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Information on how to tell if you baby is getting enough breast or formula milk.

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Breastfeeding: how much milk does a baby need?

Breastfeeding is a skill that mother and baby learn together. It is normal for it to take some practice and for it to take a while for mothers to feel confident that babies are getting the milk they need (NHS, 2018a).

In the meantime, it can be reassuring to know that a breastfed baby who is fed on demand won't overfeed (NHS, 2020). And although you can't measure how much they are drinking, they will stop drinking when they've had enough, and feed again if they want to stimulate your supply (NHS, 2020).

Watch our video about how to know if you're feeding your baby in the right way.

You'll also be able tell if they're feeding well by checking the following...

Their poo

The first type of poo your baby will produce is called meconium. It is produced from birth for the first 2-3 days, and is sticky and green/black in colour. From day four you can expect breastfed baby poo to be soft and a yellow, mustard colour. Babies who are formula feeding might have more solid poo than those who breastfeed (NHS, 2018b). Babies do an average of four poos a day for the first week.

Their wet nappies

In their first 48 hours, most babies will only have two or three wet nappies.

If you have had IV fluids during labour or if your baby was born by caesarean, this will cause extra fluids in both you and your baby, so your baby will wee more in the first 24 hours (Noel-Weiss, 2011).

But from day five, you should get at least five or six heavy, wet nappies every 24 hours. Their wee should be pale and not dark brown (UNICEF and Start4Life, 2010; UNICEF UK Baby Friendly Initiative, 2010; NHS, 2018a).

Their behaviour

If your baby has a full tummy, they should seem healthy and alert when they're awake. They will also seem calm and relaxed while they're breastfeeding (UNICEF UK Baby Friendly Initiative, 2010; NHS, 2018a).

Weight gain

It's normal for babies to lose some weight during the first few days of life: 5-7% weight loss is considered normal. If baby loses 10% or more then this is an indicator they aren't getting enough milk. This weight loss usually stops after about 3-4 days. For most babies their weight has returned to what it was at birth by the time they are three weeks old (NICE, 2017). After that, they should be growing and putting on weight steadily (NHS, 2018a).

They will be weighed regularly (approximately once a month in the first six months) and their weight recorded in their personal child health record (PCHR) or red book (NHS, 2020).

Formula feeding or expressed milk: how much milk does a baby need?

If you're offering your baby milk from a bottle, whether formula or expressed milk, it is recommended to respond to your baby's signals about when they're hungry/thirsty and when they've had enough milk, unless there is a concern and your midwife or doctor has suggested otherwise (UNICEF, 2019).

Formula packaging suggests how much milk to offer, but use this as a rough guide while you're getting to know your baby because all babies are different.

Research into responsive or 'paced' bottle feeding suggests it can help reduce the risk of obesity. When your baby has had all the milk they want, remember to throw away any milk left in the bottle. Milk left in the bottle could become a source of infection. See more suggestions about how to bottle-feed responsively. (UNICEF, 2019).

How can I tell if breastfeeding is going well?

The following are seen as signs that breastfeeding is going well:

Your baby is well-attached if:

they have a wide mouth

they have a big mouthful of breast

their chin is touching your breast

their lower lip is rolled down (although you might not see this)

their nose is not usually squashed against your breast (unless the mother has quite large breasts)

your breasts or nipples are not painful when your baby's feeding, although their first few sucks might feel strong

more of the dark skin around your nipple (areola) is visible above your baby's lips than below them.

(UNICEF UK Baby Friendly Initiative, 2010; NICE, 2015; NHS, 2018a )

Your baby is getting enough milk if:

their feeding starts with a few quick sucks and after that their sucks and swallows are longer and rhythmical, with a few pauses

you see them swallow and you may hear them swallowing by around day three to four

their cheeks are rounded when they suck, rather than hollow

they're calm and relaxed when they're feeding

they finish a feed, either by coming off the breast or falling asleep after an active feed

they've got a moist mouth after they've fed

they look content and satisfied after most feeds

your breasts become softer after feeds

your nipple looks about the same after your baby's feeds, rather than white, flattened or pinched

you may feel relaxed and sleepy after you've breastfed.

(NICE, 2015; NHS, 2016)

How do I know that my baby is thriving?

How a baby looks and their behaviour are useful guides to whether they are 'thriving'. A thriving baby:

has a good skin colour

is alert when they're awake

asks for feeds

is usually satisfied after feeds.

(UNICEF UK Baby Friendly Initiative, 2010)

What should I do if I don't think I have enough milk?

Breastmilk is made on a supply and demand basis; the more milk your baby takes from your breast, the more milk you make. But the baby must be well latched on to do this. You can increase your milk supply by: (NHS 2018a)

Feed your baby as often and as long as your baby wants

Feed from both breasts at each feed

Keep your baby close and give lots of skin-to-skin, particularly in the early weeks, to maximise opportunities to breastfeed

Avoid giving your baby infant formula

Avoid dummies until your baby has learnt how to breastfeed well

If you're worried your baby isn't getting enough milk, speak to your health visitor, midwife or a breastfeeding counsellor. They can check how the baby is latched and may suggest changes you can make to help your baby get a deeper latch. Your health visitor or midwife can also rule out any underlying health problems or may refer you for a tongue tie assessment (NICE, 2015).

If you need breastfeeding support you can visit a local breastfeeding support group (some support groups are available online). In some situations it may be possible to have a home visit.

You can also speak to an NCT breastfeeding counsellor on our helpline (0300 330 0700) which is open every day, 8am to midnight. You could take a look at our article about breastfeeding support page to find out more.

Further information

NCT supports all parents, however they feed their baby. 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.

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Is my baby getting enough milk from breastfeeding or formula? | Baby & toddler, Feeding articles & support | NCT

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It's one of the most common worries in new parents: how do you know if your baby is well fed? Here are your questions answered.

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Your baby will be weighed at birth and at particular stages during their first weeks and months (NHS Choices, 2017a). This is because weight gain can be an important indicator of how healthy and well they are.

Your baby will be weighed in the first two weeks to make sure they are regaining their birth weight.

After the first two weeks, your baby should be weighed:

once a month up to six months old

every two months from six to 12 months old

every three months over the age of one.

(NHS Choices, 2017a)

Your baby will usually only be weighed more often if you ask for it or if health professionals are concerned about their health or growth.

Baby weight gain

What to expect

In the first few days after birth, your baby will probably lose a little weight as they get rid of urine and meconium (NHS Choices, 2017a). Most babies have returned to their birth weight by three weeks old (NICE, 2017).

Babies shouldn't lose more than 10% of their weight from when they were born (NICE, 2017). If your baby loses more than this or has not returned to it by three weeks old, a health professional will assess them (NICE, 2017).

Assessment

An assessment will look for signs of illness, like dehydration. The health professional will ask for details about how your baby has been feeding. The health professional might also ask to look at your baby having a feed. That can help them give you some support with feeding (NICE, 2017).

You can also ask your midwife, health visitor or breastfeeding counsellor to observe you feeding your baby. They can check your positioning and whether your baby is taking in milk effectively (NHS Choices, 2017a). They can also help to see whether your baby is attached well at your breast and they can spot a tongue tie (NHS Choices, 2017a).

If health professionals are concerned about your baby's weight loss, they will continue to support you. Your baby should be reweighed at suitable intervals depending on the level of concern. Your baby might then be referred to paediatric services if they are showing signs of illness, obvious weight loss or if they're not responding to feeding support.

What can I do if my baby is not gaining weight?

If your baby hasn't regained their birth weight and you're breastfeeding, you might need to offer them more breastfeeds. It can take time to get the hang of breastfeeding but there is plenty of support available.

Find out from your local NCT branch what breastfeeding support services are available in your area. An NCT breastfeeding counsellor might be available locally to visit you at home. You can ask a breastfeeding counsellor about how to increase your baby's breastmilk intake.

You might have a local drop-in breastfeeding support session too, where you can meet other mums and their babies. Peer support like this can be really beneficial.

How is my baby's weight recorded?

After your baby is two weeks old, they will have their weight recorded on a centile chart in their red book (Royal College of Paediatrics and Child Health, 2016). Centile charts track average weight and height gain for all babies whether they are fed breast or formula milk.

A baby on the 25th centile is heavier than 24% of babies the same age, and lighter than 74% of babies the same age. Most babies roughly follow the same line of growth on the chart as they get older, while others veer away from the line or find a 'new' line (NHS Choices, 2017a).

Causes for concern

There might be concern about your baby's growth if:

there is a fall across one or more weight centile spaces, if their birth weight was below the ninth centile

there is a fall across two or more weight centile spaces, if their birth weight was between the ninth and 91st centiles

there is a fall across three or more weight centile spaces, if their birth weight was above the 91st centile

their current weight is below the second centile for age, whatever their birth weight.

If there is concern about your baby's growth, a health professional might:

perform a clinical, developmental and social assessment

take a detailed feeding or eating history

observe feeding or meal times

check for urinary tract infections and coeliac disease, if the diet has included gluten-containing foods

perform further investigations as needed based on the clinical assessment.

When your baby is weighed, you'll be keen to make sure it's done accurately. Your baby should be naked each time. Check the weight reading yourself and how it's written in your records as mistakes can happen.

What if my baby's weight gain is slower than expected?

Most babies who gain weight more slowly than expected are healthy with no underlying illness or difficulty. They might just be naturally slow at gaining weight (NHS Choices, 2017a).

You and your health visitor can discuss your baby's weight. If there is concern but no urgent medical recommendations, the first step is to try to increase your baby's intake of milk. You can:

Try breastfeeding more often, day and night.

Offer at least both breasts at each feed. Try 'switch nursing', which is when you try to use each breast several times at each feed.

Try breast compression.

Keeping your baby close to you, skin-to-skin when possible as this usually helps your baby to feed more often. This might be something you can try intensively over a period of a few days, it's sometimes called a 'babymoon'.

(NHS Choices, 2016a)

What about giving my baby expressed breastmilk?

Expressing and offering expressed breastmilk in addition to direct breastfeeds is another possibility. If your baby is feeding well from the breast, extra direct breastfeeds are an easier option. The more your baby feeds at the breast, the more milk your body will produce.

What about donor milk?

Donor milk is breastmilk from other mothers. It might be available from a hospital-based milk bank. But mostly, milk banks give milk to vulnerable, pre-term or sick babies who are still under hospital care. Donor milk is also available through private milk donation schemes.

What is a supplemental nursing system?

Some women whose baby has problems breastfeeding use a supplementary nursing system (SNS). This device allows a baby to receive extra milk at the breast, rather than top-ups by bottle.

It is a container of milk connected to a feeding tube at the breast. The baby breastfeeds as well as receiving extra milk from the supplementary nursing system. You can use expressed breastmilk, donor milk or formula-milk in this system.

Does my baby need formula?

Using formula might be medically necessary to help your baby grow if their weight is still a concern. This might be the case if extra breastfeeds are not making enough difference or you can't get donor milk (NHS Choices, 2017b).

Feeding your baby with formula milk does not mean you have to stop breastfeeding if you don't want to - you can do both. It also doesn't mean the benefits of breastfeeding are wiped out (NHS Choices, 2017b).

If you still want to breastfeed, you can limit the amount of formula and you may be able to drop it once your baby's weight is ok, if that's what you prefer. Talk about this with a breastfeeding counsellor or a healthcare professional.

Should my baby have solid food?

Babies under six months don't generally benefit from food other than breastmilk or formula milk. Solids might not increase a baby's calorie intake and may even mean a baby takes less milk than before. So it may be an ineffective way to address low weight (NHS Choices, 2015).

This is something you can discuss with your health visitor or GP (NHS Choices, 2015).

Most babies who are slow to gain weight eventually catch up and most are healthy with no underlying illness or difficulties. Weight is only one aspect of your baby's health and development (NHS Choices, 2017a). Trust your instincts and contact your GP if you are concerned about your baby, especially if you think they might be dehydrated, which can be serious for young babies.

Further information

NCT supports all parents, however they feed their baby. 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.

Read our list of breastfeeding support contacts to help you get support if you need it.

Find out from your local NCT branch what breastfeeding support services are available locally.

If you have serious concerns about your baby or are worried they are getting dehydrated contact your GP or 111.

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My baby is not gaining weight | Baby & toddler, Feeding articles & support | NCT

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Your baby will be weighed at birth and at particular stages during their first weeks and months (NHS Choices, 2017a). This is because weight gain can be an important indicator of how healthy and well they are. Your baby will be weighed in the first two weeks to make sure they are regaining their birth weight.

