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Why is my baby crying for no reason

It can be frustrating and distressing when your baby is crying for no reason and won't stop.

For new parents, it can also be confusing.

Why does my newborn cry for no reason when nothing seems wrong?

Here's the thing... babies don't cry for no reason.
But babies may cry for no reason that you can identify yet.

Why do babies cry

Babies can't talk. Crying is the only way they can communicate their needs. It is a survival instinct they are born with, not a choice they make.

Sometimes, the baby's needs are very straightforward - hunger, tiredness, dirty diapers, boredom, etc. But it could also be something not that obvious.

It is up to us, the grownups, to figure it out.

Using crying to achieve a young child's goals is not misbehavior. Even when your baby grows and has learned to speak, they may not understand what they feel or how to elaborate on their experience.

Until children learn to speak and understand their own needs, they behave this way in order to survive.

What causes baby crying

Babies don't cry for fun. They don't throw tantrums just to get their way.

There are always reasons why they cry, but it may not be a reason you agree with or feel worth crying about.

Many types of infant cries exist. Most parents learn to distinguish the type of crying or the meaning of their baby's cries within 2 weeks of age and they can respond accordingly.

Here are some common reasons babies cry.

Hunger

Pain

Distress

Fatigue

Dirty diaper

Boredom

Overstimulation

Anxiety or fear

Food allergy

Too full

Gas

Acid reflux

Uncomfortable clothing

Sickness or health problems

Separation from mother

High sensitivity

Pain-induced cries have significantly stronger amplitudes and are more intense.

Hunger cries, although not as strong as pain-induced cries, are still more intense than fussy cries.

Is my fussy baby colic

When infants cry excessively and regularly without identifiable reasons, they are often called "infantile colic." Colic is defined as inconsolable crying for 3 or more hours a day.

Colic is not just a "growing pain". It's not the child's temperament or a medical condition.

It means, "We have no idea why they cry, but let's give it a name."

If you and the pediatrician are unable to identify the cause of your infant's long, persistent crying, then you may say that your baby is colicky.

What are the patterns of normal crying

Healthy babies cry, too. A healthy, normal baby cries the most during the first three months of age. Newborn crying peaks at six-seven weeks after birth and drops until four months of age. Late afternoons and evenings are common times when the frequency of crying increases.

What to do when my baby won't stop crying

In a study on constant crying intervention, when parents of babies who had colic were taught to answer cries swiftly, consistently, and completely, infant crying was reduced by 60 percent.

When mothers demonstrated less sensitive or affectionate reaction to the newborn, the infant was likely to become a persistent crier.

Here are the steps suggested by researchers.

1. Answer the baby's crying quickly

There were many parenting pamphlets written between 1920s and 1940s that warned parents not to pick up a baby between feedings because that would lead to spoiled, fussy children.

Since then, studies after studies have shown that responding quickly to an infant's cry during their first few months will decrease their crying significantly by the end of their first year.

Infants whose mothers ignore their cries or delay in responding to them are the ones who show the stereotype of the "spoiled child" by the age of one.

So the first step in soothing a crying baby is to respond to them and do not ignore the baby's cues for help.

2. Answer the baby's crying consistently

No research supports the notion that an infant can be spoiled by having their every cry answered during the first six months.

Studies have shown that consistent maternal responses in the first six months reduce infant crying later in life.

This is because manipulative thinking, such as "When I cry, my mother comes to play with me", has not developed yet.

So, an infant cannot become spoiled by having their cries answered consistently. Rather than being spoiled, the infant will learn that their needs will always be met reliably.

3. Pick up the baby

Providing close physical contact is one of the most common ways mothers comfort a crying infant. Baby crying may be affected by whether the mother picks up her infant quickly after they begin crying.

Researchers found that mothers who picked up their babies soon after they began to cry recorded the shortest duration of infant crying.

Infants whose mothers have handled them tenderly and affectionately in the early days of the baby's life are content with relatively little physical touch at the end of their first year.

4. Find the reason for crying

When you respond to your baby's cry quickly, consistently, and completely, and the crying still does not stop, you may need to examine and determine what is causing the discomfort.

Babies cannot identify or communicate why they are crying. Your job is to figure it out the cause of your baby crying when there is no obvious reason.

5. More things to try

In the event that your pediatrician and you are unable to identify the cause of colic, here are a variety of techniques you can use to calm your colicky infant.

Give them a pacifier

Use swaddling

Play heartbeat sounds, lullabies, or music

Mother sings or talks in a gentle voice

Pace, rock, or use rhythmic movements

Do baby massage

Play the sound of a vacuum cleaner, white noise machine, or ocean waves

Often, the effectiveness of crying-reduction strategies decreases with repetition, so don't be surprised if what worked before doesn't work anymore.

Whenever possible, try to pinpoint the cause of the baby's crying so much, and try different ways to comfort them.

What NOT to do when babies cry

Do not shake a baby

NEVER EVER SHAKE A BABY.

Shaken baby syndrome, or inflicted traumatic brain injury, occurs when a baby is violently shaken or hit with a hard surface. It can result in head trauma and brain damage.

Shaking is often triggered by infant crying.

A colicky baby's first few months after birth are marked by prolonged, inconsolable, and unpredictable crying episodes. These episodes can be frustrating, upsetting, and exhausting for parents.

However, you should not shake a baby under any circumstances.

Colicky babies are not fussy babies. Crying spells are not meant to torture anyone.

A colic baby is a distressed infant whose parents are not sure how to help them.

Listening to excessive crying is exhausting, but consider the baby who has to produce that crying. How much discomfort must they endure for them to cry like that?

Shaking baby syndrome is a dangerous and preventable condition.

Do not shake a baby under any circumstances. If you really cannot handle it, put the baby down in a safe place, take a few deep breaths to center yourself, or walk away to put some distance between you and the child.

Make sure the baby is safe at all times.

Do not let your baby cry it out

It is for survival reasons that the human brain is born with a pretty developed fear/anxiety center, called the amygdala.

In early childhood, the frontal lobe, an important part of reasoning and regulating emotions, does not develop until around 3 years of age.

Prolonged excessive crying is associated with long-term health issues.

Children whose crying bouts were not answered quickly, consistently, and completely are found to have lower self-esteem and impaired attachment security.

Also See: 7 Tips On How To Raise Successful Kids According To Science

How to prevent infant crying

The best way to avoid the serious problems associated with crying is to prevent crying altogether.

Kangaroo care

Kangaroo care is a skin-to-skin holding practice in which the infant is placed upright with its parent, chest-to-chest, wearing only a diaper.

It's like hugging your baby with skin-contact. It is an efficient method for preventing, minimizing, and halting infant crying.

Kangaroo care is a very efficient method for preventing crying.

During kangaroo care, crying is virtually nonexistent. Maternal holding and paternal holding are the next best interventions for reducing crying.

For older babies, being held in a baby carrier may have similar effect.

Learn your baby's signs

Learn how to read your baby's cue. Cue-based infant-demand care, when applied even moderately from birth, is linked to a more settled infant's behavior in the first 12 weeks.

Practice self-care

Research shows that having inconsolable baby crying is associated with maternal postpartum depressive symptoms.

While it is vital to take good care of your baby, your mental health is also important.

It's hard to think about self-care when you haven't taken a shower in ten days, eaten a real meal, or cleaned up your dirty house.

It is alright to ask for help.

In fact, you should ask for help. Postpartum depression is associated with infantile colic. Get help early to protect the health of both you and the infant.

Check Out: Top 10 Good Parenting Tips

When to call the doctor

At 5 months, persistent crying problems are estimated to affect perhaps 5% of crying babies and are associated with negative cognitive development.

The risk of premature breastfeeding cessation and child abuse also increases with crying babies. Their mothers are more likely to suffer from postnatal depression as well.

For crying babies and their mothers, early intervention is crucial to prevent these adverse effects.

Also, medical cause can be diagnosed earlier.

When in doubt, call your baby's doctor or other health professionals.

References

About Pamela Li

Pamela Li is an author, Founder, and Editor-in-Chief of Parenting For Brain. Her educational background is in Electrical Engineering (MS, Stanford University) and Business Management (MBA, Harvard University). Learn more

View all posts by Pamela Li | Website

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Why Is My Baby Crying For No Reason & What Should I Do

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It can be frustrating and distressing when your baby is crying for no reason and won't stop. For new parents, it can also be confusing. Why does my newborn cry for no reason when nothing seems wrong? Here's the thing... babies don't cry for no reason.

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What is sensitive, responsive parenting? It's really pretty simple. First, you tune into your child's emotions, concerns, and needs. That's the sensitive part. Then you provide your child with the appropriate level of support and reassurance. That's the responsive part. Simple, and very powerful.

For years, researchers have noticed that that sensitive, responsive parenting is linked with better cognitive outcomes for children. For example, children learn language more rapidly when caregivers respond promptly and contingently to kids babies do (Tamis-Lamonda et al 2014; Bornstein et al 2020). Preschoolers develop better problem-solving ability, attention skills, and school readiness when their parents are sensitive and responsive (Landry et al 2003; Landry et al 2006; Yousafzai et al 2016).
But there may be important health benefits, too. Research suggests that sensitive, responsive parenting can protect children from chronic disease and toxic stress.
To see what I mean, consider kids living in neighborhoods blighted by poverty and crime.

These kids experience atypical fluctuations of the stress hormone cortisol, putting them at increased risk for a variety of metabolic conditions, including obesity, cardiovascular disease, and diabetes.

There is also evidence linking stress and economic adversity with chronic inflammation - a condition that can trigger atherosclerosis, autoimmune disorders, and cancer (Milaniak and Jaffee 2019; Muscatell et al 2020; Kuhlman et al 2020).

For instance, when University of British Columbia psychologists Gregory Miller and Edith Chen tested adolescents for biochemical markers of inflammation, they found that kids of lower socioeconomic status were more likely to develop a "pro-inflammatory phenotype" (Miller and Chen 2007).
Can parents protect kids from the effects of toxic stress and inflammation?
The idea fits with our everyday observations. Sensitive, responsive parents make children feel safe. They make kids less suspicious of other people, and therefore more relaxed. Secure, relaxed children experience fewer spikes of cortisol, and when they do get stressed, they recover more quickly.

In addition, by teaching their kids how to regulate their own emotions, parents help children develop effective self-soothing mechanisms. Kids learn how to cope, even when their caregivers aren't around.

Together, these factors should help protect kids from the physiological wear-and-tear caused by chronic stressors (Repetti et al 2002; Chen et al 2011).

So Chen and Miller sought to test the idea by inquiring into the early life experiences of people who grew up poor.

In one study, they asked 53 healthy young adults about their family relationships. Study volunteers who reported feelings of greater warmth toward their mothers showed fewer signs of systemic inflammation (Chen et al 2011).

In another study, the researchers explored the effects of parental warmth and sensitivity on the development of metabolic syndrome, a cluster of medical conditions that includes central obesity, high blood pressure, and insulin resistance (Miller et al 2011).

The researchers asked more than 1200 middle-aged Americans questions about their parents. Questions like, "How much did your parent understand your problems and worries?" and "How much time and attention did s/he give you when you needed it?"

Then the researchers examined participants for symptoms of metabolic syndrome, a cluster of health problems that includes high blood pressure, impaired glucose control, and the accumulation of abdominal fat.

As expected, people who grew up in low socioeconomic status (SES) households were more likely to have these symptoms. But about 45% of the people with low SES childhoods were symptom-free. And these healthy people were more likely to have had nurturing mothers.
In fact, among kids with the most nurturing mothers, there was no correlation between SES and poor health status.
To put this in perspective, the researchers also tested the effects of being upwardly mobile. If you were born relatively poor, but achieved higher SES as an adult, did you enjoy better health?

Surprisingly, the answer was no. Not when it came to symptoms of metabolic syndrome. The researchers couldn't detect any difference between people who stayed poor and people who moved up the socioeconomic ladder.

Of course, we should be mindful that these studies didn't include any direct observations of parenting. It's all based on what adult children felt or remembered about their parents. How can we be sure that those memories were accurate? We can't.

But another team of investigators - led by Allisson Farrel - has taken a somewhat different approach. Instead of relying on people's childhood memories, they analyzed decades of data collected on more than 160 individuals as they grew from infancy to adulthood. Stressful life evens were logged as they happened. Families were interviewed at many time points along the way. Parents were observed - in real time - while they interacted with their kids. And what did the researchers discover?

Once again, sensitive, responsive parenting was linked with better adult outcomes. Maternal sensitivity protected kids living in stressful environments from developing health problems as adults (Farrell et al 2017; Farrell et al 2019).

Is this proof that sensitive, responsive parenting has a lasting impact on health?

These are correlations only, and correlations can't prove causation. For instance, none of these studies controlled for genetic factors. Maybe nurturing parents are more likely to carry genes that confer better health, and they pass these genes along to their kids.

And what about fathers? In that study of the 1200 middle-aged adults, Miller and his colleagues didn't find evidence linking health benefits t nurturing dads. Just moms. Is that because the fathers in this study were less involved with childcare? Future studies are needed to rule out alternative explanations.

But in the meantime, there is other evidence to consider.
For example, experiments on nonhuman animals suggest that family interactions have a profound impact on health.
When researchers have cross-fostered rat pups - assigned them to be raised by adoptive mothers - they have found strong evidence for the power of affectionate care. Rats raised by highly responsive mothers show less stress reactivity as adults (Francis et al 1999; Meaney 2001).

And in experiments on zebra finches, investigators found that a bird's lifespan depended on the temperament of its companions. Anxious, easily "stressed out" finches lived longer when they when they were paired with calmer, more resilient companions (Monaghan et al 2012).
There are also intriguing observational studies tracking human children over the short-term.

For example, an fMRI study suggests that sensitive, responsive parents can protect kids from the brain-shrinking effects of toxic stress (Luby et al 2013).

In addition, research on babies exposed to prenatal stress found that 7-month-old infants showed signs of better emotional regulation if their mothers had exposed them to lots of physical affection (Sharp et al 2012).

Follow-up studies confirm the effect lasts into the toddler years, and researchers have connected the phenomenon to epigenetics, or long-term alterations of DNA function (Sharp et al 2015; Pickles et al 2016).

Early life stress can silence genes that help regulate an individual's stress response system. But tactile affection seems to reverse the process (Murgatroyd et al 2016).

If true, scientists may have uncovered a key mechanism for parental responsiveness and affection to impact health. But regardless of the mechanisms, researchers are amassing an increasingly impressive case for the health benefits of responsive, sensitive parenting.

More information

For more information about parental warmth and child outcomes, see these Parenting Science articles:

To read more about reasoning with children, see my article on the authoritative parenting style. And for practical parenting tips, see this guide to positive parenting.

References: Health benefits of sensitive, responsive parenting

Bornstein MH, Putnick DL, Bohr Y, Abdelmaseh M, Lee CY, Esposito G. 2020. Maternal Sensitivity and Language in Infancy Each Promotes Child Core Language Skill in Preschool. Early Child Res Q. 2020 2nd Quarter 51:483-489

Chen E, Miller GE, and Parker KJ. 2011. Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a model of behavioral and biological mechanisms. Psychol Bull. 2011 Jul 25. [Epub ahead of print]

Chen E, Miller GE, Kobor MS, Cole SW. 2011. Maternal warmth buffers the effects of low early-life socioeconomic status on pro-inflammatory signaling in adulthood. Mol Psychiatry. 16(7):729-37.

Farrell AK, Waters TEA, Young ES, Englund MM, Carlson EE, Roisman GI, Simpson JA. 2019. Early maternal sensitivity, attachment security in young adulthood, and cardiometabolic risk at midlife. Attach Hum Dev. 21(1):70-86.

Francis D, Diorio J, Liu D, Meaney MJ. 1999. Nongenomic transmission across generations of maternal behavior and stress responses in the rat. Science. 286(5442):1155-8.

Kuhlman KR, Horn SR, Chiang JJ, Bower JE. 2020. Early life adversity exposure and circulating markers of inflammation in children and adolescents: A systematic review and meta-analysis. Brain Behav Immun. 86:30.

Landry SH, Smith KE, and Swank PR. 2003. The importance of parenting during early childhood for school-age development. Dev Neuropsychol. 24(2-3):559-91.

Landry SH, Smith KE, Swank PR. 2006. Responsive parenting: establishing early foundations for social, communication, and independent problem-solving skills. Dev Psychol. 42(4):627-42.

Luby J, Belden A, Botteron K, Marrus N, Harms MP, Babb C, Nishino T, Barch D. 2013. The effects of poverty on childhood brain development: the mediating effect of caregiving and stressful life events. JAMA Pediatr. 167(12):1135-42.

Meaney MJ. 2001. Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations. Annu Rev Neurosci. 24:1161-92.

Milaniak I and Jaffee SR. 2019. Childhood socioeconomic status and inflammation: A systematic review and meta-analysis. Brain Behav Immun. 2019 May;78:161-176.

Miller G and Chen E. 2007. Unfavorable socioeconomic conditions in early life presage expression of proinflammatory phenotype in adolescence. Psychosom Med. 69(5):402-9.

Miller GE, Lachman ME, Chen E, Gruenevald TL, Karlamangla AS, and Seeman TE. 2011. Pathways to resilience: Maternal nurturance as a buffer against the effects of childhood poverty on metabolic syndrome at midlife. Psychological Science (12):1591-9.

Monaghan P, Heidinger BJ, D'Alba L, Evans NP, and Spencer KA. 2012. For better or worse: reduced adult lifespan following early-life stress is transmitted to breeding partners. Proc Biol Sci. 279(1729):709-14.

Murgatroyd C, Quinn JP, Sharp HM, Pickles A, Hill J. Effects of prenatal and postnatal depression, and maternal stroking, at the glucocorticoid receptor gene. Transl Psychiatry. 5:e560.

Muscatell KA, Brosso SN, Humphreys KL. 2020. Socioeconomic status and inflammation: a meta-analysis. Mol Psychiatry. 25(9):2189-2199.

Pickles A, Sharp H, Hellier J, Hill J. 2016. Prenatal anxiety, maternal stroking in infancy, and symptoms of emotional and behavioral disorders at 3.5 years. Eur Child Adolesc Psychiatry. 2016 Jul 27. [Epub ahead of print].

Repetti RL, Taylor SE and Seeman TE. 2002 Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin 128: 330-366.

Sharp H, Hill J, Hellier J, Pickles A. 2015. Maternal antenatal anxiety, postnatal stroking and emotional problems in children: outcomes predicted from pre- and postnatal programming hypotheses. Psychol Med. 45(2):269-83.

Sharp H, Pickles A, Meaney M, Marshall K, Tibu F, Hill J. 2012. Frequency of infant stroking reported by mothers moderates the effect of prenatal depression on infant behavioural and physiological outcomes. PLoS One. 7(10):e45446.

Tamis-LaMonda CS, Kurchirko Y, and Song L. 2014. Why is infant language learning facilitated by parental responsiveness? Current Directions in Psychological Science23(2): 121-12.

Yousafzai AK, Obradović J, Rasheed MA, Rizvi A, Portilla XA, Tirado-Strayer N, Siyal S3, Memon U. 2016. Effects of responsive stimulation and nutrition interventions on children's development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial. Lancet Glob Health. 4(8):e548-58.

Content of "The health benefits of sensitive, responsive parenting" last modified 11/2021

Image of mother and baby gazing into each's others eyes by Matrix Images / istock

Image of brain MRI by wenht/ istock

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Sensitive, responsive parenting: The health benefits

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Does sensitive, responsive parenting help protect kids from a lifetime of bad health? It seems likely. Studies suggest that parents can act as a buffer against harmful, chronic stress.

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Parenting is a steep learning curve and how to dress my baby for sleep was definitely one of the number one things I stressed about in the early days.

Whether it's summer or winter, how many layers to dress your baby in and what type of blankets/how many to pop on top is a very common question for new parents.

Part of this issue is confidence. As first-time parents may second-guess themselves a lot when it comes to how you should be dressing your baby for sleep.

This is in part because the warnings about overheating are scary. And also because you can't have a discussion with your baby about whether they're comfortable or not.

It's down to you to read their cues and monitor the room!

Thankfully there are now very clear guidelines and advice for parents on how to dress babies at night, plus super helpful baby products such as nursery thermometers and sleeping bags.
This post contains affiliate links
How to dress baby for sleep

The key tips to follow to make dressing baby for sleep super easy are:

Use baby sleeping bags, or sleep sacks, which are now made by a huge range of brands, including supermarkets. These come in a range of tog levels. So you can pick a thicker Tog 2.5 for winter and a very light 0.2 Tog for summer.

Check our handy guide setting out exactly what tog to use and what outfit to put on your baby depending on the temperature of the room. Many sleep sacks come with a guide like this for you to follow too.

I used the Grobag range for both of my babies and it honestly made it so easy! They're suitable for babies from 7lbs in weight upwards.

If you do not want to use sleeping bags, or your baby is too small to use one yet according to the manufacturers guidance on weight, then layer lightweight blankets. One light blanket is fine in summer, and two to three will keep them cosy in winter.

Whatever bedding you use, lightweight fabrics are best, such as cotton.

In terms of clothing you'll want to dress baby in a combination of bodysuits (sleeveless and legless vests that do up with poppers around the nappy) and sleepsuits (which are basically onesies that feature long sleeves and legs that cover the feet). In super cold weather your baby will wear a sleepsuit with bodysuit on underneath, but in very warm weather your baby may just need a bodysuit.

You can swaddle your baby for the first two to four months of their life (before they start to roll over). The NHS advice is to not add any blankets to a baby who has already been swaddled.

Monitor the temperature using a nursery thermometer and then dress them accordingly.

When it was particularly hot, for example 27C or warmer in their bedroom, I would simply put my babies down to sleep in just a nappy and cover them (up to the chest) with a giant muslin.

We're going to explore all of these tips in a little more detail in this article!

What clothes should babies wear to sleep?

Lightweight layers are key to dressing baby for sleep. It's possible to overthink the clothes, but you can actually be guided a little by your own clothing.

Your baby may wear one or two layers of clothing - depending on how the temperature is - and then one to three blankets on top.

When dressing a baby for sleep the advice is to mix and match the following items of clothing depending on the temperature:

Sleepsuit (also known as a babygrow) - An all-in-one layer that is long-sleeved and full leg. These usually do up with poppers or a zip.

Footless babygrow - These are great in comfy temperatures of around 17-21C. They are long-sleeved and cover the legs but leave the feet uncovered.

Bodysuit - These come in both short and long-sleeved options. For sleep I always used the short sleeves and baby either wears it alone with a nappy in very hot temperatures, or underneath a sleepsuit in very cold temperatures. These usually fasten with poppers.

If you feel comfortable in the number of layers you are wearing, then your baby should be fine as well. So if you're in a tee, with a jumper on top then putting baby down in a sleepsuit and bodysuit with a blanket on top will be fine.

What type of bedding should you use?

When getting your baby's crib or Moses basket ready use a firm mattress that is made to fit the bed, with no gaps around the edges, and a fitted cotton sheet.

A waterproof mattress cover is always handy to use underneath the sheet, as accidents do happen even with babies wearing a nappy!

You do not need cotbed bumpers or pillows, and the NHS advises these can actually be dangerous for babies.

