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Bath (Fridays, 1.30pm til 3.30pm) Percy Community Centre, New King St, Bath BA1 2BN

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Bath (Fridays, 1.30pm til 3.30pm) Percy Community Centre, New King St, Bath BA1 2BN

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Run by volunteer Lactation Consultant Heather Kale and Breastfeeding Peer Supporters. Call 01225 423014.

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Fridays 1.30-3.30pm, Bumps & Babies @ Percy Community Centre provides a space for expecting and new parents with babies to meet, drink a cup of hot drink and eat a home made cake or borrow a gentle...

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Hand expressing video

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Unicef UK Baby Friendly Initiative | Hand expression

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Essential Guide to Feeding & Caring for your baby

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Essential Guide to Feeding & Caring for your baby

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Breastfeeding Support: La Leche League, Bath  WhatsApp: 07828 149623. In person monthly meetings at Bath Central Library (above Waitrose) or Norland College (Oldfield Park)

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Breastfeeding Support: La Leche League, Bath  WhatsApp: 07828 149623. In person monthly meetings at Bath Central Library (above Waitrose) or Norland College (Oldfield Park)

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LLL GB for support from a breastfeeding counsellor: 0345 120 2918. Please check local group on social media for updates about meetings.

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Breastfeeding Support: across our LMNS (Local Maternity & Neonatal System)

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Breastfeeding Support: across our LMNS (Local Maternity & Neonatal System)

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Website for our Intergrated Care Board (ICB) covering Bath & NE Somerset, Swindon and Wiltshire

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The World Health Organisation recommends exclusive breastfeeding for the first six months and continued breastfeeding alongside other foods for at the least the first two years years and beyond.

The first few weeks can be the most difficult when you are establishing breastfeeding. Please use the tabs below for further help, tips and support. You might find it helpful to sign up to the fast, friendly, anytime, trusted NHS advice on breastfeeding.

Breastfeeding will give your baby the best start in life. However, any amount of your breastmilk will always be good for your baby's health and wellbeing.

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Feeding your baby Menu Feeding your baby Breastfeeding Baby wearing (slings) Bottle feeding Skin to skin Breastfeeding is the healthiest way to feed your baby, with important benefits for both mother and baby. We therefore encourage and support you to breastfeed your baby. We also support the right of parents to make...

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Responsive feeding and building a happy baby

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South Wiltshire and Surrounds Breastfeeding Support | Facebook

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This group is here to support all families feeding their children human milk, whatever this looks like to your family. It is a place for chatting with peers, receiving reassurance, sharing your...

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The Lived Experience - Breastfeeding a baby with Down syndrome

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Expressing and Bottle Feeding (Choosing which formula)

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Expressing and Bottle Feeding (Choosing which formula)

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A simple guide to choosing Infant formula and follow-on formula

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Expressing and Bottle Feeding: Combination (Mixed) feeding

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Expressing and Bottle Feeding: Combination (Mixed) feeding

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Mixed feeding your baby: combining breastfeeding and formula 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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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you’re separated from your baby or if he isn’t breastfeeding well.

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

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

When a baby can't breastfeed

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

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

Return to work or separation

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

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

Making more milk

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

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

See How to increase your milk supply.

Storing breastmilk

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

Pumps

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

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

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

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

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

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

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

Tips for Expressing

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

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

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

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

How often?

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

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

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

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

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

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

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

Expressing when out and about

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

Support and encouragement

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

Feeding your baby your milk

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

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

Further Reading

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

Other websites
Hand expressing:

Maximizing milk production when expressing:

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

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

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

Copyright LLLGB 2016

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Expressing Your Milk - La Leche League GB

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

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Memerah dan Menyimpan ASI

Expressing breastmilk can relieve breast fullness, soften the breasts, and make it easier for the milk to flow. It is also important to maintain a mother's milk supply during separation and make milk available for someone else to feed the baby. This video shows how to hand express breast milk and how to safely store it for later use.

Join the Conversation

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Expressing and Storing Breastmilk - Video - Global Health Media Project

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Expressing breastmilk can relieve breast fullness, soften the breasts, and make it easier for the milk to flow. It is also important to maintain a mother's

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Contact our Single Point of Access (SPA)0300 247 0055 (Mon-Fri 9:00 - 16:30) Health Visiting for information and advice

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Need to borrow a breastpump in BaNES? Our Health Visitors may be able to help.

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Need to borrow a breastpump in BaNES? Our Health Visitors may be able to help.

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Bath and North East Somerset Community Health and Care Services

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Your Health Visiting Service is accredited under the Unicef baby-friendly initiative, which means we have achieved rigorously assessed, quality standards for providing support to all parents for responsive parenting.
Health Visitors are qualified nurses or midwives with a specialist qualification in public health for children, young people and families. They work alongside families offering support and information around parenthood and early parenting, from pregnancy right through to when your child starts school. The service offers support for all parents of all children (0-5), whatever their circumstances.

Out latest Baby & Toddler Hub schedule:

BANES HV Baby & Toddler Hubs - Sept 2022

Please click here to download our 'Essential guide to feeding and caring for your baby'.

More useful links here.

Latest News

NO Baby & Toddler Hub at Paulton Hospital on 20th September

Please be aware the Baby & Toddler hub at Paulton hospital on Tuesday 20th September is cancelled. We have other hubs available in the area - Orchard Vale, MSN on Wednesdays 10.30-12.30pm or Hope House Centre, Radstock on Thursdays 9.30-11am. Sorry for any inconvenience caused. Somer Valley Health Visitors 01761 408358

NO Baby & Toddler Hub at Abbot Alphege School, Bath during school holidays

Baby & Toddler Hub at Abbott Alphege School will NOT be running on Thursday 18th August and 1st September - back on Thursday 15th September. Alternative venues are available across Bath & North East Somerset. To speak to a HV, please call us on 01225 831829. Parkside Health Visitors.
Community Hub Update
The BANES Health Visiting Service is delighted to welcome you to the Baby and Toddler drop-in Hubs from March 14th 2022.

The Hubs provide an opportunity for you to meet with a member of the Health Visiting team for advice and support.

Please bear with us as we are expecting the Hubs to be busy during the first few months and you may need to wait to be seen.

Whilst Covid restrictions have been relaxed, healthcare settings, including the Hubs, are still required to adhere to the guidance of wearing a face mask/covering; hand sanitation; and social distancing. On arrival at the Hub a member of the team will be available to greet you and run through the guidance. Please do not attend if you are showing any Covid symptoms or if you or your child are unwell.

Please remember to bring your child's red book with you.

Please also find a list of low cost BANES Baby and Toddler groups, on the Maternity Voices Partnership Padlet by clicking here
MMR
Uptake of most routine childhood vaccinations has been declining over the past 5 to 10 years. It is extremely important that all babies and children receive their routine vaccinations at the right time in order to give them the best start in life.

Diseases like smallpox and polio have been eradicated in the UK thanks to vaccines.

The MMR vaccine protects against three infections: measles, mumps and rubella. One in 10 children under the age of 5 in England haven't had one or both of their MMR vaccines which means that measles importations could lead to outbreaks.

Measles can infect around 9 out of 10 non-immune (those who are unvaccinated or have not previously been infected with the measles virus) people exposed to it and can lead to serious complications. The MMR vaccine is the safest and most effective way for parents and guardians to protect their children against measles, mumps and rubella.

Find out more here
Healthy Start Vouchers
🍏🍌🥕Have you received your letter from NHS Healthy Start? If you've been invited to apply for your new Healthy Start prepaid card, visit https://bit.ly/3dm0BIg to apply today 😊

The Institute of Health Visiting has produced some really useful advice on parenting through Coronavirus. They have also produced a guidance document regarding your baby's 6-8 week GP review during lock down.

NHS England has produced a leaflet on illness and coronavirus in newborn babies:

Take the survey here - https://www.bswmaternityvoices.org.uk/survey/

There is some useful information on this website.

More about us

We see all children (0-5 years) and their families who are residents in the Bath and North East Somerset area.

Some of these services are not available or have changed due to COVID 19. You can expect to receive support from your Health Visitor from birth through to when your child is 5 years old or enters school which includes:

An invitation to an antenatal parent course called Hello Baby! This is a free course for parents expecting a baby, which runs over 3 sessions. It is a lovely way to meet other parents and members of your health visiting team and is a really friendly and relaxed course about becoming a parent. This is currently not available.

A visit to your home while you are pregnant. This is a chance to meet your Health Visitor and discuss becoming a parent and the local support available for you. These are currently being offered virtually via video/telephone.

A new birth visit. Your Health Visitor will arrange to visit you at home before your baby is 14 days old to support you with feeding and caring for your baby and adjusting to having a new family member.

A 6-8 week visit. At 6-8 weeks your Health Visitor will arrange to see you face to face to find out how you are feeling as new parents and support you with any questions.

Next Steps Group - when your baby is 3-4 months old you will be invited to a virtual group. This is a live presentation covering topics such as home safety, oral health and introduction to solids.

Weekly baby & toddler hubs. Baby & toddler hubs are drop-in sessions which have replaced baby clinics. They offer relaxed settings for families to meet and chat with Health Visitors and other parents and Carers.

Development reviews. These are a chance to discuss the development of your child with your Health Visitor. Development reviews take place at 9-12 months and 2 - 2.5 years.

If you want to look to see how your baby is developing we have some useful websites for you to look at here.

What can I talk to my Health Visitor about?