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How skin to skin can help get breastfeeding to a good start.

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Skin-to-skin contact and breastfeeding right after birth

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You’ve just given birth for the first time and now for another new thing – breastfeeding. So how exactly do you do it? Here’s our guide to getting started.

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Caroline Warren
+447590609657
carolinewarren81@gmail.com

Send a message or email to arrange a callback.  I might not be available right away, please call the infant feeding line (see below) if you need support urgently.

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Information on common causes of nipple pain and how to treat.

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Sore nipples when breastfeeding | Baby & toddler, Feeding articles & support | NCT

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Sore nipples can be a problem in the early days of breastfeeding and beyond. This article discusses causes of sore nipples and how to ease the pain.

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

Most mothers experience some engorgement in the first weeks after birth. With changing hormone levels, your breasts swell and enlarge as milk production increases. It may seem as though they are filling up with milk, but engorgement is more than milk storage. Your body directs extra blood and fluids to your breasts to boost milk production. This causes congestion and swelling which will decrease as your body adjusts.

Minimizing early engorgement
Treat engorgement to...
When to treat engorgement
After the first few weeks
Causes of engorgement
Treating engorgment
Be sure your baby is sucking effectively
Reverse pressure softening
Keep comfortable
Watch out for signs of mastitis

Minimizing early engorgement

New mothers vary in how engorged their breasts become in the weeks after birth; some experience little engorgement, others describe their breasts as feeling like watermelons!

Try these suggestions

Breastfeed your baby frequently from birth: at least 8-12 times in 24 hours. Keeping your baby close makes it easier to nurse every hour or two.

If your baby is sleepy, perhaps from a medicated birth, you may need to wake him and encourage him to nurse.

Aim to be comfortable while breastfeeding, and learn how to get your baby latched on well.

If your newborn is unable to breastfeed, electric hand express frequently until your milk 'comes in', then combine with using a hospital-grade help establish your milk production and relieve engorgement. Your milk breastpump to can be given to your baby until he is able to nurse.

Treat engorgement to...

Make breastfeeding easier
Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well. A poor latch-on can give you sore nipples. Your baby may also have trouble coping with the flow of milk from engorged breasts.

Protect milk production
When milk isn't removed from your breasts, you will produce less milk. Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older.

Avoid blocked ducts or mastitis
Engorgement can result in blocked ducts leading to mastitis.

When to treat

Take action to relieve engorgement if your breasts feel firm, hard, shiny or lumpy. When milk is removed, blood circulation improves and swelling reduces. Use the suggestions below to reduce swelling and keep your milk flowing. Many mothers have a slight temperature when their breasts are engorged. Temperatures under 38.4ºC are not usually associated with infection. Keep your baby close and continue breastfeeding.

Engorgement after the first weeks

Treat as outlined below while working out the cause so you can prevent it happening again.

Common causes of engorgement are:

A missed feed or expressing session.
This can easily happen during holidays and festivities or when visitors arrive. Encourage your baby to feed more often, or express more frequently if you're apart from your baby.

Feeding a baby on a schedule
Recent research has revealed that mothers vary in how much milk their breasts can store without becoming uncomfortable. Mothers following routines often suffer from engorgement, mastitis and low milk production because their breasts are not drained often enough.

Expressing milk.
Some books advise expressing to keep milk production one step ahead of a baby's needs. However, making more milk than your baby needs can increase your risk of engorgement and mastitis, especially if you go for several hours without feeding or expressing.

A baby who is unable or unwilling to nurse well for any reason
Expressing milk frequently until your baby can nurse well will help you maintain milk production and avoid blocked ducts or mastitis.

Weaning from the breast too quickly
If you experience engorgement duringweaning, you may need to slow down the process. This will give your breasts time to adjust to the reduced demand for milk. If breastfeeding more often is not an option, try expressing just enough milk to relieve the fullness by hand or pump.

Treating engorgement
Reduce swelling and keep milk flowing:

Aim to breastfeed every 1½ to 2 hours during the day, and at night every 2-3 hours from the start of one feed to the start of the next. Let your baby finish on the first breast before switching to the second

Avoid using bottles or dummies. If a supplement is needed try using a spoon, flexible feeding cup or syringe.

Between feeds, apply ice for 15-20 minutes at a time between feeds to reduce swelling. Use an ice pack, crushed ice in plastic bags or bags of frozen vegetables (that can be refrozen several times before being thrown away). Wrap them in a lightweight towel to protect your skin.

Just before feeding, apply moist warmth to your breasts for up to two minutes to help milk flow. Try a warm wet towel, warm shower or immersing breasts in a bowl of warm water. Then, express to comfort if your baby isn't ready to feed.

Use gentle massage from the chest wall toward thenipple area in a circular motion.

Be sure your baby is sucking effectively:

Position your baby with his chest and tummy in full contact with your body. With his cheek in close contact with your breast, your baby can easily tip back his head to latch on. This way he'll take a large mouthful of breast. Listen for swallowing as he feeds.

If your baby is finding it hard to latch on - when your baby bobs his head and licks the nipple, he naturally makes it easier to latch on.

For more information on getting your baby positioned and attached comfortably see here.

Reverse pressure softening

works by moving fluid away from the nipple area.

Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola.

You can also press with the sides of fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be.

If this isn't enough, gently hand express a little milk before feeding to soften the areola. If you choose to use a breastpump, set it to minimum suction.

Keep comfortable:

Ask your midwife or GP to recommend an over-the-counter, anti-inflammatory medication suitable for breastfeeding mothers to relieve pain and swelling.

A well-fitting, supportive bra may help. Avoid bras (and underwires) that are tight or put pressure on specific areas of the breast.

Cold, raw cabbage leaves worn inside a bra can be soothing. Change when they become wilted or after about 2 hours. Use only until swelling goes down as long-term use may reduce milk supply. Stop use if a skin rash or other signs of allergy appear.

Watch out for symptoms of mastitis:

Inflamed, hot, red or darkened localised areas of your breast, depending on your skin tone. Changes in breast appearance may be harder to spot in darker skin. You may still have engorged breasts without a noticeable red or darkened area.

Temperature over 38.4ºC or flu-like symptoms.

Weaning can make a breast infection worse so continue to breastfeed frequently especially on the affected side and treat as for engorgement. Rest and drink fluids. If fever persists, continue breastfeeding and check with your GP as you may need antibiotics. More information on mastitis.

Engorgement should improve within a day or two. If not, contact an LLL Leader for further suggestions. You may need to improve your baby's breastfeeding technique or find ways to reduce your milk supply. These are not difficult problems to solve, especially if treated promptly.

Written by Karen Butler, Sue Upstone & mothers of La Leche League Great Britain

Further Reading

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.

Beginning Breastfeeding
Comfortable Breastfeeding
Dummies and Breastfeeding
Hand Expression of Breastmilk
Mastitis
My Baby Won't Breastfeed
Nipple Pain - why and what to do
Positioning and Attachment
Sleepy Baby - why and what to do

This information is available to buy in printed format from our shop

Copyright LLLGB 2016

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Engorged Breasts - avoiding and treating - La Leche League GB

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

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Mastitis: symptoms and treatment | Baby & toddler, Feeding articles & support | NCT

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Mastitis is a painful breast condition. Here we discuss its symptoms, treatment, how to continue breastfeeding with mastitis and how to help prevent it.

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What is a tongue-tie (ankyloglossia)?

Most people have a frenulum - a piece of tissue under their tongue that stretches from the underside of the tongue to the floor of the mouth. Tongue-tie occurs if the frenulum either extends forwards towards the tip of the tongue, is attached close to the lower gum, or is short and tight so it interferes with normal tongue movement (Oakley, 2021).

What problems does tongue-tie cause for babies?

If a baby has a tongue-tie, they may not be able to extend or lift their tongue or move it from side to side. Some will be able to lift the sides, but not the tip (v-shaped tongue). Some will be unable to lift the posterior of the tongue (bowl-shaped tongue). In babies where they frenulum extends all the way to the tip, the tongue may look heart-shaped.

Tongue-tie can affect both breastfeeding and bottle-feeding. For some babies, the effects will be quite mild. For others, tongue-tie can make feeding extremely challenging or even impossible.

In order to breastfeed, a baby needs to be able to open their mouth wide, extend their tongue over their bottom lip and scoop the breast into their mouth. Then the tongue needs to massage the breast in a wave-like motion to remove milk from the breast (Oakley, 2021).

If your baby has a tongue-tie and you are breastfeeding, you might experience one or more of the following in your baby:

difficulty in latching

difficulty in maintaining a latch, with your baby frequently coming off the breast or slipping back to the nipple

a shallow latch

clamping down on the breast

clicking noises while feeding

unsettled behaviour during feeds

frequent or long feeds

poor weight gain or excessive early weight loss

colic/wind/hiccups/reflux.

If you are breastfeeding your baby and they have tongue-tie, you might find your nipples are sore and appear squashed after a feed, often appearing ridged, lipstick-shaped, flattened or blanched. If your baby isn't draining your breasts adequately, this can lead to engorgement, blocked ducts and mastitis. It can also have a negative effect on your milk supply. Feeds which are long or frequent can be very tiring (NHS, 2020; Oakley, 2021).

If you are bottle-feeding your baby, you might notice one or more of the following - your baby:

is very slow to take a bottle

chomps on the teat

needs to be fed very often in order to get enough milk

dribbles a lot during feeds

tends to push the bottle teat out

gags on feeds even when you slow the feed down

can only manage a teat that has a very slow flow.

(Oakley, 2021)

How is tongue-tie diagnosed?

Can I tell if my baby has a tongue-tie?

If you look in your baby's mouth, you might be able to see if they:

are unable to extend their tongue fully

have a tongue with a heart-shaped appearance at the tip

have difficulty lifting their tongue or moving it from side to side.

Tongue-tie is not just about how your baby's tongue looks. A tongue can look completely normal to an untrained eye yet still cause substantial problems with feeding (Young, 2011).

A tongue-tie is diagnosed by the baby's tongue function too - what they can do with their tongue. It can only be diagnosed by a qualified tongue-tie practitioner (NHS, 2020).

Tongue-tie types

Tongue-ties can be described as anterior (where the frenulum extends towards the front of the tongue) or posterior (towards the back of the mouth).

Tongue-ties might also be described using a percentage or a number (type I, II, III and IV). This percentage or number describes how far along the underside of the tongue the frenulum comes. So 100%, or type I, would indicate that the frenulum comes all the way to the front of the tongue.

A posterior tongue-tie, which may be described as a 10% tongue-tie, can restrict tongue function just as much as an anterior one. That means these anatomical descriptions of how the tongue looks don't always relate to how severely a tongue-tie will affect tongue function and your baby's feeding (Oakley, 2021).

Tongue-tie diagnosis

Some babies have a visible frenulum that doesn't cause problems with feeding (UNICEF, no date). Tongue-tie shares many of the symptoms of other breastfeeding problems, so it's not always easy to determine whether these problems are caused by a tongue-tie or something else.

A full feeding assessment should be done before or as part of a tongue-tie assessment (Oakley, 2021). If you and/or your baby are experiencing feeding difficulties, a feeding assessment and some breastfeeding support from a breastfeeding counsellor or trained breastfeeding professional is recommended. Support to improve your baby's attachment to the breast may resolve the problem (UNICEF, no date).

A baby's inability to open their mouth widely and extend their tongue may also be caused by tension around the mouth and neck, resulting from birth tensions or interventions during labour. This might be resolved by manual therapy, such as osteopathy or chiropractic from a registered practitioner (ATP, no date; Oakley, 2021).

If the breastfeeding professional (breastfeeding counsellor, midwife or health visitor) suspects your baby has a tongue-tie, they will refer you to a local tongue-tie practitioner. Tongue-tie practitioners will do a formal assessment of tongue-tie based on how the tongue functions as well as how it looks (e.g. the Hazelbaker Assessment Tool for Lingual Frenulum Function). Most midwives and health visitors are not tongue-tie practitioners so are unable to make a diagnosis of tongue-tie themselves.

Tongue-tie treatment

What is tongue-tie division?

Your baby could have a tongue-tie division, which can release their tongue so it can move more freely. This involves cutting the frenulum (NICE, 2005).

Tongue-tie division is a safe procedure that can improve the breastfeeding problems that tongue-tie causes (NICE, 2005).

Does tongue-tie division hurt?

Tongue-tie division procedures are very quick and simple and are thought to be almost painless (NICE, 2005).

Does tongue-tie division resolve feeding problems?