The key bedding you will use to keep baby warm is:

Sleeping bag (or sleep sack) - These fasten around your baby's shoulders with zips or poppers. They can be easily opened up for nappy changes at night and prevent wriggly baby from kicking off the covers at night. Sleeping bags come in Tog ratings from 0.2 to 3.5. You'll need to follow the manufacturer's guide for weight as to when your baby can start to use a sleeping bag, however Grobag sell them suitable for babies from 7lbs in weight.

Blankets - Choose blankets made from light-weight fabric. A blanket folded in half to cover baby counts as two layers, and if you fold it in half again that counts as four layers. In general you will use one to three blankets depending on the temperature. I personally always liked to use a combination of cellular blankets and fleece baby blankets (in winter) to keep my little ones comfy.

Swaddle blanket - Many parents choose to swaddle their babies as it can help them to settle easier. You can buy pre-made swaddles that are easy to fasten around baby, or learn how to swaddle your baby in a normal baby blanket. Always use a light, cotton or muslin blanket to avoid baby overheating.

What temperature should baby's room be?

Your baby's room where they sleep should be 16 to 20C, according to the Lullaby Trust.

However we all know that controlling temperature in a house without air conditioning can be pretty tricky!

I used a GroEgg for both of my babies and I recall that many nights during the summer it would turn red with a sad face because the bedroom temperature had exceeded 25C.

So if you cannot always achieve this mythical ideal room temperature then do not panic! Follow the simple guidance in this article about how to dress your baby for any temperature!

What the NHS says about dressing baby for sleep

The NHS emphasises the importance of not allowing your baby to get too hot, as this can increase the risk of SIDS.

As parents we may also worry about our baby getting too cold, which could mean they are more likely to wake up due to discomfort.

All-night heating of the room where your baby is sleeping is rarely necessary, according to the NHS, and it's easier to adjust the temperature by using layers of lightweight blankets.

So the key is lightweight layers in summer and winter that can be added and removed to adjust for temperature.

Baby sleeping bags, or sleep sacks, are also great and recommended by the NHS as a "good choice" as baby cannot kick the covers off like with blankets.

How to keep baby warm at night

When putting a baby down to sleep in cold temperatures dress them in a long sleeve and full leg sleepsuit as well as a bodysuit (a vest with short sleeves and poppers that fix over the nappy) underneath.

You can then cover them with two to three blankets if it's below 16C or a 2.5-3.5 Tog sleeping bag.

For cold temperatures here is a rough guide to what to dress your baby in:

16C or less - Sleepsuit, bodysuit (vest) and 3.5Tog sleeping bag or 2-3 blankets (one blanket folded in half to cover baby counts as two).

16-18C - Sleepsuit, bodysuit (vest) and 2.5Tog sleeping bag or two blankets.

What should baby wear to sleep in hot temperatures

In very hot temperatures you can put your baby down in just a nappy or with a bodysuit. You can pop a very light giant muslin on top of them if you're worried they may become chilly in the night.

However during heatwaves houses can often stay in the mid 20C overnight.

When keeping your baby cool in a heatwave, you can gradually remove layers of clothing as well as the blankets, or reduce the Tog rating of your baby's sleeping bag, to keep baby comfy.

For warmer temperatures here is a rough guide for how to dress your baby:

19-20C - Sleepsuit, bodysuit (vest) and 1Tog sleeping bag or one blanket.

20-24C - Sleepsuit and one blanket or 0.5Tog sleeping bag.

25C+ - Bodysuit and one blanket (no blanket if over 27C)

How to keep baby cool to sleep in summer

It can be tough to control the temperature of your baby's bedroom in a heatwave.

Apart from following the above guidance for dressing them in the summer, you can also take a few steps to cool the room.

During the day open the windows first thing in the morning, when the temperature outside should be cooler. Once it starts to heat up outside (around 11am) then close the windows and the blinds or curtains to keep the heat of the day out.

Use a fan to help your baby feel comfortable, but monitor your baby to ensure they don't get too chilly with the air blowing directly on them. A baby wearing just a nappy may get cold with a fan blowing directly on them, so putting them in a light bodysuit or covering them with a giant muslin can keep them comfy.

You can also try popping their bed sheets into a bag and placing that in the fridge for a few hours before putting them down to sleep. This can make it feel a little cooler for them when they are settling down for sleep.

A guide to sleep sack TOG ratings

Sleeping bags, or sleep sacks, are sold in different Tog levels, or warmth ratings.

The higher the Tog rating, the thicker the sleeping bag. A 0.2 Tog is extremely light.

Here's a rough guide to which Tog rating to use for your baby depending on room temperature:

3.5 Tog - 14C or less

2.5 Tog - 14-20C

1 Tog - 20-24C

0.5 Tog - 24C or higher

How to tell if your baby is too hot or too cold

There are a few simple checks to follow at nap and bedtimes to ensure your baby's comfort.

Check the room temperature using a nursery thermometer.

Dress your baby according to the temperature guide. You can check the guide in this article, or see the guide that is likely to be included with your baby's sleeping bag (if you're using one).

Feel your baby's chest and back of their neck. If your baby is too hot their skin will feel hot and slightly clammy. It is normal for their hands and feet to be cooler.

A baby that is too hot may also have damp hair from sweating, flushed cheeks and rapid breathing.

If baby is too hot then remove a layer.

If the temperature has dropped and you think baby is cold then add another blanket.

Dressing baby for sleep dos and don'ts

Do

Use thin muslin or a thin cotton sheet for swaddling baby.

Do keep their head free of a swaddle.

Use a room thermometer to help guide you - and check the temperature before you go to sleep in case you need to add or remove layers.

Check your baby's temperature before you go to sleep by putting your fingers to their chest (underneath their clothing) and back of their neck.

Don't

Put a hot water bottle or electric blanket into the crib with your baby.

Place baby's crib directly next to a radiator, heater or fire or in direct sunshine.

Add blankets over a baby who is swaddled.

Add a hat, as heat is released from the head as part of maintaining body temperature.

Final thoughts on how to dress your baby for sleep

We cannot temperature control the rooms that our babies sleep in, so we need to adjust what they wear to accommodate.

If you're ever unsure about whether your baby is too hot in their pyjamas and bedding, touch the skin of their chest and back of their neck to see if they are sweaty and/or very hot.

Using lightweight blankets, or a Tog rating on a sleeping sack, makes your job much easier!

By the time my second baby arrived I was much more confident about what she should be wearing at night and nap times.

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Parenting is a steep learning curve and how to dress my baby for sleep was definitely one of the number one things I stressed about in the early days. Whether it's summer or winter, how many layers to dress your baby in and what type of blankets/how many to pop on top is a very common question for new parents.

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Several mums I've spoken to recently have mentioned it's hard to find good information about mix-feeding. Often breastfeeding websites don't discuss it as they promote exclusive breastfeeding and the reasons for doing so. Similarly some mums are nervous about asking too many breastmilk questions on bottle-feeding forums, for fear it may upset those not breastfeeding at all. Mix feeding, combination feeding - whatever you prefer to call it, almost seems to fall into a no mans land.

What concerns me about this is hearing from a number of mums that they thought it had to be all or nothing; some have said that once they had given a bottle and destroyed the "virgin gut" (the special environment created by baby having solely breastmilk) they believed there was no longer any point continuing.

I hope this entry helps....
Why isn't mix-feeding promoted more by breastfeeding supporters?
There is no doubt that exclusively breastfeeding is the safest way to nourish an infant. As mentioned above, certain antibodies work to help prevent harmful pathogens or allergens being absorbed into baby's bloodstream (often called "virgin gut"). Small amounts of formula remove the protective coating, although evidence also suggests several weeks of exclusive feeding can help it revert back to one dominant in good bacteria again. Read more about exclusive breastfeeding v mixed feeding here.

The other big issue is supply - in simple terms your body knows what to produce based on how much your baby consumes and how frequently. Logically if you replace one breastfeed with a bottle feed, your body will produce this much less milk and everything else will be the same. In the early days however this logic often doesn't work; a baby drinks more from a bottle because it's a more passive method of feeding, which combined with the fact formula is harder to digest leads them to go longer before the next feed. Because they've drunk slightly beyond satiation, next time they may need a slightly bigger bottle or a bigger top up, to create the same "full" feeling. Some babies then become frustrated at having to wait for the breast to "let down" and having to work for milk, rather than it just being poured out - so may fuss at the breast. Mum can easily then think baby prefers the bottle and seems happier - baby may even refuse the breast entirely, particularly if breastfeeding wasn't going that great when the bottle was introduced. It can be a slippery path from giving one bottle to the supplement amount increasing, time at the breast reducing and mum suddenly finding herself almost entirely bottle feeding, when in fact she wanted to breastfeed.
What if mum can't get help to resolve the problem or feels she has to or really wants to give a supplement/bottle. What if the choice isn't exclusive or mix feeding - but mix-feeding or nothing, is there any point continuing breastfeeding?
Yes, yes, yes, yes, yes!

There are two different issues at play here; the first is the protection from breastmilk coating the gut. The second is all the other many many constituents in breastmilk that work in a different way; those that enter babies blood stream and target pathogens, or help sweep them from the body. Cancer fighting agents, stem cells, hormones and a lot more besides! We often hear it said that even one breastfeed per day is valuable, and this is absolutely true.

If breastfeeding were only of worth when exclusive, there would be no reason to continue once solids were introduced.

I find it helps to look at things on a big scale in terms of risks/benefits - right at one end you have the exclusively breastfed infants who have never been supplemented, feed on demand and likely co-sleep with lots of nightfeeds. At the other an infant who is exclusively formula fed with no breastmilk. All other infants sit somewhere on this scale and the more breastfeeding/breastmilk is involved, the further down the "risks" scale they sit.
But is there any point if I have to return to work? I will have to stop then anyway?
Returning to work doesn't have to spell the end of breastfeeding. There are many different options to explore. Some build a "freezer stash" of expressed milk in the early months and give this when they return to work - perhaps continuing to express, or deciding to just use the stash before supplementing with another milk. Others might choose to express whilst at work and give that, whilst some might fit say one expressing session in and give the rest as a different milk. If baby is well established on solids, mum may choose not to leave another milk and instead feed lots when at home (perhaps offering more cheese/dairy products). If mum works near home or near her childcare, sometimes she can even arrange to visit baby during breaks to feed or have baby brought to her. There are no hard and fast rules as it's about finding something that works for you and your circumstances.

But what is key is in any of the above scenarios - you can still choose to breastfeed when you are with your baby. This means your baby still gets passive immunity which when starting daycare or a childminders (positively a germ party!) can be invaluable, not only for baby's health but also as a way of reconnecting after a day at work. It also means mums don't have to bother with the hassle of making up bottles/cleaning them etc taking further time out of what can be a busy day! In the UK mums may often have 6-12 months maternity leave, meaning supply is much more established by the time and can quickly adapt to new and changing patterns. Even at a few months old supply has more chance of keeping up than in the early weeks - allowing you to continue as long as you want.

There are so many reasons to breastfeed - it really doesn't have to be all or nothing...

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Mixing bottle and breast - it doesn't have to be all or nothing.

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Several mums I've spoken to recently have mentioned it's hard to find good information about mix-feeding. Often breastfeeding websites don't discuss it as they promote exclusive breastfeeding and the reasons for doing so. Similarly some mums are nervous about asking too many breastmilk questions on bottle-feeding forums, for fear it may upset those not breastfeeding at all.

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Vitamin K and newborns: what you need to know | Labour & birth articles & support | NCT

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If you’ve heard people talk about Vitamin K but are feeling a bit clueless, here’s the information you’ll need.

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The safest cot is a clear cot

The safest cot for a baby is a clear cot. That means removing anything that isn't essential. Babies need just two items in their cot:

It's important to remove anything that isn't essential because items such as toys, blankets and bumpers could cover their face and obstruct their breathing.

When preparing your baby's sleep space, remember:

No pillows or duvets

No cot bumpers

No soft toys or comforters

No weighted or bulky bedding

No products designed to keep your baby in one sleeping position, such as wedges or straps

No pods or nests, rolled up towels or anything soft placed on top of the mattress.

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Safer sleep overview - The Lullaby Trust

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An easy guide to practicing safer sleep for your baby and reducing the risk of sudden infant death syndrome (SIDS, or cot death).

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Just to add...the mother can have light bedding to her waist that goes under the baby's legs or stops short of them. She can also wear an open cardigan to keep her arms warm. The baby can have 2-3 layers of natural fibres and their own light cotton blanket to cover their legs if needed.

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"In most parts of the world... babies sleep close to their mothers, as they have through most of history." - The Womanly Art of Breastfeeding
A baby is born expecting to stay in close contact with his mother night and day, in order to keep safe, warm and well-fed.
It is perfectly normal for babies-especially breastfed babies-to wake and feed at night throughout at least the first year. Bedsharing when breastfeeding is a traditional way of caring for a baby at night-breastfeeding at night can be a whole lot easier when you take your baby into bed with you and feed lying down.

Breastfeeding mothers who bedshare get more sleep than bottlefeeding mothers and breastfeed for longer. Alternatively, co-sleeping may give your baby the closeness he craves and make breastfeeding easier without sharing the same sleep surface as you.

It is possible to bedshare with twins, but co-sleeping rather than bedsharing is recommended if they were premature or low birth-weight.

Infant sleep-what are the risks?

Accidents

Babies sleep in a variety of places at different times. Wherever a baby sleeps an accidental injury is possible. A baby could become wedged between furniture or against a parent's body, fall off the sleep surface or risk suffocation or strangulation by pillows, cords or blankets.

Anything that reduces your alertness or ability to respond to your baby, such as alcohol, drugs or certain medications, can pose a risk and may impair your judgement.

Breastfed babies orient themselves near their mother's breast in bed. Research shows that mothers who bedshare with their breastfed babies adopt a naturally protective position, making smothering unlikely. This has been referred to as the 'cuddle curl' position.

SIDS

Sudden Infant Death Syndrome (SIDS), or cot death, is a sudden unexpected infant death (usually occurring during sleep) that can't be explained by a medical condition, infection, intentional harm, or accidental causes.

What makes a baby vulnerable
SIDS can happen in any sleep situation, but research has shown that SIDS only happens to baby who are vulnerable. We don't know exactly which factors cause vulnerability, but they include:

baby being less than four months old

prenatal exposure to harmful chemicals including smoke and alcohol

preterm or low brith weight baby (under 2.5kg).

SIDs risk factors
The following factors increase the risk of SIDS for a vulnerable baby, wherever they sleep.

1. Exposure to smoke can affect a baby's ability to rouse from sleep. The risk is related to how much exposure a baby has. It is always a good idea to reduce your baby's exposure to smoke wherever they sleep, but if you are a smoker you should not share a sleep surface with your baby. Smoking is the biggest SIDS risk.

2. Placing a baby on his front to sleep may affect his ability to arouse and to breathe. 'Back to Sleep' campaigns have reduced SIDS in many Western countries. Bedsharing breastfeeding mothers often nurse in a side-lying position-when a baby comes off the breast they naturally rolls onto their back. A baby who can roll back and forth can choose his own sleep position.

3. Being unattended.
During all sleep (daytime and nightime), a baby's risk of SIDS is lower if they are in the same room as you.

4. Formula-feeding (including combi-feeding) imposes a statistically significant higher risk of SIDS.

The Safe Sleep Seven

Breastfeeding mothers who meet the criteria below are statistically low risk and can bedshare with confidence.
You need to be:

1. A non-smoker

2. Sober (no drugs, alcohol, or medications that could make you drowsy)

3. Breastfeeding

Your baby needs to be:

1. Healthy and full term (with a birth weight above 2.5kg)

2. Sleeping on their back when they are not breastfeeding

3. Unswaddled and lightly dressed

You both need to be:

On a safe surface. Never sleep with your baby on a sofa or armchair.

Make an informed decision
Use the information above along with our checklist below to evaluate your baby's different sleeping places and your own family circumstances, to reduce the risk of an accident or SIDS wherever you and your baby sleep.

Meeting Everyone's Needs

If you are struggling to reconcile your own sleep needs with those of your baby, then talking with an LLL Leader may be helpful. At an LLL meeting you can find out how other families meet the sleep needs of their sleep needs in different ways and at different stages.
Find local support here. Call our helpline: 0345 120 2918

Co-sleeping or bedsharing?

Bedsharing: adults and infants sharing the same surface for sleep.

Co-sleeping: parents and infants sleeping in close proximity, but not necessarily on the same surface eg in a bedside cot or a sidecar cot attached to the bed.

Some studies combine sofa sleeping with bedsharing, making it more difficult to separate the risk factors for each scenario. See Further Reading for more details, or for more information on these definitions, see here.

Sleep safely

Sleep tips

Do
✔ Place your baby to sleep on their back.
✔ Keep your sleeping baby close day and night, not in a room alone.
✔ Avoid exposing your baby to cigarette smoke at any time as this increases the risk of SIDS.
✔ Place your baby with his feet to the foot of any cot, crib or pram.
✔ Sleep facing your baby in bed (your thigh should prevent him slipping under the covers).
✔ Check your baby's sleeping place for hazards:

Choose a firm, flat, clean, well-fitting mattress and cover with a close-fitting sheet.

Check for gaps that they might get trapped in..

Ensure they can't fall out.

Choose clothes without strings or ties that could cause strangulation.

✔ Check your baby does not get too hot or too cold whilst sleeping. In hot weather, open a window or use a fan.
✔ Keep pets out of your baby's bed.

NEVER leave your sleeping baby:

✘ Near a fire or radiator, or in full sun.
✘ Wearing warm outdoor clothing when indoors.

NEVER sleep with your baby:

✘ On a sofa or armchair.
✘ If he is swaddled.

Bedsharing tips

Once you can safely and comfortably feed your baby while lying down, you've elimated much of the work of mothering for eight of the 24 hours in a day.

Easy Nights

You may find that different sleeping arrangements work at different times. Being inventive and focusing on how you and your family can get the most sleep tonight can help. Some of these ideas may work for you, but because only you know your own circumstances, always keep safety in mind.

Avoid tumbles by:
* Using a mesh guard rail - but make sure there is no gap between the rail and the bed.
* Taking the legs off the bed or putting the mattress on the floor.

Learn to feed lying down by:
* Practising in the daytime!
* Keeping a low light on.
* Going to a La Leche League meeting and learning from other mothers.
* Watching our video on breastfeeding while lying on your side:

These safety tips apply to healthy full-term breastfed infants. Preterm and low birth weight babies are more vulnerable. If your baby seems unwell, seek medical advice promptly. Remember that safety tips can help reduce the risk of SIDS and accidents wherever your baby sleeps, but cannot eliminate the risk altogether.

Written by Sue Cardus, Karen Butler, Sue Upstone, Bronwyn Davies & mothers of La Leche League GB.

Further Reading

Sweet Sleep: Nighttime & Naptime Strategies for the Breastfeeding Family Wiessinger, West, Smith, Pitman, LLLI. London: Pinter & Martin, 2014.
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Why Your Baby's Sleep Matters, Ockwell-Smith, S. London: Pinter & Martin, 2016.

LLL links:
Rhythms & Routines
Smoking & Breastfeeding
I need some sleep
Other Online information:
Baby Sleep Info Source
UNICEF: Caring for your baby at night. (link to UNICEF PDF)
References
1Sleep patterns and fatigue in new mothers and fathers. Gay et al, 2004.
2Ball, H. L. et al (2016). Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration? Acta
Paediatrica, DOI: 10.1111/apa.13354.
3Ball, H. L. Parent-infant bed-sharing behaviour: Effects of feeding type, and presence of father. Human Nature 2006; 17(3):301-18.
4Basis. The Triple Risk Model, www.basisonline.org.uk/hcp-the-triple-risk-model/ (accessed 16 Feb 2022)
5SWEET SLEEP: NIGHTTIME AND NAPTIME STRATEGIES FOR THE BREASTFEEDING FAMILY, LLLI. London: Pinter & Martin, 2014; 345-348.
6SWEET SLEEP: NIGHTTIME AND NAPTIME STRATEGIES FOR THE BREASTFEEDING FAMILY, LLLI. London: Pinter & Martin, 2014; 9.
7Basis. Definitions of Terms Used on This Site, www.basisonline.org.uk/hcp-definitions-of-terms-used-on-this-site/ (accessed 16 Feb 2022)

ACADEMY OF BREASTFEEDING MEDINCINE. ABM Clinical Protocol #6: Bedsharing and Breastfeeding 2019., Accessed 16th Aug 2020

You can buy this information in printed form from the LLLGB shop .

Copyright LLLGB 2022 (updated March 2022)

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Safer Sleep & the Breastfed Baby - La Leche League GB

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"In most parts of the world... babies sleep close to their mothers, as they have through most of history." - The Womanly Art of Breastfeeding A baby is born expecting to stay in close contact with his mother night and day, in order to keep safe, warm and well-fed.

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Keep your baby close and keep your baby safe. When you're wearing a sling or carrier, don't forget the T.I.C.K.S.

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Respond early as a crying baby finds it harder to feed

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Newborn Cues narrated - What is Your Baby Trying to Tell You?

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أهمية وضعية الجلد للجلد بعد الولادة مباشرة للتحفيز على الرضاعة الطبيعية المبكرة.

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Attaching your baby at the breast

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

Join the Conversation

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Attaching Your Baby at the Breast - Video - Global Health Media Project

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early breastfeeding initiation through the journeys of 3 newborns and ways to ensure the success of this vital practice for any new mother and baby.

Join the Conversation

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Breastfeeding in the First Hours - Video - Global Health Media Project

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early

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Signs of effective feeding in the early days - La Leche League GB

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Most babies are keen to feed in the first 90 minutes after they are born especially if they are in skin-to-skin contact with their mum. If your baby is too sleepy to take this first feed or needs medical attention, it’s a good idea to ask your healthcare team to show you how to hand […]

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When should I feed my baby?

As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

It's best to feed babies responsively or in a baby-led way rather than sticking to a feeding schedule (WHO, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can feel emotionally and physically challenging (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Some people may think frequent feeding is a sign of insufficient milk, or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Leurer, 2015).

Try and keep in mind that a newborn baby's stomach is really small. They need to feed little and often (NHS, 2020). It's really common for babies to have a good feed and then appear to be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed (Kent et al, 2012).

All of this also means that newborn feeding is frequent. In fact, much of the time, it's not really a question of clearly-defined 'feeds' with clear beginnings and endings (WHO 1998).

Your baby knows your voice, your smell and your taste but they are much less familiar with the 'world' outside your womb. Staying close to you gives them a vital sense of safety and reassurance. This builds their confidence that they are loved and cared for (Crenshaw, 2007).

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Daly & Hartmann, 1995). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Kent et al, 2012; WHO 2019).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2019a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (WHO, 2009). Here's what you might see...

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

Some feeds will seem to last a long time, with your baby dozing for short periods before wanting more. And more. And still more! It's normal for a young baby to be on the breast many times a day and night. 12-15 'visits' to the breast is well within a normal range (Entwistle, 2013).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they stop drinking. If they still appear hungry, offer the second breast - allowing them to drink as much as they want (NICE, 2015).

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and, provided they are well latched on, get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.
This page was last reviewed in March 2021
Further information

We support all parents, however they feed their child. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 0212.

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 20 March 2021].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 20 March 2021].