With your Health Visitor, you are able to share thoughts, feelings and experiences about being a parent health Visitors have the professional experience to support you through any worries you may have. At the hubs, you can also chat with other parents in a relaxed play environment for your baby. The Health Visiting Team may be able to support you:

Infant feeding and introducing family foods

Understanding your baby's behaviour and how they are developing

Adjusting to becoming a parent

Family life and difficulties such as postnatal depression

Healthy choices such as lifestyle, eating or immunisations

Home safety, discussing housing concerns, domestic abuse or child abuse

We work with other professionals and practitioners to support you getting additional expert help if you need it. We can also signpost you to take full advantage of the range of resources that are available to you locally so you can gain support within your own community. We also work closely with local Children's Centre's to promote family activities which help build a strong bond with your child. Children's Centre's offer a range of services, advice and support for Parents and Carers.
How do I access this service?
By phone: You can call your Health Visiting team at any time during office hours (9am - 5pm). All teams have an answering machine where you can leave a message during times when nobody is available to take your call.

In-person: You can drop into any of the baby & toddler hubs across Bath & North East Somerset - See above.

Contact Us

If you would like any support or advice about the health and wellbeing for your child or yourself from your Health Visitor please contact your local Health Visiting Team whose details are below and also in your child's red book
Parkside Team: 01225 831829 Bath South Team : 01225 831694 Keynsham Team: 0117 9461076 Chew Valley Team: 01225 613887 Somer Valley Team: 01761 408358
Learn more about the HANDi app here - a local app providing expert advice on common childhood illnesses.

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Health Visiting - Bath and North East Somerset Community Health and Care Services

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Your Health Visiting Service is accredited under the Unicef baby-friendly initiative, which means we have achieved rigorously assessed, quality standards for providing support to all parents for responsive parenting. Health Visitors are qualified nurses or midwives with a specialist qualification in public health for children, young people and families.

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Breastpump hire in BaNES area: Simone 07765 708 422

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Breastpump hire in BaNES area: Simone 07765 708 422

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Simone has 4 medical grade Medela breastpumps available to hire. Contact her for further information about cost and availability

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How to hire a hospital grade breast pump

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How to hire a hospital grade breast pump

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Works out at less than £1.70 per day

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Hire a Symphony Double Breast Pump | Hospital Grade

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The Hospital Grade Medela Symphony Plus breast pump is the number one choice for midwives and UK hospitals. Rent from less than £1.50 a day today!

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Maximising milk production with Hands-On Pumping

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Maximising milk production with Hands-On Pumping

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This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

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This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

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The Milk Room on Mary Ward, RUH Bath (opposite Day Room & kitchen)

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The Milk Room on Mary Ward, RUH Bath (opposite Day Room & kitchen)

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Your midwife or MSW will be happy to tell you how the facilities in this room can support you on your feeding journey.

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Expressing and Bottle Feeding: for parents who aren't planning to get baby back to the breast

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Expressing and Bottle Feeding: for parents who aren't planning to get baby back to the breast

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Video: how do I use the time I spend bottle feeding to help me bond with my baby? Really lovely resource for parents re responsive bottle feeding

This is embedded in a page of information about bottle feeding. 1m 53s

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How much formula does my baby need?

Newborn babies need quite small amounts of formula to start with. The amount will vary from baby to baby.

Although most babies settle into a feeding pattern eventually, they vary in how often they want to feed and how much they want to drink.

Feed your baby when they show signs that they want it. Babies tend to feed little and often, so they may not finish their bottle. Having a big feed does not mean your baby will go longer between feeds.

How do I know if my baby is getting enough formula?

Your baby's weight gain and the number of wet and dirty nappies will tell you whether your baby is getting enough formula.

Your baby should have around 6 wet nappies a day from a few days after the birth. Nappies should be wet with clear or pale yellow urine, or feel heavy.

For the first day or two after birth, your baby will pass a dark, sticky substance known as meconium. Within the first week your baby should start to pass pale yellow or yellowish brown poo. They should be having at least 1 poo a day.

Your baby will usually be weighed at birth and again in the first week. After that, healthy babies only need to be weighed at 8, 12 and 16 weeks, and again at 1 year.

This information should be entered on a chart in your personal child health record (PCHR) or "red book".

Read more about the personal child health record (red book) in Your baby's health and development reviews.

If you have any questions or concerns about your baby's weight gain, speak to a midwife or health visitor.

How will I know if my formula-fed baby is hungry?

After a while, you'll get to know the signs that show your baby is ready to feed.

For example, your baby may:

start to get restless

begin to turn their head and open their mouth (rooting)

find something to suck - usually their fist or fingers

Try to feed your baby before they cry, as this is a late sign of hunger.

What do I need if I'm formula feeding away from home?

If you need to feed your baby away from home, take with you:

a measured amount of formula powder in a small, clean and dry container

a vacuum flask of hot water that's just been boiled

an empty sterilised feeding bottle with cap and retaining ring in place

The vacuum flask does not need to be sterilised, but it should be clean, and only used for your baby. The boiling water should kill any bacteria present in the flask. If the flask is full and sealed, the water will stay above 70C for several hours.

Make up a fresh feed only when your baby needs it. The water must still be hot when you use it, to destroy any bacteria in the formula powder.

Remember to cool the bottle (with the lid on) under cold running water before you feed it to your baby.
Read more about how to make up baby formula
Alternatively, you could use a carton of ready-to-feed liquid formula when you're away from home.

What if I need to transport a made-up feed?

If it's not possible to follow the advice for formula feeding away from home, you should use a carton of ready-to-feed liquid formula.

But if you still need to transport a feed (for example, to a nursery), prepare the feed at home, cool under a running tap or in a bowl of cold water, and put it in the fridge to cool.

Make sure the feed is cold. Take it out of the fridge just before you leave and carry it in a cool bag with an ice pack, and use it within 4 hours. If you do not have an ice pack, or access to a fridge, the made-up infant formula must be used within 2 hours.

If the formula that you made up at home is stored:

in a fridge - use within 24 hours

in a cool bag with an ice pack - use within 4 hours

at room temperature - use within 2 hours

Can I use bottled water to make up infant formula?

Bottled water is not recommended for making up infant formula feeds for your baby. This is because it's not usually sterile and may contain too much salt (sodium) or sulphate.

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Information and advice on formula feeding, including how much formula to give your baby, how many wet nappies they should have and how to handle feeds away from home.

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Breastfeeding Challenges and Concerns: breast surgery

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Breastfeeding Challenges and Concerns: breast surgery

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BFAR - Breastfeeding After Breast and Nipple Surgeries

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The BFAR website provides information and support to mothers who wish to breastfeed after breast or nipple surgery, and their friends and family. It is also an online resource for healthcare providers who help mothers breastfeed.

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Breastfeeding Concerns and Challenges - Keeping babies hydrated in hot weather

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Breastfeeding Concerns and Challenges - Keeping babies hydrated in hot weather

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Keeping your baby safe in the sun, including advice on hydration for babies.

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Babies and young children can become ill during very hot weather. Their health can be seriously affected by:

Try these tips for keeping your child happy and healthy in the heat.

Sun safety

Keep your baby cool and protect them from the sun.

Babies less than 6 months old should be kept out of direct sunlight. Their skin contains too little melanin, which is the pigment that gives skin, hair and eyes their colour, and provides some protection from the sun.

Older babies should also be kept out of the sun as much as possible, particularly in the summer and between 11am and 3pm, when the sun is at its strongest. If you go out when it's hot, attach a parasol or sunshade to your baby's pushchair to keep them out of direct sunlight.

Apply a sunscreen with a sun protection factor (SPF) of at least 30 to your baby's skin. Make sure the product also protects against both UVA and UVB rays. Many brands produce sunscreen specifically for babies and young children, as these products are less likely to contain additives that might irritate the skin. Apply the suncream regularly, particularly if your child is in and out of the sea or paddling pool.

Make sure your child wears a sunhat with a wide brim or a long flap at the back to protect their head and neck from the sun.

Avoid dehydration

Like adults, babies and young children need to drink plenty of fluids to avoid becoming dehydrated.

From 0 to 6 months

Fully breastfed babies do not need any water until they've started eating solid foods. During hot weather they may want to breastfeed more than usual.

If you're bottle feeding, as well as their usual milk feeds, you can give your baby a little cooled boiled water. If your baby wakes at night, they'll probably want milk. If they have had their usual milk feeds, try cooled boiled water as well.

Remember you can ask your health visitor or another health professional for advice about any baby care issue, advice will then be tailored to meet your baby's needs.

From around 6 months

Once you have started to introduce solid foods, you should offer your baby sips of water from a cup or beaker with meals. Remember that breastmilk or infant formula should be their main drinks during the first year. In hot weather, you may need to offer some additional water outside of mealtimes.

From 12 months

Water, breast milk or whole cows' milk should be your baby's main drinks. In hot weather, you can try giving them frozen lollies made from plain water or from very diluted fruit juice to help keep them hydrated. Lollies made from diluted fruit juice should only be given at mealtimes because they can cause tooth decay.

For older children, give them plenty of fruit and salad to help keep their fluid levels up. Remember that undiluted fruit juice or smoothies should not be given to children until they are 5 years old, as these can also cause tooth decay.

Read more about drinks and cups for babies and young children.

Keeping cool

Follow these tips to help keep your children cool and safe during hot weather.

Playing in a paddling pool is a good way of keeping babies and children cool. Keep the pool in the shade during very hot weather and supervise the children carefully at all times.

Run them a cool bath before bedtime.

Keep your child's bedroom cool during the day by closing blinds or curtains. You can also use a fan to circulate the air in the room.

