the first 3-5 days after birth. If they lose more than this, or keep losing weight after day 5, they need to be checked by a healthcare provider.

You can read more about this here (is my baby getting enough milk?) and here (what's in a nappy?).

Normal growth

Babies usually get back to their birth weight by 10-14 days after birth. In the first 3-4 months of life, boys grow at an average of about 40g a day, and girls at an average of 34g a day. A baby who puts on less than 30g a day on average, or whose growth curve drops down across more than one "centile line" on their weight chart, needs to be checked by a healthcare provider.

Why protecting milk supply is urgent

Whatever the reason, when a baby isn't taking as much milk as she needs at the breast, the mother's milk supply may not increase enough to meet all the baby's needs. Milk supply usually increases quickly in the early days after birth, reaching its peak level by the end of the first month. Most of this increase happens in the first 2 weeks, so the amount of milk that is removed at this time is really important. If too little is removed, it may limit how much milk a mother can make later.

When breastfeeding is going well, a baby nursing at the breast will remove milk much more effectively than any breast pump. However, if your baby isn't breastfeeding at all yet, or isn't taking as much milk as he needs at the breast, it is important to start expressing your milk as soon as possible. This will ensure that your body gets the signal it needs to make more milk. Babies who are not breastfeeding effectively may want to spend a lot of time at the breast, so it can be difficult to find time to express milk. Given the importance of protecting your milk supply at this stage, it may be necessary to limit the baby's time at the breast to free up enough time to express. This is an investment of time to make sure you have enough milk later. Find good breastfeeding support as soon as possible.

You can read more about expressing and storing milk here.

Why a mother might not be able to make a full milk supply

Occasionally, a mother may have a medical history or health issues which limit the amount of milk she can make. These reasons can include:

A history of infertility due to hormonal imbalances

Past breast surgery, especially breast reduction

Breast hypoplasia/Insufficient Glandular Tissue (IGT) - breasts may be unusually small, unevenly-sized, long and thin, with a wide space between them and there may be no breast changes (such as increase in size and tenderness) during pregnancy

PCOS (polycystic ovary syndrome)

Thyroid problems (over- or under-active)

Obesity (BMI over 30)

If any of these apply to you, you may still be able to make milk normally. However, if your breastfed baby isn't growing well it is important to find good breastfeeding support quickly.

Giving extra milk - what kind of milk

The first choice when extra milk is needed is your own expressed milk, which is tailor-made for your baby. The second choice is donated milk from another mother. This may be available from a Milk Bank if your baby is still in hospital.

You can read LLL's policy on informal sharing of breastmilk here.

When none of these is available in the amounts needed, infant formula milk may be necessary. If you are not sure what kind of formula milk to use, check with your midwife or health visitor. You can find independent information about infant milks in the UK here.

Mothers' feelings about using formula milk

When you were looking forward to breastfeeding your baby, it can feel disappointing to realise that he needs formula milk as well. You might even wonder whether it is worth carrying on breastfeeding, or whether your baby will come to prefer formula milk. It can help to think of formula milk as a kind of medication, to give your baby the energy he needs to breastfeed well. Babies are "hard-wired" to breastfeed and even a small amount of breastmilk can have a significant positive effect on health outcomes that no formula can provide. Even if your milk supply is very low, you and your baby can still enjoy the cuddly, calming, comforting aspects of breastfeeding, for as long as you want to. Breastfeeding is about much more than just milk!

Extra milk - how to give it

There are several options for giving extra milk to a baby.

In the first 1-2 days after birth, when the baby needs small amounts, a teaspoon can work well. You could express your own milk directly into the spoon and use it to feed the milk to your baby. On day 1 after birth, a full feed is about 7ml (1 ½ teaspoons), on average. On day 2 after birth, this doubles to about 15ml (3 teaspoons) per feed. Newborns need at least 8-12 feeds in 24 hours.

By day 3, something larger is needed. Cup-feeding can work well, with practice. You can use any clean cup - a small one, such as a shot glass, can work well. Trying to feed your partner or support person with a cup of water and having them feed you in return can help you quickly learn how far to tip the cup so that your baby can sip from it.