Crenshaw J. Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education2007;16(3):39-43. Available at: doi:  10.1624/105812407X217147 (Accessed 26 Apr 21)

Daly SEJ, Hartmann PE (1995). Infant Demand and Milk Supply. Part 1: Infant Demand and Milk Production in Lactating Women. Journal of Human Lactation. 11(1):21-26. doi:10.1177/089033449501100119 Available at https://journals.sagepub.com/doi/10.1177/089033449501100119 [Accessed 13 April 2021]

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 20 March 2021].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 20 March 2021].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 20 March 2021].

Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 20th March 2021].

NHS. (2019a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 20 March 2021].

NHS. (2019b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 20 March 2021].

NHS. (2020) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 20 March 2021].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 20 March 2021].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 20 March 2021].

World Health Organization. (1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization.

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 20th March 2021].
Further reading
Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 20 March 2021].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at:   https://www.mdpi.com/2072-6643/8/5/279 [Accessed 20th March 2021].

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How often should I breastfeed my baby? | Baby & toddler, Feeding articles & support | NCT

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Read our tips on when to breastfeed your baby and how much milk they need.

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Breastfeeding is something only you can do for your baby. It should be a pleasant experience for both of you. A healthy, full-term baby is likely to know instinctively what to do at the breast. In the first three to five days after birth, if you experience nipple soreness beyond a slight tenderness when your baby latches on, it may be a sign that something isn't right with the baby's latch, position, or suck. An adjustment to the latch or positioning can help you and your baby to be more comfortable. With proper positioning and latch-on techniques, you can expect little or no nipple soreness. Correcting poor positioning or latch-on can often alleviate sore, cracked nipples and allow healing to begin.

If nipple pain worsens after the early days of breastfeeding your nipple pain may be due to other causes like thrush, bacterial infection, or tongue-tie. Contact a La Leche League Leader for help if you need further assistance to improve your sore nipples.

The First Week: Positioning and Latch-On

Learn to recognize your baby's early feeding cues so you have time to get in a good position and comfortable before he becomes desperately hungry. Early cues include opening his mouth and moving his head side-to-side-known as the rooting reflex-or sucking on hands or fingers. Don't wait for baby to cry to let you know he is hungry. Crying is a very late hunger cue.

Adjusting the position can improve breastfeeding pain. If you have pain, try different positions such as laid-back, football or cradle position.

Laid-back position

Position yourself comfortably in bed, on the couch or in a recliner with back support, pillows to also support your head, shoulders, arms. Since you're leaning back, your baby can rest on you in any position you like.

If you are seated, support your feet with a footrest or a telephone book.

Let your baby's whole front touch your whole front. His mouth and nose should be facing your nipple. Let your baby's cheek rest somewhere near your bare breast.

Rub your nipple on baby's upper lip to encourage baby to open wide. Bring your baby close. Have his chin touch your breast first, and then his nose will touch your breast.

Position baby close to you, with his hips flexed, so that he does not have to turn his head to reach your breast. Baby's feet need to feel supported by your body so they don't dangle in the air.

Use one hand to support your breast, if needed, and the other to support baby's thigh or bottom.

If you are feeling pain, detach baby gently by using your finger to touch the corner of baby's mouth and try again.

Football position

This is a good position for a mother who has had a Cesarean birth, as it keeps the baby away from the incision.

Baby's is to your side on the same side you are breastfeeding and under your arm. Support your baby's head in your hand and his back along your arm beside you.

Support your breast with a "C" hold.

Have baby facing the nipple, with his mouth at nipple height. Use pillows to bring the baby to the correct height.

Your baby's legs and feet are tucked under your arm with his hips flexed and his legs resting along side your back rest so the soles of his feet are pointed toward the ceiling. (This keeps him from being able to push against your chair.)

Cradle position

Make sure you are relaxed and comfortable as your baby feeds. Lean back in your chair, supporting your back with a bed pillow turned vertically if needed. Don't lean forward and hunch over your baby. Raise your feet off the floor, using an ottoman or even a phone book. Breathe deeply and be sure to relax and drop your shoulders.

Position your baby on his side, with his whole body facing yours and angled so his chest is securely against your abdomen. Baby should not have to turn his head to nurse.

Cradle baby in the arm on the same side as the breast he will be nursing from. If you're breastfeeding on the right breast, baby's head will rest on your right forearm near your elbow, his nose at the level of your nipple, and his head tilted slightly back. He is supported by your forearm with your hand holding his bottom or thigh.

Support your breast with your other hand well back from the nipple and baby's mouth, keeping your fingers positioned either above or below or on either side of the breast.

Bring your baby to the breast. Trigger his natural response to open his mouth wide by touching his lips lightly with your nipple. Light, repeated tapping or brushing triggers a wide-open mouth.

As you bring baby to the breast with his head slightly tilted back, his chin will press into the breast first. More of your breast will be covered with his lower jaw.

Aim your nipple toward the roof of baby's mouth and gently bring him onto the breast as he latches on.

When baby is latched well, his chin should be pressed into the breast, and his nose slightly away from it.

If you leave the hand supporting the breast in place, be sure you do not press down with your thumb, which can pull your nipple to the front of baby's mouth. If you remove the supporting hand from your breast, make sure baby has enough head control to keep him well latched. If your breasts are large, it can be helpful to put a small rolled-up towel beneath them for support.

Cross Cradle Position

This position is a variation of the cradle position, called the cross-cradle position.

For this position, your baby is supported on a pillow across your lap to help raise him to your nipple level.

Pillows should also support both elbows so your arms don't hold the weight of the baby; they will tire before the feeding is finished.

If you are preparing to breastfeed on the left breast, your left hand supports that breast in a "U" hold.

You support your baby with the fingers of your right hand. Do this by gently placing your hand behind your baby's ears and neck with your thumb and index finger behind each ear.

Your baby's neck rests in the web between the thumb, index finger and palm of your hand, forming a "second neck" for baby. The palm of your hand is placed between his shoulder blades.

As you prepare to latch on your baby, be sure his mouth is very close to your nipple from the start. When baby opens his mouth wide, you push with the palm of your hand from between the shoulder blades. His mouth will be covering at least a half-inch from the base of your nipple.

If baby is not latched on well or if it hurts, remove him from the breast by inserting your finger into the side of his mouth and try again.

Look at your nipple after breastfeeding, if it looks blanched or pinched, review the latch and positioning tips to see if you can find adjustments to make. The nipple should look the same way it did before breastfeeding, neither pinched nor blanched.

If nipple soreness persists, contact a La Leche League Leader for help. Mild soreness, if left untreated, can lead to more pain.

You may also find this post about Positioning useful.

Causes of Sore Nipples

Improper latch-on occurs when baby does not grasp enough breast tissue or his tongue is positioned improperly. Baby must be able to compress your breast tissue with your nipple positioned deep in his mouth. First, check baby's body position. Be sure that he opens his mouth very wide, like a yawn, before you offer your breast, checking to see that his tongue is cupped and forward in his mouth. His lower lip should not be tucked in-it should be fanned outward on the breast. If you gently pull down the corner of the baby's mouth while he is nursing, you should see the underside of his tongue, which should extend over his lower gum line, cupping the breast

Sometimes babies latch deeply, but slide down the nipple during the feed-watch for more distance between his nose and your breast. If this happens, break the suction and re-latch your baby, being sure that he is well supported.

Tongue-tie can also cause sore nipples. When baby cries, can you see if his tongue is able to reach past his lower lip? If baby's tongue appears heart-shaped, it could be a short or restricted frenulum (tongue-tie) that prevents a good latch-on. Contact a La Leche League Leader if your baby does not seem to be latching on well.

Flat or inverted nipples can make it difficult for baby to grasp your breast in his mouth and properly latch on. With proper latch-on, your baby's sucking can effectively draw out flat or inverted nipples. Gentle pumping or special exercises are sometimes recommended to draw the nipple out. If you received IV fluids for several hours during the birth process, this can be a cause of edema (swelling) in the breast and nipple. Reverse Pressure Softening can help create a softer nipple/areola that baby can grasp. Reverse Pressure Softening involves using gentle finger pressure around the base of the nipple. This temporarily moves some of the swelling slightly backward and upward into the breast. This technique is also helpful in preventing sore nipples if your breasts become engorged (swollen and uncomfortable) when your milk supply comes in several days after birth, making it difficult for baby to latch on comfortably.

Removing baby from the breast without breaking the suction first can be painful and cause damage to sensitive breast tissue. If baby is latched on and sucking well, he will end the feeding himself by letting go of the breast or releasing the nipple as he falls asleep. Allowing baby to determine the end of the feeding will ensure that he is getting the right balance of foremilk at the beginning of the feed, which is more watery and quenches baby's thirst, and hindmilk at the end of the feed, which is creamy milk that is higher in calories and satisfies baby's hunger. If you decide to take baby off the breast before he is finished, you can break the suction by pressing down on your breast near baby's mouth, pulling down on baby's chin, or inserting your finger into the corner of baby's mouth.

Personal care practices may lead to nipple soreness. Avoid bras that are too tight and put pressure on your nipples. Be vigilant about thorough rinsing of nursing bras to be sure any laundry detergent residue is removed. Soap, shampoo, body wash, and alcohol can dry your nipples. Take care when applying cologne, deodorant, hair spray, or powder near your nipples. When bathing, rinsing breasts with clear water is all that is needed to keep your breasts and nipples clean.

When your nipples are sore you can gently apply your own milk or an emollient that is safe for the baby to ingest, such as HPA® Lanolin. Either of these can be very soothing. Contact a La Leche League Leader for suggestions.

Be aware that more than one cause can be contributing to nipple soreness at the same time. Avoid limiting the length of nursing sessions, a practice that is mistakenly thought of as a way to avoid sore nipples. Instead, aim to coordinate optimal positioning with careful personal care practices, and contact a La Leche League Leader for helpful tips.

Treatment of Sore Nipples

While the cause of sore nipples is being determined and corrected, continued breastfeeding is important. When baby is latched on well with your nipple deep in his mouth, the nipple is protected from further damage. You may want to try one or more of these comfort measures while the cause of your sore nipples are being corrected.

Vary nursing positions-cradle hold, cross cradle hold, football (clutch) hold, and lying down-in order to vary the position of baby's mouth on your breast. (For information on various nursing positions, contact an LLL Leader for assistance.)

Begin to nurse on the least sore side until the letdown occurs, then gently switch baby to the other breast, paying careful attention to good positioning and latch-on. Some mothers use relaxation breathing until their milk lets down.

Express a little milk or colostrum onto your nipples after nursing. In many cultures, human milk's antibacterial properties are used to treat skin irritations. However, this is not recommended when soreness is due to thrush, which is a yeast infection of the nipples.

When your nipples are sore, apply some of your own milk on your nipples. Your milk has healing properties to relieve soreness. Also, a small pea-sized portion of ultrapure modified lanolin, such as HPA® Lanolin, between clean fingertips and apply to the nipple and areola. Gently pat it on: do not rub it in. It does not need to be removed before feedings. This provides a moisture barrier that will slow down the loss of internal moisture, which is vital to healthy, supple skin, eases discomfort, and promotes healing without scab formation. This process is known as "moist wound healing." Gel pads may provide relief from soreness and promote healing.

Lanolin or gel pads are not recommended if you have a yeast infection.

If the pressure of your clothing or your bra causes further discomfort for your nipples, apply ultrapure lanolin after feedings to help soothe, protect, and heal nipples, then use breast shells with large openings.

In most cases, sore or cracked nipples are no longer painful once good positioning and latch on are achieved. It is rarely necessary to discontinue breastfeeding. The many benefits to both baby and mother make continuing to breastfeed worthwhile.

It is not typically recommended any more that mothers dry sore nipples with a hair dryer or use a sun lamp. These practices have been shown to dehydrate skin further and cause additional damage to tender nipple tissue.

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Breastfeeding with Sore Nipples | La Leche League International

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Breastfeeding is something only you can do for your baby. It should be a pleasant experience for both of you. A healthy, full-term baby is likely to know instinctively what to do at the breast.

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How to Sterilize Baby Bottles - Babylist

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies. About the Breastfeeding Series " DOWNLOAD

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Jean Merrill, Maryland
What is more relaxing than chilling out in your recliner? Not much, and research has shown that breastfeeding our babies in this reclined position stimulates natural feeding reflexes in both mothers and babies. So, you have full biological permission to chill out and breastfeed your baby as you lie back and relax!

For years the trend in teaching mothers to breastfeed has been to push a managed approach to positioning and latch. Mothers sit straight upright as they offer the breast or even slouch forward as they try to bring the breast to the baby. Then, they must offer support to their breast as well as baby's head, back, and body throughout the feeding. While that six-pound baby might not seem heavy at first, holding this position for the length of a newborn feeding eight to 12 times a day can take its toll.

This managed approach to breastfeeding positioning isn't only tiring for mothers. Suzanne Colson, as part of her doctoral thesis, studied infant feeding reflexes and biological nurturing. She found that, beyond just rooting and sucking, there are many more innate reflexes associated with infant feeding. These include infant leg, hand, and head movements that help a baby locate and latch on deeply to the breast. Dr. Colson found these movements help babies to latch if a mother was in the laid-back breastfeeding position: reclined and using gravity to hold her baby on her chest. These reflexes and innate infant latching behaviors were so powerful during laid-back breastfeeding (also known as biological nurturing) that babies can latch effectively even when in light sleep.

Babies aren't the only ones with feeding reflexes, according to Colson. When breastfeeding babies in the laid back, biological nurturing position, mothers showed reflexive nursing instincts as well. Studies show that mothers stroke their baby's feet at just the right time during latching and feeding, which triggers infant toe reflexes that also release lip and tongue feeding reflexes. The timing was like a well-choreographed instinctual dance.

When a mother reclines backward, relaxing her back and neck, tilting her pelvis forward, and allowing gravity to hold her baby to her chest and abdomen, her hands were free to stroke and admire her baby. Her hands aren't busy rigidly maintaining a feeding position. This sounds pretty pleasant, doesn't it? Our babies are little for such a short time-what a relief to be able to enjoy all of that feeding time more! Also, when all of those instinctual feeding behaviors are used to facilitate latch, mothers report that nipple pain was immediately relieved. Those of us who struggled with latch and sore nipples know how truly fantastic this sounds! Laid back breastfeeding allows the baby to become an active participant in the feeding process, and this seems to smooth out a lot of the wrinkles.

Isn't it funny that allowing our children to become active participants at every single stage of their development is the way to go? This is true from facilitating breastfeeding in a way that allows their natural infant behaviors to help them to latch on, to offering simple choices to toddlers, and all the way through to allowing our adolescents a bit of room to make decisions. There is really some amazing wisdom to that old mother-to-mother adage to "let baby take the lead" and "watch the baby not the clock." Baby instinctually really does know best!

Dr. Colson states it beautifully in her article, What Happens to Breastfeeding When Mothers Lie Back, when she writes, "It was as if the position the mother sits in could transform breastfeeding from a method reliant upon skills, into a relationship." Isn't that just what we are after as mothers-the relationship with our children. It turns out that relaxing back into motherhood might just be the perfect way to get started down our mothering paths.

Your Laid Back Breastfeeding guide: (from The Womanly Art of Breastfeeding, 8 th edition, pg. 449):

Laid-back breastfeeding, or Biological Nurturing, means getting comfortable with your baby and encouraging your own and your baby's natural breastfeeding instincts. See biologicalnurturing.com for further information.

Dress yourself and your baby as you choose.

Find a bed or couch where you can lean back and be well supported- not flat, but comfortably leaning back so that when you put your baby on
your chest, gravity will keep him in position with his body molded to yours.

Have your head and shoulders well supported. Let your baby's whole front touch your whole front.

Since you're leaning back, you don't have a lap, so your baby can rest on you in any position you like. Just make sure her whole front is against you.

Let your baby's cheek rest somewhere near your bare breast.

Help her as much as you like; help her do what she's trying to do. You're a team.

Hold your breast or not, as you like.

Relax and enjoy each other.

References and Resources

1. The Womanly Art of Breastfeeding, 8th edition, 2010 pgs: 63-67, 114, 123, 133, 349-52, 411, 449

2. Breastfeeding Answers Made Simple; A Guide for Helping Mothers, 2010, Nancy Mohrbacher IBCLC, FILCA

3. "Biological Nurturing: The Laid-back Breastfeeding Revolution" by Suzanne Colson http://www.midwiferytoday.com/articles/BiologicalNurturing.asp

4. "Biological Nurturing or Laid Back breastfeeding" (one mothers story)- http://www.llli.org/btissue5pg04

5. "What Happens to Breastfeeding When Mothers Lie Back" - http://www.biologicalnurturing.com/assets/Colson%20CL%20Vol%201-1.pdf

6. Biological Nurturing FAQ's - http://www.biologicalnurturing.com/pages/faq.html

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Lie Back and Relax! A Look at Laid-Back Breastfeeding - La Leche League USA

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Jean Merrill, Maryland What is more relaxing than chilling out in your recliner? Not much, and research has shown that breastfeeding our babies in this reclined position stimulates natural feeding reflexes in both mothers and babies. So, you... Read More

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Here's how to handle cluster feeding, the incessant-nursing phase when breastfeeding a newborn.

So you have a newborn, and lately your evenings have been hijacked by non-stop nursing sessions. If this sounds familiar, you're probably dealing with the common breastfeeding phenomenon known as cluster feeding.

What is cluster feeding?

Infants nurse frequently (at least eight to 12 times in a 24-hour period), but sometimes it's even more often, and they may bunch up those feedings-especially in the evening. This is frustrating for both the parent who's been home with the baby all day and the parent who may only get to see the baby after work.

But cluster feeding is perfectly normal, says Attie Sandink, a lactation consultant in Burlington, Ont. "Babies instinctively know how much milk they need. If they're not getting enough, they just want to feed and feed," she says. This doesn't mean your milk supply is tanking or you need to supplement with formula. And letting newborns nurse as often as they like doesn't mean you are spoiling them.

"I remember thinking, Is this how life is going to be?" recalls first-time mom Alison Pearce of Toronto. "It was like looking down a tunnel with no light at the end of it." From two to eight weeks old, her daughter, Simone, spent most evenings nursing non-stop. But once Pearce and her family noticed the pattern, they came up with a plan. Each night, before the intensive breastfeeding session began, Pearce's mom (who stayed with them for the first month) made an early dinner while Pearce took a bath. Then, armed with snacks, they all settled in with a movie while Simone nursed and dozed, and everyone took turns holding her.

Cathy Wegiel, a mom of four in Airdrie, Alta., knew to expect a cluster-feeding phase, because all of her babies had spent their evenings attached to her boobs. But her son, Parker, was particularly enthusiastic. For two months, he was latched from 5 p.m. until 10 p.m. Wegiel suspects Parker-who had needed heart surgery at three weeks old-was trying to pack on the weight he'd lost before his operation. Parker's need to feed became part of the family routine. "I always nursed in the armchair in the living room, and the other kids would snuggle with me and read stories," Wegiel explains. "And if he was hungry during dinner, I nursed at the table and tried not to spill my food on him."

Why is my baby breastfeeding all the time?

Babies cluster-feed for many reasons. One theory is that a mother's prolactin levels drop toward the end of the day, which means her milk supply decreases and the flow is slower, so babies may nurse for a longer time to fill up, says Taya Griffin, a lactation consultant in Toronto. They could be frustrated by the slow flow and go on and off the breast more often. Mastering breast compressions-pressing down on your boob while the baby sucks-can help, because it expresses the milk faster and more efficiently. Babies can also cluster-feed at any time of day if they're feeling out of sorts and need comfort, adds Sandink. Sometimes babies who seem ravenous are having a growth spurt (which lasts a few days).

To make cluster feeding more manageable, get things done earlier in the day and lean on your partner for meals. Wegiel would make dinner while her older kids were at school and then reheat it. Also be prepared to lower your household standards. "I really let things slide," she says. "It was a disaster for quite a while." Keep a basket of filling snacks (like energy bars or almonds) and a water bottle near where you nurse most often.

Feeling marooned on the couch? Wearing your baby in a sling or carrier so you can multi-task (or even nurse!) can save your sanity. Or forget about your to-do list and spend the time catching up on TV shows, scrolling through social media or reading a book with one hand. Cluster feeding is temporary-so settle in and make the most of it.

Should I be worried my baby isn't getting enough to eat?

When a baby is eating all the time, almost every mom wonders, Do I have a milk-supply issue? Just remember that this pattern is normal for a newborn. You should only worry if your baby is not gaining weight well (something your doctor or midwife will keep track of) or is not producing enough wet diapers (typically six per day for newborns six days old and up). If you are in pain while breastfeeding, reach out to a lactation consultant for help.

Read more:
How to prevent wrist pain while breastfeeding
3 tips for surviving the first three months with baby
How to combine breastfeeding and bottle feeding

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How to survive your newborn's cluster feeding - Today's Parent

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Here's how to handle cluster feeding, the incessant-nursing phase when breastfeeding a newborn. So you have a newborn, and lately your evenings have been hijacked by non-stop nursing sessions. If this sounds familiar, you're probably dealing with the common breastfeeding phenomenon known as cluster feeding.

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Introduction

You have a sore or tender breast, a change in color in an area of the breast, or feel a hard spot or small lump. What now? Could it be mastitis?
Whatever the reason for your sore breast:

Breastfeed as often as your baby wishes

Rest

Apply ice or cold packs to the tender area

If you are engorged, consider doing lymphatic drainage-a very gentle, light yet firm touch, with fingertips flat to the skin in the armpit area and upper chest. To see a demonstration of lymphatic drainage massage, you can watch this video

In consultation with your healthcare provider, consider using ibuprofen (Advil®, Nurofen®...) alternating with acetaminophen/paracetamol (Tylenol®, Panadol®...)

What breastfeeding experts used to think of as separate problems in the breast, such as mastitis, blocked ducts, milk blister "blebs," and abscesses, are now suggested to be stages in the process of inflammation-the body's response to a threat. The Academy of Breastfeeding Medicine (ABM) has revised their protocol explaining this: ABM Protocol #36.pdf: The Mastitis Spectrum. The information in this article is based on this ABM protocol.

Blocked Ducts

Milk flows through a system of microscopic-sized tubes-ducts-in your breasts, which are easily compressed. When more milk is produced than your baby drinks (for example, if you're pumping in addition to breastfeeding), or a tight bra or strap compresses your breasts, this can produce pressure which your body responds to as a threat. Inflammatory cells and fluids rush into the area to help repair the damage and fight off bacteria. The swelling that occurs from this inflammation presses on some of the ducts, which slows or blocks the milk from flowing well. The skin in this area may appear darker, redder, or pinker than usual. In darker skin, redness may not be as easily detected or may not be visible at all. It may feel warm to the touch. If this inflammation is not treated, the area can become more inflamed or infected. This can occur any time your breasts become overly full, Possible factors include:

You and your baby are separated for longer stretches than usual between feedings

Your baby starts sleeping longer at night

Your baby is teething, has a stuffy nose, or is otherwise feeling out of sorts and nursing less.

Treatment for what we know as blocked/clogged/plugged ducts and mastitis is similar. You may want to try the following ideas:

Consider yourself sick, and rest! Focus on caring for yourself, your breast, and your baby.

Apply cold or ice packs to the affected area.