Keep nightwear and bedclothes to a minimum. If your baby kicks or pushes off the covers during the night, consider putting them in just a nappy with a single well-secured sheet that will not work loose and cover their face or get entangled during the night.

A nursery thermometer will help you monitor the temperature of your baby's room. Your baby will sleep most comfortably when their room is between 16C and 20C.

Further information:

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Babies and young children can become ill during very hot weather. Their health can be seriously affected by: Try these tips for keeping your child happy and healthy in the heat. Keep your baby cool and protect them from the sun. Babies less than 6 months old should be kept out of direct sunlight.

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Bottle Feeding and Expressing - Costs of Infant Formula (April 2023)

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Bottle Feeding and Expressing - Costs of Infant Formula (April 2023)

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First Steps Nutrition Trust have found that the price differentials across a range of, essentially, nutritionally identical products is staggering – the difference between £9.39 and £19 a week.

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Breastfeeding Challenges and Concerns: feeding in public

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Breastfeeding Challenges and Concerns: feeding in public

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It is legal to breastfeed anywhere in public in the UK as long as you are allowed to be there. A mother is not required to cover herself or go to a specific feeding room

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The battle to breast feed | Embarrassed feat. Hollie McNish by Jake Dypka | Short Film | Random Acts

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Breastfeeding Challenges and Concerns: medications whilst breastfeeding

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Breastfeeding Challenges and Concerns: medications whilst breastfeeding

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The Breastfeeding Network constantly review the information available on drugs and breastfeeding as new research is conducted.

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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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Breastfeeding Challenges and Concerns: Mastitis

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Breastfeeding Challenges and Concerns: Mastitis

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Mastitis and Engorgement

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Take anti-inflammatory tablets and apply a warm compress before feeding to soothe the pain, but the most important thing is to get someone to help you position and attach your baby correctly. Speak to your doctor if after 2 feeds (6-8 hours) you are still feeling hot and shivery or the inflammation or lump is worsening. They may prescribe stronger anti-inflammatory tablets or antibiotics. Anything you're given will be safe for breastfeeding, but using antibiotics can make thrush more likely so try correcting positioning and attachment and anti-inflammatory medication urgently in the first instance to see if you can clear it yourself.

Call your Midwife or Health Visitor right away and, if you are still feeling shivery after a few hours and have a high temperature (feeling very hot and then very cold) then ring your GP immediately, or if they aren't open call NHS24 on 111.

It's probably the last thing you want to do, but try to carry on frequent breastfeeding during a bout of mastitis - emptying the breast is the only solution. Watch the video to hear a mum's story on how she overcame mastitis.

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Mastitis | Breastfeeding Support & Tips | Parent Club

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Take anti-inflammatory tablets and apply a warm compress before feeding to soothe the pain, but the most important thing is to get someone to help you position and attach your baby correctly. Speak to your doctor if after 2 feeds (6-8 hours) you are still feeling hot and shivery or the inflammation or lump is worsening.

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Expressing and bottle feeding: NHS Guide to Bottle Feeding 2022

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Expressing and bottle feeding: NHS Guide to Bottle Feeding 2022

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Breastfeeding Challenges and Concerns: Milk Allergy in babies

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Breastfeeding Challenges and Concerns: Milk Allergy in babies

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Information about cows’ milk protein allergy (CMPA)

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Babies can have allergies and intolerances to food just as children and adults can. The most common culprit causing a reaction for babies is cows' milk protein and a reaction to soy protein is also very common. There are various names for this including cows' milk protein allergy (CMPA), cows' milk protein intolerance (CMPI), food sensitivity and related conditions such as allergic proctocolitis or food protein-induced enterocolitis syndrome (FPIES). This article discusses infant food allergy with a particular focus on milk allergy in babies including common symptoms, causes, diagnosis and treatments.

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Can breastfed babies have milk allergies?

Although it is much more likely that a baby would react to a food he was given directly such as infant formula or dairy produce; an exclusively breastfed baby can have an allergy or intolerance to tiny traces of proteins from his mother's diet passing into breast milk. The most common food to trigger an allergic reaction through human milk is cows' milk protein. Less than 1% of exclusively breastfed babies are said to develop allergic reactions to cows' milk proteins in their mother's milk compared to 1.9-4.9% infants who have CMPA generally.

What other foods can cause allergies?

In addition to cows' milk products, other common allergenic foods include peanut, tree nuts, egg, wheat, soy, sesame, fish and shellfish but any food might cause a sensitivity in an individual mother or baby.

What about lactose intolerance?

Lactose intolerance is not the same as CMPA, but a food allergy may cause symptoms of lactose intolerance due to damage to the baby's gut affecting the digestion of lactose See Lactose Intolerance in Babies for more explanation.

Allergy or intolerance? What is the difference?

A food intolerance is an inability to digest a certain food or substance in the food. Symptoms might include tummy ache, bloating, diarrhoea or headache. Symptoms may be similar to food allergy but are not life threatening.

A food allergy is more serious than an intolerance but less common. The body makes an immune system reaction to a food, even tiny traces of the food, and occasionally this can be life threatening e.g. anaphylaxis. Allergic responses tend to be either:

Immediate (IgE-mediated). Symptoms such as swollen eyes and lips, hives, rashes, or difficulty breathing could be seen within minutes to two hours.

Delayed (non-IgE-mediated). Symptoms such as eczema, diarrhoea/constipation, blood in the stool, respiratory symptoms, or reflux might appear within hours to several days.

It's possible to have a combination of types.

How quickly can allergies be triggered through breast milk?

An allergic individual can react to trigger foods eaten directly almost immediately. But how long does it take for cows' milk and other allergens in a mother's diet to affect her breastfed baby? Kelly Bonyata IBCLC says:

Food reactions may occur within minutes, but symptoms in breastfed babies more commonly show up 4-24 hours after exposure. If baby has an acute reaction to a new food, or to a food that mom ate a large amount of, then he will probably be back to normal within a couple of hours. If baby is sensitive to a food that mom eats frequently, symptoms may be ongoing.

Symptoms of milk allergy

The most common symptoms of food allergy in the breastfed baby include:

Stomach or intestinal problems such as vomiting or reflux, signs of tummy ache/colic or diarrhoea (runny, frequent poops), green poos, poop with blood in it (allergic proctocolitis), poop with a lot of mucus, sore bottom, flatulence (often unpleasant smelling), constipation, an inflamed oesophagus (eosinophilic oesophagitis) or FPIES-a rare food allergy with severe vomiting and diarrhoea.

Skin problems such as eczema, patches of dry skin, cradle cap, nappy rash/sore bottom, rashes, hives, swelling of the eyelids or lips, flushed cheeks, skin may be unusually pale.

Breathing problems for example snuffles or cold-like symptoms, frequent ear infections, a persistent cough, wheezing or asthma.

Fussing during breastfeeding, biting at the breast or sore nipples can be associated with pain from allergies as babies can be very tense and clamp down at the breast. Sometimes there can be pronounced creasing or ridging of the nipple/areola. Babies with allergies may resist traditional positions and may push at the breast with their hands or keep coming off the breast or wriggling. Babies may want to feed all day and all night or conversely refuse to feed. Babies can seem incompetent at the breast.

Unhappy baby, unexplained crying, grunting, general fussing, baby difficult to settle and comfort, difficulty gaining weight despite copious poops, hiccups, frequent or persistent startle reflex or trouble sleeping (Noble, 2015). Allergy author Maureen Minchin describes allergy related behaviours as follows:

[Babies] who are either hyperactive before [in the womb], and persistently miserable after birth, or

[Babies] who start screaming in the second or third week of life, and

[Babies] who give many indications of gut discomfort

[Babies] who progressively develop other minor symptoms, like night sweats, cradle cap, or patches of rough skin

[Babies] who do not respond more than briefly to mothercraft skills

Is it really allergy?

There can be other reasons for symptoms of reflux, waking at night, green poop or fussy behaviour that may not necessarily be to do with the mother's diet or allergy. They are more likely to be due to food allergy if there is a family history of allergies. Discussing symptoms with your health professional and IBCLC lactation consultant will help you determine the most likely causes for your baby's symptoms.

What can cause milk allergy in babies?

There are several theories to explain the rise in childhood allergies. Some researchers are making connections between foods now thought allergenic (cows' milk, nuts, egg, wheat, soy) and their use in early infant formulas and vaccines past and present . Theories include:

A family history of allergy including hay fever, asthma, or eczema, can mean a baby has a higher risk of having allergies.

Giving a breastfed baby an early supplement of industrially made formula (including soy formula) may predispose or "sensitise" some babies to allergy. The younger the baby is when he has some formula, the more likely this is thought to happen. Although symptoms of allergy may not be seen with the first exposure, when they next encounter that protein either directly or via mothers' milk, a reaction can be triggered . Sensitisation could even occur during pregnancy . Note: Sometimes supplements may be medically necessary if your baby is not gaining weight or has high levels of jaundice and donor breast milk is unavailable. Your health professional will help you weigh up the best decision for your baby, and your IBCLC lactation consultant can help you increase your milk supply.

Vaccines contain potential allergens including milk proteins, gelatine, egg, and soy that could sensitise a baby and cause allergies with repeat exposure .

Factors such as mode of birth, nutrition, antibiotics, toxins, pollutants, and changes to the microbiome (friendly bacteria living in our bodies) may influence our gut health, how our immune systems work and hence our responses to allergens.

Diagnosis of milk allergy

Full history

Your medical professional or lactation consultant can help assess whether your baby could have a food allergy by taking a full medical history including a family allergy history. A sample questionnaire and discussion around interpreting it can be found in Maureen Minchin's book Crying Babies and Food: In the early years, 2015

Allergy tests?