Most parents say their baby's feeding improves after a tongue-tie division and many find it resolves the problem completely (Buryk et al, 2011; Berry et al, 2012). But a few babies do continue to have feeding difficulties even after a tongue-tie division.

Do I need to get my baby's tongue-tie treated?

The decision on whether to have a tongue-tie divided is a personal one and different parents will make different decisions. Every tongue-tie is different too and the range of issues it causes can vary from very mild to severe. So how much the tongue-tie is affecting feeding and your life with your baby might influence your decision.

You might find it helpful to talk things through with an NCT breastfeeding counsellor too. They can help you explore your thoughts and feelings plus find ways of coping if you decide not to have the procedure done.

What else might help with feeding difficulties due to tongue-tie?

For some babies, it may be possible to improve feeding without having a tongue-tie division.

If babies are fed in a laid back position, they are more relaxed, can open their mouth wider and get a bigger mouthful of breast. But some babies are unable to extend their tongue enough to scoop the breast into their mouth, so this position doesn't make feeding easier. A side-lying position or koala hold might also help.

Babies can also be helped by using an 'exaggerated latch'. This is where you hold your baby close to but below the breast, and use your forefinger to tilt your nipple upwards. That way, when your baby tips their head back and is brought into the breast, your nipple can be flipped towards the back of their mouth (Oakley, 2021).

Babies who are bottle-fed might find feeds easier if paced bottle feeding techniques are used. Occasionally, finger feeding can be a more comfortable option than using a bottle (Genna, 2013). A tongue-tie can make it difficult for babies to form a seal around the bottle teat. A high palate, often associated with a tongue-tie, can trigger the baby's gag reflex. Shorter, wedge-shaped or flatter teats may be easier for babies with a tongue-tie to drink from (Oakley, 2021).

How can I find tongue-tie division services near me?

Only registered healthcare professionals who have received proper training in tongue-tie division should perform this procedure. In many areas, the NHS provides a tongue-tie division service. But provision varies across the country and parents in some areas have to travel long distances to reach a tongue-tie division service.

It can be even harder to find a tongue-tie division service when a baby is having problems bottle-feeding. Unfortunately, some areas might have no service available (Wise, 2015).

The National Institute for Health and Care Excellence - also known as NICE - supports considering tongue-tie division. Yet there is no common agreement among tongue-tie dividers on how to carry out the procedure or how far the membrane should be divided (NICE, 2005). This means the service different health professionals offer varies.

Online, you can see a directory of both NHS and private tongue-tie practitioners on the Association of Tongue-tie Practitioners (ATP) website.

What can I expect after my baby's tongue-tie division?

Babies are often unsettled in the first day or two after a tongue-tie division and might need more cuddles and nurturing. After the procedure, you'll probably see a white patch under your baby's tongue; this takes 24 to 48 hours to heal but it won't bother your baby (UNICEF, no date).

Do I need to do anything after the tongue-tie division?

Some tongue-tie practitioners recommend some tongue exercises or wound massage after a tongue-tie division. The exercises involve encouraging the baby to move their tongue through finger sucking and tongue-poking games. Massaging the wound with a clean finger may help prevent the tongue division knitting together and re-forming but there is no evidence to suggest that this is safe or effective (Oakley, 2021).

Will my baby's feeding improve after their tongue-tie division?

Parents often expect that feeding will improve immediately after a tongue-tie division.

Feeding can be more difficult for the first day or two after a tongue-tie division because it takes time for your baby to adjust to their new, freely-moving tongue (Oakley, 2021).

Some babies might need further support even after a tongue-tie division. If things have not improved after a few days, you might find it helpful to get extra support to improve feeding - see below.
This page was last reviewed in March 2022.
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

Attending a Baby Cafe or other breastfeeding support drop-in can be a good way to access support with feeding your baby. You may also find other parents there whose babies have had a tongue-tie.

Pictures of babies with tongue-tie can be found on Catherine Genna's website.

The Association of Tongue Tie Practitioners has a list of locations where tongue tie can be divided.

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Tongue-tie in babies | Baby & toddler, Feeding articles & support | NCT

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https://www.tongue-tie.org.uk/Tongue-tie (ankyloglossia) in babies can affect both breastfeeding and bottle-feeding. Here we explain about tongue-tie symptoms and treatment.

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Information about breastfeeding in public.

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Many mums wonder how others might respond to them breastfeeding in public. So it's good to know that public opinion is behind you - a survey said 72% of people support breastfeeding in public (gov.uk, 2015).

And you do of course have the right to breastfeed in public. NCT spent many years campaigning to bring about the specific protection of breastfeeding in public (NCT, 2011). Specific laws now protect breastfeeding in public in England, Wales and Scotland, and other laws protect it in Northern Ireland.

But breastfeeding in public isn't just accepted and protected, it can have a bunch of benefits. Here's how and why you could make breastfeeding in public work for you...

Why breastfeed in public?

Breastfeeding is a convenient way of feeding your baby when you're out and about as you don't need any extra equipment. In fact, with a little practice it can become virtually effortless. You'll have the great tool at your disposal of being able to feed your baby anywhere and to calm them when they're fretful at any time.

"I found breastfeeding useful when we were out for the day as the only 'kit' that was needed was me! But especially so if my baby became overstimulated with the sounds and lights of busy shops - if she started getting restless or agitated, holding her close for a feed would help to calm her down."

How do I start breastfeeding in public?

In the early days, before going out with your baby, it can help to gain confidence with different breastfeeding positions and making sure your baby's achieving an effective latch. That way you'll feel more comfortable feeding in front of others. Some mums find it useful to practice in advance - either in front of the mirror or in front of someone else, such as their partner, a close family member or a friend.

If you want to keep covered up, having easily accessible clothing can help with that. You could try wearing a loose vest underneath a t-shirt - so one layer goes down and the other goes up. You could also try wearing a loose cardigan or a scarf.

"I would wear stretchy vest tops underneath so that I kept warm still while feeding. Plus, I was more concerned about flashing my mummy tummy than anything else!"

It's possible to feed in a sling or carrier too. A sling or carrier has the added advantage of keeping your baby close and the oxytocin flowing, which aids milk production (Knowles, 2019).

How do I get more confident about breastfeeding in public?

Some new mums worry about feeling embarrassed or uncomfortable breastfeeding in front of others (Public Health England, 2017). So it can be really helpful to look for support around you and check what groups your local NCT branch run.

You could also ask your midwife, health visitor, breastfeeding counsellor or lactation consultant about local drop-in groups. At these groups, you're likely to meet other breastfeeding mums and this will help you gather some tips, ideas and general support.

Attending a local Baby Café or other breastfeeding drop-in provides an environment where you're likely to be around other parents at a similar stage of parenting and feeding. This peer support and having the support of a qualified practitioner might increase your confidence in many areas of breastfeeding, not just feeding in public (Fox et al, 2015).

It can be handy to have someone with you that first time you head out with your baby. It's also good to look ahead for information about breastfeeding friendly places to go. You can find breastfeeding friendly places on social media, websites, and local/national initiatives where breastfeeding friendly businesses can register.

Is breastfeeding in public difficult?

It's not difficult but there can be challenges. One challenge of breastfeeding in public is dealing with breastmilk leaks. Most mums find that breastpads provide sufficient protection from leaks should you experience them.

If you're out and can feel a let down of milk but you're unable to feed your baby, then applying compression to your nipples for a few seconds might help stop the leaking. You can do this by folding your arms over and using the palms of your hand to press down firmly on your nipples (La Leche League GB, 2016).

When your baby is older, feeding in public may seem more challenging as your child is mobile and vocal. So it's good to read their body language and be ready to move if they do and if you want to keep covered up. You could also consider having some snacks or toys to offer as a distraction until you are somewhere more comfortable to breastfeed (kellymom, 2018).

What exactly are my rights about breastfeeding in public?

A mum has a right to breastfeed her child across the UK, but the area of the UK you live in will govern which legislation covers this right:

England and Wales - the Equality Act 2010 (British Chambers of Commerce, 2010) states that 'a business cannot discriminate against mums who are breastfeeding a child of any age.' This means that anybody providing a service, and their employees, cannot ask a mum to stop breastfeeding or to leave their premises.

Scotland - the Breastfeeding etc. (Scotland) Act 2005 states that 'it is an offence deliberately to prevent or stop a person in charge of a child from feeding milk to that child in a public place or on licensed premises.' (The age of the child is determined as up to the age of two years and feeding is determined as breast or bottle feeding.) This means that any person feeding a child milk cannot be asked to stop or leave the area or premises.

Northern Ireland - there is no specific legislation currently in Northern Ireland covering rights to breastfeed. But there is some protection within the Sex Discrimination (Northern Ireland) Order 1976 for women who have been treated unfavourably while pregnant and for the duration of their maternity leave. In January 2017 a potential Breastfeeding Bill was announced but progress on passing this Bill was on hold at the time of writing (Department of Health, 2018).

Are there any circumstances where I can't breastfeed in public?

Across the UK, there are two main categories where it is not unlawful to prevent a mum from breastfeeding:

1. If there is a valid health and safety reason to do so. For example, the mum and/or child may be at harm if they do not leave.

2. If there is a justified reason for a single sex service where women would not ordinarily be permitted.

(Maternity Action, 2019)

If you have reason to complain about how you were treated while feeding your child, the first course of action would be to complain to the business/organisation where the mistreatment occurred, where possible (Maternity Action, 2019). Ask them for their complaints procedure, which will explain how to lodge your complaint. If you're not satisfied with the outcome, you could make a claim in a county court in England, Wales and Northern Ireland, or in a Sheriff court in Scotland.
This page was last reviewed in August 2019.
Further information

NCT supports all parents, however they feed their baby. 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.

Breastfeeding etc. (Scotland) Act 2005. Available at: http://www.legislation.gov.uk/asp/2005/1 (Accessed 25th August 2019)

British Chambers of Commerce. (2010) Equality Act 2010: What do I need to know? Quick-start guide for businesses who sell goods and services. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/85008/business-quickstart.pdf (Accessed: 25th August 2019)

Department of Health (NI). (2018) Breastfeeding - a great start. A strategy for NI 2013-2023 Mid-term review. Available at: https://www.health-ni.gov.uk/sites/default/files/publications/health/draft-mid-term-review-breastfeeding-strategy.pdf (Accessed 25th August 2019)

Fox R, McMullen S, Newburn M. (2015) 'UK women's experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services', BMC Pregnancy and Childbirth, 15: 147. doi: 10.1186/s12884-015-0581-5

Gov.uk (2015) New mothers are anxious about breastfeeding in public. Available at:

https://www.gov.uk/government/news/new-mothers-are-anxious-about-breastfeeding-in-public (Accessed 9th December 2019)

Kellymom. (2018) Breastfeeding in public. Available at: https://kellymom.com/bf/concerns/legal/bfip/ (Accessed 26th August 2019)

Knowles R. (2019) Breast and bottle feeding safely in a sling. Available at: https://www.carryingmatters.co.uk/breast-and-bottle-feeding-safely-in-a-sling/ (Accessed 29th August 2019)

La Leche League GB. (2016) Out and about with your breastfed baby. Available at: https://www.laleche.org.uk/out-about-with-your-breastfed-baby/ (Accessed 26th August 2019)

Maternity Action. (2019) Breastfeeding while out and about. Available at: https://maternityaction.org.uk/advice/breastfeeding-in-public-places/ (Accessed 25th August 2019)

NCT. (2011) Historic month for NCT as women win right to breastfeed in public. Available at: https://www.nct.org.uk/about-us/news-and-views/news/historic-month-for-nct-women-win-right-breastfeed-public (Accessed 11th December 2019)

NHS. (2017) Breastfeeding in Public. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-in-public/ (Accessed 25th August 2019)

Sex Discrimation (Northern Ireland) Order 1976, c. 5A. Available at: http://www.legislation.gov.uk/nisi/1976/1042/article/5A (Accessed 25th August 2019)

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How to breastfeed in public | Baby & toddler, Feeding articles & support | NCT

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You're not alone if you have questions about breastfeeding in public. Here we explain how to do it comfortably and confidently and what your rights are.

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Attaching Your Baby at the Breast – Breastfeeding Series

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Tips on formula feeding (including paced bottle feeding)

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Tips on formula feeding (including paced bottle feeding)

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+44 300 330 0700

Open 7 days, 8am to midnight, including bank holidays

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Information on combining breastfeeding and bottle feeding

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019).

What is mixed feeding?

Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk.

Watch our video to find out more about mixed/combination feeding.

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

If you and your baby have some difficulties getting breastfeeding established or if there are concerns about your baby's weight, you might be advised to give some formula feeds alongside breastfeeding.