Be aware that antibiotics may not be recommended right away. This is not an infection when it starts, and antibiotics may encourage resistant strains of bacteria to thrive, and may make you more likely to have recurrent mastitis or an abscess in the future.

Make sure you are breastfeeding responsively to your baby (on cue) so that you don't unintentionally go too long between feedings. You want a good match between your baby's needs and the rate at which your breasts are producing milk. Read more about frequency of feeding in our FAQs.

Avoid excessive pumping. Extra pumping can make it difficult for your breasts to keep milk production at the level matching your baby's needs.

Check to see that your baby or child is well-positioned and has a good latch or attachment. This helps the baby to take more of your milk.

Change positions when you feed your baby to increase your comfort and help remove milk around the breast. This video showing natural breastfeeding positions can be helpful.

If you wear a bra, make sure it is well-fitting, supportive, and not tight. Avoid clothing or straps that are tight on the breast, chest, and underarm area.

If you have frequent blocked ducts that are not helped by the above recommendations, taking a lecithin supplement may help. The supplement may be sunflower lecithin or soy lecithin, if you do not have sensitivities or allergies to soy or dairy. The evidence for this supplement is not strong. You can find more information about this in the ABM protocol.

MILK BLISTERS (BLEBS)

A milk blister, or bleb, is usually a painful white dot on the nipple or areola. This is the result of inflammation or mastitis in the breast which sends inflammatory cells from the ducts down to the surface where they lodge in the nipple or areola area.

These are treated as any other condition in the mastitis spectrum. They do not always hurt and may resolve over several weeks. If you have a painful milk blister:

Apply ice or cold packs

Keep breastfeeding as your baby wishes

Follow the same recommendations as for blocked ducts

Avoid opening the blister yourself. It may bring some relief, but it also brings a risk of infection, more inflammation, and the possibility it will re-form. Avoid using soap or other cleansers on the nipple, as this can cause skin damage and pain.

If these suggestions don't help, ask your healthcare professional for help. They may prescribe a steroid cream to help the skin to thin out and open up, allowing better milk flow in that area.

MASTITIS

Mastitis can occur when an area of blocked ducts continues to be compressed, or more generally, when your breasts become overly full, causing swelling and inflammation. This does not happen as the result of one delayed feeding, but rather is part of a process.

Chronic engorgement, over pumping or trying to "empty the breasts," all increase the risk of mastitis. Areas of the breast where ducts are compressed may create opportunities for bacteria to take hold, becoming an infection.

It is important for your baby to continue breastfeeding from the affected side to help prevent the inflammation from worsening and creating an abscess. It is a myth that it is unhealthy for your baby to breastfeed while you have mastitis. Mastitis is not contagious: there is no risk to your baby in continuing to breastfeed. Breastfeeding responsively can help to reduce the inflammation in your breast.

If you have mastitis, you can try all the recommendations in the section on blocked ducts, as well as the following plan. Many symptoms of inflammation will go away without antibiotics when you follow these guidelines.

Signs, Symptoms, and Treatment

If you:

Can feel a hard, sore lump in your breast

Feel achy, tired, or run down

Have a low-grade fever of less than 101°F (38.4℃)

Notice a change in the appearance of the skin on the affected breast. An area of red, pink, brown, or gray may be noticeable depending on your skin tone and which part of the breast is inflamed. Some mothers have described a color change as triangular or "wedge" shaped on the skin. However, the absence of skin changes does not mean that mastitis is not present.

Then:

Rest as much as you can. Try resting in bed with your baby lying with you. Here are some LLL guidelines for safe bedsharing: sleep-safe-surface-checklist. Keep supplies such as nappies/diapers and wipes, toys, books, your phone, a container of water, and some snacks near you to minimize trips out of bed.

Keep applying cold packs or ice packs as often as you like to reduce inflammation and swelling.

Continue to feed your baby on cue, at least 8-12 times each 24 hours from both breasts. If you have a nursing toddler or older child, they may feed less frequently. If your baby refuses the sore side, you may need to express or pump some milk, just enough to soften the breast to the point it usually feels after a feeding.

To relieve engorgement, consider using lymphatic drainage, which is a very gentle, light yet firm touch, with fingertips flat to the skin in the armpit area and upper chest. This helps to move the fluid away from the ducts. Watch Lymphatic Massage for the Breast During Pregnancy and Lactation for a demonstration.

Ask your healthcare provider about using medications such as Ibuprofen (for example, Advil®, Nurofen®) to reduce inflammation alternating with acetaminophen/paracetamol (for example,Tylenol®, Panadol®) to help with pain.

Probiotics, taken by the mother, might help with mastitis. Two strains which were studied and found to be of possible help are Limosilactobacillus fermentum and Ligilactobacillus salivarius.
The authors state that more research is needed.

If you:

Do not feel any better, or feel worse after the first 24-48 hours

Develop a fever of 101°F (38.4℃) or more

Then:

Call your doctor or primary healthcare provider.

If antibiotic medication is prescribed, take it until the recommended course is completed, even if you feel better.

Continue to rest and drink plenty of fluids.

Continue to nurse. Hand express or (gently, try not to overdo this) if your baby is unwilling or unable to feed on the affected side.

Discuss using therapeutic ultrasound (TUS) with your healthcare provider. If TUS is available in your area, it may be helpful to relieve edema (swelling and extra fluid in the breast) and reduce inflammation. Many areas do not have this technology available, and the evidence for TUS is not very strong.

If there is no improvement after 48 hours, you might ask your healthcare provider if culturing your milk would be appropriate or available. Milk cultures are not available in all areas and there is some debate about the value of them, as interpretation of the results is difficult.

ABSCESS

An abscess is a swollen area of pus and bacteria walled off within the breast. This occurs in a small percentage of mastitis cases. It often appears as a very reddened or dusky area in a light skinned breast. In darker skin, redness may not be easily detected or may not be visible at all.

The area feels hard to the touch. This lump is usually very tender. It can seem to get better and then worsen, or your symptoms can worsen until the abscess needs to be drained.

In some cases, the abscess will open up and drain itself through the skin. If it needs to be drained, a physician (usually a radiologist or a breast surgeon) will either draw out the contents of the abscess with a needle aspiration, which may have to be performed several times, or by inserting a drain which will stay in place until the abscess has drained. A drain is typically inserted if more than two aspirations are necessary. In certain cases, surgery under anesthesia is necessary. In addition, antibiotics will most likely be prescribed if you have an abscess. No matter how your abscess is taken care of, continued breastfeeding on the affected breast is valuable in decreasing inflammation.

It can be useful to discuss the options for your individual situation with a La Leche League Leader. If you need to have a breast imaging ultrasound, here is a reference for continuing to breastfeed after testing: lumps-and-breast-imaging.

RECURRING BLOCKED DUCTS/MASTITIS

In order to prevent future inflammatory problems, it is wise to be cautious of unusually long stretches between breastfeeds. Frequently changing your baby's feeding positions, while ensuring a good latch, will help to get milk flowing from all the ducts. Maintaining good general health through your diet and getting extra rest may help keep your breast from getting sore again. Examine your breasts gently each day. If you find an area of tenderness, make sure to rest, use cold packs, and continue breastfeeding or expressing your milk to decrease the inflammation.

Mastitis can recur for different reasons. When bacteria are resistant or not sensitive to the antibiotic which was prescribed or when the antibiotics are not continued for long enough, it can recur. It can also recur when nursing is not continued on the affected side; or when the initial cause of the mastitis is not corrected.

If mastitis recurs, ask your healthcare provider if you might be able to have a culture and sensitivity test done on your milk. This can indicate what organism is causing the infection and what antibiotic will eliminate it.

Antibiotic-resistant bacteria are becoming much more common and are causing more serious infections, including in mastitis. Use of ineffective antibiotics, especially when used repeatedly, increases the risk of bacteria developing resistance to antibiotics. This can lead to an abscess.

OTHER CAUSES OF MASTITIS AND HOW TO PREVENT IT

There is some evidence that mastitis is more common in women who have recently taken antibiotics. Mothers who test positive for group B strep and those who have cesarean births are usually given antibiotics during their labor and delivery. This causes changes in the breast microbiome-the number and balance of microbes which live in healthy breast tissue. When the microbiome is changed in an adverse way, it is called "dysbiosis." Dysbiosis is one reason inflammation occurs.

Frequent pumping to build up a supply of milk in the freezer or to try to "empty the breasts" can be another cause of dysbiosis and inflammation from increased milk supply.

Exclusively pumping can also affect the microbiome, since there is no feedback from saliva in the baby's mouth to the nipple. Pump suction pressures may be higher or lower than the infant's suction when feeding at the breast. Suction pressures that are too high can lead to breast and nipple trauma and inflammation, increasing the risk of mastitis. Suction pressures that are too low can lead to breast inflammation due to insufficient milk removal. Pumps do not remove milk as efficiently as a baby feeding well directly from the breast and may contribute to a bacterial imbalance in the ductal system. Taking care in selecting your pump flange size and checking regularly around the nipple and areola after pumping can help reduce these risks.

If you are exclusively expressing, you may find the following articles helpful:
Life as an Exclusive Expresser
Exclusively Expressing Breastmilk for Your Baby

Nipple shields, pacifiers and other artificial nipples can affect how babies suck. They can affect the microbiome of the ductal system and thereby initiate an inflammatory process. Of course these tools may be important to help transition to direct feeding or to soothe a baby when breastfeeding is not feasible. As always, we encourage you to do what is best for your family. If you are trying to minimize pump, shield, and pacifier usage, get in touch with your local LLLLeader.

Some babies are reluctant to feed, have difficulties latching, or refuse the breast due to a nursing strike or other factors. Sudden changes in breastfeeding patterns may contribute to inflammation. Problems with inflammation commonly occur around the holidays or when you are entertaining company. At these times, feedings are likely to be delayed more than usual due to your being busy.

Make sure your clothing isn't too tight-fitting, particularly your bra. Some bras and bathing suits, particularly those with underwires, may put too much pressure on areas of your breast. A heavy purse or bag with a strap that crosses your breast or baby carriers can cause problems. Frequently changing which side you carry bags/purses on or how you wear your carriers, slings, and wraps may help.

Changing sleep positions throughout the night can help relieve pressure on the breasts. Wearing a stretchy sleep bra or camisole bra top may also help to take pressure off the breasts if you feel the need to wear a bra to sleep.

The shoulder strap of a seat belt can cause a sore breast, with a too tight strap applying pressure to your breast. Also, the pressure from the shoulder strap with a sudden stop may cause a sore breast. When taking long car trips, it is helpful to get out of the car to feed the baby periodically, which also removes pressure from the seat belt.

Certain injuries can result in sore breasts, such as being kicked or hit by an active toddler, or biting the breast. These may result in bruising and inflammation. Treat them with rest, cold or ice packs, and nurse per your baby/toddler's cues.

Prior breast surgery, breast lumps, or injury to the breast can also hamper milk flow and increase the risk of inflammation.

Another common cause of mastitis is reducing or attempting to stop breastfeeding (weaning) suddenly or too quickly. You might develop mastitis when you return to work outside the home, for example. See our article Working and Breastfeeding for support in expressing your milk or to work feeding around separations.

Breastfeeding challenges can sometimes make you feel anxious or sad. Anxiety may lead to over-pumping to create a stash of breastmilk, potentially causing inflammation. If you are feeling this way, please talk to a La Leche League Leader, and reach out to your healthcare provider.
At times, mastitis is the result of difficulties with positioning and/or latch that impact how efficiently your baby takes milk from your breast. A La Leche League Leader can help you explore changes you can make to help prevent these conditions from recurring.
Get local support.
Treatments which are NO LONGER recommended
Revised January 2023 by Dr. Justice Reilly, MBChB, IBCLC, and Susan Mocsny Thomas, RN

Heat to the breast, or soaking in warm water

Vigorous, deep massage, or squeezing to try to get rid of a clog

Dangling over baby for feeding to try to move a clog using gravity

Using a comb, vibrator, or electric toothbrush on the breast

Trying to "empty" the breast through extra pumping or breastfeeding which increases milk production

Using antibiotics right at the beginning of symptoms

Using Epsom salts in a Haakaa or similar silicone breast pump for nipple blebs

Using saline soaks, warm compresses, olive oil, castor oil, or other oils on the skin of the breast or nipple

Removing the skin or "popping" a bleb, which may allow infection to develop

Routine sterilization of pumps and household items is not necessary, although daily cleaning according to the manufacturer's instructions is important to avoid infection from dirty pump parts. For more general information see this.

Footnotes

1. Some points in the protocol are controversial within the lactation community. We will note and comment on them.

2. As noted in the disclosure statements in the protocol, one of the authors (Dr. Juan Miguel Rodriguez) has been the PI (primary investigator) of research projects and clinical assays funded by Puleva/Biosearch Life (Granada, Spain) or Nutricia (Utrecht, The Netherlands), involving the characterization, safety, and efficacy of probiotic strains for the mastitis target. He and his research group have never received any payment or royalty related to the commercialization of probiotic strains.

3. If you do not have access to a safe water supply, you can clean pump parts with water boiled (at 212°F, 100°C) for at least 20 minutes.

Resources

If you would like to read more about the causes of mastitis, here is a good review: Interventions for the prevention of mastitis following childbirth | Cochrane

Since much of the information in the most recent ABM mastitis protocol is new, you may find it helpful to share it with your healthcare provider: ABM Protocol #36.pdf

References

1. Mitchell, K. B., Johnson, H. M., Rodríguez, J. M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., ... & Academy of Breastfeeding Medicine, Clinical Protocol# 36: The Mastitis Spectrum, 2022, Breastfeeding Medicine, 17(5), 360-376,
https://pubmed.ncbi.nlm.nih.gov/35576513/ (accessed 7 February 2023)

2. Mitchell, K. B., & Johnson, H. M., Breast pathology that contributes to dysfunction of human lactation: a spotlight on nipple blebs, 2020, Journal of Mammary Gland Biology and Neoplasia, 25(2), 79-83,
https://pubmed.ncbi.nlm.nih.gov/32495215/ (accessed 7 February 2023)

3. Crepinsek, M. A., Taylor, E. A., Michener, K., & Stewart, F., Interventions for preventing mastitis after childbirth, 2020, Cochrane Database of Systematic Reviews, (9),
https://pubmed.ncbi.nlm.nih.gov/32987448/ (accessed 7 February 2023)

4. Baeza, C, Paricio-Talayero, J.M., Pina, M and De Alba, C. , Letter re 'Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022'' , Breastfeeding Medicine, 2022, Volume 17, Number 11,
https://pubmed.ncbi.nlm.nih.gov/36378818/ (accessed 7 February 2023)

5. Mitchell et al, Response to Baeza et al re Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022'', Breastfeeding Medicine, 2022, Volume 17, Number 11,
https://pubmed.ncbi.nlm.nih.gov/36378817/ (accessed 7 February 2023)

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You have a sore or tender breast, a change in color in an area of the breast, or feel a hard spot or small lump. Could it be mastitis?

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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you're separated from your baby or if he isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

When a baby can't breastfeed
Return to work or separation
Making more milk
Storing breastmilk
Pumps
Tips for expressing
Expressing when out and about
Support and Encouragement
Feeding your baby your milk

When a baby can't breastfeed

Breastmilk is especially important for babies who are unwell. And if your baby can't breastfeed because of prematurity he will benefit from every drop of breastmilk you can give him. Some babies have conditions which mean they can't feed at the breast, they can still have your milk. If your full term baby is taking a while to learn to breastfeed, expressing protects your milk production and gives you both time to practice.

The prospect of expressing might seem daunting at first but giving your milk is something you can do that will make a real difference to your baby's short and long term health.

Return to work or separation

When you can't be with your baby, expressing maintains your milk production and helps you avoid engorged breasts during the separation. It also means your baby can continue to have his familiar milk when you're away.

See Working and breastfeeding, and When mum can't be there.

Making more milk

You teach your breasts to make more milk by removing milk. Full breasts signal to your body to slow down milk production, so don't wait for your breasts to 'fill up' before expressing, as this will mean a lower milk supply over time. The more thoroughly and frequently you remove milk from your breasts, especially in the early days and weeks, the more milk you will make and the greater the benefit for your long term supply. If you're expressing to establish milk production, making extra milk in the early days can make it easier to produce more milk later on to keep up with your baby's needs. Milk can always be frozen and used later.

If you are expressing to increase milk production remember a well-attached baby is far more effective than any pump, so do seek help to improve positioning and attachment so your baby can feed more effectively when at the breast.

See How to increase your milk supply.

Storing breastmilk

Breastmilk's antibacterial properties help it stay fresh so it can be safely stored at room temperature for up to 4 hours and in the fridge for up to a week. If away from home you could use a cool bag with ice packs. Our page Storing Your Milk has comprehensive details on safe periods for storing expressed milk for healthy babies. If your baby is unwell or premature then follow hospital guidelines. Your baby will benefit more from fresh than frozen breastmilk because its living properties will help him fight off possible infections.

Pumps

You can simply use your hands to express, or you can buy or rent a pump. Your choice of pump will depend on your reasons for expressing and your circumstances.

If your baby can't yet feed directly from the breast, or if you need to greatly increase your milk production then consider a hospital-grade double electric pump. Such a pump lets you adjust the suction and pumping speed (cycling) and is designed for long-term use. Many hospitals have these pumps available for use on the ward. Some have pumps that you can hire and take home for use during the night, or you could rent from a pump manufacturer.
Even if you rent a hospital-grade pump you may also find a smaller, portable pump useful for when you are out and about.

For expressing while out at work mini electric pumps are a popular choice. These usually come in a carry case for portability.

For occasional pumping a smaller electric or hand pump may be sufficient. Or you could just hand express.

Double pump set: hire pumps and some mini electric pumps come with two pump sets. Double pumping (expressing from both breasts at once) improves milk flow and saves time.

Check fit: check that your pump flange and nipple tunnel fits you comfortably. If too much of your areola is pulled into the tunnel during pumping it can cause rubbing and soreness. If the tunnel is too tight it can inhibit milk flow. Size varies between different makes and models, with some available in a choice of sizes. You may need a different size for each breast.

Suction and cycling controls: look for a pump with separate controls for suction and cycling (speed) so you can vary these to suit yourself.
Cleaning the equipment:
Always wash your hands before expressing milk.
If you're expressing for a premature or sick baby who is still in hospital then you'll need to follow the hospital procedures for cleaning and sterilizing the pump parts.
If your baby is healthy, pump manufacturers generally recommend washing with hot soapy water. Just like your milk, pumping equipment can safely be left at room temperature for short periods and refrigerated in a clean container or bag for longer periods, giving you more time for your baby.

Tips for Expressing

Relax!
Successful expressing has a lot to do with your emotions and how you are feeling. The hormone oxytocin causes the milk in your breasts to be released (let-down). Oxytocin is released when you feel happy and relaxed. It can be difficult to relax if your baby is very ill and in hospital, or if you feel rushed or under pressure. Make a conscious effort to put your mind at ease and use your senses to help trigger milk release. Hold or sit near your baby, or look at a picture or video of him, listen to a sound recording or hold and smell an item of his clothing. Relax your shoulders and take a deep breath to calm yourself before you begin. Try not to think about how much milk you are producing-instead, try distracting yourself by reading, listening to music or a relaxation CD, watching TV or even chatting on the phone. Some mothers who express long term build up a pre-expressing ritual that 'prompts' their breasts to release milk.

Use your hands
When hand expressing, the skin-to-skin contact helps stimulate the let-down reflex. And your hands can remove milk from parts of your breast which the pump can't. It's also perfect for the first few days after birth when the small droplets of precious colostrum you make can be collected on a clean teaspoon.

Combine hand expression with pumping
This can help you remove milk more thoroughly than with pumping alone.
Each time you express start with hand expression to stimulate a let-down. Then alternate pumping (double pumping if possible) and massage/hand expression until the flow slows. Finish by hand expressing into the pump flange, or single pumping with intensive breast compressions, switching between breasts until you feel that no more milk can be removed.

Suction and cycling speed
When using a pump, set its suction strength so it feels comfortable. Aim for the lowest suction strength which effectively produces milk for you; higher settings can hurt and won't necessarily produce more milk. Encourage multiple milk releases by mimicking a baby's natural sucking pattern. Increase the cycling speed when milk flow slows and use a slower speed as flow increases again. Aim for at least 3-5 milk releases during the session. If single pumping, switching between breasts several times can help trigger milk releases.

How often?

If you need to establish milk production without breastfeeding your newborn baby, aim to express 8-12 times per 24 hours including at least once during the night to mimic a baby's natural breastfeeding pattern. It might help to plan when to express during the day (e.g. on waking, after breakfast, mid-morning, after lunch, mid afternoon, early evening, twice during the evening and once at night).

Once your milk supply is well established, you may find that you can maintain your milk production with fewer expressing sessions.

You don't need to express at evenly spaced intervals-little and often can be more effective than long sessions.

Express until milk flow stops, then have a short break and come back to it-even a few extra drops of milk or expressing for a few minutes here and there make a difference.

Expressing several times (cluster pumping) during the evening can help you increase the number of times you remove milk per day, so increasing your milk production.

If you're expressing to increase milk production, or because your baby isn't yet feeding well at the breast, do it after or between feeds to ensure your breasts stay well drained. This will stimulate them to make milk faster.

If you are expressing at work or for a short term separation from your baby see our page Workday Practicalities for useful suggestions.

Expressing when out and about

You can breastfeed your baby very discreetly but you may feel much more exposed when expressing. In a public place you can use a lockable baby change facility or ask to use a changing room in a clothes shop. A battery or hand pump can be useful in these situations. Some mothers express in the car, creating privacy with shades on the windows and/ or with a cardigan or scarf. When visiting people you may feel more comfortable and relaxed in a separate room. At home it helps if you can get used to expressing with family around, as retreating to a separate room may reduce how often you do it. But some women just find it easier in a private place.

Support and encouragement

Expressing milk is sometimes challenging but it's always worthwhile, whether you are establishing breastfeeding, producing milk for a baby who is unable to breastfeed, increasing your milk or returning to work. Seek support from people who understand and value what you are doing and ignore comments from those who don't. Your local LLL Leader and Group will be able to give you encouragement and support. To find them take a look at our website.

Feeding your baby your milk

See Further Reading and resources below for information on ways to feed your baby your expressed milk.

Written by mothers of LLLGB. Photos courtesy of Lois Rowlands and Rae Vacher Lowe.

Further Reading

How to increase your milk supply
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won't Breastfeed
When Mum Can't Be There
Comfortable Breastfeeding
Sleepy Baby - Why and What to Do
Storing Your Milk
Bottles and other tools

Other websites
Hand expressing:

Maximizing milk production when expressing:

Books
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Breastfeeding Solutions. Mohrbacher, N. New Harbinger Publications, Inc. 2013.
Exclusively Pumping Breastmilk, Second edition. Casemore, S. Gray Lion Publishing, 2014

References:
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.

This information is available to buy in printed form from our shop.

Copyright LLLGB 2016

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Expressing Your Milk - La Leche League GB

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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you're separated from your baby or if he isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

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Barriers to Breastfeeding: Why rates in Wales are amongst the lowest in the world

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Breastfeeding is the most 'natural' way for a mother to feed her baby, but with only a quarter of women doing so six weeks after giving birth however 'natural' it may be it is no longer the 'norm'. In fact, breastfeeding rates in Wales are amongst the lowest in the world.