According to CMPA Support-a small UK charity run by parents for parents of babies and children with food allergies and intolerances-an elimination diet (a diet for the mother that avoids trigger foods) is said to be a more accurate form of diagnosis than allergy tests:

Although there are medical tests available, they are not conclusive. Allergy Tests often return false positive and false negative results. Allergy testing only tests for IgE antibodies meaning that a non-IgE allergy will produce a negative result. The most common and accurate way to diagnose CMPA is by eliminating Cows' Milk Protein (CMP) from the diet (aka an elimination diet) for a period of time to see if the symptoms improve, and then re-introduce CMP to see if a reaction re-occurs.

CMPA Support also provide the MAP (milk allergy in primary care) guidelines to help GP's to diagnose and manage CMPA in primary care.

Treatment for milk allergy

Elimination diet

The first line of treatment recommended for suspected milk allergy in babies is to trial an elimination diet to eliminate trigger foods ( infantproctocolitis.org, Wambach & Riordan 2015, ABM, 2011). In addition to the offending allergen(s) in the mother's diet, low levels of essential fatty acids (omega-3s rather than omega-6s) and vitamin D can also be associated with infant allergies (Noble, 2015). A dietitian can be an important partner in the process to ensure you are still getting a healthy diet while excluding certain food. See the separate article Elimination Diet for more information on possible diets to follow.

Heal the mother?

A food allergy can cause damage to the lining of the gut (intestines). Repeated exposure to food allergens is sometimes said to cause "leaky gut syndrome". Author Robyn Noble explains that repeated gut damage allows more undigested food components to enter the blood stream from the intestine than normal leading to symptoms of food intolerance. Symptoms may also appear without gut damage due to enzyme or other biochemical deficiencies. Healing the mother's gut with the right diet may help her breastfed baby with food intolerances and allergies by making her breast milk less inflammatory. In extreme cases, Noble notes that when mothers consume only cooked foods or take pancreatic digestive enzymes* it seems to help food breakdown to reduce food allergy severity (Noble, 2015, p50-53).

Are probiotics helpful?

Probiotics ("friendly" bacteria and yeasts) are commonly promoted as having health benefits when taken as a food supplement. Internet searches may claim that probiotics for mother and baby can be helpful for food allergies but more research is needed. UK's National Health Service says there is no evidence to confirm that probiotics can help treat eczema . Probiotic products themselves could contain allergens and author Maureen Minchin discusses the pros and cons and recommends caution in Are Baby Biotics Bugging You?

Allergic proctocolitis

Allergic proctocolitis is an inflammatory response in the large intestine to certain proteins in the diet. The main symptoms are seen in the baby's dirty nappy; loose, mucousy stools with streaks of bright red blood . Babies generally appear well but may occasionally have anaemia or low albumin levels in the blood or, rarely, may fail to thrive. For further information see;

Treatment

The Academy of Breastfeeding Medicine suggest the following protocol for mild to moderate symptoms if an elimination diet doesn't seem to help:

Consider eliminating other allergens.

Breastfeeding may continue with monitoring of weight gain and growth.

Consider following hemoglobin and albumin levels if continued moderate degree of blood loss (blood is visible) in stools.

Consider use of pancreatic enzymes* for the mother. Dosage is generally one or two capsules with snacks and two to four with meals as needed dependent on the baby's symptoms.

In severe cases with impaired growth, decreasing hemoglobin level, or decreasing serum albumin level, the use of a hypoallergenic formula may be considered; however, one should consider referral to a specialist.

*The protocol recommends further research to establish the safety and efficiency of mothers' taking pancreatic enzymes as a treatment option. The theory behind it is that the enzymes break down potential allergens before they can get into the breast milk.
FAQs on cows' milk protein allergy

How quickly will my baby improve on an elimination diet?

Our sister article Elimination Diet explains:

Once a mother has excluded the trigger food from her diet, her baby's symptoms may start to improve within three to four days however it may take two to four weeks to see full improvement. This is likely to be associated with the time taken for any existing inflammatory reactions to settle down in the baby rather than the time taken for allergens to leave breast milk.

I've tried an elimination diet but my baby is no better, what next?

If you have tried an elimination diet for dairy with no improvement see Elimination Diet for more ideas such as how to spot hidden dairy in processed food, trying a total exclusion diet and more. In the event that a food allergy is not the culprit, stay in close contact with your health professionals and IBCLC lactation consultant to help find other causes for your baby's symptoms.

What if my doctor says I should stop breastfeeding?

Some doctors are concerned that an exclusion diet isn't healthy for mother or baby and advise that weaning baby to a specially modified formula would be better for both. However there's no evidence that industrially made hydrolysed or elemental (enzyme pre-digested) prescription formulas are "better" for the prevention of allergy in preference to exclusive breastfeeding-and poor bone health has been reported with exclusive use of certain specialist formulas While it can be challenging to follow an elimination diet, with careful supervision and help from a dietitian it can still be a healthy diet. Breast milk will be easier for your baby to digest and contains all the other benefits of breast milk.

Absolutely! Your body makes sure that your breast milk contains all of the essential nutrients, antibodies and other factors your baby needs to grow and develop. Even though you may feel your diet is missing something, chances are that you are getting all the nutrients you need from the foods you are still able to eat. Even in mothers who do not have enough food to eat, levels of micronutrients such as folate, calcium, iron, copper and zinc in their breast milk remain relatively high. A multi-vitamin is a good idea for all breastfeeding mothers, and taking 500 mg of Calcium twice a day with meals plus 1,000 to 2,000 IUs of vitamin D3 will help protect your bone health while you are avoiding dairy.

What can I share with my doctor?

Some doctors may be unaware of the latest recommendations and excellent resources available on this topic:

The ABM Protocol on Allergic Proctocolitis

The Infant Proctocolitis website designed to educate healthcare professionals as well as families. It has a special medical section for your doctors. The recommendation that mothers work with a registered dietitian will reassure your health professionals that your health is being looked after. The section for "Frequently Asked Questions" (FAQ) on infantproctocolitis.org is very useful. Should I Switch to Formula?explains Allergic Proctocolitis doesn't require switching to special formulas which are often expensive and don't always suit the baby and that breastfeeding with an elimination diet is the healthiest choice.

The GP Infant Feeding Network website has comprehensive information for GPs on CMPA, explaining it is rarely necessary to stop breastfeeding, how breastfeeding is important for allergic children and when to refer to a paediatric allergy clinic.

Breastfeeding Works! Even With Allergies by Robyn Noble contains over 500 references to support its information.

If I need to supplement, what sort of formula can I use?

There may be situations where a breastfeeding mother needs to supplement her allergic baby. Or situations where a baby's allergic symptoms are very severe and a special formula may need to be considered ( ABM, 2011). Extensively hydrolysed formulas are often recommended and in some cases, elemental amino acid based formulas may be indicated ( infantproctocolitis.org). Nutritional information for alternative milks is discussed in Specialised Infant Milks in the UK: 0-6 Months, April 2020 by First Steps Nutrition Trust. Allergy author Robyn Noble cautions that although some clinicians believe it is not possible for babies to react to elemental formulas she has seen many babies react as not all ingredients are enzyme reduced to amino acids. (Noble, 2015)

What about soya based formulas, or goat's milk?

Soya based formulas, or goat's milk formulas are not recommended as many infants will have similar allergic reactions to the proteins they contain. Soy is itself a highly allergenic protein often causing reactions . UK Department of Health Government advice 2014 states:

goats' milk-based formula is not suitable for infants diagnosed as being allergic to cow's milk. GPs will prescribe an appropriate infant formula with fully hydrolysed proteins

Will my baby grow out of allergies?

A high proportion of children (90%) can grow out of their allergies by three years of age .

How can I protect my next baby from allergies?

Allergy prevention is a concern in high risk babies with a family history of allergies. Current recommendations include:

The breastfeeding mother can continue to eat allergenic food such as milk products, fish, cooked eggs and nuts during pregnancy and lactation if she can tolerate them safely. See Elimination Diet for more information.

Introduce solids while continuing to breastfeed.

UK's NHS recommends introducing potentially allergenic food gradually into a baby's diet after six months of age . See Starting Solid Foods for a full discussion of the guidance in UK and USA.

There is no evidence that using hydrolysed formula can prevent allergies and health concerns such as poor bone health have been associated with exclusive use of certain specialist formulas.

Summary

One of the most common proteins likely to trigger an allergic reaction in breastfed babies through mother's milk is cows' milk protein from cows' milk and dairy produce in a mother's diet. Known as cows' milk protein allergy there are a number of related symptoms and conditions such as allergic proctocolitis. Lactose intolerance is not the same as milk allergy, see Lactose Intolerance in Babies. Once identified, an elimination diet for mother can remove the allergens from breast milk. Many babies will grow out of allergy over time.
Information in this article is not tailored for you and your baby. Always consult with your health professionals for advice that takes yours and your baby's medical history into account.

Footnotes & References

1. Minchin, Milk Matters Infant feeding & Immune Disorder, 2015

2. Milk Matters: Infant Feeding & Immune Disorder, Maureen Minchin, 2015 p 715

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This article discusses infant food allergy with a particular focus on milk allergy in babies including causes, common symptoms, diagnosis and treatments.

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Breastfeeding Challenges and Concerns: Twins and Multiples

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Breastfeeding Challenges and Concerns: Twins and Multiples

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Many mothers of twins or more breastfeed their babies successfully and Twins Trust are here to support you

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Many mothers breastfeed their twins, triplets or more. Twins Trust is here to support you with whichever feeding choice is best for your family.