You might need to leave your baby for periods of time (for example, if you are returning to work).

Your partner might want to be involved with feeding.

You might be bottle feeding and want to start or resume breastfeeding.

It can be helpful to talk to a breastfeeding counsellor, a midwife or health visitor about your options and the potential impact on breastfeeding of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700.

How do I combine bottle feeding and breastfeeding?

Some families choose to express milk and feed it to their babies through a bottle. They might do this if someone else would like to feed the baby or if the mum has to be away from their baby for a while.

Others choose to substitute some breastfeeds for formula. If you want to do this, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS, 2019).

You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or a breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to achieve ultimately.

There are some cases when formula might be given before a breastfeed (for example, with babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you're not with your baby and can't breastfeed or if someone else is sharing the feeding.

Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged. It will also reduce your risk of developing mastitis (NHS, 2019). It helps to reduce the number of breastfeeds slowly, starting with the one which is convenient for you (NHS, 2020). If you substitute a breastfeed with a formula feed, it may take around five to seven days for the amount of milk your breasts are producing to adjust to missing that one feed (NHS, 2017).

If you 'top up' with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk (NHS, 2020).

On the other hand, if you've been advised to 'top up' as a temporary measure and want to return to exclusive breastfeeding, it is important to express milk between feeds to prevent a decrease in the amount of milk you make (NICE, 2017). Try and feed your baby any available breastmilk before each formula feed.

What effect will combining breastfeeding and formula feeding have?

Your baby will enjoy the benefits of breastmilk, even if you're not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2019).

If you want to feed your baby with both breastmilk and formula milk, it is recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2019). This can take up to a month (La Leche League, 2019).

It's best to wait until breastfeeding is established because breastmilk supply is generally driven by frequent, effective removal of milk from the breasts. Giving your baby formula reduces your milk supply, which is particularly important when you are both getting used to breastfeeding. If your baby breastfeeds less often, your breasts produce less milk (Daly and Hartmann, 1995).

You might have heard that babies can get 'nipple confusion' but there is no evidence that this exists (Kotowski et al, 2020).

How many breastfeeds does an older combination-fed baby need?

Older babies, beyond the newborn stage, can maintain your breastmilk supply alongside formula feeding as long as you breastfeed several times a day. Much older babies - from eight or nine months - can breastfeed just a handful of times a day, and there is still a supply.

Very well-established breastfeeding, with a baby who is one year or older, can continue with as few as one or two feeds in 24 hours.

If your baby is over six months they can use a beaker or cup rather than a bottle (NHS, 2020).

Tips to introduce a bottle to a breastfed baby

You might find your baby does not want to take a bottle at first. The different sensations may confuse them and they don't know the bottle contains food. But there are lots of different things you can try to help your baby:

Offer a bottle when your baby is relaxed and happy, rather than very hungry.

Maybe ask someone else to offer a bottle so they can't smell their mother's milk.

Try softening the teat with warm, boiled water.

Hold your baby in a different position from their usual breastfeeding one. It might help your baby get used to the new way of feeding.

Try a different bottle or teat, this might make a difference.

(La Leche League, 2019)

Unicef (2016) recommend feeding responsively, which means following your baby's cues, whether breastfeeding or bottle feeding. They also recommend using paced bottle feeding. The way a baby is fed with the bottle can affect their comfort, their control of the amount of milk they drink, and the transition between breast and bottle (Kotowski et al, 2020).

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line 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.

Further information

Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

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Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

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Here we look at mixed feeding your baby, which is combining breastfeeding and bottle feeding

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Information sheet shows a babies feeding cues.

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Offers breastfeeding support across Edinburgh and West Lothian, including online drop-in groups, 1:1 online sessions, and in-person groups run by NCT-trained peer supporters. Please see their Facebook page for more information.

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Lothian Breastfeeding Buddies. 1,145 likes · 65 talking about this. All free. All friendly. All welcome. Online drop-in groups, 1:1 online sessions & in-person groups run by volunteer Peer...

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Offer a range of breastfeeding support across East Lothian including in person groups, online groups and 1:1 support through video call. Please see Facebook page for details or email for more information.

breastfeeding.eastlothian@nct.org.uk

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Welcome to the East Lothian Breastfeeding Support Facebook Page!

During the current situation, the breastfeeding support groups in the area are running online - please contact breastfeeding.eastlothain@nct.org.uk for a secure joining code.

If you have any immediate concerns or require urgent support, please do not hesitate to contact an appropriate health professional, or speak to a fully-qualified NCT Breastfeeding Counsellor by calling the NCT's Feeding Line 0300 330 0700 8am-midnight every single day of the year.

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Welcome to the East Lothian Breastfeeding Support Facebook Page! During the current situation, the breastfeeding support groups in the area are running online - please contact breastfeeding.eastlothain@nct.org.uk for a secure joining code.

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Looking for breastfeeding support or just want to chat to another mum about breastfeeding?

The Breastfeeding Network has trained peer support volunteers in your local area. There are lots of ways to access support, and all events can be found on our Facebook Events ( https://www.facebook.com/breastfeedingforthvalley/events) page.

In Person

Thursday 1:30pm - Ben Cleuch Centre, Tillicoultry

Friday 10:30am - Walk, Talk, and Feed group, Callendar Park, Falkirk

Friday 12-1.30pm Mayfield Centre, St Ninians, Stirling

Virtual Support

Phone support is available to all mums within 48 hours of discharge from hospital. You will be asked if you would like to be referred to the service while you are still on the ward. If you are not offered this service before you go home, please complete this form (https://forms.office.com/r/fm0gMFNdeA) and we will telephone you.

Every Tuesday at 10:30am is our weekly Zoom group where you can join from your living room in your jammies! Find the link on our Facebook events page.

Antenatal Zoom Sessions, every second Wednesday at 11am. Come and ask all your breastfeeding questions and meet some parents to be.

Join our local Facebook page @BreastfeedingForthValley You can use this to contact trained volunteers for support or just to chat to other mums. There are also smaller Facebook groups associated with local breastfeeding support groups and you can find these details on the page

Ring the National Breastfeeding Helpline on 0300 100 0212 or message them on Facebook @NationalBreastfeedingHelpline

Email ForthValley@breastfeedingnetwork.org.uk and we can offer support via email or arrange to call you back to offer support over the phone or via a free video call

Join in with a virtual breastfeeding group video chat to say hello to other mums and peer supporters without leaving the house! Details of the groups and links to join are on our Facebook page

All our volunteers are mums who have breastfed their own children and then done training so that they can support other families. Whatever your question or if you just want to chat to someone please get in touch

Please be aware that emails and messages to our Facebook page will be seen by a small team of volunteers. If you contact us by E-mail please send just a brief outline of your question or concern initially so we can support you in the most appropriate way. To find out how we look after your data you can go to http://www.breastfeedingnetwork.org.uk/privacy-notice/

Updated 27/09/2021

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Forth Valley - The Breastfeeding Network

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Looking for breastfeeding support or just want to chat to another mum about breastfeeding? The Breastfeeding Network has trained peer support volunteers in your local area. There are lots of ways to access support, and all events can be found on our Facebook Events (https://www.facebook.com/breastfeedingforthvalley/events) page.

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Deciding how to feed your baby is an important and personal decision that parents make for their child. However you decide to feed your baby, NHS Lanarkshire will support your choice and will provide you with as much information as you need to make your decision easier. You can also ask your midwife for information on how to book onto an infant feeding workshop where you can explore your feeding options.
For help and advice, contact the Infant Feeding Team on 01698 366710.
Follow the NHS Lanarkshire Mums Babies Facebook page for more tips and advice.

The Benefits of Breastfeeding

Research shows that the effects of breastfeeding your baby last well into childhood and beyond. Many mums breastfeed to help improve their baby's health, not realising that it actually improves their own health too.

Pregnancy

Pregnancy can be a stressful time with lots of changes to your body and your lifestyle. Did you know even before they are born, your baby can tell when you are stressed and busy? Taking some time out of your day to relax, even if it's when you are in the bath or shower. You can take time to talk to your bump, play some music and see how they respond. Encourage your partner and other children to do the same. Connecting with your baby before birth and taking some time to notice their movements and how they respond can help your baby's brain to grow and develop.

During your pregnancy, your midwife will give you the opportunity to talk about your options for feeding after birth and how you can get this off to a good start. We know that breastfeeding helps to protect both you and your baby. The evidence shows that breastmilk is far better at stopping babies from getting ill and developing certain health conditions. We also know that breastfeeding for as long as you can is best not just for babies, but for mums too. There are physical and emotional benefits for you from birth and beyond, and it's also much cheaper and better for the environment.

Why is breastmilk so good for babies?

Breastmilk changes to meet your babies needs as they grow and develop and can respond to their surroundings, making antibodies to protect them from germs and infections

Beyond the early years, breastmilk also improves brain development and improves health by reducing your child's chances of conditions such as asthma, diabetes and obesity

What are the advantages for you?
There's a lot of evidence that breastfeeding limits your chances of breast and ovarian cancer later on in life, as well as lowering your risk of weak bones.

It can help you lose your baby weight by burning up to 500 calories a day. While you're pregnant, your body stores fat for feeding. Using this up will also protect against the long term risks of being overweight e.g. diabetes and heart disease.

Mums say that breastfeeding helps them feel really close to their baby and is a lovely thing to do.

Your breast milk is safely available at the right temperature whenever and wherever your baby is ready for a feed, making it really convenient.

Breast milk is, of course, absolutely free and will save you a fortune because it never runs out. As your baby feeds, your body is busy making more milk.

Common Concerns And Challenges

Breastfeeding may be natural, but for most of us it takes a bit of practice. Even if you've breastfed before, remember that your new baby hasn't, so try not to worry if getting the hang of it is taking a little longer than you expected.

It's always okay to ask for help, whether it's talking to another mum at a breastfeeding support group, or speaking to your midwife, health visitor or calling the National Breastfeeding Helpline on 0300 100 1212. They might give you some practical tips or refer you to a specialist infant feeding advisor for some one-to-one guidance. You can also read on to find out more about the most common issues faced by mums.

Getting Help

It's always OK to ask for help, whether it's talking to another mum at a breastfeeding group, or speaking to your midwife, health visitor or infant feeding team. They might give you some practical tips or refer you to a specialist Infant Feeding Advisor for some one-to-one guidance. You can also read on to find out more about the most common issues faced by mums.

Pre-term Babies

Breastmilk is very important to the health of a sick, small or preterm babies. For very early babies it is even more important that they get the first milk or colostrum to help protect against infection and also encourages better eyesight and brain development especially in premature babies. If your baby is born early or is sick and needs admitted to the neonatal unit after birth your midwife and your baby's doctors will encourage you and support you to express your milk during this vulnerable period, this doesn't mean that you have to breastfeed unless you want to though. Expressing your milk is the one thing that only you as a mum can do to give them protection and help them recover.
Isn't formula just as good?
Formula milk is safe but it doesn't have the extra active ingredients from breastmilk that help protect you and your baby form illness. Formula milk is made from either cows or goats milk that has been processed so that it can be digested by babies, it is really important that you make up formula milk as safely and as accurately as you can to stop your baby getting ill.

We would encourage you not to make your feeding decision before birth, but wait until your baby is in your arms and in skin to skin contact. You might want to try it for even just one or two feeds, this is absolutely fine and your baby will benefit from getting the colostrum. However you decide to feed your baby, NHS Lanarkshire will support your choice and will provide you with as much information as you need to make your decision easier.

You can also ask your midwife for information on how to book onto an infant feeding workshop where you can explore your feeding options.

Meeting your baby for the first time- the magical "Golden Hour"

When your baby is born the first hour or so after birth is an important time for you both to adjust and get to know each other skin to skin contact at this time will really help you and baby calm, bond and recover from the birth. For your baby coming from the warmth and security of the womb the world can be a scary place, so holding your baby next to your skin where they can hear your heartbeat and feel safe warm calm and comforted. Keeping your baby there until after their first feed- no matter how you are feeding gives you the best start to parenting. Protecting this time is really important so ask visitors to wait until after your baby has fed before disturbing them. If for whatever reason skin to skin can't happen after birth don't worry as soon as you and your baby are well enough you can have skin to skin at any time.

Skin-to-skin after birth contact has several benefits for both mum and baby:

Baby is warmer and calmer.

Baby can hear your heartbeat.

Baby's heart and breathing rates normalise more quickly.

Your baby is less likely to have low blood sugars

Your baby is less likely to be admitted to the NNU

It's a great start to feeding.