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Breastfeeding in public can mean breastfeeding in front of a relative or friend in your own home, or in a public place, such as a cafe or shopping centre.
During your baby's first few days, you may prefer to breastfeed only where you feel most comfortable. But, as you get more used to doing it, you're likely to feel more confident about breastfeeding in front of other people when you're out and about.

Most people support women breastfeeding in public. The more it's done, the more normal it will become.

Here are some ideas to help you get started.

Know your rights. You should not ever be made to feel uncomfortable about breastfeeding in public. It is illegal for anyone to ask a breastfeeding woman to leave a public place, such as a cafe, shop or public transport.

Plan ahead. Before you go out, it can help to think about where you will feel comfortable breastfeeding when your baby gets hungry. Ask breastfeeding friends for recommendations.

A midwife, health visitor or peer supporters at a local breastfeeding drop-in will also know of good places in your area where you can feed your baby.

Clothes and bra. What you wear when you're breastfeeding is a matter of personal taste and what you feel comfortable in. For example, some mums like to wear loose tops that can be lifted up.

Others, who prefer to keep their tummy covered, wear two stretchy tops, so that the top layer can be lifted up and the bottom layer can be pulled down. A soft, non-underwired bra can be easily pulled up or down when you want to feed your baby.

Baby slings, scarves and cloths. Some baby slings are designed so you can breastfeed while your baby is in the sling. Some mums feel more comfortable putting a scarf or muslin cloth over their chest while they're breastfeeding.

Take someone with you. It can help to go with a friend who has an older baby and can take you to places that she already knows. You could go with someone else, such as your mum, partner, sister or friend, so that there's always someone to talk to.

Avoid the loos. Do not feel that you should sit in a public toilet to breastfeed. You would not eat in there, so do not feel that your baby should be fed there.

Mums talk about breastfeeding away from home

2 breastfeeding mums talk about their experiences of feeding in public:

Cara, from Banbury

"I thought I would need special nursing tops, but once my baby finally arrived, I realised that my normal clothes (and favourite maternity tops) all worked much better. I could pop my baby under my top to feed her, and she would be tucked up next to my skin.

"It took me a while to get the hang of attaching her easily without looking, but soon I felt confident feeding almost anywhere. I've never had any negative comments from other people. I do not think people realise I'm feeding a baby most of the time."

Claire, from Aberystwyth

"At first, I could not imagine how I would be able to feed the twins away from home. I was really nervous, as they each took half an hour to feed, and I would only be able to feed 1 at a time when I was out. But then I became so confident that I hardly noticed I was feeding them."

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Breastfeeding in public can mean breastfeeding in front of a relative or friend in your own home, or in a public place, such as a cafe or shopping centre. During your baby's first few days, you may prefer to breastfeed only where you feel most comfortable.

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Openly breastfeeding in public can take a little getting used to - check out our top tips to help make it a stress-free experience for both you and your baby

The great thing about breastfeeding is that everything you need to feed your baby is always with you, readily available and at the right temperature, wherever you are. But while breastfeeding is the most natural way to feed your baby, it's not unusual to feel a bit nervous about nursing in public, particularly if you've never done it before. Whether you're worried about other people's reactions or really don't care what they think, these tips will help you be prepared.

1: Practice makes perfect

If you're feeling anxious about breastfeeding in public for the first time, try practising at home in front of a mirror so you can see what you look like while feeding. You'll probably notice you're not exposing as much of your breast as you might have imagined, as your baby's head is covering it.

You may find breastfeeding in public easier if you do it in a supportive environment for the first few times. Visiting a mother and baby group or a cafe with a friend may be better than going to a crowded shopping mall or on a train by yourself.

2: Dress for the occasion

When it comes to what to wear when breastfeeding in public (and for breastfeeding in general), there are lots of options. If breastfeeding goes well and you intend to continue, it might be worth investing in a few items of nursing wear to make life easier.

"My nursing top was very convenient and easy to use. I could breastfeed discreetly outside, even in winter, as I didn't have to remove my top. You just place your baby's face in the opening and there you go. Anywhere, any time!" Caroline, mum of two, France.

However, it's not necessary to buy specific breastfeeding clothing - you can simply layer up two of your normal tops. "What worked for me was wearing a stretchy camisole, which I could pull down on one side so it hooked under the breast I wanted to feed from, under a looser top that I pulled up. The looser top covered my chest and the camisole concealed my belly. As well as being subtle it meant I didn't show my wobbly post-birth tummy or get chilly when feeding out and about." Susannah, mum of two, UK.

Alternatively, for easy access, wear tops and dresses with buttons or a zip at the front, dungaree-style straps or side-openings. Or try wrap-around styles, or cowl or shawl necklines that you can pull down.

"I found wrap-front cardigans a lifesaver while breastfeeding in public," shares Natalie, mum of one, UK. "I just untied one side then draped it over my baby feeding, so I could cover up easily and instantly when she was hungry or crying, without having to find something from the change bag."

3: Do your research

Before venturing out with your newborn, make a list of good places to breastfeed in public near you, so you don't have a last-minute scramble to find somewhere. Shopping malls, department stores and babywear shops often have baby-feeding rooms, which are quiet and private with a comfy chair and changing facilities. Many cafes and hotel lounges also welcome breastfeeding mothers.

"If you're a bit nervous, look up feeding-friendly locations before you go out so you know where you can have a pit stop. Breastfeeding is not always easy at first, but you get better and better at it, until you're so quick and subtle nobody realises you're doing it anyway." Rachel, mum of one, Maldives.

Other places to try include department store changing rooms, furniture stores, community centres, libraries, museums and parks. Ask other local mums for advice on the best places for public nursing nearby.

"I live in the UAE, where children have a right under law to be breastfed until age two. There is a lot to encourage breastfeeding here, with fancy nursing rooms in malls and respect for breastfeeding mothers in public places, such as restaurants." Faye, mum of two, UAE.

4: Consider a breastfeeding cover

Some mums like to use a nursing cover up for privacy when feeding their babies in public, and there are lots of styles to try. From simple shawls and ponchos to specially designed wraps or aprons with a semicircle of wire in the top so you can still see your baby while she feeds, there should be something to suit you both. There's also the option of feeding your baby while she's in a sling or carrier, which will support her, as well as giving you privacy.

"My tip is to buy a baby carrier," says Caroline, mum of two, US. "With a little practice you'll be able to breastfeed while walking around and getting on with your day."

Ultimately, however, you may find your little one makes the decision for you. Some babies hate being covered while feeding, while others get distracted if they aren't. "Neither of my babies liked shawls draped over their heads while breastfeeding, so I just relied on their heads blocking the view," says Esther, mum of two, UK.

5: Know your breastfeeding rights

In many countries you're legally entitled to breastfeed in any place open to the public, and there are laws to protect breastfeeding mums. If you're unsure about what the breastfeeding in public laws are where you live, try doing some online research - government or public health websites are a good place to start - or speak to your healthcare professional. Otherwise, you could ask local mums or nearby friends and relatives about what their experiences have been. Their responses may surprise you.

"Breastfeeding is widely accepted in Australia and it's perfectly acceptable to wop one's breast out while ordering a skinny latte from the friendly male cafe waiter!" Amy, mum of two, Australia.

If you're breastfeeding your baby in public and someone complains, you could politely remind them of your legal rights. If you feel that a business, such as a shop or cafe, has discriminated against you by asking you not to breastfeed, you may be able to make an official complaint, again depending on how you feel and the laws where you live.

"I was feeding at the table in a diner after I'd finished eating (having established there was no feeding room), and a blushing junior manager was dispatched to ask me if I'd be more comfortable in the ladies' room. Er no, I said, would you eat in there? 'Would I consider moving to a side booth?' No again. I didn't go anywhere until we were done!" Maya, mum of two, Spain.

"My advice is try not to worry. I was apprehensive but regularly breastfed in public - everywhere from urban to very rural areas - and never had any negativity, comments or looks. Obviously not everyone will be so lucky, but I breastfed for a year so there were lots of opportunities for people to be horrible, but nobody was. Not in the slightest. So your fears might turn out to be totally unfounded." Tiffany, mum of one, UK.

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Openly breastfeeding in public can take a little getting used to - check out our top tips to help make it a stress-free experience for both you and your baby The great thing about breastfeeding is that everything you need to feed your baby is always with you, readily available and at the right temperature, wherever you are.

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The Breastfeeding Companion is privately owned and is completely free. What's more, we don't make any money for the services we provide. Everything is self-funded.

And we're more than just providing breastfeeding tips - everything is research based and supported by Jackie Hall, IBCLC, who has dedicated over a decade of her life in support of tens of thousands of women.

There are approximately 6 million babies born in countries across the world, where English is the primary language. Whilst it's our long term desire to have our website translated into many languages (costs forbid this at the moment), we would certainly love to help those women amongst the six million, that choose to breastfeed - we know many of them will have problems.

How can you help? Simple - tell someone about this site.

Tell your midwife, tell your NCT class members, tell your health visitor, tell your friends in your support group. Share us on social media - all it takes is a click (see buttons below!)

Your continued support means the world to us. We appreciate every email we get, every like on Facebook, every re-tweet, and do drop us a line if you have the time.

Lastly, if you want to tell us about your experience with breastfeeding, as an encouragement to other mothers, we'd love you to share your story with us - and we'll share it on this page and on our social media channels.

We all need encouragement, and many women have gone from struggles to success - let's shout about it!

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Breastfeeding Tips - The Breastfeeding Companion

# data[].attributes.attachment_link.description
The Breastfeeding Companion is privately owned and is completely free. What's more, we don't make any money for the services we provide. Everything is self-funded. And we're more than just providing breastfeeding tips - everything is research based and supported by Jackie Hall, IBCLC, who has dedicated over a decade of her life in support of tens of thousands of women.

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Bathing a Newborn Baby (with Umbilical Cord): Step-by-step Video

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Responsive Bottle Feeding: A guide for Midwives, Students, and Parents.

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Responsive Bottle Feeding: A guide for Midwives, Students, and Parents.

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Role-played but good up-to-date stuff!

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Responsive Bottle Feeding: A guide for Midwives, Students, and Parents.

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This video is about how to responsively bottle feeding your baby. Click on the link for the Department of Health leaflet "Guide to Bottle Feeding" http://www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/start4life_guide_to_bottle_%20feeding.pdf

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How do I choose the best type of nappy for my baby?

This can be a surprisingly difficult decision because there are so many types available.

The first choice you'll need to make is whether you want to use cloth or disposable nappies, or a combination of the two.

Most parents use disposables. That's because they are:

Easy to use

Convenient - you don't have to do any washing

More affordable in the short term; you can buy the nappies as you go rather than paying for them in a pack up front

On the downside, disposables are usually more expensive than cloth in the long run. And of course they contribute to the amount of waste that goes to landfill.
Read more about using disposable nappies and the different types on offer.

Although cloth nappies aren't for everyone, many parents who choose them absolutely love them. In the BabyCentre community, you'll hear mums raving about cloth nappies, or "fluffy bums" with an enthusiasm that disposables can never match.

Reasons for choosing cloth nappies include:

They are cheaper over time, particularly if you're planning to have more than one child.

They reduce the amount of waste you send to landfill.

They look cute, with many different colours and styles to choose from.

However, using cloth nappies means you'll be dealing with more washing and drying than if you choose disposables.
Read more about the pros and cons of cloth nappies, and the many different styles.

It's worth remembering that all babies are different, so a nappy that works brilliantly on one baby might be hopeless on another. And you may find that a particular nappy brand works well for a few months, then stops being effective as your baby grows and her poo changes. So you may need to be flexible and keep experimenting.

What do I need when I'm changing my baby's nappy?

To change your baby's nappy, you'll need:

A clean nappy.

A changing unit or mat, or a clean towel that you can lay on the floor or a bed.

Unscented baby wipes, or a small bowl of warm water with a clean cloth or cotton wool.

A clean towel for drying your baby's bottom, although this is optional.

A barrier cream to protect against nappy rash.

Nappy sacks for the dirty nappy or disposable nappy liner, and any used wipes or cotton wool.

If you're using cloth nappies, you'll also need a wet bag for your baby's wet or soiled nappy.

You should never leave your baby unattended during a nappy change, so do a quick check before each change to make sure that everything you need is in easy reach.
If you're packing a changing bag, it's a good idea to include a change of clothes in case your baby's nappy leaks. A distraction for your baby, such as a small toy, can also come in handy, but it's not essential.

How do I change my baby's nappy?

The basics of changing a nappy are the same whether you use disposables or cloth nappies:

Open the dirty nappy and wipe away the worst of the poo with the front of the nappy. Tuck it under her bottom with the clean side facing up.

Wipe your baby's bottom from front to back, gently lifting her legs by the ankles to wipe under her bottom. You can also roll her to the side if you need to wipe higher up her back.

Pat your baby's bottom dry with a clean towel, or wait until it dries naturally.

Apply a thin layer of barrier cream to your baby's bottom.

Take the used nappy out from under your baby and place into a nappy sack with the soiled wipes or cotton wool. If you're using a cloth nappy, put it into a wet bag, and just bin anything disposable such as liners and wipes.

Slide a new nappy under your baby and fasten over her tummy. All done!

These steps may be different depending on the nappy you're using. For example, if you're changing a cloth nappy, you may choose to add a liner or put a waterproof wrap on. Or if you're using a pocket-style nappy, you'll need to add the insert.
As you get more confident in changing nappies, you may also find that you prefer to do things slightly differently. You may decide to let your baby have some nappy-free time at the end of each change to give her skin a chance to breathe. In the meantime, these basic steps should serve you well.

How often should I change my baby's nappy?

In the first few days, your baby will need changing about 12 times a day. After this, for the first few weeks, she'll still poo several times a day and wet at least six nappies. Feeling wet may not bother her at this age, so don't assume that she'll cry or show discomfort when she needs changing. As she gets older, she may have just one or two poos a day.

It's important that you don't leave her sitting in a wet or dirty nappy for too long. This is because her wee, and the bacteria in her poo, may make her skin sore and lead to nappy rash.

To help protect against nappy rash, try to get into a routine of changing your baby's nappy before or after every feed, and whenever she's done a poo. If you find that her bottom still becomes red and sore, she may have sensitive skin. If this is the case, check her nappies more frequently, and change them as soon as you realise that they're wet .

Disposable nappies absorb a lot of moisture, so you may not always be able to feel when they're wet. Some nappies have a wetness indicator, which is a line that changes colour when the nappy's wet. This isn't a must-have, but it can be a handy way to tell if it's time for a change.

You don't need to wake your baby up to change her nappy at night. But when she wakes for a feed, take the opportunity to change her, otherwise she may wake up later because she's uncomfortable. You may prefer to change her nappy as soon as she wakes, so that she's sleepy again by the end of the feed. But if she usually poos during or immediately after she has fed, it would make more sense to wait and change the nappy afterwards. Either way, keep the change as calm and quiet as possible.

How can I make nappy changing fun?

Take the chance to chat to your baby while you change her. She'll love to see you talking, singing and making funny faces, and may be more likely to stay still. It will also help you both bond, and it's great for her development, too.

Find out what nappy-changing accessories you'll need, and learn how to change your baby's nappy safely.

Last reviewed: April 2017

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This can be a surprisingly difficult decision because there are so many types available. The first choice you'll need to make is whether you want to use cloth or disposable nappies, or a combination of the two. Most parents use disposables.

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The women who were interviewed had a mean age of 25.9 years, ranging from 18 to 35 years old. The partners varied in age from 19 to 37 years old with a mean age of 27.9 years. The women and their partners were mainly White-British but there was one South-East Asian couple, and three where one partner was White-British and the other Brazilian, Dutch or Asian. They had a range of socio-economic backgrounds and came from several different geographical areas of the two healthcare organisations. The women's employment status was varied, for example, these included several different professions (n = 6), administrators (n = 4), teachers (n = 2), secretaries (n = 2), looking after the home (n = 2) and manual worker (n = 1). There were also two women who were unemployed and one who was a student. The partners' employments ranged from those who were manual workers (n = 7) to those who were professionals (n = 6). One was also a student, one who was unemployed and another who was on Incapacity Benefit.

We aimed to recruit equal numbers of women who were in a stable relationship and those who said that they were not. However, recruitment of women who were without a partner was very slow and we recruited only four in the time available. Nevertheless, we found their views were similar to other women in the study and they did not introduce subjects that had not already been raised.

Themes arising from the interviews

The themes that emerged from the antenatal interviews included: types of support received and available to the women and their partners; their views on their preparation for parenthood, the postnatal period and baby care; and the information they received and sources of this information. Postnatally, issues included some of those above (support, information and preparation) but in addition, the following were highlighted: breastfeeding and the pressure to do so; parents' relationships and the challenges they had been, and were, going through; and partners' perspectives on their involvement and inclusion in the care his partner had received both antenatally and postnatally. Parents also expressed feelings such as fear, excitement and joy about becoming parents. These themes will be discussed below, following the transitional process from pregnancy to parenthood, rather than the order of importance.

Support received and available

The women identified five groups of people who were important to them for support: their partners, their own parents, friends and colleagues, health professionals and antenatal and/or postnatal groups. The partners, however, only mentioned their own partner, their colleagues and health professionals as avenues of support that were open to them.

Parents

The main area of support that the women expected to, and felt secure in turning to, were female relatives, mainly their mother, but aunts, grandmothers and sisters were also mentioned.

My mum...she's been pretty good. She knows not to overstep the line. She's suggesting but she won't ever say.

[mother #20045, postnatal interview]

The importance of the woman's mother really stood out. This was in contrast to the men who occasionally mentioned their own father, mostly in the sense that they wanted to offer their own child a different fathering experience.

Postnatally, the practical aspect of support and help that their mother gave them ranged from aspects of baby care to housework, cooking and/or babysitting, so that the couple could have 'time out'.

Everything [things her mum helped her with]. Draw a bottle, tea, cooking, housework, everything.

[mother #20037, postnatal interview]

Friends and colleagues

The women valued friends who had been through childbirth recently or who had experience of childcare. 'The information and support they could offer was greatly appreciated and sought after. In some instances these were relatively new friends who they had met at their antenatal classes but who had had their babies before them. The sharing of experiences was of paramount importance, in one instance this included the helpfulness of an interactive website. In comparison, the men appeared to lack support networks, some even felt that they had no-one to turn to, apart from their partner and, for some, their work colleagues.

Yes, my colleague's just had a baby, about 6 months old now ...then we've got the old administrator who says what it was like in her day and things like that what the pregnancy was like and the involvement of a man.

[partner #20010, antenatal interview]

Others felt they could only turn to health professionals, due to a lack of support from other sources. One father felt very strongly that, because he was employed, he was unable to access any support and therefore felt punished for working.

...I mean all my sort of friends from school I have lost contact with and I haven't really got any friends, nothing like that, it's basically work. I felt that, because I worked, I wasn't being allowed to be involved in any of it. I felt punished for working...you are missing everything.

[partner #20052, postnatal interview]

Health professionals

The support received from community health professionals was described as being quite varied but generally more positive than negative. Comments related to the importance of continuity of care, both from the midwife and health visitor, especially because this was often not achieved. The women also thought that the role of the midwife in the postnatal period should be longer than two weeks due to the trust that had built up antenatally.

....in those two weeks you've built up such a relationship. I felt comfortable and... a few weeks is not long enough for breastfeeding and all that...When she left I felt very alone.... Because she takes all my notes and I didn't have any contact numbers for the health visitor. What do I do in the next week?.... A relationship with someone, it's trust isn't it? [mother #20058, postnatal interview]

Those families who had received only one home visit from the health visitor, in contrast to frequent midwives' visits, were critical of the small amount of contact.

She just came the once [health visitor]....she said we don't visit anymore. You will have to come up to the surgery.

[mother #20039, postnatal interview]

Antenatal and postnatal groups

Some of the women had attended antenatal classes. These classes are usually held during the day, which makes it difficult for some working men to attend with their partners. Women who kept in postnatal contact with those in their antenatal group greatly valued the support. One or both parents spoke highly of this source of support and mentioned it several times.

....the people who are useful are the people that go through it at the same time...... Without that we'd really be struggling, without that network of mums that H [his partner] only met through antenatal classes....we don't need any help/support, or very little, other than this antenatal group.

[partner #20058, postnatal interview]

The usefulness of this 'support' was mainly perceived as reassurance; that, as new parents, they were all going through similar difficulties and experiences. In addition, it was encouraging that trying out different solutions to problems to find out what suited them best was not only normal and acceptable but also common practice.

Yeah we all get together and sort of lash things out and talk, babies...and you know everybody learns from their own experiences and if we all can sort of contribute, that's really good.

[mother #20055, postnatal interview]

It also provided a forum in which the mothers (since they often consist only of women) could exchange hints and tips as to what had 'worked' for each of them, eg. in relation to sleeping problems. The mothers often then fed the advice and reassurance back to their partners.

Preparation for parenting and baby care

Both parents alluded to the fact that antenatal classes were mainly aimed at the woman and they were generally not well attended by expectant fathers. They said that the topics covered in the classes were useful but mainly concentrated on pregnancy and birth, with little if any, discussion about parenthood.

I would say that that was one thing that I haven't received the information on, the baby element, bay care...when it is here and that's probably why I'm not so confident really.

[woman #21004, antenatal interview]

Antenatally, although the expectant parents felt excited about life with a baby they also expressed feelings of apprehension about caring for their baby about both the practical and general aspects of caring for a baby. They felt unprepared for becoming parents. The men articulated feelings of ignorance and fear about soon having a baby at home.

...how to hold a baby. I know the principle, but the actual doing it....The fact that you can't communicate, you can't talk... [partner #20010, antenatal interview]

Postnatally, in the first few weeks with their new baby, many parents mentioned feelings of surprise, confusion and excitement. They also spoke of overwhelming emotions towards their baby: amazement, love and a sense of great responsibility; that it was a life-changing event.

Every time I see her I still cannot believe she is mine or I am really a mum now (laughter)....It changes your whole life completely...there are no words to describe it really, but it is just overflowing with joy.

[mother #20036, postnatal interview]

The parents drew attention to the different ways in which they each interacted with their baby and the consequent reactions their baby displayed. For example, parents noticed that the father often played more with their babies, especially on return from work but that the mother was often able to calm their baby more easily when upset.

And sometimes my husband is quite jealous because every time she sees me, it is like, she sees me as comfort you know. I am the one feeding her, singing to her something like that. Every time she sees her dad she is always playing. My husband says, how come she does not sleep with me, every time she sees me it is like playtime. She always plays with her dad.

[mother #20033, postnatal interview]

Type and sources of useful information

Parents gathered, and were given, information from a variety of sources, both before and after their baby was born. Family and friends, work colleagues, healthcare professionals, discussions at antenatal appointments and antenatal classes, leaflets and books, television, videos and the internet were all referred to. In addition, as previously mentioned, their own parents' knowledge often appeared to be valued even though it was not usually recent.

The midwife was generally seen as a reliable source of information and someone to whom the woman could turn for advice and support. The two main sources of information given out by midwives were the NHS Pregnancy Book, a Department of Health, evidence-based, comprehensive guide given to all expectant parents [ 44], supported by a variety of leaflets. The Pregnancy Book was singled out by many parents as being very useful, comprehensive and something that they referred to on a regular basis.