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Breastfeeding Challenges and Concerns: Premature babies

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Breastfeeding Challenges and Concerns: Premature babies

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This information is also available in on the Baby Buddy App

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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Breastfeeding Challenges and Concerns: Covid Vaccination

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Breastfeeding Challenges and Concerns: Covid Vaccination

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These Q&As were updated on Monday 20 December 2021 and will be reviewed as new information and advice emerges.

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More than 1.3 million women worldwide have had COVID-19 vaccines in pregnancy.

Studies following up nearly 350,000 pregnant women in the US and UK who were vaccinated in pregnancy have not raised any safety concerns. Since most of these women received mRNA vaccines, such as Comirnaty/Pfizer BioNTech and Moderna Spikevax, the JCVI advises that it is preferable for these mRNA vaccines to be offered to pregnant women in the UK, where available.

The UKHSA (formally Public Health England) and Public Health Scotland have reported that well over 150 000 pregnant women have received a COVID-19 vaccine in England and Scotland, with no serious adverse effects recorded. UKHSA data from April to June 2022 reported that 72.6% of women who gave birth had received at least one dose of COVID-19 vaccine prior to giving birth.

Current research indicates COVID-19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to a developing baby. Studies of the vaccines in animals to look at the effects on pregnancy have shown no evidence that the vaccines cause harm to the pregnancy or to fertility.

The COVID-19 vaccines being used in the UK are not 'live' vaccines and so cannot cause COVID-19 infection in you or your baby. Vaccines based on live viruses are avoided in pregnancy in case they infect the developing baby and cause harm. However, non-live vaccines have previously been shown to be safe in pregnancy (for example, flu and whooping cough).

Studies have shown that protective antibodies from vaccination do cross the placenta, helping with the baby's immunity to COVID-19. We know that catching COVID-19 during pregnancy can cause severe illness in a pregnant woman, which is why COVID-19 vaccine in pregnancy is so strongly recommended.

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COVID-19 vaccines, pregnancy and breastfeeding FAQs | RCOG

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These Q&As on COVID-19 vaccines, pregnancy and breastfeeding are reviewed as new information and advice emerges.

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Breastfeeding Challenges and Concerns: different conditions appear differently on black and brown skin

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Breastfeeding Challenges and Concerns: different conditions appear differently on black and brown skin

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In a world where the majority of breasts and nipples are some shade of brown, we cannot afford to treat white skin as the default in our practice

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"In a world where the majority of breasts and nipples are some shade of brown, we cannot afford to treat white skin as the default in our practice."

- Nekisha Killings, MPH, IBCLC

Founder of The Melanated Mammary Atlas®

Partners helping us #normalizebrownbreasts

The Melanated Mammary Atlas® improves care for the underserved by broadening the health professional knowledge base in real-time, one image at a time.

Re-envisioning diagnostics. Transforming support. Normalizing brown breasts.

We aim to normalize how breast conditions manifest on patients of color. The more you see, the better you can support.

The Atlas

The Melanated Mammary Atlas® is your portal to a world of images displaying mammary related conditions on Asian, Indigenous, Black and Brown folks. We feature the first and only cache of images of this type available for viewing and constantly updated by health professionals and the public.

Who is this for?

- Lactation Specialists

- Midwives and Doulas

- Family Practitioners

- ObGyns

- Dermatologists
- Oncologists

- Aspiring Health professionals

- Any Provider who works with breasts/chests

"Indeed, if we are to truly develop an inclusive curriculum, appropriate representation must be given to all racial groups. The shortfall in representation in medical curricula is an important contributor to racial inequality in health-care experience, treatment, and patient outcomes."

Contribute an Image to The Melanated Mammary Atlas®

Our image upload tool is available to anyone who has relevant images to share. Images are input using key descriptors that will ensure accurate and robust search results. Each image is also accompanied by a case brief further detailing how the condition was recognized and treated.

We seek an equitable future of healthcare that normalizes a diverse representation of brown skin.

Subscribe

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"Pay What You Want" model

Allows for additional contributions

Grants access to all features

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Donate

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Support the movement to normalize brown breasts® by making a tax-deductible donation to Lioness Lactation Cares through our fiscal sponsor - F&L Organizational Support Services.

Community-based philanthropy

Our "pay what you want" pricing model allows for members to commit to monthly contributions above the base subscription rate. A portion of additional contributions will go back into communities whose families are most impacted by health inequities.

This isn't a moment: it's a movement.

Join the movement to normalize brown breasts® today.

Breast conditions are not shown on dark skin in most textbooks, and as a result, many health professionals are unaware of how differently some conditions present on more deeply melanated skin.

The Melanated Mammary Atlas® was born out of a need. The sad truth is a dearth of images exists in representation of breast conditions on melanated skin in health education. By and large, the images that aspiring medical professionals see during their training are of fair skinned breasts with pink nipples. Not only is this inconsistent with the pigmentation of most of the people on this planet, it creates a gap in acumen that shows up in the care and assessment of patients of color.

Necessity is the mother of invention.

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The Melanated Mammary Atlas | Health Movement

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Health movement to normalize diversity in breast healthcare and education. The Melanated Mammary Atlas™ improves care for the underserved by broadening the health professional knowledge base in real-time, one image at a time.

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Breastfeeding Challenges and Concerns: Where will baby sleep?

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Breastfeeding Challenges and Concerns: Where will baby sleep?

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First-time parents are often unprepared for the frequency with which their breastfed newborns need to feed, or how long night-time breastfeeding is likely to continue.

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First-time parents are often unprepared for the frequency with which their breastfed newborns need to feed, or how long night-time breastfeeding is likely to continue.

Breastfed babies are generally still feeding as frequently throughout the night at 3 months of age as they were at 1 month (Elias et al 1986; Ball 2003).It has been suggested by various researchers that frequent night waking is a factor contributing to the introduction of formula milk to babies, thereby undermining breastfeeding (Pinilla & Birch 1993; Marchand & Morrow 1994; Greenslade 1995; Ball 2003) given the common (but possibly no longer valid - see Doan et al 2007) perception that formula use promotes infant sleep.

A study of 253 families in the North-East of England reported that mothers who started bed-sharing in their babies' first month of life were twice as likely to still be breastfeeding when their baby was 4 months of age, in comparison with women who breastfed their baby in the absence of early bed-sharing (Ball 2003). Similar results have been seen in other studies (Blair and Ball 2004; Clements et al 1997; Elias et al 1986; Ford et al 1994; McCoy et al 2004; Mitchell & Scragg 1994; Rigda et al 2000; Quillin and Glen 2004; Baddock et al 2007, Santos et al 2009) indicating that bed-sharing is an important night-time care strategy in the context of breastfeeding. Results from the NECOT trial showed that participants who had reported bed-sharing in the first 13 weeks postnatally were half as likely as those who had reported no bed-sharing to have ceased breastfeeding at any given point (Ball et al 2011). A recent study using data from US mothers (Huang et al 2013) showed that, after adjusting for covariates, longer bed-sharing duration was associated with longer duration of any (but not exclusive) breastfeeding.

Although it is not possible to say that bed-sharing causes women to continue breastfeeding it seems likely that a positive feedback loop exists, and the two behaviours are mutually reinforcing: bed-sharing facilitates frequent feeding which supports milk supply, while breastfeeding introduces oxytocin into the mother's blood and milk, reducing mothers' blood pressure (Jonas et al 2008) and inducing sleep for both mother and infant (Stuart-Macadam & Dettwyler 1995; Hrdy 1999). Bed-sharing breastfeeding mothers cope more easily with frequent night time feeds, getting more sleep and continuing to breastfeed for longer. McKenna and Gettler (2014) have termed the combination of bed-sharing and night-time feeding 'Breast-sleeping'.

Bed-sharing inherently puts mothers and babies in close body contact; a condition which anthropologists and others consider to be the evolutionary 'norm' for human infants - click here for more information. Bed-sharing has a number of benefits, as identified by researchers, or as perceived by parents who choose to bed-share. The flip-side of these factors can be viewed as the risks or drawbacks associated with cot sleeping.

It is important that parents are made aware of how their individual circumstances affect risk; the magnitude of their personal risk-related behaviours, and how these may change from night-to-night . Parents should also know about the risks and consequences of alternate infant sleep locations, some of which can be more hazardous than bed-sharing, and are given the tools to arrive at an informed decision about whether or not to bed-share with their infant at any given time.

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Breastfed babies are generally still feeding as frequently throughout the night at 3 months of age as they were at 1 month (Elias et al 1986; Ball 2003).It has been suggested by various researchers that frequent night waking is a factor contributing to the introduction of formula milk to babies, thereby undermining breastfeeding (Pinilla & Birch 1993; Marchand & Morrow 1994; Greenslade 1995; Ball 2003) given the common (but possibly no longer valid - see Doan et al 2007) perception that formula use promotes infant sleep.

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Breastfeeding Challenges and Concerns: NICU and SCUBU units

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Breastfeeding Challenges and Concerns: NICU and SCUBU units

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Feeding your baby on the neonatal unit can be different to what you had planned, but you can still find the best way of feeding for you and your baby.

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Feeding your baby on the neonatal unit can be different to what you had planned, but you can still find the best way of feeding for you and your baby. Find out more here.