Skin to skin can be used anytime to settle and comfort both you and your baby- you can never cuddle your baby too much, the more you cuddle and respond to your babies needs the more secure they will feel, cuddles and comfort actually help your babies growth and development. It's a great way to settle your baby at any age and it's always good for you to sit down and enjoy cuddles with your baby.

Starting to Breastfeed

When babies are born at or near their due date, they have enough stores and extra fluids to sustain them for the first couple of days while they learn how to breastfeed. Keeping them close to you, so you can watch for "feeding cues" and offering the chance to breastfeed often will help to tell your body to start making milk for your baby, the first milk- colostrum is super concentrated milk, designed to meet all your baby's needs for the first few days after birth. It's rich in protective antibodies and sometimes yellow in colour. If your baby is sleepy in the first few days as you recover from delivery we don't worry too much as long as they are well and maintaining their temperature, small amounts of colostrum given really often are usually enough, your midwife will support you to begin expressing if your baby isn't feeding well in the beginning.. Breastfeeding or expressing often in the first hours and days also helps establish a good milk supply.

Like any new skill, some babies take to it right away and others can take a few days to learn, there's always help on hand- just ask

Breastfeeding may be natural, but for most of us, it takes a bit of practice. Even if you've breastfed before remember that your new baby hasn't, so try not to worry if getting the hang of it is taking a little longer than you expected. Newborn babies have tiny tummies, and breastmilk is easily digested, which is why they need to feed frequently - usually 8 or more times in 24 hours, around the clock, day and night. Keeping your baby close to you- in the same room day and night will mean you can see when they show "feeding cues" these are subtle signs that babies are ready to feed, You'll learn to pick up the cues from your little one when the time is right for each feed - to begin with, your baby may stir, turn their head or open their mouth. Other cues include stretching or putting a hand to their mouth. To help you spot these little signals from your baby, see this link for more information.

Expressing Breastmilk

Hand Expressing

Hand expressing is an important skill for all breastfeeding mothers to have, the most common reason you will need it is if the baby sleeps a little too long and your breasts are very full or if there is an issue like a blocked duct then it can easily be resolved.

Some mums may choose to express milk from the beginning, hand expressing works better in the first few days as colostrum is in such small amounts. If your baby is learning how to breastfeed then introducing bottles can make it more difficult for them, but once you and your baby have got the hand of breastfeeding most babies don't have any problems switching between. If you are giving expressed milk or formula to a breastfed baby then remember breastfeeding works on supply and demand, the more often you feed the more milk your body will make. So if you give a baby anything other than a breastfeed your supply might become reduced so expressing at these times will help to maintain or increase your supply.

How to I know my baby is getting enough milk?

If you are feeding your baby frequently and they are well attached at the breast they will usually get all the milk they need, but a really good wayto tell is if they are getting the right amount of wet and dirty nappies. This breastfeeding checklist shows you all the signs a baby is feeding well.

How to I know my baby is getting enough milk?

If you are feeding your baby frequently and they are well attached at the breast they will usually get all the milk they need, but a really good wayto tell is if they are getting the right amount of wet and dirty nappies. This breastfeeding checklist shows you all the signs a baby is feeding well.

If you are feeding your baby responsively- that is whenever he/she shows feeding cues, or whenever you feel you just want to cuddle hold and feed your baby. Your baby is well attached at the breast and you are not sore then how many wet and dirty nappies they are having is a great sign that feeding is going well.

Find out how your breastfeeding is going with these helpful checklists:

Formula Feeding

Formula feeding means feeding your baby cow's (or goat's or soya) milk that's specially treated to be suitable for babies, all formula milks are made to very strict guidelines and there is no advantage of one brand over the other. More expensive brands have no nutritional advantage. Choosing a "first" milk is important as it is much easier for babies to digest, second or follow on milks are not required, first milks are all babies need for the first year of life and after that babies can drink ordinary cow's milk.

You should feed your baby as soon as they show signs that they are hungry, and you can still experience skin-to-skin contact - which is particularly important for calming your baby and building a special bond in the early days.

If you are formula feeding, always make sure you sterilise all the equipment - responsive bottle feeding will help you to build a loving bond with your baby. Your baby will feel the most safe and secure if only you, as the main care giver, carries out their feeds for the first few weeks - and after that, only you or your partner. Hold your baby close to you, as skin-to-skin contact can help calm your baby and strengthen the secure attachment. Gently invite them to take the teat of the bottle, and keep eye contact while they're feeding.

You can find out more about feeding your baby responsively when they show feeding cues;

Here is a list of top tips for feeding:

Crying is the last sign of wanting to feed, so try and feed your baby before they cry.

Hold your baby close in a semi-upright position so you can see their face and reassure them by looking into their eyes and talking to them during the feed. Begin by inviting baby to open their mouth: gently run the teat against their top lip.

Gently insert the teat into baby's mouth keeping the bottle in a horizontal position to prevent milk from flowing too fast.

Your baby may need a few breaks during the feed to burp (this is especially important if your baby has reflux or colic). Sit your baby on your lap facing away from you - or over your shoulder - and gently pat or rub their back. Have a look at our guide to burping your baby for more information. When your baby burps, they may bring up small amounts of milk - this is very normal and nothing to worry about, just make sure you have a muslin or cloth handy.

If your baby appears to be uncomfortable at any time - for example, turning away from the bottle, feeding too quickly or too slowly, or being sick afterwards - there may be simple steps you can take to turn any feeding problems around. It's important to let your baby pace the feed, and respond to the cues to wind. Don't try and push your baby to take more than their tiny tummy needs. Pacing the feed, small, frequent feeds and responding to your baby's cues solves most problems. If you have any concerns, talk to your midwife or health visitor as soon as you can for help and advice.

How to make up formula feeds safely

Formula milk is a processed product and is not sterile so it needs to be made up as freshly and safely as possible, using freshly boiled very hot water of at least 70°C will destroy any bacteria that might be in the powder.

For help and advice, contact the Infant Feeding Team on 01698 366710

Getting Out And About

If you are breastfeeding, getting out and about is easy and all you need is yourself and your baby! When you are both still getting the hang of feeding it can feel a bit daunting to begin with. Once you get established with breastfeeding, you'll be able to do it without anyone even noticing. If you wear something that lifts up from the waist, like a t-shirt or a jumper rather than a shirt or blouse with buttons, you can breastfeed without any breast showing at all. The more you breastfeed when out and about, the more confident you'll get and the easier you will find it.

Remember, your baby has the right to be fed in Scotland wherever they are and however they are being fed. In Scotland breastfeeding is protected by law, meaning it is an offence to stop someone in a public place from feeding their child, if under two, with milk. For more information on the law, visit the Citizens Advice Scotland. Look out for the Breastfeeding Scotland and Breastfeeding Welcome signs for businesses promoting breastfeeding friendly enviroments.

If you are a business and are looking to become breastfeeding friendly, visit MyGov - Become a breastfeeding friendly business

Sometimes new mums can worry that someone will notice or say something about them breastfeeding, but thousands of mums are out and about everyday breastfeeding their babies - it is normal after all! In the early days you might want to look out for the "Breastfeeding Welcome" or "Breastfeeding Friendly" stickers. When you see these you can be sure of an extra special welcome as the staff in these premises will have had additional training to know how to welcome breastfeeding families.

There are over 500 breastfeeding friendly locations throughout Lanarkshire for you to try where you will be made to feel comfortable.

For help and advice, contact the Infant Feeding Team on 01698 366710

If you are formula feeding, there are a few options you can try, some mums like to take a sterile bottle and some ready-made formula with them. Or if you know you will have access to a kettle taking a sterile bottle and some pre-measured formula powder in a sterile container to make up the feeds as you need them will work. Or if you aren't sure you will have access to freshly boiled water taking a clean flask you keep only for water and some powder with you will work.

However you are feeding your baby getting out and about and meeting old and new friends is important, even going for a walk and getting some fresh air can make you feel so much better.

Vitamin D

Vitamin D is essential for good bone health. The best source of vitamin D is sunlight and there are small amounts in some foods however when babies are growing either in the womb or in the first few years of life, they need additional vitamin D in the form of a supplement. The recommended amount is 10 micrograms a day and should be taken by:

Pregnant women

Breastfeeding women

Babies

All children up to the age of 5 years old

If babies are receiving more than 500ml of formula milk per day then they do not require vitamin D until they are receiving less than that amount.

All Pregnant women can receive free Healthy Start vitamins from their community midwife for the duration of their pregnancy. They can continue to receive these vitamins after they have had their baby until they are 1 year old. These are available from their health visitor, health centre front desk or local breastfeeding group. Some community groups stock mothers vitamins. Health Visitors can provide information on the nearest stockist.

Breastfeeding Groups In Lanarkshire

NHS Lanarkshire has a number of breastfeeding groups that run weekly throughout both North and South Lanarkshire. They are an excellent opportunity to meet up with other breastfeeding mums and get advice from breastfeeding experts. You don't need to be having a problem to come along to the breastfeeding groups, it's a great way to meet other mums and pick up hints and tips, they also have events throughout the year for you and your baby to enjoy. No need to book just turn up at the times stated.

Airdrie

Gartlea Community Centre,
Hillfoot Road, Airdrie, ML6 9PB,
Wednesday 10am-noon

Bellshill

Salvation Army Church and Community Centre,
Gladstone Street, Bellshilll, ML4 1AT,
Tuesday 1.30pm-2.30pm

Blantyre

Calderside Nursery,
Boswell Drive, Blantyre, G72 0BL,
Monday 10am-11.30am

Carluke

Carluke Community Health Centre,
40 Chapel Street, Carluke, ML8 4BA,
Monday 1pm-2pm

Chryston

Chryston Parish Church,
Main Street, Muirhead, G69 9LA,
Tuesday 1.30pm-2.30pm

Coatbridge

Coatbridge Health Centre,
1 Centre Park Court, Coatbridge, ML5 3AP,
Wednesday 1.30pm-3pm

Cumbernauld

Condorrat Health Centre,
Health Education Room 16, Airdrie Road, Cumbernauld, G67 4DN,
Thursday 1.30pm-3pm

East Kilbride

Village Centre,
12 Maxwellton Drive, East Kilbride, G74 4H,
Friday 11.30am-12.30pm

Hamilton

Fairhill Lifestyle Centre,
Neilsland Road, Fairhill, Hamilton, ML3 8HU,
Tuesday 1.30pm-2.30pm

Kilsyth

Kilsyth Community Health Centre,
Health Education Room, Airdrie Road, Kilsyth, G65 0HU,
Wednesday 11am-noon

Lesmahagow

The Fountain,
Abbeygreen, Lesmahagow, ML11 0DD,
Tuesday 10.15am-11.45am

Motherwell

Daisy Park Centre,
Cassells Street, Motherwell, ML1 1DX,
Tuesday 10.30am-noon

Rutherglen

Maternity Care Centre,
Rutherglen Primary Care Centre, Stonelaw Road, Rutherglen, G73 2PQ,
Tuesday 2pm-3.30pm

Strathaven

Strathaven Health Centre,
The Ward, Strathaven, ML10 6AS,
Wednesday 10am-11.30am

Wishaw

Houldsworth Centre,
Wishaw Library, Kenilworth Avenue, Wishaw, ML2 7LP,
Wednesday 10am-11.30am

Your Feedback - comments, concerns and complaints

NHS Lanarkshire is committed to improving the service it provides to patients and their families. We therefore want to hear from you about your experience. If you would like to tell us about this please visit our feedback page.

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Deciding how to feed your baby is an important and personal decision that parents make for their child. However you decide to feed your baby, NHS Lanarkshire will support your choice and will provide you with as much information as you need to make your decision easier.

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Looking for breastfeeding support or just want to chat to another mum about breastfeeding? The Breastfeeding Network has trained peer support volunteers in your local area working alongside volunteers from the Association of Breastfeeding Mothers. At the moment our face to face support options are s…

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Information about how partners can help support breastfeeding.

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When it comes to breastfeeding, you might wonder what you can do to support your partner and baby. The truth is you can make a huge difference.

Did you know that a mum is more likely to choose to breastfeed if she's sure her partner is positive about it? And if she does decide to breastfeed, she's much more likely to have a good experience and manage any difficulties if her partner supports her decision (Tohotoa, 2009; Rempel, 2011). A partner's emotional support is so important for helping mums to breastfeed for longer too (Tohatoa et al, 2009; Su, 2016).

Why is breastfeeding important?