Yeah, it's brilliant [NHS Pregnancy Book], I always look there when I need reassurance or just a little read through really.

[woman #20004, antenatal interview]

Most parents had read books, some of which they had bought, others had been given or lent them by family and friends, or borrowed from the library. Antenatally, parents watched television programmes relating to pregnancy and birth, and accessed the internet. Commercial gift packs, given to women early in pregnancy, were mentioned by many women, especially those who had signed up to receive weekly emails about their pregnancy. However, such advertising was not acknowledged as potentially influential in their choice of products. Nonetheless, whether in the form of literature, television programmes or services, there appeared to be few resources intended for fathers either ante- or postnatally, especially for those who were unable to take time off during the day.

I was sort of trying to push for information and I was finding it hard to get...from a dad's point of view.

[partner #20014, antenatal interview]

For blokes that don't work the same sort of hours as I do there is actually one [a group] run with just dads, run just through the day...but I mean there is nothing I heard of for dad's in the evenings....I would have loved to have done it. You know, meet a couple of people. [partner #20052, postnatal interview]

In discussing what else might have been helpful to them, eight parents raised the idea of a new DVD that could be specifically targeted at them. For those other parents who themselves did not mention the idea of a DVD, this was introduced at the end of the interview. They felt that an innovative DVD would be a helpful and supportive resource to have when entering parenthood. They thought that if one was available, late pregnancy would be a good time to watch it when they would have time to do so.

It would be nice if the midwives could do a mini-video like thing? About mothers' experiences? Let other mothers know about what's going on, what's going to happen to them....Yeah, 'cos you could sit in your own comfort of your own home and watch it in detail, and you can always play it back to yourself.

[woman #20007, antenatal interview]

I've looked in DVD stores and found that there isn't really that much, it's more to do with exercise and pregnancy, but that would be an excellent addition.

[partner #20024, antenatal interview]

Breastfeeding

Women mainly gained advice and information about breastfeeding from midwives, either in antenatal classes where videos might have been used, or through being given leaflets to read.

but we did one yesterday on breastfeeding ....the breastfeeding was one of the most informative for me.. they picked up in the itinerary that this one was gonna be about breastfeeding so none of the men that normally come came.

[woman #21004, antenatal interview]

Men often excluded themselves from the antenatal breastfeeding sessions because they did not feel that breastfeeding was relevant to them. Their partners were usually of the same opinion and this was sometimes backed up by midwives who told them they didn't need to attend when breastfeeding was being discussed.

I think if it was general feeding he would have, because it was just breastfeeding he didn't feel that he'd have anything to do with it. [woman #20022, antenatal interview]

The majority of women started breastfeeding and wanted to succeed in doing so but many commented on the pressure they felt, from health professionals, to continue.

We struggled on for six days trying to breastfeed. It wasn't so much that the midwife pushed you to carry on breastfeeding, because when we made the decision that we wanted to stop they were actually really supportive. I was worried that I was going to get given a hard time, but they were actually fantastic. [mother #20055, postnatal interview]

Parents' relationships

During the antenatal interviews the women and their partners were aware that they themselves might change when they became parents but made few allusions to the possibility of any change in their relationship.

The bit afterwards I think we both know that we'll change quite a lot, personality wise and stuff, I think we'll both change a lot. [woman #21003, antenatal interview]

This was in contrast to postnatally when parents talked openly about the additional stresses on their relationships. They expressed surprise at the demands that had been placed on their relationships and the effect that having a baby had had on them as a couple.

We don't argue, we don't snap at one another. And......knowing I was doing it...for no good reason and was upsetting her ... things would've been different if we hadn't been as strong together. If you got any, any stress in your marriage, and a kid, they would struggle I think. [partner #20051, postnatal interview]

There was also some sadness and bemusement that no-one had talked to them about the changes they would experience in their relationships. Postnatally, they could understand why the changes had taken place but would have preferred to have been warned in advance.

[Partner]: I mean if the awareness could have been made a lot more, because no one ever really spoke to us about that other side...and the relationship with us and the baby. It was never the relationship with us.

[Mother]: About relationships, like, it was always about the baby. [postnatal interview #20052]

Making time to talk and spending time together were recognised as valuable ways to reduce relationship tensions. Although these were common feelings, the parents made many positive comments about feeling like a family and enjoying their baby.

I think that we're probably closer if anything because we sort of feel like a complete package.

[mother #20036, postnatal interview]

The interview experience itself allowed couples 'time out' to discuss their feelings, concerns and relationships. It often proved to be a positive experience that highlighted the need for them to make time to communicate their feelings. For one couple, the partner implied that they might have split up if they hadn't realised the need to make that time.

If this carried on we would not have been together for this meeting. We sort of sat down and we tried about two or three different ways and thought about it .. now we've got just back to the way we were before. The only difference is we've got a little girl. [partner #20051, postnatal interview]

Partners' perspectives

The womens' partners generally felt very involved with the woman's pregnancy but often felt excluded from antenatal appointments and classes.

I didn't find it very useful to be honest with you, because it was not ... it was more on S. [his partner] and her pain. I don't ... I wasn't ready and they didn't involve ...The only thing they said I could really do was just be there and that was it really.

[partner #20013, antenatal interview]

The men mentioned there was a lack of information for them and that they were personally given none of the contact numbers for midwives, health visitors etc.

I was terrified... you know the sort of the care is, it is very much geared towards the women, I am not aware of anyone or have any numbers that I can speak to.

[partner #20058, postnatal interview]

They generally felt unprepared for caring for a baby, both the practical aspects as well as concern about being unable to communicate with their new baby.

I' m absolutely petrified..suddenly they are going to release you with this child that doesn't communicate in English and you're going to take this thing home.

[partner #20023, antenatal interview]

Some also reflected on how difficult it had been to go back to work and to achieve a work-life balance. They also spoke about feeling excluded from advice and support once they were working.

...trying to get a balance between the relationship and the baby. After two weeks I had to go back to work but I did not want to leave her. [partner #20039, postnatal interview]

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Transition to parenthood: the needs of parents in pregnancy and early parenthood

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Pregnancy and the transition to parenthood are major adjustment periods within a family. Existing studies have asked parents, retrospectively, about their experience of antenatal education, mainly focusing on women. We sought to address this gap by asking first-time mothers and their partners about how they could be better supported during the antenatal period, particularly in relation to the transition to parenthood and parenting skills.

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4.3 Long-term/chronic life stress

4.3.1 Transition to parenthood studies

The period surrounding the birth of a first child is one of the most joyful but also most stressful times that couples ever face, making it an ideal phase of life during which to test diathesis-stress processes. During the transition to parenthood, couples must cope with a wide range of stressors, including dramatic role changes, fatigue, new family demands, financial strain, and work-family conflict. Although the transition enhances marital well-being in some couples ( Cowan & Cowan, 2000), most partners experience sharp downturns in marital satisfaction, declines in companionate activities, and increases in conflict (e.g., Belsky & Pensky, 1988; Doss, Rhoades, Stanley, & Markman, 2009). Attachment theorists such as Bowlby (1988) and Mikulincer and Florian (1998) have proposed that attachment insecurity should render certain people more vulnerable to marital distress and related negative outcomes during the transition period. In our program of research, we have examined how attachment anxiety and avoidance are systematically related to three outcomes indicative of well-being: changes in marital satisfaction, depressive symptoms, and attachment orientations. In this research, we have tested the basic hypothesis that events or conditions (e.g., the quality of spousal support, the presence of relationship conflict) experienced during the transition to parenthood that activate the fundamental worries or concerns of persons who have avoidant or anxious attachment orientations should have adverse effects on their well-being over time.

In this section, we review the findings of two longitudinal transition to parenthood studies. The first transition study started 6 weeks before the birth of each couple's first child and ended when their child was 6 months old. This first study focused on women's well-being in relation to what their male partners did while in the role of potential support providers. We examined three markers of well-being: marital satisfaction, depression, and changes in attachment orientations across the transition. The second transition study tested both how husbands support their wives and how wives support their husbands across a longer time period (the first two years of the transition). Two measures of well-being-marital satisfaction and depressive symptoms-were investigated in this longer and more detailed transition study.

In our first 6-month transition study, we (Rholes, Simpson, Campbell, & Grich, 2001) found that, under specific conditions, women who have insecure attachment orientations experience more negative outcomes at 6 months postpartum. For example, as shown in Fig. 6.4, marital satisfaction declined significantly from the prenatal to the 6-month postnatal testing period in more anxiously attached women if, at the prenatal session, they perceived their husbands were less supportive. According to attachment theory (Bowlby, 1973), perceptions of deficient support should increase fears of abandonment, especially in highly anxious women who need support and are already preoccupied with thoughts of possible abandonment.Bowlby, 1988). Conversely, the relative absence of worries about abandonment may explain why perceptions of lower spousal support did not reduce marital satisfaction in less anxious (more secure) women; such women remained confident that their relationships were not in jeopardy. ⁵ These deep-seated fears are likely to be the root cause of marital dissatisfaction among highly anxious women during the transition to parenthood (

Statistical interactions between women's attachment anxiety and their perceptions of their spouses' degree of supportiveness also produce several other effects. For example, highly anxious women who perceived their spouses as less supportive during the prenatal testing session reported larger prenatal-to-postnatal declines in the amount of support that was available from their husbands, and these changes fully mediated their declines in marital satisfaction over time. Anxious women who perceived less spousal support also reported seeking less support from their husbands between the prenatal and the postnatal periods. In addition, the husbands of women who perceived less spousal support differed from other husbands. These men reported significant declines over time in both their marital satisfaction and the amount of support they reported giving to their wives. Similar to women, changes in men's marital satisfaction were also fully mediated by changes in their wives' perceptions of spousal support across the 6-month transition period.

Viewed together, these findings indicate that perceptions of low or declining spousal support by anxiously attached women have broad impact on their marriages. Consistent with our diathesis-stress model (see Fig. 6.1), anxious women are not invariably unhappy with their marriages. When they perceive higher levels of prenatal and postnatal spousal support, anxious wives and their husbands both have higher marital satisfaction that is on par with securely attached spouses.

In our second transition study, we (Kohn et al., 2011) focused on changes in marital satisfaction over the first 2 years of the transition to parenthood. This study also addressed partner perceptions and their ties to personal well-being (see Fig. 6.1). The findings of Kohn et al. (2011) were similar in many ways to those of Rholes et al. (2001). For instance, Kohn et al. found that anxiously attached women and men who perceived less spousal support were less satisfied with their marriages compared to less anxiously attached people. Anxious women who perceived lower levels of spousal support started the transition to parenthood with lower levels of satisfaction, which remained consistently low throughout the 2-year study. Anxious men who perceived less partner support also started the transition with lower satisfaction, but they experienced further declines in satisfaction across the 2-year period, leaving them even more dissatisfied than their wives, on average, 2 years after childbirth. These findings reveal that relationship problems that occur during the transition do not flair up and settle down quickly. Rather, many of them begin during the very early stages of the transition and exert long-term effects on marriages, especially among anxiously attached persons.

Kohn et al. (2011) also found that avoidance plays an important role in marital satisfaction during the transition to parenthood. The effects of avoidance, however, were moderated by a different set of variables, the first of which was perceptions that the new baby was interfering with outside activities such as leisure pursuits, free-time, etc. Specifically, more avoidant men and women who anticipated greater baby interference prenatally reported less marital satisfaction prior to childbirth, and those who perceived greater baby interference postnatally experienced declines in satisfaction over time, especially in the case of highly avoidant men. Work-family conflict was also a significant moderator. Highly avoidant men and women who perceived greater work-family conflict started the transition with lower satisfaction, and avoidant men experienced continued declines in satisfaction across time. Finally, the demands associated with family responsibilities also moderated this effect, such that avoidant men and women who perceived heavier demands began the transition with lower satisfaction, and avoidant men experienced continued declines over time.

Some of the most dissatisfied people in the Kohn et al. (2011) study were highly avoidant people, especially men, who perceived that their baby was interfering with their other life activities, creating too many family responsibilities, and generating work-family conflicts. These findings suggest that many avoidant parents may resent childcare responsibilities. Bowlby (1988), in fact, claimed that one of the gravest fears of avoidant people is that they will have to become caregivers at some point during their lives. Whereas anxious individuals worry about abandonment, avoidant individuals are concerned with losing autonomy and becoming too interdependent with others. For this reason, avoidant people become dissatisfied with their marriages when they perceive that their children are interfering with other outside activities, when they encounter work-family conflict, or when they perceive heavy demands from their family life because all of these factors can undermine autonomy and independence.

The second measure of well-being examined in our transition to parenthood studies was depressive symptomotology. With regard to the model in Fig. 6.1, two of our depressive symptoms studies have focused on partner behaviors, perceptions of partners, and how both of these variables predict changes in depressive symptoms across the transition. The results we have found for depressive symptoms conceptually parallel those we have found for marital satisfaction. Simpson, Rholes, Campbell, Tran, et al. (2003), for example, found that anxiously attached women who perceived less spousal support or more negative social interactions with their spouses during the prenatal period experienced increases in depressive symptoms across the first 6 months of the transition. The increase in depressive symptoms over time was fully mediated by women's perceptions of declining spousal support across the 6-month transition period. Specifically, anxious women were more likely to perceive declining support from their husbands over the first 6 months of the transition, and these negative support perceptions forecasted increases in their depressive symptoms. Thus, as with marital satisfaction, perceptions of low prenatal spousal support and declining spousal support from the prenatal to the 6-month postnatal period assume a major role in predicting changes in depressive symptoms in anxiously attached women.

Simpson, Rholes, Campbell, Tran, et al. (2003) also sought to determine whether anxiously attached women held biased perceptions of the spousal support that was potentially available to them. To test this hypothesis, women's perceptions of available spousal support were regressed on their partner's perceptions of the support that they gave them. Residual scores were then calculated to assess the difference between the amount of support women perceived relative to the amount that would be expected based on their male partner's reports of support giving, controlling for his attachment orientation. These residual scores were then correlated with women's attachment anxiety scores. The results revealed that: (1) more anxious women perceived less support than would be expected based on their husband's reports of support-given, and (2) less anxious (more secure) women perceived more support than would be expected based on their husband's reports. Viewed together, these findings suggest that highly anxious women may have a negative support perceptual bias, whereas less anxious (more secure) women might have a positive support perceptual bias. ⁶

Men's reports of support giving were also examined in relation to their wive's attachment anxiety to determine whether men who were involved with more anxious partners provided less support. There was no association between men's support giving and women's attachment anxiety at the prenatal period. Six months after childbirth, however, there was a significant association, such that men-regardless of their own attachment orientation-reported providing less support if they had more anxious wives. Thus, highly anxious women's perceptions of low/declining spousal support appear to have a partial basis in reality.

The final question addressed in the Simpson, Rholes, Campbell, Tran, et al. (2003) study dealt with why men withdraw support from anxious women. At 6 months postpartum, men completed a questionnaire about dispositional attributions for their wive's behavior during the transition period. Men rated their wives on four dispositions: mature versus immature, emotionally strong versus emotionally weak, self-reliant versus excessively needy, and stable versus unstable. Men involved with more anxiously attached partners attributed more negative dispositions to their partners, and their more negative attributions fully mediated the link between women's attachment anxiety and men's reports of support giving at 6 months postpartum. Thus, men who have highly anxious spouses tend to pull away from them during the transition, causing these men to reduce their levels of support. One reason for their alienation may be excessive reassurance seeking on the part of highly anxious women (Shaver et al., 2005).

Rholes et al. (2011) also investigated changes in depressive symptoms across the first 2 years of the transition to parenthood. The results for attachment anxiety were very consistent with the Simpson, Rholes, Campbell, Tran, et al. (2003) depression findings. For example, Rholes et al. (2011) found that highly anxious women who perceived lower spousal support reported more depressive symptoms, which remained constant over 2 years. Anxious men who perceived less spousal support started the transition with fewer depressive symptoms than their female partners, but they increased in symptom levels across the 2 years of the study and eventually had symptom levels that were as high as their female partners. Anxious men and women who perceived their partners were interacting more negatively with them (e.g., by being disrespectful, rude, irritated, angry) had depressive symptom outcomes that were almost identical to anxious individuals who perceived lower spousal support. These findings are noteworthy because they replicate our 2003 depression study and they also show that depressive symptoms that arise during the transition continue to be problematic for an extended period of time. As discussed earlier, both lower perceived spousal support and greater negative social exchanges with partners should exacerbate abandonment concerns. Highly anxious individuals often ruminate about negative events and negative potential outcomes much more than less anxious (more secure) people do (Burnette, Davis, Green, Worthington, & Bradfield, 2009). The well-established link between rumination and depression (Rood, Roelofs, Bogels, Nolen-Hoeksema, & Schouten, 2009) suggests that greater rumination about abandonment may play a primary role in generating depressive symptoms in highly anxious people.

The Rholes et al. (2011) findings for avoidance and depressive symptoms focused on perceptions that the new baby was interfering with the romantic relationship (e.g., not having enough alone-time with one's spouse) and/or outside personal activities (e.g., recreation). Avoidant people who harbored these views started the transition having more depressive symptoms, which increased across the 2 years of the study. Interference with the relationship may seem surprising because avoidant people claim that they do not want, need, or value close relationships. This finding, however, clearly indicates that some aspects of romantic relationships are important even to highly avoidant individuals.

To summarize, the four transition to parenthood studies reviewed above reveal findings that are consistent with both attachment theory and our process model. The results concerning the predictors of marital satisfaction were very consistent across the two marital satisfaction transition studies, and those regarding the predictors of depressive symptoms were also consistent across the two depression transition studies. Moreover, the predictors of marital satisfaction and depressive symptoms were also conceptually consistent with one another. The core findings indicate that certain circumstances arising during the transition to parenthood tend to activate and/or exacerbate the cardinal concerns of highly anxious and highly avoidant people-abandonment for anxious persons, and lack of autonomy and independence for avoidant persons-which have negative effects on marital satisfaction and depressive symptoms across the transition to parenthood. The findings are consistent with our diathesis-stress model by showing that the principle vulnerabilities of avoidant and anxious persons emerge only when these individuals confront certain difficult circumstances or events. In the absence of such circumstances or events, highly avoidant and highly anxious persons appear to be just as well adjusted as their less avoidant and less anxious (more secure) counterparts.

The transition to parenthood is an excellent context for studying potential changes in attachment orientations. According to Bowlby (1980), individuals are likely to experience such changes if they encounter events that reinforce or contradict the central assumptions of their working models. During chronically stressful periods, changes in attachment orientations should be more common because working models are both more accessible and more open to assimilating new attachment-relevant information and experiences (Bowlby, 1988). The transition is also a time when individuals have radically new interpersonal experiences (e.g., caring for and trying to soothe a newborn) that may alter their interpersonal expectations and underlying working models.

Simpson, Rholes, Campbell, and Wilson (2003) also found that men's and women's level of avoidance changed as a function of their own behavior during the transition. For example, men became less avoidant if they perceived they had given more support to their partners, and women became less avoidant if they perceived they had sought more support from their partners. The seeking and giving of support are both starkly inconsistent with the working models and typical behavior of avoidant persons. When the parental role strongly elicits and sustains these behaviors, the sheer inconsistency between them and avoidant working models ought to produce changes in the cognitions underlying avoidance (cf. Festinger, 1957).

4.3.2 Culture-fit studies

Attachment orientations may also generate behaviors that may be incongruent with a given culture's prescriptive norms about how to think, feel, and behave in relationships. As a result, certain attachment orientations may "fit better" in some cultures than others, a concept we have termed the "cultural fit" hypothesis. When an individual's interpersonal style of relating to others (i.e., his/her attachment orientation) goes against the grain of what a culture deems appropriate or desirable, she or he should experience chronic stress.

Friedman et al. (2010) tested whether avoidance fits better (or has fewer negative relationship consequences) in individualistic cultures (such as the United States) than in interdependent cultures (such as Hong Kong and Mexico). Friedman et al. (2010) hypothesized that avoidance, with its emphasis on emotional distance and autonomy, should be a stronger predictor of relationship problems in Hong Kong and Mexico than in the United States, considering the greater importance of closeness and interpersonal harmony in more interdependent cultures. As expected, avoidance was associated with greater relationship problems in all three cultures, but the associations were significantly stronger in Hong Kong and Mexico than in the United States. Compared to the United States, avoidance was more strongly associated with greater conflict with romantic partners, less perceived partner support, less investment in the relationship, and lower relationship satisfaction in Hong Kong. Also compared to the United States, greater avoidance was more strongly linked to lower relationship satisfaction, less perceived partner support, and more relationship conflict in Mexico.

Within interdependent cultures, the romantic partners of avoidant people may find that their expectations of what constitutes a "good" relationship are less completely met than are the expectations of partners who live in more independent cultures such as the United States. This should create disappointment and frustration, exacerbating the relationship problems of highly avoidant individuals. Another contributing factor may be pressures from either romantic partners or others (e.g., family members, friends) that impel avoidant individuals to engage in behaviors they find uncomfortable and would prefer not to do. Interdependent cultures may, for instance, exert pressure on avoidant people to engage in levels of self-disclosure they find disconcerting or to perform levels of caregiving they find stifling (Wilson, Simpson, & Rholes, 2000). Living in a culture that makes it difficult to avoid behaviors that activate the attachment system should generate considerable stress and resentment in avoidant people, only aggravating their relationship problems.

Mak, Bond, Simpson, and Rholes (2010) tested whether relationship satisfaction mediated the link between attachment insecurity and depressive symptoms in the United States and Hong Kong. Mak et al. (2010) predicted that attachment insecurity should be related to perceptions of less support from romantic partners, and that these perceptions should in turn be associated with lower relationship satisfaction enroute to predicting more depressive symptoms. Consistent with the cultural fit hypothesis, avoidance was more strongly associated with perceptions of less partner support and greater relationship dissatisfaction in Hong Kong than in the United States. The partners of avoidant persons in Hong Kong should be particularly upset by their partners' normatively low levels of support and, therefore, may withdraw from the partner/relationship, generating these clear cultural differences. In addition to withdrawing support, the partners of avoidant persons may also display their dissatisfaction in other ways by being more critical or rebuking when their avoidant partners violate cultural practices and norms for intimate relationships.

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4.3.1 Transition to parenthood studies The period surrounding the birth of a first child is one of the most joyful but also most stressful times that couples ever face, making it an ideal phase of life during which to test diathesis-stress processes.

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What is postnatal depression?

Postnatal depression (PND) is the most common perinatal mental health disorder women experience in the first year after having a baby (NICE, 2014). Between 10% and 20% of women have depression and anxiety in pregnancy and after birth (Coates, 2016). PND is an illness and will get better in time.

Watch our video below where three mums talk about what it feels like to experience postnatal mental health issues.

How do I know if I have postnatal depression?

A good place to start is NHS Choices' depression screening tool. Women who are concerned should make an appointment to see their GP or call 111.

Feel proud of yourself for seeking help because recognising that you're suffering from postnatal depression is the most important step to getting better (Boots Alliance Trust, 2013). It's probably also the hardest step.

Is postnatal depression like other forms of depression?