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Breastfeeding Challenges and Concerns: feeling left out if you're not the parent breastfeeding

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Breastfeeding Challenges and Concerns: feeling left out if you're not the parent breastfeeding

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Sensory fun, a singing session, a time to bond, great for early development, a mindful moment, still smelly, crucial face-to-face engagement

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Sure, nappy changes are sometimes a dirty job but they can also be magical moments of one-to-one time with your child.

Find ways to make the most of the eye contact you have.

You could softly sing to newborn babies, whether it's a traditional nursery rhyme, our 'Wee, Wee, Poo' song written specifically for this moment, or your favourite new track on the radio. "It doesn't have to be a nursery rhyme," says Kerry, "you could put on some tunes and have a little dance in front of baby. If it raises a giggle, it'll help your stress too."

As well as singing, hands-on play with your baby is ideal for nappy-changing time as it allows babies to feel your touch. "'Along Came a Spider', tickle time and blowing raspberries on their tummy - all of those things can be fun and unlimited in their appeal."

As children get older, they also get wrigglier, which can pose problems in getting things done. But it can just mean a change of approach to distract children and focus their attention. You could try using their senses for example, asking them to listen out for the things they can hear or look out for what things they can see. Kerry suggests involving toddlers in their own nappy changes, getting them to fetch nappies and hold the things you need as you change them.

She has an ingenious suggestion for a game to play with them too. "Sleeping Lions - toddlers love that. 'Can you keep as still as you can while I get this nappy changed?'"

No matter the age, there's no pressure to make nappy time magical, but it's worth trying to make the most of it where possible. "We're not saying you have to make every nappy change this meaningful interaction by any means, but I think it's just an opportunity, just to sort of pause in the day with your baby," says Kerry. Taking a moment to distract your baby from what's going on can stop them from wriggling and generally make it a more enjoyable experience for you too. "We know all the baby brain development that comes from interaction, but equally it makes it less stressful for you."

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Changing baby's nappies: How to make nappy changes fun

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How to change a nappy and make it more fun for baby and less stressful experience for you while you're at it.

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Breastfeeding Challenges and Concerns: Down Syndrome 

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Breastfeeding Challenges and Concerns: Down Syndrome 

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A resources for parents and health professionals

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The Lived Experience - Breastfeeding a baby with Down syndrome

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Breastfeeding Challenges and Concerns: Green Feeding

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Breastfeeding Challenges and Concerns: Green Feeding

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Good for babies, for Mums, for communities and for our planet

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Breastfeeding Challenges and Concerns: Inverted and Flat Nipples

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Breastfeeding Challenges and Concerns: Inverted and Flat Nipples

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Inverted or Flat Nipples

The size and shape of nipples and breasts vary from person to person and can change during the breastfeeding journey. It is common for nipples to gradually change shape, become more elastic and protrude more during pregnancy and while breastfeeding. When babies suck at the breast, they stretch the nipple and surrounding breast tissue into their mouth. The more elastic or stretchy the nipple, the easier it will be for your baby to latch. However, even if the nipples don't protrude more during pregnancy, you can still breastfeed. These variations often have very little to do with the baby's ability to breastfeed, because baby latches to the nipple and surrounding breast tissue.

If you have inverted or flat nipples, your baby may need more time and patience to breastfeed. A flat nipple is smooth next to the breast tissue. Inverted nipples withdraw below the surface of the nipple. If you think your nipple may be inverted, try placing your thumb and finger on opposite sides of the areola (the darker area of skin surrounding the nipple) and squeezing gently inwards. Sometimes nipples may be partly inverted, looking dimpled or folded. Severely inverted nipples retract deeply when compressed or stimulated. A nipple that stands out when stimulated is not inverted.

After your baby is born, your nipples may appear flatter than usual but babies often lick the nipple to stimulate it before latching on. Your nipples may also appear flatter if your breasts are very full or engorged.

A deep latch and comfortable position helps your baby latch and breastfeed effectively. In the beginning, the following techniques may help you initiate breastfeeding:

Immediately after birth, place your baby in skin-to-skin contact on your chest. Continue to use skin to skin during early breastfeeding to soothe your baby and to ease frustrations during breastfeeding. Ideally, the breastfeeding dyad is kept together until both are discharged.

Being with your baby helps you to recognize your infant's hunger cues.

Before breastfeeding, express several drops of milk, so the milk is immediately available when your baby latches.

You may massage your breast while breastfeeding to assist your baby in receiving milk.

To help evert the nipple:

Pull back on breast tissue so nipple will protrude more.

Breastfeed in a laidback or side-lying position especially if you have large breasts.

Breast engorgement can contribute to the nipple being less protruded. Massage the nipple and areolar area so milk will move back into the breast or will leak out, softening the areola and everting the nipple. Also try reverse nipple softening. Reverse pressure softening involves using gentle finger pressure around the base of the nipple to temporarily move some of the swelling slightly backward and upward into the breast.

Roll the nipple between the thumb and index finger and immediately afterwards touch the nipple with a moist cold cloth. Avoid making the nipple too cold because it can result in the nipple being numb, and inhibit let down.

Use nipple and breast support to help protrude the nipple. Use both hands on each side of breast to make a "sandwich", to squeeze nipple and areola. Use hands to press in on breast like the way you hold a big sandwich to put in the mouth.

Use a breast pump for several minutes to draw out the nipple. The suction from a pump will often cause the nipple to protrude more.

If you have had assistance with latch and tried the tips in this article and your nipples are still sore, consider trying a nipple shield. The nipple shield is a thin silicone devise that goes on top of your nipple and areola while breastfeeding. It looks like a brimmed hat. The nipple shield is a commercially made product. A nipple shield can be used temporarily to help establish breastfeeding or in some cases to help ensure that breastfeeding continues. A shield provides a firm stimulus at the roof of a baby's mouth where the soft and hard palate meet. This may help your baby suckle more effectively.

Commercial products that are intended to assist in drawing out inverted nipples such as breast shells or everters are best used only with the guidance of a trained lactation consultant.

If Nipple Soreness Occurs

You may experience nipple soreness for about the first two weeks of nursing while your flat or inverted nipple is gradually drawn out by baby's suckling. This discomfort is generally the result of adhesions or skin binding to underlying breast tissue. If the soreness is severe, or continues past the initial two weeks, consult your health professional.

If your nipple retracts after feedings, that skin may remain moist, leading to chapping of the skin. After feeding, pat your nipples dry and apply a moisturizer safe for breastfeeding. You may also want to wear breast shells or other devices to keep your nipple out between feedings so the skin can dry.

When Nipple Soreness is Prolonged
Rarely, sore nipples may persist for a longer period because instead of stretching, the adhesions remain tight. This can create a stress point which may lead to cracks or blisters.

If one breast is easier for your baby to grasp and he nurses well from that breast, you can continue to feed on that side. You can pump the breast with the deeply inverted nipple until the adhesions loosen and the nipple is drawn out. Your baby will get all the milk he needs from one breast if allowed unlimited and unrestricted time at the breast.

If both nipples are deeply inverted, you can pump both breasts simultaneously for 15-20 minutes 8 or more times in 24 hours. You can feed your baby with an alternative feeding device until she is able to latch on effectively and comfortably.

How long you will need to pump in order to draw out your nipples depends upon the strength of the adhesions and the degree of inversion. One pumping may be enough to completely draw out the nipple. If the nipple continues to deeply invert, you may need to continue pumping. When your nipple stays out after pumping, you can resume breastfeeding immediately.

Once your nipple can be drawn into the baby's mouth correctly and the baby can breastfeed effectively, you should be able to discontinue pumping and breastfeed without discomfort.

On rare occasions you may continue to feel some discomfort even after your nipple has been drawn out. This could be due to the correction to the nipple.

The nipple may invert again as your baby pauses during a feeding. In this case, you may need to stop breastfeeding and pump again for a few minutes before putting baby back to the breast.

As a temporary transition to exclusive breastfeeding, breast compressions or the use of a nursing supplementer might help to encourage continuous sucking and swallowing so that the nipple won't be as likely to invert during feeding.

If you do encounter challenges during your breastfeeding journey, support from a La Leche League Leader and other participants in Group meetings may help you to overcome the challenges. ( Find a Leader or meeting.)
Additional Resources
Cotterman, Jean K., Reverse Pressure Softening, http://breastfeedingmadesimple.com/wp-content/uploads/2016/02/SimplerRPSsheet2.pdf

Cotterman, Jean K., Reverse Pressure Softening, http://www.breastfeedingonline.com/rps.shtml#sthash.2MPE4KHE.T3v63FBt.dpbs

Cotterman, Jean K., Engorgement Help: Reverse Pressure Softening
... a technique to aid latching when a mother is engorged, https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/

Cotterman, Jean K. Reverse Pressure Softening, http://www.health-e-learning.com/articles/RPS_JCotterman_ver2005.htm

Genna, Catherine Watson, Supporting Sucking Skills in Breastfeeding Infants, C. Burlington, MA: Jones & Bartlett, 2012.

La Leche League Great Britain, Nursing Supplementers, https://www.laleche.org.uk/nursing-supplementers/

Mohrbacher, N. Breastfeeding Answers: A guide to helping Families, 2nd edition

( Revised February 2022)

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Inverted and Flat Nipples - La Leche League International

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Inverted or Flat Nipples The size and shape of nipples and breasts vary from person to person and can change during the breastfeeding journey. It is common for nipples to gradually change shape, become more elastic and protrude more during pregnancy and while breastfeeding.