If your partner is breastfeeding your baby - or planning to - that's fantastic because breastmilk has so many benefits for babies. For instance, breastmilk can help to reduce the risk of your baby getting infections and diseases (NHS, 2017). It also contains hormones that help your baby's development (Victora et al, 2016).

Overall, breastfeeding will have a positive impact on your baby's health. What's more, it can influence their health as an adult too (Victora et al, 2016).

Is breastfeeding hard or will my partner just know what to do?

Many parents see breastfeeding as a natural process but it can take time for mum and baby to learn this new skill together. It might take around six weeks to get the hang of it fully (NHS, 2016).

The good news is that with the right support, your partner can overcome any challenges and continue breastfeeding if she wants to. If you think your partner needs more information, support or just someone to talk to, why not give one of our trained breastfeeding counsellors a call on our support line: 0300 330 0700. The line is open every day from 8am to midnight, including bank holidays.

You might find it helpful to read up about breastfeeding and attend a breastfeeding session before your baby is born. This can help you know what to expect and perhaps give you a little more confidence. It can also help you both talk about feeding your baby and raise any questions or worries you might have.

What do I need to know about breastfeeding?

You might find it helpful to know how breastfeeding works and what normal behaviour is for breastfed babies. Here are a few quick and handy facts:

Babies are happier if they're fed as soon as they show signs of being hungry.

Babies usually feed frequently (anything from eight to 12 times or more in 24 hours) in the early weeks, especially during the evenings.

Some babies are slow feeders at first, but they get quicker as they get older.

The more a baby feeds, the more milk their mum makes because it's the removal of milk that drives the production of it.

The Department of Health recommends exclusive breastfeeding for at least your baby's first six months. Breastfeeding is also beneficial for toddlers because it gives them a health boost every time they feed. So your partner can breastfeed your baby for as long as they both want to.

Nipple soreness or pain during feeding might be a sign that a baby needs some adjustment to their attachment at the breast. If there is soreness or pain when breastfeeding, talking to a healthcare professional or breastfeeding counsellor can help.

Women enjoy feeding more when they are comfortable and relaxed.

(Department of Health, 2011; La Leche League, 2016; NHS, 2016)

What can I do to help support my partner with breastfeeding?

There are lots of things you can do to support and encourage breastfeeding.

Here are 10 tips:

1. Boost your partner's confidence by encouraging her and being positive about her progress. As with learning any new skill, reassurance and praise are a massive help.

2. Listen and talk honestly about how you each feel about finding your way with your new baby.

3. Be involved with your baby in other ways so that the caring is shared (see below).

4. Help to reduce the household chores so your partner can feed your baby for as long and as often as they need.

5. Try to help your partner to relax by giving them a massage.

6. Women don't need to eat anything special while breastfeeding, but it's a good idea to encourage your partner to eat and drink regularly.

7. Help her get specialist support if she's struggling with breastfeeding. As mentioned above, you can both talk to one of our breastfeeding counsellors on 0300 330 0700.

8. Help out by bottle feeding your baby expressed milk once your partner and baby have got the hang of breastfeeding (see below).

9. Accept your partner's decision on when to stop breastfeeding.

10. Try to remember that with your support, breastfeeding can quickly become just another part of your family life.

(Rempel et al, 2010)

What practical support can I give to my baby if my partner is breastfeeding?

You might expect to feel like a bit of a spare part with feeding but it's good to remember that each parent plays a different and vital role. The decision on how you feed your baby is certainly a joint one (deMontigny et al, 2018). It might take a while to get used to the different parts you play though.

Whatever you decide to do, you might actually find feeding is less important to you than you expected anyway. Especially if you're hands-on with your baby in different and rewarding ways.

Tips for being a hands-on partner with your baby

Changing nappies and generally caring for your baby - it's great if you can spend time with your baby and interact (see below) with them while you're looking after them.

Bathing your baby - you could bath your baby or even have a bath with your baby. You'll both enjoy the bonding benefits of skin-to-skin contact and one-to-one time together (NHS, 2018).

Talking and playing - babies enjoy hearing gentle sounds. They even recognise the muffled tones of people talking from their time in the womb and they'll be aware of familiar voices like yours (Lee and Kisilevsky, 2013). So a chat with your baby might be a little one-sided but rest assured, they know it's you. Socially interacting with your baby through their senses helps to stimulate their brain development; for example, you could pull some different expressions (Boucenna et al, 2010).

Baby carrying - this means taking your baby out and about in a sling. It can be a rewarding and comforting experience for both you and your baby (Miller, 2019).

For more ideas on being a hands-on parent, see our article about bonding with and getting to know your baby.

How can I share feeding our baby?

If you're keen to feed your baby, you could give them expressed breastmilk from a spoon, syringe, cup or a bottle. But only introduce your baby to a bottle once breastfeeding is going well. For more on expressing, see our 10 bottle feeding tips for breastfed babies article.

And once your baby's moved on to solid food, there are so many ways you can get involved with that...chopping, mashing, cleaning up all the food that ends up on the floor...

I want to support breastfeeding but will it affect our sex life?

Possibly, but tiredness - and your partner's birth experience and recovery - is more likely to affect their sex drive rather than breastfeeding (Rowland et al, 2005). See our article about breastfeeding and sex for more details.

What if I feel uncomfortable about my partner breastfeeding in public?

If you're feeling uncomfortable or nervous about your partner breastfeeding in public, have a chat with her so you can talk it through. Maybe you're worried about your partner showing her breasts in public? Yet in reality, very little breast actually shows when a baby is feeding. You might have even seen a mum breastfeeding before without realising it.

It might also help to talk to other families where the mum is breastfeeding and find out about both partners' experiences of it. The chances are, you'll change your mind as you get used to seeing breastfeeding.

It's good to know that breastfeeding in public is protected by the law under the Equality Act 2010. That means providers of any services or facilities open for the public are not allowed to discriminate against women who are breastfeeding (Maternity Action, 2019).

Many places now welcome breastfeeding and have special facilities for mums if they'd prefer to feed in private.

Some mums might feel uncertain themselves about feeding in public at first and may appreciate the reassurance of having their partner with them.

At the end of the day...

Don't underestimate the huge difference you can make if your partner is breastfeeding. With you both on board, breastfeeding can quickly become an everyday part of your lives (Rempel, 2011).
This page was last reviewed in October 2017.
Further information

NCT supports all parents, however they feed their baby. 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.

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.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

National Breastfeeding Line (government funded): 0300 100 021.

Health Talk has some interesting videos about different people's experiences of breastfeeding, click here to view them.

Boucenna S, Gaussier P, Andry P, Hafemeister L. (2010) Imitation as a communication tool for online facial expression learning and recognition. 2010 IEEE/RSJ International Conference on Intelligent Robots and Systems, Taipei: 5323-5328. Available at: https://ieeexplore.ieee.org/abstract/document/5650357 (Accessed 1st July 2018)

deMontigny F, Gervais C, Larivière-Bastien D, St-Arneault K. (2018) The role of fathers during breastfeeding. Midwifery. 58:6-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29272696 (Accessed 1st July 2018)

Department of Health. (2011) Breastfeeding. Available at: http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publichealth/Nutrition/Nutritionpregnancyearlyyears/DH_127625 (Accessed 1st July 2018)

La Leche League. (2016) Still nursing? Available at: https://www.laleche.org.uk/still-nursing/ (Accessed 1st July 2018)

Lee GY, Kisilevsky BS. (2013) Fetuses respond to father's voice but prefer mother's voice after birth. Dev Psychobiol. 2014 Jan;56(1):1-11. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23817883 (Accessed 1st July 2018)

Miller R. (2019). Babywearing education in the neonatal intensive care unit. The International journal of childbirth education: the official publication of the International Childbirth Education Association. 34. 43-47. Available at: https://www.researchgate.net/publication/334151320_Babywearing_Education_in_the_Neonatal_Intensive_Care_Unit (Accessed 1st July 2018)

NHS. (2016) How to combine breast and bottle feeding. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/combining-breast-and-bottle/ (Accessed 1st July 2018)

NHS. (2017) Benefits of breastfeeding. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/benefits-breastfeeding.aspx (Accessed 1st July 2018)

NHS. (2018) Washing and bathing your baby. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/washing-your-baby/ (Accessed 1st July 2018)

Rempel LA, Rempel JK. (2010) The breastfeeding team: the role of involved fathers in the breastfeeding family. J Hum Lact. (2):115-21. Available at: http://journals.sagepub.com/doi/abs/10.1177/0890334410390045 (Accessed 1st July 2018)

Rowland M, Foxcroft L, Hopman WM, Patel R. (2005) Breastfeeding and sexuality immediately post partum. Can Fam Physician. 2005 Oct;51:1366-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479788/ (Accessed 1st July 2018)

Su M, Ouyang YQ. (2016) Father's role in breastfeeding promotion: lessons from a quasi-experimental trial in China. Breastfeed Med. 11:144-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26836960 (Accessed 1st July 2018)

Tohotoa J, Maycock B, Hauck Y, Howat P, Burns S, Binns C. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. Int Breastfeed J. 4:15. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788531/ (Accessed 1st July 2018)

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC; Lancet Breastfeeding Series Group. (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 387(10017):475-90. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26869575 (Accessed 1st July 2018)

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How can dads and partners support breastfeeding? | Baby & toddler, Feeding articles & support | NCT

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This article looks at how dads and partners can help support a new mum who is breastfeeding in the early days.

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Link Tree of Lothian Breastfeeding Support

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Link Tree of Lothian Breastfeeding Support

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This contains details of all the breastfeeding support groups in the Lothians.

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Breastfeeding in the Lothians(breastfeedinginthelothians) - Official - Linktree

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FREE groups run by trained peer supporters & additional breastfeeding resources

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National Breastfeeding Helpline – 0300 100 0212

Association of Breastfeeding Mothers – 0300 330 5453

La Leche League – 0345 120 2918

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Information on different types of infant milk. A simple table showing which types of infant milk are recommended at different age ranges is shown on page 5.

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Information of how to responsively bottle feed your baby

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Information on how to safely prepare infant formula, sterilise bottles and feeding your baby.

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Unicef UK Baby Friendly Initiative | Hand expression

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Comprehensive guide to expressing and storing breastmilk.

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Myth busting leaflet, with information about how build a close relationship with your baby to support your baby's brain development.

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Positions for Breastfeeding - Breastfeeding Series

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Information about feeding patterns and how often you might want to feed your baby.

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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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How to tell if breastfeeding is going well

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How to tell if breastfeeding is going well

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This information sheet covers how to tell if your baby is getting enough breastmilk.

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations. BfN endeavours to provide information to enable mothers to breastfeed their babies for as long as they wish and to provide information on the safety of medicines for each mother and baby pair.

Please use the below links for more information

We are constantly reviewing the information available on drugs and breastfeeding as new research is conducted. Therefore, from time-to-time the information on this website may be updated - please be sure to check regularly for any new information and changes to the drug information fact sheets and leaflets.

What is the Drugs in Breastmilk Information Service?

The original Drugs in Breastmilk Helpline was set up by BfN in response to the number of calls we were receiving that concerned medication.

In 2017 we noticed that majority of enquiries from parents and professionals to the Drugs in Breastmilk Helpline were coming via email or social media. As a charity operating on reducing funds we need to run the service in the most efficient and effective way possible without compromising the needs of parents. As a result we decided to run the Drugs in Breastmilk service via email and social media enquiry only.

You can still access information on taking prescription drugs while breastfeeding by sending a private message via our Facebook page or via . Please provide as much information as possible (age of baby, dose, frequency and name of medication or drug). All enquiries are answered as soon as possible by one of our small, volunteer team of qualified pharmacists or breastfeeding supporters. As we can't guarantee a response time, in an emergency situation, please do not wait for our reply, but access help from a trained healthcare professional.

If you call the old Drugs in Breastmilk helpline 0844 number, you will hear a recorded message with information about where to access alternative support. Calls won't be answered live and there is no voicemail service available.

If you still have the Drugs in Breastmilk helpline number on any materials or web pages please could you remove it and replace it with the following information:
'If you have specific questions about medications or treatments, please message the Drugs in Breastmilk information service Facebook page or email druginformation@breastfeedingnetwork.org.uk. If you require breastfeeding support, please call the National Breastfeeding Helpline on 0300 100 0212."

The service is open to mothers and professionals. As the time available to deal with breastfeeding support of mothers is limited, professionals are encouraged to find out the information to enable them to support the mothers themselves.

Evaluation of the Drugs in Breastmilk Information Service

In 2019, BfN commissioned Swansea University to undertake an evaluation of the DIBM service we offer. The executive summary of this report can be found and the full report can be found .