Yes, in a lot of ways. Like depression at other times in life, it can be mild, moderate or severe. It can come on gradually or suddenly. (NICE, 2014)

The main difference though is that it can be a lot trickier to recognise. That's because your mental state is likely to change in the weeks and months after you have a baby anyway (NICE, 2014). You will also have such a lot going on around you.

When do people get postnatal depression?

It usually comes on within six weeks of giving birth although it can emerge up to a year after your baby is born (MIND, 2017). While postnatal depression should dissipate within a few months, 30% of people with PND will still be ill after the first year (NICE, 2014).

What are postnatal depression symptoms?

They can include:

feeling down and teary

an inability to concentrate

low sex drive

feeling worthless

inability to feel happiness

sleep problems

anger

finding it difficult to leave the house

overeating

problems bonding with your baby

suicidal thoughts.

(Boots Alliance Trust, 2013)

PND often goes unreported, why is that?

A terrifying 30% of new mums with perinatal mental health problems had never talked about it to a professional (Boots Alliance Trust, 2013).

First, this is because symptoms can be difficult to recognise when your life has just gone through such a large shift anyway (NICE, 2014; NHS Choices, 2017). And there's another reason: women worry that people will judge them or even that social services may take away their baby from them (NICE, 2014; Ayers and Delicate, 2016).

Try to remember that postnatal depression doesn't mean you are doing anything bad. It just means that you're suffering from an illness and deserve to get some help.

How do I know if I'm at risk of postnatal depression?

You can't really but there are a number of risk factors. You're more likely to get postnatal depression if you:

have an ongoing mental health problem

have a family or personal history of PND

have had a traumatic birth experience like a stillbirth

live in a bad or violent social or economic situation

are a refugee or asylum seeker

have a history of childhood or adulthood abuse

have poor social support.

(RCOG, 2011; NICE, 2014; Ayers and Delicate, 2016)

Speak to your GP or midwife if you think you are at risk of postnatal depression.

Is it important to get help for postnatal depression?

Yes. By speaking to your GP, midwife or health visitor and accessing the right treatment and support, you can get better (Shakespeare, 2015). If not, it can have major consequences for your mental health, your relationship, your partner's mental health and the development of your baby (Fatherhood Institute, 2010; Howard et al, 2014; Ayers and Delicate, 2016).

Treatments to try include talking therapies like cognitive behavioural therapy (CBT) or anti-depressants (talk to your GP for advice if you're breastfeeding) (NICE, 2014; NHS Choices 2017). If postnatal depression becomes severe or develops into postpartum psychosis, you might need a stay in hospital or mother and baby unit (RCOG, 2011; NHS Choices, 2017).

Is there anything else I can do to help?

Yes, here are a few self-care tips:

1. Build a support network and make time to meet friends and other mums for a much-needed cup of tea and a chat (NEF, 2008).

2. Accept offers of help. It might be your mum dusting your living room or your best friend walking your newborn around the block so you can lie down. Whatever it is, take it (Boots Alliance Trust, 2013).

3. Make time for a run or rejoin your old netball team. Exercise can work wonders for the way you feel (Cooney et al, 2013). It is also a great long-term practice for safeguarding your mental health (NEF, 2008; NHS Choices, 2017).

4. Try to eat healthily and regularly, and cut back on caffeine and alcohol (NHS Choices, 2017).

5. Get showered and dressed, even if your plan for today is to go no further than the back door to put some nappies in the bin (MIND, 2017).

6. Be mindful - apps like Headspace can help improve your mental wellbeing and help you to deal with daily challenges (NEF, 2008). You can even practice mindfulness on the sofa while your newborn is feeding.

7. Keep a mood diary. It can help you notice how people, places and activities affect your mood (MIND, 2017).

8. Sign up to a baby massage class at NCT or with your local children's centre through a referral from your health visitor (NHS Choices, 2017).

9. Contact local or national specialist organisations - they may offer the opportunity to talk to other women who are going through the same thing. Services available might include a dedicated telephone helpline, a buddy service, online support, support groups, counselling and wellbeing sessions.

This page was last reviewed in June 2018
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Contact specialist organisations like PANDAS for more help and support with postnatal depression.

Ayers S, Delicate A. (2016) Recognising and acting on perinatal mental health. Perspective; 32. Available from: https://www.nct.org.uk/sites/default/files/related_documents/Ayers%20and%20Delicate%20Recognising%20and%20acting%20on%20perinatal%20mental%20health.pdf [Accessed 1st December 2017].

Boots Family Trust Alliance. (2013) Perinatal mental health: experiences of women and health professionals. Available from: http://www.bftalliance.co.uk/the-report/ [Accessed 1st December 2017].

Coates R. (2016) Broadening the net: assessing the full range of perinatal mental health problems. Perspective; 32. Available from: https://www.nct.org.uk/sites/default/files/related_documents/Perspective-September-2016_0.pdf [Accessed 1st December 2017].

Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. (2013) Exercise for Depression. Cochrane Database of Systematic Reviews; (9):CD004366. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004366.pub6/full [Accessed 1st December 2017].

Fatherhood Institute. (2010) Research summary: fathers and postnatal depression. Available from:

http://www.fatherhoodinstitute.org/2010/fatherhood-institute-research-summary-fathers-and-postnatal-depression [Accessed 1st December 2017].

Howard LM, Piot P, Stein A. (2014) No health without perinatal mental health. The Lancet; 384(9956):1723-1724 Available from https://www.ncbi.nlm.nih.gov/pubmed/25455235 [Accessed 1st December 2017].

MIND. (2017) Postnatal depression and perinatal mental health pages. Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postnatal-and-antenatal-depression/#.WcozHYokqRs [Accessed 1st January 2018]

NEF (National Economics Foundation). (2008) Five ways to wellbeing. A report presented to the Foresight programme on communicating the evidence base for improving people's wellbeing. Available from: http://b.3cdn.net/nefoundation/8984c5089d5c2285ee_t4m6bhqq5.pdf [Accessed 1st January 2018].

NHS Choices. (2017) Postnatal depression pages. Available from: http://www.nhs.uk/conditions/Postnataldepression/Pages/Introduction.aspx [Accessed 1st December 2017].

NICE (National Institute for Health and Care Excellence). (2014) Antenatal and postnatal mental health. CG192. Available from: https://www.nice.org.uk/guidance/cg192/evidence/full-guideline-pdf-193396861 [Accessed 1st December 2017].

RCOG. (2011) Management of women with mental health issues during pregnancy and the postnatal period. Good Practice No. 14. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/managementwomenmentalhealthgoodpractice14.pdf [Accessed 1st January 2018].

Shakespeare J. (2015) Perinatal mental health: the picture today. Perspective; 26. Available from: https://www.nct.org.uk/sites/default/files/related_documents/Perinatal%20mental%20health-%20the%20picture%20today.pdf [Accessed January 2018].

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Postnatal depression: the questions you really want to ask

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Postnatal depression (PND) is the most common perinatal mental health disorder women experience in the first year after having a baby (NICE, 2014). Between 10% and 20% of women have depression and anxiety in pregnancy and after birth (Coates, 2016). PND is an illness and will get better in time.

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Mothers get more sleep when their baby is exclusively breastfed

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OBJECTIVES:

This study describes sleep patterns for mothers and fathers after the birth of their first child and compares exclusive breast-feeding families with parents who used supplementation during the evening or night at 3 months postpartum.

METHODS:

As part of a randomized clinical trial, the study utilized infant feeding and sleep data at 3 months postpartum from 133 new mothers and fathers. Infant feeding type (breast milk or formula) was determined from parent diaries. Sleep was measured objectively using wrist actigraphy and subjectively using diaries. Lee's General Sleep Disturbance Scale was used to estimate perceived sleep disturbance.

RESULTS:

Parents of infants who were breastfed in the evening and/or at night slept an average of 40-45 minutes more than parents of infants given formula. Parents of infants given formula at night also self-reported more sleep disturbance than parents of infants who were exclusively breast-fed at night.

CONCLUSIONS:

Parents who supplement their infant feeding with formula under the impression that they will get more sleep should be encouraged to continue breast-feeding because sleep loss of more than 30 minutes each night can begin to affect daytime functioning, particularly in those parents who return to work.

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Breast-feeding increases sleep duration of new parents.

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OBJECTIVES: This study describes sleep patterns for mothers and fathers after the birth of their first child and compares exclusive breast-feeding families with parents who used supplementation during the evening or night at 3 months postpartum. METHODS: As part of a randomized clinical trial, the study utilized infant feeding and sleep data at 3 months postpartum from 133 new mothers and fathers.

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The summary of 'Why Love Matters', by Sue Gerhardt

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Transition to Fatherhood

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Nighttime Breastfeeding Behavior Is Associated with More Nocturnal Sleep among First-Time Mothers at One Month Postpartum

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Study Objective:

To describe sleep duration and quality in the first month postpartum and compare the sleep of women who exclusively breastfed at night to those who used formula.

Methods:

We conducted a longitudinal study in a predominantly low-income and ethnically diverse sample of 120 first-time mothers. Both objective and subjective measures of sleep were obtained using actigraphy, diary, and self-report data. Measures were collected in the last month of pregnancy and at one month postpartum. Infant feeding diaries were used to group mothers by nighttime breastfeeding behavior.

Results:

Mothers who used at least some formula at night (n = 54) and those who breastfed exclusively (n = 66) had similar sleep patterns in late pregnancy. However, there was a significant group difference in nocturnal sleep at one month postpartum as measured by actigraphy. Total nighttime sleep was 386 ± 66 minutes for the exclusive breastfeeding group and 356 ± 67 minutes for the formula group. The groups did not differ with respect to daytime sleep, wake after sleep onset (sleep fragmentation), or subjective sleep disturbance at one month postpartum.

Conclusion:

Women who breastfed exclusively averaged 30 minutes more nocturnal sleep than women who used formula at night, but measures of sleep fragmentation did not differ. New mothers should be encouraged to breastfeed exclusively since breastfeeding may promote sleep during postpartum recovery. Further research is needed to better understand how infant feeding method affects maternal sleep duration and fragmentation.

Citation:

Doan T; Gay CL; Kennedy HP; Newman J; Lee KA. Nighttime breastfeeding behavior is associated with more nocturnal sleep among first-time mothers at one month postpartum. J Clin Sleep Med 2014;10(3):313-319.

Keywords: Actigraphy, sleep, maternal, breastfeeding, infant formula

BRIEF SUMMARY

Current Knowledge/Study Rationale: Common belief suggests that infant formula leads to better infant sleep and in turn to better maternal sleep. Prior research in a sample of socio-economically advantaged mothers indicated that breastfeeding mothers obtained more sleep at night than those using formula, and this study was conducted to determine whether a similar pattern was also evident in a sample of lower-income and ethnically diverse women.

Study Impact: This study replicates our prior findings that mothers who breastfeed exclusively obtain more sleep than mothers who use at least some formula, despite common belief to the contrary. Infant feeding type was unrelated to sleep fragmentation, and the mechanism by which feeding type influences sleep duration remains unclear.

Participants and Design

This study was approved by the Committee on Human Research at the University of California, San Francisco. As part of a randomized clinical trial aimed at minimizing sleep disruption and stress for new mothers, pregnant women in their third trimester were recruited from free childbirth preparation classes and prenatal clinics serving primarily low-income women. Inclusion criteria were (1) English-speaking women expecting their first child, (2) ≥ 18 years of age, (3) not working the night shift, (4) not taking medications that alter sleep, and (5) no history of diagnosed sleep disorder or affective disorder. Intention to breastfeed was not an inclusion criterion.

After eligible women consented and baseline measures of sleep were collected in the last month of pregnancy, women were randomly assigned to an experimental group and given a modified sleep hygiene kit to help them feel more prepared for infant care during the night and more competent in their new role. The control group received nutritional information and comparable time with the researcher. Breastfeeding information was not a component of either group's intervention content. Follow-up assessments of sleep and well-being occurred at 1, 2, and 3 months postpartum. Each assessment took place in the participant's home. This analysis focused on the 1-month postpartum data because that time point is a critical time for lactation establishment.

Measures

Breastfeeding Behaviors

Breastfeeding behaviors were ascertained from the sleep and infant feeding diary completed by the mother over 3 consecutive days and nights. To facilitate the mother's diary completion, each day was divided into 12-h time periods from 09:00 to 20:59 for daytime recording and from 21:00 to 08:59 for nighttime recording. Each hour was further divided into 15-min sections. For each feeding session, mothers were instructed to mark start times and type of feeding. For descriptive purposes, type of infant feeding was initially classified in categories congruent with standard definitions: (a) Exclusive breastfeeding = 100% breastfeeding or breast milk feeding; (b) partial breastfeeding = any combination of breastfeeding or breast milk feeding, and formula supplementation; and (c) formula-feeding = 100% formula feeding.

To analyze the effect of infant feeding method on maternal sleep at night (from 21:00 to 08:59), breastfeeding behavior was then categorized as either (1) exclusive breastfeeding (EBF) = 100% breastfeeding or breast milk feeding on all 3 nights, or (2) formula = giving any formula at night on any of the 3 nights. These 2 categories of feeding were specific to nighttime breastfeeding behavior. Thus, at any time during the 72 h, women in the formula group could also have breastfed or given breast milk in addition to formula.

Sociodemographic Characteristics

Data on age, race, marital or relationship status, education, monthly household income, and employment status or working for pay outside the home were obtained when women were screened for eligibility during their third trimester. Women enrolled in the study were asked about their breastfeeding intention (yes/no) and, if yes, how long they planned to breast-feed (months). At one month postpartum, participants were asked again about their employment status. To assess support women received or perceived at this time, they were also asked whether they had help with the baby each night during the 72-h study period.

Objective Measures of Sleep

To estimate day and night sleep time, each participant was asked to wear a wrist actigraph (Ambulatory Monitoring, Inc., Ardsley, NY) for 72 h at each assessment point. This device weighs about 2 ounces and provides continuous motion activity data using a battery-operated wristwatch-size microprocessor that senses motion with a piezoelectric linear accelerometer. An amplifier setting of 18 (filter 2.0-3.0 Hz) was used, along with zero-crossing mode and 30-sec epochs. Although polysomnography is considered the gold standard for measuring sleep stages, it is cumbersome, more invasive, and cannot run continuously for 72 h to get an estimate of both daytime and nighttime sleep in the home environment. Assessment of sleep in healthy young adults showed strong correlations between polysomnographic measures and actigraphy measures ( r = 0.93 to 0.99) and 88% agreement between the 2 methodologies.

Actigraphy data were analyzed using Action4 software (Ambulatory Monitoring, Inc., Ardsley, NY). The autoscoring program for sleep uses activity counts to determine sleep and wake episodes on the basis of the criteria of Webster et al.: after 4 min scored as wake, the next 1 min of sleep is scored as wake, and ≤ 6 min of sleep surrounded by 10 min of wake before and after is scored as wake. Three sleep-related variables from the autoscoring program were included as outcomes for this study: (1) total sleep time at night (TST-night) or average minutes of sleep between 21:00 and 08:59 over 3 nights, (2) total sleep time during the day (TST-day) or average minutes of sleep between 09:00 and 20:59 over 3 days, and (3) wake after sleep onset (WASO), calculated by dividing the minutes awake by minutes in bed after falling asleep and presented as a percentage. TST-night and TST-day were subsequently summed to obtain an estimate of average sleep duration over 24 h (TST-24). To facilitate interpretation of maternal sleep from the actigraphy data, mothers completed a 72-h sleep diary with information about bed times, wake times, naps, and sleep locations. The use of standard 12-h blocks (09:00 to 20:59 and 21:00 to 08:59) to calculate estimates of TST was to minimize threats to validity from inconsistency in interrater scoring procedures related to unpredictable or polyphasic sleep patterns typical in the early postpartum period. If the 12-h blocks split a sleep period (e.g., the woman was still sleeping at 09:00 and the diary indicated a later wake time), they were adjusted to incorporate the entirety of that sleep period within the nocturnal block.

Subjective Measures of Sleep

Mothers also completed the 21-item General Sleep Disturbance Scale (GSDS) at each time point. The GSDS is used to assess frequency of specific sleep problems experienced during the past week. Each item is rated on a scale of 0 ( no days) to 7 ( every day); the total score ranges between 0 and 147, with higher scores indicative of more frequent sleep disturbance. The GSDS was originally developed and tested in a sample of shift-working nurses and further tested in other samples of pregnant and postpartum women. Cronbach α reliability coefficients for this sample were 0.80 at the last month of pregnancy and 0.77 at one month postpartum.

Data Analysis

Actigraphy, diary, and self-report (GSDS) data were processed and reduced to descriptive means and standard deviations (SD). Preliminary analyses were performed to ensure no violation of normality, linearity, and homoscedasticity assumptions. Women were grouped by feeding behavior at night for analysis. Women in the EBF group exclusively breastfed or fed breast milk to the infant (n = 66), and they were compared to women in the formula group (n = 54) who used any amount of formula at night on any of the 3 nights of actigraphy monitoring.

To evaluate potential demographic factors associated with breastfeeding, continuous variables were tested with independent group t-tests, and categorical variables were tested with χ ² tests. Repeated measures analysis of variance (RMANOVA) was used to test for mean group differences in sleep variables in the last month of pregnancy and at one month postpartum. The design had 1 between-subjects factor with 2 levels (EBF and formula) and 1 within-subjects factor (time) with 2 levels (last month of pregnancy and 1 month postpartum). This design allowed for testing of the main effect of group, the main effect of time, and the interaction of group by time. Post hoc testing of significant interactions was conducted to identify group differences at each of the 2 time points. Demographic variables that differed by feeding type were included in the RMANOVA as covariates. Associations between actigraphy measures of sleep and perception of sleep disturbance were measured using Pearson correlation coefficients. Data were analyzed using a two-tailed statistical significance level of α = 0.05 with 95% confidence intervals (95% CI) using SPSS version 18.0 software for Windows.

Breastfeeding Behavior

Across the 3 days and nights of diary measures at one month postpartum, breastfeeding behavior was classified using standard definitions. About half (52%, n = 62) were exclusive breastfeeding, 28% (n = 34) were partial breastfeeding, and 20% (n = 24) were exclusive formula-feeding. For analysis of nighttime feeding, 55% (n = 66) were categorized as EBF for all 3 nights, 24% (n = 29) were partial breastfeeding, and 21% (n = 25) were exclusive formula-feeding. The partial breast-feeding and exclusive formula-feeding women did not differ on demographic variables or sleep outcomes, and these women were grouped together for subsequent analyses. In addition, 28% (n = 27) of the 95 women using breast milk reported giving it to their infant in a bottle at least once over the 3 nights, and bottle-feeding breast milk was more common (62%) in the partial breastfeeding group than in the EBF (14%) group (χ ²(1) = 23.2, p < 0.001). Because there were no significant differences on demographic variables or sleep outcomes between mothers giving breast milk from a bottle or from the breast, the EBF group included both types of breast milk feeding.

Sociodemographic Characteristics

provides sample characteristics for the 2 feeding groups. Participants ranged in age from 18 to 41, and the mean age of 26.5 years is similar to the mean age of 25 years among first-time mothers in the United States. On average, the EBF group was 3 years older than the formula group. The feeding groups also differed by race; two-thirds of the African American women and roughly half of women of Asian, Latina, or mixed/other race used formula at night, while nearly 80% of Caucasian women were exclusively breastfeeding at night. Most women in the sample (68%) indicated they were single or unmarried. Although there was no difference in marital status by feeding type, women in the EBF group were more likely to be in a relationship than women in the formula group. The sample was predominantly low-income. There were no group differences in income or education. About 21% of the EBF group worked for pay during the third trimester, but none of these women had returned to work by one month postpartum. These rates differed significantly from the formula group in which only 4 women (7%) worked during pregnancy and at one month postpartum.

Table 1

There was a significant difference in the prenatal intention to breastfeed between the 2 feeding groups. All 4 participants who stated no intention to breastfeed were African American women in the formula group. Of the 116 women who intended to breastfeed, the planned duration did not differ between the feeding groups. Women in the formula group were somewhat more likely than EBF women to report having help on all 3 nights of the monitoring period, although this difference did not reach statistical significance (p = 0.056). Intervention assignment in the larger clinical trial (sleep hygiene intervention vs. nutrition control) was unrelated to type of feeding or to maternal sleep outcomes at one month postpartum.

Sleep Outcomes

Comparisons of sleep outcomes by time and by type of feeding group are presented in . There were no differences between groups in the last month of pregnancy. At one month postpartum, TST-night was lower for both groups but decreased more in the formula group (62 min, 95% CI: 39, 85) than in the EBF group (21 min, 95% CI: 0.1, 42), resulting in a significant interaction between time and group (). In post hoc testing of the interaction, the feeding groups did not differ in late pregnancy, but at one month postpartum, EBF mothers obtained significantly more nocturnal sleep than formula feeding mothers. To ensure that these results were not unduly influenced by the grouping of exclusive and supplemental formula feeding mothers, separate post hoc tests were done to compare each formula group to the EBF group. Although the supplemental (356 ± 63 min) and exclusive (356 ± 73 min) formula groups obtained similar amounts of nocturnal sleep, only the supplemental group differed significantly from the EBF group ( t ₉₁ = 2.03, p = 0.045); the analysis of the exclusive formula group did not reach statistical significance ( t ₈₉ = 1.87, p = 0.064), likely due to the slightly smaller sample size and greater variance in this group. TST-day (actigraphy) did not differ by time or feeding group, and TST-24 patterns were similar to those observed for TST-night. However, the post hoc analysis comparing TST-24 for EBF and formula-feeding mothers was not statistically significant in the slightly smaller and more varied sample for the TST-24 analysis ( n = 113).

Table 2

The time spent awake after initially falling asleep (WASO) was also higher at one month postpartum compared to the third trimester, but did not differ by feeding group. Perception of sleep disturbance (GSDS score) differed significantly by time, as women in both feeding groups perceived more sleep disturbance at one month postpartum than the last month of pregnancy. The relationship between perceived sleep disturbance (GSDS scores) during the past week, and actigraphy WASO for 72 h was weak at the third trimester time point ( r = 0.12) as well as at one month postpartum ( r = 0.15).

To account for the potential effects of sociodemographic differences on the sleep outcomes, variables in Table 1 that differed between the groups were included as covariates in the RMANOVA. Due to the relatively small sample, each covariate was evaluated in a separate analysis. The significant time by group interactions for TST-night and TST-24 remained significant even when the following covariates were included in the models: maternal age, Caucasian race, relationship status, work status in pregnancy or postpartum, intention to breastfeed, or having help with infant care at night. Intervention assignment (sleep hygiene intervention vs. nutrition control) was also evaluated as a possible covariate, and its inclusion had no impact on the significant time by group interactions for TST-night and TST-24.