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Breastfeeding Challenges and Concerns: Tongue Tie

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Breastfeeding Challenges and Concerns: Tongue Tie

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Information to support parents in making decisions around tongue tie

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Breastfeeding Challenges and Concerns: Mastitis and brown skin

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Breastfeeding Challenges and Concerns: Mastitis and brown skin

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Different skins colours can mean infections appears differently - be mindful of this when making an assessment

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Breastfeeding Support: ABM (Association of Breastfeeding Mothers) 

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Breastfeeding Support: ABM (Association of Breastfeeding Mothers) 

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National Breastfeeding Helpline:
0300 100 0212

(9.30am – 9.30pm).

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Trained breastfeeding counsellors are available at:National Breastfeeding Helpline, Find a local support group, Access web chat or email us.

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Breastfeeding Challenges and Concerns: Donor milk 

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Breastfeeding Challenges and Concerns: Donor milk 

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For premature and vulnerable babies donor breast milk is the next best nutrition if a mother’s own milk is unavailable.

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The Southwest Neonatal Network Donor Milk Bank was established in November 2011 at Southmead Hospital in Bristol. We are one of 15 UK milk banks and the only one in the South West.

Our aim is to provide safe, screened donor breast milk for all babies who need it within the South West Neonatal Network. The Southwest Neonatal Network Donor Milk Bank provides about 100 bottles of milk to 10 units around the South West and beyond each month.
Why do we need a milk bank?
For premature and vulnerable babies donor breast milk is the next best nutrition if a mother's own milk is unavailable. It offers specific benefits for these babies:

Protection from infection

Protection from necrotising enterocolitis

Easier to digest

How does it work?
Frozen breast milk is collected from a donor's home regularly and is delivered to the milk bank to be processed. After pasteurization, donor breast milk is distributed to neonatal units around the south west to be given to babies who may need it.
Being a milk donor
Breast milk donors exclusively breastfeed their own babies. We can accept donations of their excess milk from when their own baby is at least 6 weeks old and until they are about 6 months of age.

Mothers who are interested in donating are screened (in a similar way to blood donation screening) to ensure their milk is safe to be given to premature and sick babies. This process involves a blood test, a visit to the hospital with their baby to meet a member of the milk bank team and the completion of a short lifestyle and medical history questionnaire. If you are interested please contact the Milk Bank on milk.bank@nbt.nhs.uk
For further information on donor milk please visit the UKAMB website www.ukamb.org

O ur daughter, Abigail, was born at 25 weeks gestation weighing just 550g. After the initial shock of giving birth so early, feeding Abigail my expressed breast milk became a way that I could still contribute to my daughter's well-being despite her being inside a plastic box and not being able to hold her. It was amazing to hear that I could still produce breast milk and feed it to her through a tube despite such an early birth.
Yet at 550g, the amounts of feed she could take were only a very small portion of what I was able to produce. After filling up my home freezer with breast milk one of the NICU nurses suggested I consider donating milk to the milk bank. The process of becoming a donor was easy - just a bit of paperwork and a blood test. I then arranged for collection of the milk by Mike on behalf of the milk bank. Mike came to the house and even gave me a few lifts into the hospital as well at the same time - a very practical solution to an oversupply of milk. But the best thing was the feeling I got when I first saw someone's baby being fed donor breast milk (the milk had a different coloured lid indicating donor milk). I obviously didn't know if it was mine or not, but seeing another baby benefit made me feel that some good had come from my own situation. Our daughter is now doing well and I like to think that the benefits of having fed her breast milk for the first eight months of her life have put her in good stead for the future. I hope that the donor milk has done the same for other babies.

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The Southwest Neonatal Network Donor Milk Bank

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The Southwest Neonatal Network Donor Milk Bank was established in November 2011 at Southmead Hospital in Bristol.

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Virtual support available on iPhone and Android

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Breastfeeding Support: Anya (formerly Latch Aid) App 

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Breastfeeding Support: Anya (formerly Latch Aid) App 

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Virtual Support for iPhone and Android. Download FREE App from Google PlayStore

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Using smart technology, we provide parents and parents-to-be with vital support on their breastfeeding and parenting journey, anytime, anywhere.

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Male Midwife Mark Harris speaks to Dads

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The risks of not breastfeeding
A lot that you and you partner have about breastfeeding, will give you this information, but they will emphasis the benefits for breastfeeding rather than talk about the risks of not doing so. I say that breastfeeding is the way we have evolved over millions of years to feed our babies, and that anything else is a risk. Some people find this way of looking at it uncomfortable, but if you read around it I think you'll see it makes sense. Remember we are mammals, and have been for millions of years. All mammals feed their young milk from breasts or teats. The word mammal actually means that the animal has a mammary gland to produce milk.
The use of artificial formula is a very very recent phenomenon, and is not as safe as you might think. For one thing, babies fed on 'modern' formula (since, say, the 1970s) are not even in middle age yet.

No long- term studies have been done. What we do know is that artificial formula changes the body: it alters a baby's gut (breastfed babies' poo is yellow and smells milky, while that of formula fed babies is browner and smellier, more like adult poo) and immune system, making babies more vulnerable to infections. The immune protection that your partners
breastmilk provides cannot be underestimated.

Breastfeeding has served us as a species for millions of years of successful evolution, and probably has many more effects on the body than we currently know about - and we know about a lot. If you read about it, or Google the benefits of breastfeeding, you will probably be overwhelmed! Artificial formula can never come close to matching the living fluid that your partners breasts will produce.

Having said all this, her choice regarding how you feed your baby is sovereign, and supporting her choices is your role, sharing your opinions but understanding that whatever conclusions you come to are the right ones for you and your family.

The risks to your baby (and partner) from not breastfeeding:

The risks of not breastfeeding for the mother:

Any breastfeeding will protect your lover and your baby from these risks, and the longer she breastfeeds for, the longer the protection will last.

Where to get breastfeeding support

In most hospitals the midwives will be able to help your partner and your baby get breastfeeding started. There are infant feeding advisors on staff if you need more help.

In some hospitals there are maternity assistants or volunteer peer supporters on post-natal wards who can also offer support. If you give birth at home, or once you come home from hospital, community midwives will visit or offer clinics in the early days.

Then you'll be allocated a health visitor, who should be able to direct you to breastfeeding groups or peer supporters in the community. Peer supporters are other mothers who've breastfed their own children, who've had additional training in supporting breastfeeding.

They can offer understanding and support and help with minor challenges, such as poor attachment/'latch', and they can signpost you to more help for other difficulties. They often run breastfeeding groups where your lover can meet other mothers with new babies, which can be very reassuring.

There's also a national breastfeeding helpline staffed by trained breastfeeding counsellors, and organisations like La Leche League, the Association of Breastfeeding Mothers and the Breastfeeding Network which run support groups, online discussion groups and Facebook pages and offer great information on their websites. Details of them all are at the back
of the book. There's bound to be something in your area. If your partner is finding breastfeeding challenging, you can help her to access the support she needs.

Copyright 2017 by Birthing4Blokes.

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Supporting your partners breastfeeding choices

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A lot that you and you partner have about breastfeeding, will give you this information, but they will emphasis the benefits for breastfeeding rather than talk about the risks of not doing so. I say that breastfeeding is the way we have evolved over millions of years to feed our babies, and that anything else is a risk.

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Breastfeeding Support: Finding and paying for a Lactation Consultant

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Breastfeeding Support: Finding and paying for a Lactation Consultant

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Face to face and telephone/online support for those who feel able to pay

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This resource padlet has been put together by a team of MNVP Volunteers.
It is aimed at parents/to-be but may also be of use to midwives, maternity healthcare workers, birth workers and anyone else working within maternity services or Early Years settings.  Contact:  chaya.tagore@nhs.net

​While we make every effort to keep these padlets up to date, we make no warranties or representations that the information will be:

current

accurate

secure

complete

free from bugs or viruses

As an MNVP, we are not liable for any loss or damage that may come from using these padlets. We are unable to endorse the information held on third party websites, it is for information only.

www.bswmaternityvoices.org.uk

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Swindon Breastmates - Breastfeeding Support

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Swindon Breastmates - Breastfeeding Support

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Swindon Breastmates (Breastfeeding Support) | Facebook

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Breastfeeding Support Group run by breastfeeding mothers for breastfeeding mothers in and around the Swindon Area. It was set up for Swindon mums who are attending the groups to seek support 24/7....

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Getting your baby positioned and attached comfortably at the breast is an art-mothers often say it takes a little while for breastfeeding to feel entirely comfortable and natural, even if they've breastfed before. In the past girls grew up learning about breastfeeding by watching mothers in their families and communities. These days many of us become mothers having never seen a baby breastfeed.
But breastfeeding has worked for mothers and babies for thousands of years and it can work for you too.
Many babies can find their way to the breast by themselves, especially if they haven't been too affected by birth interventions. Other mums and babies need a little longer to work it out with maybe some help from a skilled breastfeeding supporter such as an LLL Leader.

When all is going well, specific holds and positions don't really matter because you and your baby will work out what suits you best. However if you are finding it awkward, uncomfortable or downright painful then the following information is designed to help you think about where you can make adjustments and get breastfeeding working comfortably for you.

Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively. This is important for maintaining milk production. Well-drained breasts make milk quickly. If there is any concern about how much milk you are making, working on improving positioning and attachment is an important first step.

There's no 'right' or 'wrong'. If you are comfortable, your baby is producing plenty of dirty nappies and is gaining weight after the first few days, then breastfeeding is going well for you. There are no rules-but there are a few principles that can help you work out what to do if things aren't going well: see Latching on - getting a good attachment.

Positioning describes how you sit or lie and how you support your baby as he takes the breast. How you hold your baby can make a big difference to how well he can breastfeed. Even small adjustments can be significant. Attachment describes the way he latches onto the breast.