Become a Friend of Drugs in Breastmilk

Please click here for more information on how you can help support this vital service.

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Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations.

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Information about caring for your baby at night, however you decide to feed your baby.

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So can I drink alcohol when I'm breastfeeding?

Alcohol consumed occasionally in low or moderate amounts is unlikely to harm your baby (NHS, 2019; Wilson et al, 2017) . There is also no evidence that low-level drinking during breastfeeding shortens how long you will breastfeed (Wilson et al, 2017). What's more, there's no information on the effect of long-term daily exposure to alcohol.

When you consume alcohol, it goes into your blood, and then into your breastmilk at around the same level it is in your blood (Mennella, 2018). Alcohol in the mum's blood would reach 300mg/100ml before the baby is mildly sedated (Hale & Rowe, 2017). For comparison, 80mg/100ml would fail drink/drive limits in England, Wales and Northern Ireland (50mg/100ml in Scotland) (Gov.uk, no date).

NHS guidance states that alcohol consumption for all adults, including breastfeeding women, shouldn't exceed 14 units spread over a week (NHS, 2019).

One unit of alcohol is 10ml of pure alcohol. So, for example:

Single 25ml shot of spirit like vodka or gin = 1 unit

275ml bottle of alcopop = 1.5 units

Small 125ml glass of wine = 1.5 units

330ml bottle of lager, beer or cider = 1.7 units

440ml can of lager, beer or cider = 2 units

Pint of lower-strength lager, beer or cider = 2 units

Standard 175ml glass of wine = 2.1 units

Pint of higher-strength lager, beer or cider = 3 units

Large 250ml glass of wine = 3 units

Remember that 'home' measures might be larger than these, so take that into consideration if you are drinking while breastfeeding.

What are the effects of drinking alcohol while breastfeeding?

The amount of alcohol a baby takes in through breastmilk is very small. If the mum has consumed alcohol in the hour beforehand, it will peak in the breastmilk at between 2% and 5% of the amount the mum has had (Haastrup et al, 2014; Mennella, 2018). The concentration then reduces over the following several hours, though it's not possible to say exactly how long this takes for each woman (Menella, 2018).

One study suggests that a 'low level of drinking' is not linked to a shorter duration of breastfeeding or adverse outcomes in babies up to 12 months (Wilson et al., 2017).

But there is very little research on the effects of such small amounts of alcohol on a growing baby. The available research does suggest that drinking alcohol while breastfeeding might have the following effects:

Effects on your ability to take care of your baby

The most significant thing to consider is that alcohol can make you less aware of what your baby needs, and impair your judgement and reaction time - both of which are important when taking care of a baby (NHS, 2018c). So if you do plan to drink heavily, make sure a sober adult is around to help with looking after your baby (NHS 2019).

Never share a bed, armchair or sofa with your baby if you have had any alcohol, as this has been strongly linked to an increased risk of sudden infant death syndrome (NHS, 2019).

Effects on milk supply

People used to think that moderate beer consumption might help to start off breastfeeding. Mums were actually encouraged to drink alcohol to help them relax and encourage their milk supply (Koletzko and Lehner, 2000).

Research now suggests it's the barley and hops that might increase a mum's milk supply rather than the alcohol. That's because the effect was similar whether it was alcoholic beer or non-alcoholic beer (Lactmed, 2019).

Other research has shown that women who have consumed alcohol produce 20% less milk at the next feed than those who have had a non-alcoholic drink (Mennella, 2018). The babies made up their intake in the following 8-16 hours (Hale & Rowe, 2017) . The quality of the milk was not affected, and babies did not reject the milk, but if you're concerned about low milk production, you may wish to avoid alcohol while you're breastfeeding (Mennella, 2018).

Effects on your baby's sleep

Another myth about having an alcoholic drink while breastfeeding is that it relaxes your baby and helps them to sleep.

Studies have shown that a mum's alcohol consumption while breastfeeding might negatively affect their child's sleep. A small study of 12 babies found babies exposed to alcohol though breastmilk might sleep for shorter periods but more often during a day, although their total amount of sleep in the three hours after consuming milk including alcohol was not significantly different to days when the mum didn't drink (Mennella and Beauchamp, 1991).

Conversely, another study of 13 babies found that they slept less in the 3.5 hours after consuming breastmilk with alcohol when their mothers drank one or two alcoholic drinks than when they didn't drink (Mennella and Gerrish, 1998).

There is no evidence that alcohol has a positive affect on babies' sleep. Some research shows babies may be more agitated and mothers less consistent in their responses when they have drunk alcohol. (Schuetze et al, 2002)

When breastfeeding, how long does it take for alcohol to leave the system?

Around 30 to 60 minutes after drinking there will be the highest concentration of alcohol in breastmilk. It'll take a little longer if you've been eating too. The alcohol concentration in your breastmilk declines at the same rate as it does in your blood (Mennella, 2018).

The NHS suggest you avoid breastfeeding for two to three hours per drink after drinking to minimise the concentration of alcohol in breastmilk (NHS, 2019). To avoid any impact on supply, you may want to make sure breastfeeding is well established before you try this. This will usually be when your baby is 6-8 weeks old.

'Pump and dump'

So-called 'pumping and dumping' is when women express or 'pump' their breastmilk and discard/'dump' the milk. Some mums believe that this will 'get rid' of the alcohol so they can breastfeed their baby afterwards.

The snag is that breastmilk will have the same alcohol concentration as your blood. So pumping and dumping immediately after drinking alcohol doesn't speed up the disappearance of alcohol from the milk. The newly produced milk will contain alcohol as long as the mother has measurable blood alcohol levels (Mennella, 2018).

All your body needs is time to metabolise the alcohol so there's no more left in your blood or breastmilk. The length of time varies by woman, but 2-3 hours for every drink is suggested (NHS, 2019).

If you're not sure how much you might end up drinking, you could plan ahead by expressing some milk beforehand. You can then skip the first breastfeed after the event and feed your baby with your previously expressed milk instead (NHS, 2019).

There is no need to 'pump and dump' milk unless you're experiencing discomfort from your breasts being too full. If you're separated from your baby for a few hours, you might wish to express milk (by hand or using a pump) for comfort, but also to prevent blocked ducts or mastitis.

Tips on cutting down on alcohol

If you normally enjoy a drink and want to cut down on alcohol whether or not you are breastfeeding, these ideas may help:

If you're going out, make a plan and set a budget to spend on alcohol that you stick to.

Buy a smaller drink, or choose something that isn't as strong.

Quench your thirst with non-alcoholic drinks or mocktails and stay hydrated by drinking water between alcoholic drinks.

Sip your drink and put it down between sips.

Ask family and friends to support you by not offering to pour or prepare you drinks.

Make some of the days of the week alcohol free and don't drink more than two units on the other days.

If you drink a lot and are worried about how to cut down, then talk to your midwife or family doctor. Alternatively, you can call one of the helplines listed below.
This page was last reviewed in March 2021.
Further information

NCT supports all parents, however they feed their baby. Call our infant feeding support line on 0300 330 0700 to speak to a breastfeeding counsellor if you have questions, concerns or need support, 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.

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.

Alcoholics Anonymous (AA) is concerned with the personal recovery and continued sobriety of individual alcoholics who ask for help. National Helpline number 0800 917 7650.

Al-Anon Family Groups are there for anyone whose life is or has been affected by someone else's drinking. Call 0800 0086 811.

With You is a UK-wide treatment agency that delivers support and raises awareness around drugs, alcohol and mental health.

Adfam empowers family members and carers to prevent drug and alcohol abuse threatening family relationships and wellbeing.

Gov.uk (no date) The drink drive limit, Available at: https://www.gov.uk/drink-drive-limit \

Haastrup MB, Pottegård A, Damkier P. (2014) Alcohol and breastfeeding. Basic & Clinical Pharmacology & Toxicology. 114(2):168-173. Available at: https://onlinelibrary.wiley.com/doi/10.1111/bcpt.12149

Hale TW & Rowe HE (2017) Medications and mother's milk. New York, Springer

Koletzko B, Lehner F. (2000) Beer and breastfeeding. Adv Exp Med Biol. 478:23-28. Available at: https://pubmed.ncbi.nlm.nih.gov/11065057/

Lactmed. (2019) Alcohol. Available at: https://www.ncbi.nlm.nih.gov/books/NBK501469/&nbsp;

Low level drinking during breastfeeding is not linked with shorter breastfeeding duration or adverse outcomes in infants up to 12 months of age. (Wilson et al, 2017 https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12473 )

Mennella JA, Beauchamp GK. (1991) The transfer of alcohol to human milk: effects on flavor and the infant's behavior. New England Journal of Medicine. 325:981-985. Available at: https://www.nejm.org/doi/10.1056/NEJM199110033251401?url_ver=Z39.88-2003%C2%A0%5B

Mennella JA, Gerrish CJ. (1998) Effects of exposure to alcohol in mother's milk on infant sleep. Pediatrics. 101:e2-e2. Available at: https://pubmed.ncbi.nlm.nih.gov/9565435/

Mennella JA. (1998) Short-term effects of maternal alcohol consumption on lactational performance. Alcoholism: Clinical and Experimental Research. 22(7):1389-1392. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9802517 [Accessed 1st June 2018]

Mennella JA. (2018) Alcohol's effect on lactation. Available at: https://pubs.niaaa.nih.gov/publications/arh25-3/230-234.htm [Accessed 1st June 2018]

NHS. (2019) Breastfeeding and drinking alcohol. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-alcohol/

NHS. (2018b) Alcohol units. Available at: https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/ [Accessed 1st June 2018]

NHS. (2018c) Tips on cutting down. Available at: https://www.nhs.uk/live-well/alcohol-support/tips-on-cutting-down-alcohol/ [Accessed 1st March 2018]

NICE (2021) Postnatal care [NG194]. Available at: https://www.nice.org.uk/guidance/ng194/chapter/recommendations#bed-sharing [Accessed 11 Jan 21]

RCOG. (2018) Alcohol and pregnancy. Available at: https://www.rcog.org.uk/globalassets/documents/patients/patient-informa... [Accessed 1st June 2018]

Schuetze P, Das Eiden R, Chan AW. The effects of alcohol in breast milk on infant behavioral state and mother-infant feeding interactions. Infancy. 2002;3:349-63.  https://pubmed.ncbi.nlm.nih.gov/33451218/&nbsp;

Wilson et al (2017) Alcohol consumption by breastfeeding mothers: Frequency, correlates and infant outcomes. Available at: https://doi.org/10.1111/dar.12473

Links all accessed/checked/updated 17th March 2021.

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Can you drink alcohol if you breastfeed?

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Alcohol consumed occasionally in low or moderate amounts is unlikely to harm your baby (NHS, 2019; Wilson et al, 2017) . There is also no evidence that low-level drinking during breastfeeding shortens how long you will breastfeed (Wilson et al, 2017). What's more, there's no information on the effect of long-term daily exposure to alcohol.

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This webpage contains the information seen on the handout show at the session. If you click the 'download article as pdf' you will see the handout.

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Useful guide to expressing, when to express, why its useful, and how to do it! Details of hand expressing and pump, and how to use Expressed breast milk.

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Breastfeeding Network - Expressing information

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Breastfeeding Network - Expressing information

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Information shown on the handout seen at the session. Handout can be accessed by clicking the link to download the leaflet.

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This page gives you some tips on how to hand express and store your breastmilk. It also answers some frequently asked questions on this topic.

You might be thinking of returning to work, or study, or planning a night out. It can also help relieve pressure from a blocked duct or mastitis. Expressing small amounts of colostrum before your baby is born can help give your baby extra milk in the first few days.

Please also refer to our downloadable leaflet on Expressing and Storing Breastmilk.

If you will be exclusively expressing (feeding only expressed breastmilk), whether for just a few days or longer, you might like to read our blog post on this.

Note: If your baby has been ill or was born prematurely please discuss this information with your health professional to check that the storage times apply. This is especially important if you are bringing your colostrum or milk into hospital for your baby.

Your breastmilk

Can be expressed by hand, by hand pump or by electric pump. Once you know how, hand expressing is easy and needs little equipment.

Contains anti-infective ingredients that limit the growth of unwanted bacteria.

Should still be handled and stored carefully to stop unwanted bacteria from getting into your milk and growing.

Stays at the highest quality when stored in a fridge, particularly when running at 4°C or below. Note: some fridges run higher at 5-10°C - if you don't know the temperature of your fridge assume it is running at this higher temperature.

Can be frozen, which affects some (but by no means all) of the nutrients and anti-infective ingredients of breastmilk.