A nursing supplementer (also known as a lactation aid) is a tool that lets you feed extra milk (either expressed milk or formula milk) while your baby breastfeeds. It can be useful if you want to breastfeed but don't have enough milk. The extra flow of milk can encourage your baby to breastfeed. You can read more about supplementers here.

If bottles are used, it is important to know how to use them in a way that supports breastfeeding. It is easy to feed a baby too much, too fast by bottle, and this can be unhelpful for a baby who is finding breastfeeding difficult. You can find out how to do "paced" bottle feeding - at a good speed for your baby, letting him choose how much to take - here.

Extra milk - when to give it

It is often suggested that you breastfeed first, before giving the extra milk. This often means that the baby is at the breast when he is hungry and least happy, which can make breastfeeding stressful for both of you.

An alternative might be to try ending feeds with your baby at the breast. This may mean starting with some extra milk, to calm your hungry baby enough to help him breastfeed. Or you could start with one breast, give the extra milk in the middle, and finish on the second breast. It's much nicer for your baby to fall asleep at your breast than with a cup or bottle!

Even if your baby isn't breastfeeding much or even at all yet, spending happy time being at or near your breast will make it easier for him to breastfeed when he is ready. Carrying your baby in a sling, cuddling him skin-to-skin, taking a bath together and lying down together in a prepared bed ( if it is safe for you and your baby to do so) are all good ways for him to spend relaxed time at the breast. Babies who feel comfortable at the breast are more likely to try breastfeeding when they are ready. You might like to give the extra milk with your baby's cheek resting on your breast, letting him fall asleep on the breast as he finishes.

Extra milk - how much to give

Healthy, full-term babies are usually very good at knowing how much milk they need. If you are giving extra milk by cup or bottle, carefully watch your baby for signs that he wants more or has had enough. Your baby can show you how much they want.

Sometimes, though, a baby is so early, unwell or sleepy that they are not able to ask for as much as they need. A baby who has been getting less milk than he needs for a while may act as if he is not hungry, because he doesn't have much energy. He may look as if he is finished after a very short feed, but he will not be pooing or growing as expected.

When this happens, it is important to encourage the baby to take more milk. Keep your baby close, doing skin-to-skin as much as you can. This will encourage your baby's interest in feeding, and help you to notice the first signs that he is waking up and getting ready to feed. Your baby may only be able to feed for a short time, so he needs to do it very often. Feeds don't have to be equally spaced, but they need to happen at least 8-12 times in 24 hours. It can be helpful to record the number of feeds, along with the number of wet and dirty nappies he has done each day.

When your baby is growing and pooing as expected, he is taking as much milk as he needs.

It is important to keep in close touch with your healthcare provider during this time. If your baby starts doing fewer wet nappies, or it is getting more difficult to wake him to feed, please contact your midwife or doctor straight away.

Once your baby starts to take more milk, his energy will increase. He will start to catch up with his growth, and he might want a lot more milk. Don't panic! Give him as much as he wants, making sure that you feed carefully if using a cup or bottle, so that he can stop when he has had enough. Once his growth has caught up with where it needs to be, his appetite will calm down.

Reducing the amount of extra milk

If your goal is to feed your baby only with your milk, you will be wondering how to reduce the amount of donor or formula milk your baby is getting. It is important to work with your healthcare provider and your local breastfeeding supporters to come up with a plan tailor-made for you and your baby.

Read our article on Weaning from Supplements here.

What if you need to keep using formula milk?

Sometimes, however hard you try to increase your milk, your baby might need to keep having some formula milk. This might be an important part of his diet, or even most of it, but remember that breastfeeding is about much more than just milk. If you ask mothers of older breastfeeding babies or toddlers what they and their babies value about breastfeeding, they usually forget to mention milk! They talk about how much their babies enjoy it, how useful it is for calming them down and getting them to sleep, and how restful it can be for the mother to sit or lie down to feed. Breastfeeding can still work really well in all these ways, whether or not the baby is also having some formula milk.