Inclusion of covariates did not change the results for TST-day or WASO. However, in analyses of perceived sleep disturbance, controlling for maternal age, partner status, or postpartum work status, resulted in a significant interaction for time by feeding group ( F 1,117 = 4.26, p = 0.041 with age, F 1,117 = 4.22, p = 0.042 with partner status, and F 1,117 = 4.69, p = 0.032 with postpartum work status). After controlling for maternal age, GSDS scores for the EBF group increased by an average of 2.4 points (from 46.8 ± 16.4 to 49.3 ± 15.6), indicating worse sleep postpartum, while the formula group increased by 9.1 points (from 42.5 ± 16.4 to 51.6 ± 15.6). Similarly, when controlling for partner status, GSDS scores for the EBF group increased by an average of 4.0 points (from 45.5 ± 16.1 to 49.5 ± 15.8), while the formula group increased by 10.6 points (from 40.2 ± 17.4 to 50.8 ± 17.1). Lastly, when accounting for the effect of postpartum work status, GSDS scores in the EBF group still increased by an estimated 3.2 points from pregnancy to postpartum (from 46.5 ± 16.1 to 49.7 ± 15.4), while the formula group increased an estimated 9.9 points (from 42.0 ± 16.7 to 51.9 ± 16.0).

1. Blackburn S. Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective. 2nd ed. Saunders; 2003. Postpartum period and lactation physiology; pp. 158-77. [ Google Scholar]

17. Livingston G, Cohn D. Social and Demographic Trends: The New Demography of American Motherhood. PewResearchCenter Publications. 2010 [ Google Scholar]

20. McDowell MM, Wang CY, Kennedy-Stephenson J. Breastfeeding in the United States: findings from the national health and nutrition examination surveys, 1999-2006. NCHS Data Brief. 2008:1-8. [[ PubMed] Google Scholar]

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Nighttime Breastfeeding Behavior Is Associated with More Nocturnal Sleep among First-Time Mothers at One Month Postpartum

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To describe sleep duration and quality in the first month postpartum and compare the sleep of women who exclusively breastfed at night to those who used formula.We conducted a longitudinal study in a predominantly low-income and ethnically diverse sample ...

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People show love and perceive love in different ways. Which do you prefer? How about your baby?

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Infant formula and responsive bottle feeding

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Infant formula and responsive bottle feeding

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This simple, concise guide provides parents who are bottle feeding with an overview on how to bottle feed responsively and, for parents who are formula feeding, how to choose an infant formula.

Bottle feeding as responsively as possible can help support the development of a close and loving parent-infant relationship. More tips on building a close and loving relationship with babies can be found in our Building a Happy Baby leaflet for parents.

UNICEF UK's Baby Friendly Initiative is firmly committed to the promotion, protection and support of breastfeeding. However, in the UK bottle feeding remains very common and so we also work to ensure the best outcomes possible for babies when they are not breastfed. When considering use of our materials outside of the UK, we suggest taking into account the country context and individual needs before deciding whether or not our materials are suitable for use.

Further reading

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Infant formula and responsive bottle feeding - Baby Friendly Initiative

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This guide provides an overview on how to bottle feed responsively and, for parents who are formula feeding, how to choose an infant formula.

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How to Hold a Newborn Baby - 5 Easy Baby Holds for New Parents | Adaptable Dad

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You won't need to bath your baby in the early days because you will probably be giving them a top and tail wash. But when you do start to bath your newborn baby, it can be a lovely experience although it may feel stressful at first. Some babies take to baths well and others don't seem to like them.

"Your little one may really enjoy their first bath. But don't worry if they don't like it straight away."

Most babies grow to enjoy bath time as they get more familiar with the experience.

You might find it helpful to watch this video from the NHS about how to bath your baby.

Safety tips for bath time

It's important to keep safety in mind at bath time. Babies and young children should never be left unattended in a bath, not even for a second (NHS, 2021). Here are some bath time tips:

Get everything ready ahead of your baby's bath, so you have everything you need to hand.

Make sure you always use the hot and cold taps at the same time when you run the bath.

Check the bath water temperature first before putting your baby in. The standard way to check is to put your elbow in the water because your hand can cope with high temperatures. The water should feel neither warmer or colder than your elbow.

Don't be distracted away by another child, a phone call or doorbell. What feels like a couple of seconds can turn into a minute or two. Leaving your little one even for a few moments could be enough time for them to seriously hurt themselves or drown.

If you forget anything - ask your partner or another family member to grab it for you. Or take your baby with you to get what you need. (NHS, 2021)

"Never leave your baby alone in the bath, not even for a second (NHS, 2021)."

When should I give my baby a bath?

There is no set age when you should give your baby a bath. Babies get cold quickly, and that's more risky for them than being a bit dirty.

If you're anxious about bathing your little one, you don't need to put them into a bath until you feel confident about it.

You may prefer to just wash your little one's face and bottom to begin with. This is sometimes called 'topping and tailing'.

If you're feeling confident about bathing your baby you can do so when you wish.

Choose a bath time when your little one is content and awake. It's better not to bathe your baby straight after a feed or when they're hungry or tired.

Some babies love bath time to begin with, others don't. You may need to try different ways of bathing your baby and at different times of day, to find out what suits you both. Choose a time of day when your baby is happy and awake (NHS, 2021).

How often can I give my baby a bath?

Your little one won't need a bath every day but if they enjoy it, there's no reason why you can't.

If you'd prefer to top and tail your newborn, you can do this every day or every few days or as needed.

Every baby is different - you will soon find out what works best for you and your little one.

How do I wash my baby?

If you want to top and tail your newborn, you can do this by washing them using cotton wool or a soft cloth and bowls of warm water. Warm tap water is probably fine but if you want to be particularly careful, use cooled boiled water to reduce the chance of infections in the first week or until your baby's cord drops off.

You can wash your newborn in a small baby bath.

If you'd prefer to share a bath with your little one, see below for more details.

It can help to have an extra pair of hands at bath time, if available, until you feel confident about bathing your baby on your own.

You don't need any special products to bathe your baby; only mild, non-perfumed soap can be used where needed. Plain water is best for your baby's skin during in the first month (NHS, 2021).

To find out more about caring for your newborn baby's umbilical cord, see our article on topping and tailing.

Can I take a bath with my baby?

Babies love to lie on a parent's chest in the bath.

Having a bath with your baby can help you both relax and encourage breastfeeding.

Remember, your baby might have a wee or poo while in the bath with you!

Baths are slippery, so it's not a good idea to get into or out of a bath carrying your baby. It's better to bath with your baby when there's someone else to hand them to you and take them from you. This could be your partner, your parent or a friend.

Tips for co-bathing

Get yourself settled and relaxed in the bath. Check the temperature is not too hot with your elbow.

Ask your partner, parent or friend to pass you your baby and lay them on your legs facing you.

Now you can lower as much of them into the water as you and they want by straightening your legs.

You might want to chat or sing to your baby to help soothe them.

Remember that your baby will get cold more quickly than you.

When you want to get out, make sure you pass your baby back to your helper before getting out yourself.

As your little one gets more used to bath time and you become more confident handling them, bathing with your baby becomes lots more fun.
This page was last reviewed in November 2021.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

NHS Choices Birth to Five section.

Public Health England (PHE) provides guidelines about bathing children under two safely.

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Bathing your baby | Baby & toddler articles & support | NCT

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We discuss when to give your baby a bath, ways you can wash your little one and tips to help keep them safe at bath time.

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Everything You Need to Know to Wear Your Baby Safely & In Style

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Lots of baby-wearing reduces the time the baby spends lying on his or her back.

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Flat head syndrome is the name given to the condition when part of a baby's head becomes flattened due to continued pressure on one spot. There are two types of flat head syndromes in babies.

Plagiocephaly - This is a flattening on one side of a baby's head. Its most common form is 'positional plagiocephaly', which happens when a baby's head develops a flat area due to continued pressure on one side of their head. Babies are most vulnerable because their skull is soft and pliable when they're born.

Brachycephaly - This refers to the condition where a baby's head is disproportionately wide compared to its depth. It can happen when babies lie for long periods on their backs. This causes the whole of the back of their head to flatten, resulting in a much wider and shorter head. Brachycephaly is less common.

"Surveys show the proportion of babies affected by positional plagiocephaly ranges from 16% at six weeks, 20% at four months7% at 12 months to 3% at 24 months".

Why are some babies affected?

Babies' skulls are made up of several plates of bone which are loosely held together. As they grow older the bones will gradually join. However, during birth and for the first few months their skulls are very soft and their shape can be changed by gentle pressure. In some babies continued pressure on one area of the skull may lead to some form of flat head syndrome.

Symptoms

Flat area on back or one side of the head.

Bulging on one side of the head.

One ear more forward than the other.

Unbalanced look to the face.

Possible causes

It is thought that there has been an increase in babies with flat head syndrome following the successful 'Back to sleep' campaign, which advises laying babies on their backs to sleep. Research studies do not bear this out but there is certainly more awareness of the condition.

The number of babies who have died due to Sudden Infant Death Syndrome(SIDS) has halved as a result of this campaign. However, laying babies on their back to sleep, combined with the use of baby equipment which has babies leaning back onto their heads for periods of time, such as car seats and bouncers, can lead to babies spending more time on their backs than ever before. It must be stressed that the benefits of laying your baby on his back to sleep far outweigh the risks of flat head syndrome (see articles on ' Your baby's sleep').

"Babies who have their head turned one way most of the time, perhaps because of an uncomfortable neck are more likely to develop a flattened head".

Other possible causes could include:

Sometimes a baby's skull may be moulded whilst in the womb. There may not be enough amniotic fluid to cushion the baby, which means his head can become temporarily deformed as he travels down the birth canal. Also, this can happen as part of a multiple birth as the babies become squashed within the womb. This sort of moulding tends to correct itself without treatment.

Premature babies are more likely to have an unusual head shape at first because their skulls are less developed.

Muscular problems - sometimes a baby will have tightened muscles in their neck (torticollis), which prevents them from turning their head one way and means they will always rest their head on the other side, causing this to flatten.

Craniosynostosis - rarely a flattened skull can come about by the bone plates within the baby's skull joining together too soon. This can pull the baby's head out of shape and will need to be corrected with surgery, so its worth checking with your GP if you are concerned about the shape of your baby's head.

Are some babies more at risk than others?

This condition shows up most often in babies who:

have unusually large heads

are premature, twins or multiple births

have had an assisted birth (forceps or ventouse)

have limited ability to turn their head or torticollis (tight or shortened muscle on one side of the neck, causing the chin to tilt to the other side).

There are other factors which are open to change including:

Caring for the baby on one side all the time

Not enough 'tummy time' or carrying where there is no pressure on the head

Baby's preference for turning their head to one side.

What can be done to help?

Doctors recommend that your baby is not left on his back for too long or too often, as this can create pressure on the same areas of his head.

Suggestions for reducing pressure on your baby's head

When asleep:

Always put your baby on his back to sleep. If he's in a cot alternate different ends of the cot to encourage him to sleep on a different side of his head each night or turn the cot around if its against the wall.

Move the light in the room as babies tend to follow the source of light.

Change the position of his head away from the flattened side when he is sleeping.

When playing:

Put your baby down while he is awake, on his front, on a firm, flat surface. This will also help with his development and co-ordination, strengthening his neck and trunk muscles.

Alternate the side you hold him when feeding and carrying.

When travelling:

Reduce the time spent with his head on a firm flat surface, such as car seats and buggies.

Rather than walk with him in his car seat, take him out and put him in a sling or front carrier.

Treatment

In most babies, the shape of the head will correct itself by their first birthday. Mild flattening of the skull will normally correct itself by the end of the first year or possibly two. However, this can be helped with a few simple measures to remove pressure on the affected area of the skull. These measures could include:

Changing the position of your baby's head throughout the day so that the rounded side of his head is placed against the mattress, repositioning cribs and other areas that he spends time in so that he will have to look in a different direction to see you or others in the room.

If your baby appears to have discomfort or cries when they are repositioned, they may have a problem with their neck which you can discuss with your health visitor or GP.

For babies older than about five months, some people recommend the use of 'helmets' or 'headbands', known as cranial orthoses to encourage the bones to mould into a more rounded shape. This is somewhat controversial as it is unclear how important head shape is and most babies' heads would revert to a more rounded shape naturally. These custom-made devices are designed to be used for babies between six and 12 months (during the period of greatest skull growth), to apply pressure to 'bulgy' parts of the skull and relieve pressure from other parts. Medical opinion is divided, about the effectiveness of such helmets or whether they are even necessary, believing that the condition generally corrects itself in time.

The Canadian Paediatric Society found that using a specially fitted helmet to reduce the skull flattening 'has some drawbacks: it is expensive, significantly inconvenient due to the long hours of use per day and associated with skin complications. There is evidence that helmet therapy may increase the initial rate of improvement of asymmetry, but there is no evidence that it improves the final outcome for babies with moderate or severe plagiocephaly.'

The reality

It's normal for a baby's head to be slightly misshapen when they're born, usually as a result of its passage down the birth canal. However, if after a few weeks it does not appear to have improved and/or you notice a flat spot or flattening area on your baby's head then do take him to see your GP.

A baby's skull toughens as they grow, so the sooner the condition can be dealt with the more successful the treatment is likely to be. Most conditions will improve over time. Whilst the more severe cases of head flattening may also improve, some flattening will remain. However, in most cases, once baby's hair begins to grow it won't be noticeable anyway.
This page was last reviewed in March 2018.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

NCT position statement on Plagiocephaly.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby. Link to website branch info
NHS Choices has information on plagiocephaly and brachycephaly.

Headstart4babies belives the use of helmets is useful in treating this condition and provides information to that effect.

The Canadian Paediatric Society Practice as information on Positional plagiocephaly and research on the use of helmets.

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What is flat head syndrome (plagiocephaly or brachycephaly)?

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Flat head syndrome is the name given to the condition when part of a baby's head becomes flattened due to continued pressure on one spot. There are two types of flat head syndromes in babies. Plagiocephaly - This is a flattening on one side of a baby's head.

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On this site...the menu is at the bottom of the page.

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Parenting Science - The science of child-rearing and child development

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The science of parenting and child development. Fully-referenced evidence-based articles about the anthropology, psychology, biology, and neuroscience of raising kids.

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The health effects of sensitive, responsive parenting

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The health effects of sensitive, responsive parenting

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© 2011-2016 Gwen Dewar, Ph.D., all rights reserved

What is sensitive, responsive parenting? It's really pretty simple.

First, you tune into your child's emotions, concerns, and needs.

That's the sensitive part.

Then you provide your child with the appropriate level of support and reassurance.

Simple, and very powerful.

For years, researchers have noticed that that sensitive, responsive parenting is linked with better cognitive outcomes for children. For example, infants learn language more rapidly when caregivers respond promptly and contingently to what babies do (Tamis-Lamonda et al 2014).

And young children develop better problem-solving ability, attention skills, and school readiness when their parents are sensitive and responsive (Landry et al 2003; Landry et al 2006; Yousafzai et al 2016).

But there may be important health benefits, too. Research suggests that sensitive, responsive parenting can protect children from chronic disease, premature aging, and toxic stress.

Take, for example, kids living in neighborhoods blighted by poverty and crime.

These kids experience atypical fluctuations of the stress hormone cortisol, putting them at increased risk for a variety of metabolic conditions, including obesity, cardiovascular disease, and diabetes. Elevated cortisol levels may also "turn on" genes that cause inflammation.

When University of British Columbia psychologists Gregory Miller and Edith Chen tested adolescents for biochemical markers of inflammation, they found that kids of lower socioeconomic status were more likely to develop a "pro-inflammatory phenotype."

Having such a phenotype increases your risk of developing inflammatory diseases like atherosclerosis, autoimmune disorders, and cancer (Miller and Chen 2007).
Can parents protect kids from the physiological effects of stress?
The idea fits with our everyday observations. Sensitive, responsive parents make children feel safe. They make kids less suspicious of other people, and therefore more relaxed. Secure, relaxed children experience fewer spikes of cortisol, and when they do get stressed, they recover more quickly.

In addition, by teaching their kids how to regulate their own emotions, parents help children develop effective self-soothing mechanisms. Kids learn how to cope, even when their caregivers aren't around. Together, these factors should help protect kids from the physiological wear-and-tear caused by chronic stressors (Repetti et al 2002; Chen et al 2011).

So Chen and Miller sought to test the idea by inquiring into the early life experiences of people who grew up poor.

In one study, they asked 53 healthy young adults about their family relationships. Study volunteers who reported feelings of greater warmth toward their mothers showed fewer signs of systemic inflammation (Chen et al 2011).

In another study, the researchers explored the effects of parental warmth and sensitivity on the development of metabolic syndrome, a cluster of medical conditions that includes central obesity, high blood pressure, and insulin resistance. The researchers asked over 1200 middle-aged Americans questions about their parents. Questions like:

How much did your parent understand your problems and worries?

How much time and attention did s/he give you when you needed it?

Then the researchers examined participants for symptoms of metabolic syndrome.

As expected, people who grew up in low socioeconomic status (SES) households were more likely to have these symptoms. But about 45% of the people with low SES childhoods were symptom-free. And these symptomless people were more likely to have had nurturing mothers.
Among kids with the most nurturing mothers, there was no correlation between SES and poor health status.
To put this in perspective, the researchers also tested the effects of being upwardly mobile. If you were born relatively poor, but achieved higher SES as an adult, did you enjoy better health?

Surprisingly, the answer was no. Not when it came to symptoms of metabolic syndrome. The researchers couldn't detect any difference between people who stayed poor and people who moved up the socioeconomic ladder.

Is this proof that sensitive, responsive parenting has a lasting impact on health?

No. These studies don't control for genetic factors. Perhaps nurturing parents are more likely to carry genes that confer better health.

Perhaps, too, the results are skewed by the participants' inaccurate reports of their parents' behavior.

And what about fathers? Miller and his colleagues didn't find evidence of any effect for nurturing dads. Just moms. Is that because the fathers in this study were less involved with childcare? Future studies are needed to rule out alternative explanations.

But in the meantime, there is other evidence to consider. For instance, experiments on nonhuman animals suggest that family interactions have a profound impact on health.

When researchers have cross-fostered rat pups -- assigned them to be raised by adoptive mothers -- they have found strong evidence for the power of affectionate care. Rats raised by highly responsive mothers show less stress reactivity as adults (Francis et al 1999; Meaney 2001).

And in experiments on zebra finches, investigators found that a bird's lifespan depended on the temperament of its companions. Anxious, easily "stressed out" finches lived longer when they when they were paired with calmer, more resilient companions (Pat Monaghan et al 2012).

There are also intriguing observational studies tracking human children over the short-term.

For example, an fMRI study suggests that sensitive, responsive parents can protect kids from the brain-shrinking effects of toxic stress (Luby et al 2013).

In addition, research on babies exposed to prenatal stress found that 7-month-old infants showed signs of better emotional regulation if their mothers had exposed them to lots of physical affection (Sharp et al 2012).

Follow-up studies confirm the effect lasts into the toddler years, and researchers have connected the phenomenon to epigenetics, or long-term alterations of DNA function (Sharp et al 2015; Pickles et al 2016).

Early life stress can silence genes that help regulate an individual's stress response system. But tactile affection seems to reverse the process (Murgatroyd et al 2016).

If true, scientists may have uncovered a key mechanism for parental responsiveness and affection to impact health. But regardless of the mechanisms, researchers are amassing an increasingly impressive case for the health benefits of responsive, sensitive parenting.

For more information about parental warmth and child outcomes, see my article about the effects of sensitive, responsive parenting.

To read more about reasoning with children, see my article on the authoritative parenting style. And for practical parenting tips, see this guide to positive parenting.

References: Health benefits of sensitive, responsive parenting

Chen E, Miller GE, and Parker KJ. 2011. Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a model of behavioral and biological mechanisms. Psychol Bull. 2011 Jul 25. [Epub ahead of print]

Chen E, Miller GE, Kobor MS, Cole SW. 2011. Maternal warmth buffers the effects of low early-life socioeconomic status on pro-inflammatory signaling in adulthood. Mol Psychiatry. 16(7):729-37.

Francis D, Diorio J, Liu D, Meaney MJ. 1999. Nongenomic transmission across generations of maternal behavior and stress responses in the rat. Science. 286(5442):1155-8.

Landry SH, Smith KE, and Swank PR. 2003. The importance of parenting during early childhood for school-age development. Dev Neuropsychol. 24(2-3):559-91.

Landry SH, Smith KE, Swank PR. 2006. Responsive parenting: establishing early foundations for social, communication, and independent problem-solving skills. Dev Psychol. 42(4):627-42.

Luby J, Belden A, Botteron K, Marrus N, Harms MP, Babb C, Nishino T, Barch D. 2013. The effects of poverty on childhood brain development: the mediating effect of caregiving and stressful life events. JAMA Pediatr. 167(12):1135-42.

Meaney MJ. 2001. Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations. Annu Rev Neurosci. 24:1161-92.

Miller G and Chen E. 2007. Unfavorable socioeconomic conditions in early life presage expression of proinflammatory phenotype in adolescence. Psychosom Med. 69(5):402-9.

Miller GE, Lachman ME, Chen E, Gruenevald TL, Karlamangla AS, and Seeman TE. 2011. Pathways to resilience: Maternal nurturance as a buffer against the effects of childhood poverty on metabolic syndrome at midlife. Psychological Science.

Monaghan P, Heidinger BJ, D'Alba L, Evans NP, and Spencer KA. 2012. For better or worse: reduced adult lifespan following early-life stress is transmitted to breeding partners. Proc Biol Sci. 279(1729):709-14.

Murgatroyd C, Quinn JP, Sharp HM, Pickles A, Hill J. Effects of prenatal and postnatal depression, and maternal stroking, at the glucocorticoid receptor gene. Transl Psychiatry. 5:e560.

Pickles A, Sharp H, Hellier J, Hill J. 2016. Prenatal anxiety, maternal stroking in infancy, and symptoms of emotional and behavioral disorders at 3.5 years. Eur Child Adolesc Psychiatry. 2016 Jul 27. [Epub ahead of print].

Repetti RL, Taylor SE and Seeman TE. 2002 Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin 128: 330-366.

Sharp H, Hill J, Hellier J, Pickles A. 2015. Maternal antenatal anxiety, postnatal stroking and emotional problems in children: outcomes predicted from pre- and postnatal programming hypotheses. Psychol Med. 45(2):269-83.

Sharp H, Pickles A, Meaney M, Marshall K, Tibu F, Hill J. 2012. Frequency of infant stroking reported by mothers moderates the effect of prenatal depression on infant behavioural and physiological outcomes. PLoS One. 7(10):e45446.

Tamis-LaMonda CS, Kurchirko Y, and Song L. 2014. Why is infant language learning facilitated by parental responsiveness? Current Directions in Psychological Science23(2): 121-12.

Yousafzai AK, Obradović J, Rasheed MA, Rizvi A, Portilla XA, Tirado-Strayer N, Siyal S3, Memon U. 2016. Effects of responsive stimulation and nutrition interventions on children's development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial. Lancet Glob Health. 4(8):e548-58.

Content of "The health benefits of sensitive, responsive parenting" last modified 8/16

Title image by Yogendra Joshi / flickr

Image of mother with blond toddler by semacc / istock

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Sensitive, responsive parenting: What are the health benefits?

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© 2011-2016 Gwen Dewar, Ph.D., all rights reserved What is sensitive, responsive parenting? It's really pretty simple. First, you tune into your child's emotions, concerns, and needs. That's the sensitive part. Then you provide your child with the appropriate level of support and reassurance. Simple, and very powerful.

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S U P P O R T I N G C L O S E A N D L O V I N G R E L A T I O N S H I P S

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Combination or mixed feeding is when you offer your baby bottles of expressed breast milk or formula alongside breastfeeding.