Expressing breastmilk

When you first start to express it is common to get only a few drops of milk. As with breastfeeding, the more you practice, the easier it gets. Expressing at a different time of day may work better for you.

When might I need to express?

Before your baby is born - you may be advised that your baby might need extra milk when they are born. You can express and store your first milk (colostrum) from 36 to 37 weeks gestation. You can read more about this here.

In the first few days - if your baby is sleepy, or to help them attach and feed.

For both these stages your midwife will give you small oral syringes to collect your milk. These are usually 1ml to begin with.

Use the ideas in this leaflet to discover what works for you. Colostrum usually starts in tiny droplets and is often sticky - having help to collect these drops in the syringe can be useful.

Aim to express twice a day from 36-37 weeks for no more than 10 minutes, freezing the same day.

Once your baby is born, express as needed aiming to stimulate your breasts at least 8 times a day including once overnight through direct breastfeeding or expressing as this will increase your milk supply to meet your baby's needs and can help you feel more comfortable.

Hand Expressing

Once your milk is flowing, you will need a wide mouthed container like a sterile plastic pot or container that is well-cleaned and scalded with boiling water - a jug is ideal - so get this ready before you start.

Remember to wash your hands first.

Find somewhere comfortable to relax, then to help your milk to flow (let down) you might:

Relax with a warm drink, music or TV.

Have your baby close, or look at a photograph, clothing or toy to remind you of your baby.

Warm your breasts in a bath, shower or using warm flannels and practice expressing.

Try some ways to gently massage your whole breast, working from the outside toward your nipple.

Take care not to drag your skin:

Stroke with your fingertips

Roll using your knuckles.

Try using circular movements.

Make a 'C' shape by placing your thumb above and your fingers below your breast 2-3 centimetres back from your nipple

Gently press your thumb and fingers together, release your fingers and repeat in a rhythmic movement.

Sometimes pressing inwards back towards your chest wall as you squeeze helps. You may need to experiment with how far back from your nipple to squeeze - everyone is slightly different.

When the milk flow slows, re-position your fingers and thumb (as if moving them around a clock face), then express another area of your breast.

Try to express all areas of your breast and alternate between breasts.

See this video on hand expressing from UNICEF for more ideas.

Good hygiene is very important:

Always wash your hands before expressing and handling breastmilk and ask others giving expressed milk to do the same.

Always use a sterile container with a lid, not the collection jug, to store your breastmilk. You can buy disposable containers. Take care with plastic bags that can puncture easily.

Try to use a different storage container each time you collect milk. If necessary, newly collected milk may be cooled and added to previously stored milk on the same day only.

Label the storage containers or syringes with your name, breastmilk, time and date and put inside a clean sealed bag or box before storing. Name and date the bag too.

Store your breastmilk in the fridge or freezer as soon as possible.

Store away from meat products, eggs or any uncooked foods. Store at the back of the fridge and not in the door.

Storing expressed breastmilk

How long can I keep my breastmilk at room temperature if a fridge is not available?

If your breastmilk is freshly expressed it will keep for 6 hours without refrigeration, either at home or away from home. See 'travelling with breastmilk' section below for more details.
If your baby has been ill or was born prematurely please discuss this with your health professional to check that the same storage times apply.
How long can I store breastmilk in the fridge?

You can store your breastmilk for up to 3 days where you don't know the temperature, or it runs between 5-10°C.

Breastmilk can be stored for 5 days in a fridge running at 4°C or lower.*
*One study has shown fresh breastmilk can be used for up to 8 days when the fridge temperature is kept stable at 4°C or below.

If the fridge temperature goes above 4°C during this time, use your milk within 6 hours or throw away.

If you can't use a fridge at 4°C, try using a cool bag or box with deep frozen ice packs (changed every 24 hours). Protect your milk from direct contact with the ice packs or it may freeze - try wrapping the ice packs in kitchen towel. The bag can also be used to carry milk.

The lower the storage temperature, the longer expressed breastmilk can be stored. The storage temperatures given here include a degree of caution so that your milk remains safe for your baby.

If you wish to store your breastmilk for longer than 5 days, freeze as soon as you can after expressing.
If taking colostrum or milk into hospital follow their storage and transport times. REMEMBER: The more often the fridge door is opened, the more likely the temperature will rise. Try to check the temperature of every fridge (or cool bag) used for storing your milk each time you use it. If the fridge has no built in thermometer, use a fridge thermometer which can be bought cheaply from kitchenware stores.
How long can I store breastmilk in the freezer?

Breastmilk can be stored in a freezer at -18°C for up to six months.

You can store breastmilk in the ice compartment of a fridge for two weeks.

Safe Storage of breastmilk in the home

This table aims to provide a guide to how long you can store breastmilk for a full term baby with no additional health concerns.

Why are there variations in recommendations for storing expressed breastmilk?

More information about this can be found at the bottom of this page.

Please note that previous versions of our leaflet are still available in our shop and the information is still correct, noting the above.

Feeding baby expressed breastmilk

What happens if my baby doesn't take all of one bottle? Can I put it back in the fridge or on the side use it again?

Once the baby has drunk from a bottle of expressed milk it should be used up within an hour or thrown away. To avoid wasting your expressed breastmilk it is best to offer the baby only a little (e.g. 30ml) at a time until you know your baby's pattern. You can do this by keeping most of it in one container, in the fridge, and using it to top up the baby's bottle a little at a time.

Defrosting frozen breastmilk

How do I defrost my milk?

Ideally, defrost frozen breastmilk in the fridge. This milk should be used once fully defrosted which usually takes about 12 hours. If your breastmilk is still frozen after this time or you need to use it quickly, try defrosting under cool, then warm, running water. Dry the outside of the container with kitchen paper before use and use immediately. If you frequently find your milk is frozen after 12 hours in the fridge, try to freeze in smaller quantities.

How long can I keep defrosted breastmilk?

Defrosted breastmilk should be used straight away once it has fully defrosted. Throw away any unused milk.

Why can't I defrost breastmilk in a microwave?

Breastmilk should not be defrosted in the microwave because it heats unevenly, destroying antibodies and nutrients. There is also a risk of scalds and the milk would need to be left at room temperature before use.

Travelling with expressed breastmilk

How do I bring my milk home, which I have expressed at work or elsewhere?

Try to use a cool bag for transportation and put the milk in the fridge once you are home.

Fresh breastmilk can be transported within 24 hours provided storage temperatures are maintained using an insulated box or bag and deep frozen ice-packs, and total storage and transportation times do not exceed the recommended storage times.

Previously refrigerated breastmilk can be kept cool (10°C or below) for up to 24 hours when in a well-insulated bag with deep-frozen ice-packs. Take care not to freeze your milk by wrapping the ice-packs in kitchen paper first. Ensure this milk is used within the recommended refrigeration storage times as mentioned above.

Re-heating expressed breastmilk

How do I re-heat expressed breastmilk?

Expressed breastmilk can be used straight from the fridge. It does not need to be warmed. If you would like it warmed place the container (such as a bottle or sealed cup) in warm water to take the chill off. Take care not to over warm.

If the milk smells sour DO NOT USE.

When stored, the cream and milk may separate out. This is normal. Shake gently to mix before use.

Some babies are reluctant to take milk from a bottle, particularly at first. Try offering milk from a cup or spoon. They may be less reluctant when someone else gives it. If expressed milk is refused try not to worry - your baby will make up any missed feeds by breastfeeding more often or for longer on your return. See also info on this page about introducing a bottle.

Finding a breast pump

The two UK breast pump hire companies are:
Ardo breast pumps Medela breast pumps
Your midwife, health visitor or a local breastfeeding supporter may also be able to give you details of pump hire services near you.

Useful links
Human Milk Foundation
UKAMB (UK Milk Banks - find out about donating or receiving milk)
Milk Bank Scotland
Antenatal Expressing - more detailed information about this

References

(links checked May 2023)

Cook, P. Food Standards Agency. MCN10. 2006 Handling and storage of expressed breastmilk pp1-12 https://www.nice.org.uk/guidance/ph11/documents/mcn-consultation-expert-report-handling-and-storage-of-expressed-breast-milk2

Eglash, A, Simon, L, and The Academy of Breastfeeding Medicine, ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants, BREASTFEEDING MEDICINE Volume 12, Number 7, 2017 (c) Mary Ann Liebert, Inc. pp390-395 https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/8-human-milk-storage-protocol-english.pdf See correction to freezer temp here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065517/

Forster, Della A et al. (2017) Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. The Lancet, Volume 389, Issue 10085, 2204 - 2213 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31373-9/ppt

Hands A. (2003) Safe storage of expressed breastmilk in the home. MIDIRS Midwifery Digest, vol 13, no 3.

Royle, J. Weaver, G. (2016) Guidelines for the Preparation and Handling of Expressed and Donor Breast Milk and Special Feeds for Infants and Children in Neonatal and Paediatric Health Care Settings. 2nd Ed. Section 6, p18-32
BDA Guidelines for the Preparation and Handling of Expressed and Donor Breast Milk and Specialist Feeds for Infants and Children in Neonatal and Paediatric Health Care Settings
IMPORTANT: If you have any further questions on expressing or breastfeeding, do contact your midwife, health visitor or breastfeeding supporter for help and support. You can also call the National Breastfeeding Helpline on 0300 100 0212, open 9.30am-9.30pm every day of the year.

Page reviewed and updated November 2019

Variations in Recommendations for Storing Expressed Breast Milk

Written by Anabel Hands

In 2003, aware of the confusion for mothers resulting from the significant variations in recommendations for storing expressed breast milk, the BfN decided to collate all available information from primary research papers, and national and local guidance documents. These findings were published in the MIDIRS Midwifery Digest 1. The study found that storage temperature clearly determines storage time. Recommended storage times given in our Expressing and Storing Breast Milk leaflet were based on the primary research papers discussed in the study. You can find the link to this leaflet below for more information 2.

Our publication was sent to other breastfeeding organisations, including the Department of Health (DH), to facilitate agreement on storage recommendations using the results of primary research. The DH asked the National Institute of Clinical Excellence (NICE) to review breast milk storage guidelines, and official storage recommendations were changed from 24 hours in the fridge to up to 5 days at 4°C or lower, two weeks in the ice compartment of a fridge and up to six months in a freezer (March 2008) 3.NICE also recognised that refrigeration preserves the unique properties of breast milk more effectively than freezing. The National Health Service (NHS) adopted these guidelines, which appear in their leaflet Off to the best start (updated November 2009) which you can find a link to below 4.

Although a little different to BfN guidelines, the NICE and NHS recommendations took into account that fridge temperatures can vary and that a 5-day storage time covered most situations, including the need for milk expressed at the end of one working week to be used at the beginning of the following week. Some busy hospital neonatal units restrict the time milk is refrigerated as an added precaution; this is because their fridges are opened very frequently, which may affect the storage temperatures 5.

Other breastfeeding organisations, such as La Leche League, updated their published recommendations to distinguish between acceptable storage (8 days in the fridge) from ideal storage (72 hours in the fridge), and also recognised that refrigerated expressed breast milk was preferable to frozen breast milk (March 2012) see link below for more information. These recommendations are in line with the BfN leaflet 6.

It is important for mothers and breastfeeding supporters to note that leaflets and recommendations inconsistent with the published research are still in circulation, particularly on the Internet, and that countries outside of the UK may recommend different guidelines.

Please note that previous versions of our leaflet are still available in our shop and the information is still correct, noting the above.

References

1. HANDS A. Safe storage of expressed breast milk in the home. MIDIRS Midwifery Digest, vol 13, no 3, Sep 2003, pp 378 & 385.

2. BfN (Breastfeeding Network) leaflet. Expressing and storing breast milk. September 2004.

3. National Institute for Health and Clinical Excellence (NICE) Public health guidance 11: Maternal and child nutrition. March 2008.

4. Department of Health. Off to the best start. Crown Copyright 2007 278957 5p 200k Nov 09 (BEL) 299223.

5. MCN consultation: Expert report & Handling and storage of expressed breast milk. 05 April 2007.

6. La Leche League International. "The Breastfeeding Answer Book" Updated March 2012.

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Expressing and storing breastmilk - The Breastfeeding Network

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This page gives you some tips on how to hand express and store your breastmilk. It also answers some frequently asked questions on this topic. You might be thinking of returning to work, or study, or planning a night out. It can also help relieve pressure from a blocked duct or mastitis.

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Antenatal Expression of Colostrum - La Leche League GB

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth. Why express while pregnant? Being familiar with your breasts and…