It is sometimes possible to stop using formula milk after the baby has started eating other foods, usually from around 6 months. As your baby eats more food, he will need less milk. It is often possible to reduce the amount of formula he takes while still breastfeeding as much as you like. After a year, babies can drink unmodified animal milk (such as cow's milk or goat's milk) and no longer need formula milk. You can continue to breastfeed for as long as you and your child want to. Many mothers who have needed to use formula milk in the early months of their child's life find that the later months and years of breastfeeding are much more enjoyable, because they no longer need to think about how much milk their child is getting.
Written by Jayne Joyce, LLL Oxfordshire, June 2018

# data[].attributes.attachment_link.title
Using donor milk and formula to support breastfeeding - La Leche League GB

# data[].attributes.attachment_link.description
Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don't yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don't have as much milk as their baby needs.

# data[].attributes.body
By the NHS and UNICEF. How to prepare infant formula and sterilise feeding equipment to minimise the risks to your baby.

# data[].attributes.body
Info on fridge and freezer storage times

# data[].attributes.body
Positive info about feeding expressed milk or formula

# data[].attributes.attachment_link.authors[].name
Emma Pickett
IBCLC, Lactation Consultant and Breastfeeding Counsellor

# data[].attributes.attachment_link.title
Responsive Bottle-Feeding - Attachment Parenting UK

# data[].attributes.attachment_link.description
We know bottle feeding isn’t just about the milk. It’s also about holding the baby in a particular way & responding to cues.

# data[].attributes.body
Helpful tips on holding baby and bottle

# data[].attributes.body
Straightforward positive vidoe demonstrating how to make bottlefeeding positive and minimise the risks of overfeeding

# data[].attributes.attachment_link.readable_text
Your donation means a lot to us!

Anything you give will help us continue changing the lives of families with babies for the better!
Please support our charity's ground-breaking work as we educate health professionals, connect parrents, and further research our programs.

# data[].attributes.attachment_link.title
About paced bottle feeding - by Renee Keogh | Possums for Mothers and Babies

# data[].attributes.attachment_link.description
Anything you give will help us continue changing the lives of families with babies for the better! Please support our charity's ground-breaking work as we educate health professionals, connect parrents, and further research our programs.

# data[].attributes.body
Info from the Australian Breastfeeding Association

# data[].attributes.attachment_link.description
Yes, babies can drink from a cup! It may seem a bit awkward but they just need a little practice.

# data[].attributes.body
Information which may help you decide if they are a good choice.

# data[].attributes.body
Straightforward trustworthy information on introducing solids and eating well up to 1 year old

# data[].attributes.attachment_link.title
Infants & new mums — First Steps Nutrition Trust

# data[].attributes.attachment_link.description
First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

# data[].attributes.body
Hand-expression can have benefits that make it a valuable addition or alternative to pumping

# data[].attributes.attachment_link.readable_text
Diana West, BA, IBCLC

Originally published January 2015 and republished with the express permission of the author.

I was a new mother struggling with low milk production and a baby who wouldn't nurse when the first effective "consumer grade" breast pumps were invented. I'd been renting a hospital-grade pump to remove my milk, but the idea of owning a good quality pump that was more portable enticed me to buy a double-sided electrical model. It looked so cool! It was in a black bag designed to look like a briefcase so it could be carried to work discreetly. I wasn't working, but I loved the way it made me feel efficient and smart. I was in the first wave of breastfeeding mothers to flock to this type of pump, and millions have been sold over the years.

Knowing what I've learned since those days, my heart sinks to think I put such stock in a cool looking pump when my own two hands could have done a better job. But expressing my milk by hand never crossed my mind then. My impression of hand expression in those days was as a last resort when a good pump wasn't available. My mind has changed quite a bit since then.

I now see hand expression as far more powerful than pumping in many ways.Research has shown that it can be more effective at removing milk in the first days after birth when the colostrum is thick and the breasts are swollen. ¹ Pumping colostrum leaves only sprays on the side of the bottle that are hard to give to the baby, but hand expression into a spoon saves every drop. Hand expression can also be used as a technique during and after pumping to increase caloric content 2 and remove more milk. ³ It can be more reliable than a pump when electricity is scarce. It's quieter than a pump when privacy is needed. It's certainly less expensive than a pump. But I think the most powerful aspect of hand expression is the way it affects our perception of our breasts and what they can do.

Many young women have an uncomfortable relationship with their breasts before they become mothers. They're usually aware of the sexual aspects of their breasts before they think about their ability to make milk. As an erogenous zone, women often feel it's more appropriate for their partners to handle their breasts than to touch them themselves. There can be a delicate balance between breasts as sexual power and targets of sexual vulnerability.

Many women have discovered that learning how to hand express during pregnancy helps them feel more comfortable touching and handling their breasts. I jokingly call this "making friends with the girls" when I suggest the idea to a client. That usually makes her laugh and lightens the mood, but there's some real truth to it. One study found that learning hand expression during pregnancy increased mothers' confidence and readiness for breastfeeding. ⁴ Another study found that it increased not only breastfeeding confidence, but also how long they breastfed. ⁵ Experimenting slowly with hand expression to figure out what it takes to get drops of milk can be empowering, especially during pregnancy before there's any pressure to express milk for the baby.

In my experience, there's no one right way to hand express. When I was nursing my first baby almost 20 years ago, I remember being taught the Marmet Method of Milk Expression, which was developed by Chele Marmet, one of the pioneers of the lactation consultation field. Over the years, there have been several other official methods, many of which are now demonstrated on YouTube. But I think hand expression methods are best used as a starting point to figuring out what works best on your own individual breasts. We're all different, and what works for you might be different than what works for me. The one movement that I find helps no matter what else you do is to move the skin over the breast tissue instead of sliding your fingers over the skin. You'll also almost always get milk to spray by compressing just behind the areola where there's a sort of "sweet spot."

Getting to know the landscape of your breasts and the way they work can help you start to think of them as your breasts. You may feel a slowly growing pride as you see that they can feed and soothe your baby. You'll start to appreciate their superpower. After a few days of nursing, you may realize that your breasts are your connection to this baby with whom you are falling so deeply in love. That's the power of hand expression.

Resources
LLLI Hand Expressing LLLGB Hand Expression of Breastmilk LLL USA, Working and Breastfeeding: My Experience with Hand Expression Stanford School of Medicine demonstration video: Hand Expression of Breastmilk. Maya Bolman, IBCLC and Ann Witt, MD, FABM, IBCLC. The Basics of Breast Massage and Hand Expression.
The Womanly Art of Breastfeeding, 8th edition. Schaumburg, IL: La Leche League International, 2010, 292-293.

¹ Ohyama M, Watabe H, Hayasaka Y. Manual expression and electric breast pumping in the first 48 h after delivery. Pediatr Int. 2010 Feb;52(1):39-43.

² Morton, J., et al. "Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants." Journal of Perinatology 32.10 (2012): 791-796.

³ Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhine WD. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology 29.11 (2009): 757-764.

⁴ Forster DA, McEgan K, Ford R, Moorhead A, Opie G, Walker S, McNamara C. Diabetes and antenatal milk expressing: a pilot project to inform the development of a randomised controlled trial. Midwifery. 2011 Apr;27(2):209-14.

⁵ Flaherman VJ, Gay B, Scott C, Avins A, Lee KA, Newman TB. Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly. Arch Dis Child Fetal Neonatal Ed. 2012;97:F18-23.

Diana West, BA, IBCLC, is an LLL Leader and one of the co-authors of the LLLI books The Womanly Art of Breastfeeding and Sweet Sleep. She is co-author with Lisa Marasco, MA, IBCLC, of The Breastfeeding Mother's Guide to Making More Milk, and with Dr. Elliot Hirsch of Breastfeeding After Breast and Nipple Procedures. She is also author of the Clinician's Breastfeeding Triage Tool and Defining Your Own Success: Breastfeeding After Breast Reduction Surgery.

# data[].attributes.attachment_link.title
The Power of Hand Expression | La Leche League International

# data[].attributes.attachment_link.description
Diana West, BA, IBCLC Originally published January 2015 and republished with the express permission of the author. I was a new mother struggling with low milk production and a baby who wouldn't nurse when the first effective "consumer grade" breast pumps were invented. I'd been renting a hospital-grade pump to remove my milk, but the ...

# data[].attributes.body
How to keep things simple, easy and fun.

# data[].attributes.attachment_link.readable_text
Introducing solids to your baby can feel like yet another complicated thing that you have to do right. Just when it feels like you've finally cracked milk feeds, someone brings up the idea of starting solids.

'Have you thought about when? You must introduce / delay as much as possible'

'Are you going to spoon-feed or let your baby feed themselves?'

'Are you sure they need that much milk / don't need more milk?'

It's unsurprising that this can all start to feel a bit exasperating. Suddenly you're worrying about what, when and how much your baby needs. But need it really be this stressful?

Moving your baby onto a solid diet is an important stage, yes. But it's not the rush and precision exercise many will lead you to think it is. In the midst of all the conflicting advice you will likely get, here are 10 evidence based things to think about that will help you make the best choice for you and your baby - and stop you getting too overwhelmed in the process.

1. Try to delay solids until six months.

Research has shown that there is generally no benefit in starting any earlier, but the risk of gastroenteritis can go up if you start earlier. And besides, six-month-old babies are a lot easier to feed than 4-month-old babies as they can sit up, chew and swallow food. Far more of your carefully chosen offerings are likely to actually go in rather than around your baby.

2. The first few months of solid foods are about tastes and textures, not amounts.

Babies actually need very little solid foods until they are a year old and these foods should be the best possible choices. Estimates of how much a baby needs from food between 6 - 8 months suggests less than 200 calories. Choose wisely - choices should complement milk (hence the name complementary feeding), not replace too much of it.

3. On that note, milk should still be a major part of the diet.

You do not need follow-on formula, whatever the adverts might tell you, whether you're breast or bottle-feeding. First stage formula is more nutritious than second stage. There is no need to switch. Breast milk does not suddenly lose all its nutrients overnight at six months. Milk is one of the most energy dense and nutrient rich foods you can give your baby. Reduce it as you introduce solids but bottle fed babies will still need around 600ml a day at 6 - 8 months and breastfed babies should be fed on demand.

4. Commercial baby foods are fine occasionally and can be convenient.

However, they tend to be high in sugar and lack the range of textures home-cooked food provides; so don't give them all the time. Be careful with how much you give your baby too. Many of the jars have too much food in them for one meal for a younger baby.

5. Remember the baby food industry is there to sell products

The more you buy of their product the better for them and the worse for your pocket. Baby foods are really expensive compared to their non-jarred and 'adult' equivalents. You really don't need a load of devices and ... stuff... if you don't want it.

6. Whatever approach you take to introducing solids, remember the importance of responsive feeding.

What really matters is looking to your baby and matching their pace. Whether you're offering finger foods or puree, baby jars or home made - feed slowly, looking whether your baby wants more. Don't try to encourage them to eat or finish a meal if they don't want to. They know best how hungry they are.

7. Baby-led weaning makes a lot of sense but it might not be right for everyone

A baby-led approach promotes good choices such as delaying solids, family mealtimes and responsive feeding, but that doesn't mean spoons and purees are evil. If you don't want to baby-led wean you can still follow these steps. Let your baby sit with you at meal times and have some finger foods. Offer foods to play with - it helps them learn about textures and might help them be better eaters.

8. Foods are sadly not magical.

They will not help your baby sleep despite what your mother in law says. Weaning foods are often low in calories and end up displacing milk so your baby might even eat less. And besides, babies wake for lots of different reasons, not just hunger - just like adults do. Feeling cold, wanting a drink, or just needing to be close to someone - but babies can't sort those things out for themselves.

9. If a baby is hungry, or a big baby but not yet six months old, the best choice is to give more breast or formula milk.

Milk is energy dense. You can make enough breast milk for your bigger baby - after all the body can adapt to feeding twins or more. As above, weaning foods are lower in calories than milk and more difficult to persuade a young baby to eat.

10. Relax. It is likely your baby is getting enough.

We have survived for millennia without weaning guides and specific schedules for types of foods and nutrients. Offer your baby a wide range of foods, tastes and textures and keep giving them lots of milk. Your baby will let you know if they are hungry!

Dr Amy Brown discusses these steps and more in her new book Why Starting Solids Matters out now, published by Pinter and Martin.

# data[].attributes.attachment_link.keywords[]
babies weaning when to feed baby solids solids baby-led complementary-foods parents parents

# data[].attributes.attachment_link.description
Introducing solids to your baby can feel like yet another complicated thing that you have to do right. Just when it feels like you've finally cracked milk feeds, someone brings up the idea of starting solids. 'Have you thought about when?