Tips for getting started
The laid-back approach
Latching on - getting a good attachment
Different breastfeeding positions
As time goes by

Tips for getting started

If it hurts then make changes

If it doesn't feel right to you, then it isn't fine, whatever anyone says. Pain is your body's way of letting you know something is wrong. Start by trying to improve positioning and attachment. A few quick adjustments to how you are sitting or lying or how your baby comes towards the breast may be all that are needed.

Sometimes it can take a little longer. You may need to work with one or more skilled breastfeeding supporters over a period of time to get to the point where everything falls into place and breastfeeding starts feeling natural.

Each mother and baby pair is different and what works well for one mother and baby may not work for you. This is one reason why you may hear different suggestions from different helpers. You are the best judge of what is helpful so don't be afraid to use what feels right for you and discard the rest.

Your baby needs to be calm

You can offer the breast at any time when you are both calm. You may even find it easier if your baby isn't obviously hungry. Feed your baby before he needs to cry. Early cues for wanting to eat include suckingtheir hand, smacking their lips, turning their head towards you, or fussing. They won't latch well if they are distressed. If your baby is upset take time to soothe them. Hold them upright against you, stroke them and talk to them. A little expressed colostrum or breastmilk given on a spoon can help to calm them if they are desperately hungry.

Your baby needs full body contact

When your baby is held in full body contact against you, they will feel stable and be better able to coordinate their movements. Laid back positions ensure full body contact. If you're sitting up, you'll need to hug your baby in as tightly as if you were standing up holding them against you. Babies who don't feel stable tend to wave their arms around, which can make latching more difficult. Pillows can get in the way and aren't always necessary. So wait until after your baby's latched on, and then tuck them in only if you need them for support.

Some babies need time

Some babies find it difficult to latch on, or simply nurse ineffectively at the breast. Often a difficult birth or interventions during labour or birth are the cause. Giving a baby time to recover, and using laid-back breastfeeding positions with skin-to-skin contact can maximise your baby's natural instinct to breastfeed. If your baby isn't latching or feeding well seek help from an LLL Leader and read our page My Baby Won't Breastfeed. With time and patience, most babies will breastfeed. In the meantime express your milk for your baby to maintain milk production and give you both the time to work it out.

Laid-back breastfeeding

Many people assume you have to sit up to breastfeed. Not so. In fact evidence suggests humans evolved to breastfeed in laid-back positions with our babies upright against our chests. You may have experienced this type of position when you had your first feed, soon after your baby's birth. There is more and more evidence that laid-back breastfeeding positions (also called Biological Nurturing) help babies breastfeed more effectively and are more comfortable for mothers, especially in the early days and weeks.

Laid back breastfeeding is really useful for those first few days and weeks when you want to rest and recover and your baby needs to be in close contact with you to get breastfeeding established. It can be done skin-to-skin or with you both lightly dressed. You don't have to be in bed; the sofa or a reclining chair is a comfortable alternative.

You can also use laid-back breastfeeding principles when sitting in an upright chair by shifting your weight back onto your tail bone and reclining your body back a little, to open up a space for your baby. This allows more of their weight to be supported by your body and less by your arms. It isn't safe to sleep with your baby on a chair or sofa.

Sleepy babies

If your baby is sleepy, perhaps because of birth interventions, then using laid-back positions with skin-to-skin contact can encourage your baby's interest in feeding. In laid-back positions babies often attach and feed when in light sleep so it helps to spend substantial periods of time with your sleepy baby against you. When you notice the little movements that indicate your baby is moving into a light period of sleep you can encourage them to latch.

How laid back breastfeeding works

You lay back in a comfortable, supported semi-reclining position (not flat) that opens up your body, creating space for your baby.

Your baby lies against you, their whole front against your body, vertically or at any comfortable angle.

Your baby feels stable and secure and their instinctive feeding reflexes are triggered, prompting them to bob their head and seek out the breast.

Gravity helps them latch deeply and stay latched, rather than hindering the process.

Your hands are free to support and caress your baby and help them attach.

Your body releases the hormones that stimulate milk production and make you experience loving feelings towards your baby.

There are no rules-you and your baby are free to work it out between yourselves.

Latching on - getting a good attachment

Your baby needs to tip their head back and reach forward with their lower jaw. As your baby tips their head back their jaw drops and their mouth opens wide, so they can anchor their chin and lower lip firmly against your breast. If they have to tuck their chin in to reach the nipple they won't be able to open their mouth so wide. Tipping their head back also makes a deep latch possible, swallowing easier, and frees up their nose for comfortable breathing. In laid-back positions lay your baby with their head between your breasts. If you are sitting up, keep your supporting hand away from the back of their head. Babies tend to creep forward, so try shifting them so that their eyes and nose are opposite the nipple to encourage them to reach forward and anchor their chin first. In sitting or side lying positions a little push between the shoulder blades with your supporting hand or arm as they latch brings their chest in closer and helps their head tip back.

Their lower jaw needs a clear space to anchor. Think about how you might take a mouthful from a big sandwich by placing your lower jaw first then opening your mouth to accommodate the top of the sandwich-the principle is the same. Your baby's lower jaw needs to be deeply placed on your breast well away from the nipple. Keep the fingers of your supporting hand away from the place where their chin and lower jaw need to be so their lower lip and chin can sink into your breast. Your baby's chin needs to stay firmly in contact with your breast.

Your baby needs a big mouthful. When a baby chews on a nipple, this compresses the milk ducts, prevents milk flowing and hurts. When a baby has a good big mouthful of breast beyond the nipple, breastfeeding is comfortable and milk can flow. Some women like (or need) to hold their breast when nursing. They flatten their breast as they would a big sandwich they were offering to the baby, matching it to the oval of his mouth. This can help their baby grasp more breast tissue. It doesn't matter if fingers are closer to the upper jaw but try to keep the "lower jaw fingers" out of your baby's way. Biological Nurturing™ positions make use of gravity to help a baby get a bigger mouthful.

The exaggerated latch. To get an even deeper latch you could try this optional extra. Place your thumb or finger near the base of the nipple where the middle of your baby's upper lip will be, lined up with their nose. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. Avoid pressing your nipple into their mouth. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. You can then slip your finger out.

Our own video below demonstrates flipple technique (aka exaggerated latch), it can be very helpful for getting an effective pain free latch:

Let your breast rest at its natural level. It can be tempting to lift your breast and move it towards your baby's mouth. If you do this, your baby probably won't get a full mouthful, and after a while your hand will get tired and the breast will drop and slip out of their mouth. Breastfeeding pillows can get in the way too because they lift a baby up too high and prevent you tucking them in against your tummy. See where your breasts naturally rest and hold your baby accordingly. If you need them, tuck pillows in after they are well attached.

Bring baby to breast, not breast to baby. Since breasts are attached to you and you baby is moveable it makes much more sense to bring your baby to the breast, not the other way round! And it works better too. With their body tucked firmly against you (or laid on top of your body), your baby will feel more stable and have better head control, and you'll feel a lot more comfortable too.

It's easier to latch onto a softer breast. It's much easier to get a deep mouthful if the breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, it naturally makes it easier to latch on. If your breast is full and hard, you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Apply gentle steady pressure with your fingertips on the areola around your nipple for about a minute. You can also press with the sides of your thumbs or fingers. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help. Gently hand express a little milk too if needed.

Your baby needs to choose his own timing. Your baby will probably do best if they pick the moment to latch on. You can help by supporting them in a position that lets them do this when they are ready. To encourage your baby to gape hold them close against you, close enough to the breast so they know the nipple is there, but where they can't quite reach it. Be prepared for your baby to lick and nuzzle for several minutes before they are ready to open wide.

The natural or laid-back breastfeeding positions shown in the following videos can be a great help in encouraging your baby to latch on well, as well as being comfortable for you. You can recline comfortably with your baby on top of you with their whole front against you and their body completely supported by yours.

Best Beginnings' video demonstrates clearly how to make sure your baby is attaching well to the breast, you can view it here.

This video demonstrates how to enable your baby to latch deeply on to your breast so that breastfeeding is comfortable for you and means your baby get enough milk:

This video shows how to attach your baby well, and shows a variety of comfortable breastfeeding positions:
http://m.raisingchildren.net.au/articles/breastfeeding_attachment_video.html

Using different breastfeeding positions

The cradle hold

Although the cradle hold is one of the most common nursing positions it can be a challenge for new mothers to learn. You need to hold your baby's body firmly against you to give them stability because their weight is supported mainly by your arms. Shifting so you are sitting on your tailbone, rather than upright can help stability and reduce the strain on your arms (see picture right). It can be difficult to control a baby's head and to keep them high enough and close enough to your breast. A small baby may tend to curl up in a ball in this position if not pulled in closely enough against your body. It may not be the best choice at first if you're experiencing any problems with latch-on, milk transfer or if you have sore nipples. Once you're more confident with breastfeeding, you may find you use a version of the cradle hold much of the time, especially when out and about.

Your baby's whole front is against your tummy, their hip resting on or near your thigh, tucked around you like a comma. Their chest will be snuggled into the breast and your nipple near their nose.

Their head is resting on your forearm and/ or wrist (not the crook of the elbow).

As your baby opens their mouth to take the breast, pull their body in firmly against you.

Once your baby is attached, settle back a little for your own comfort and so that more of their weight is taken by your body.

Laid back breastfeeding

Remember that Biological Nurturing™ positions aren't just for the first week or two. They can be really useful later on when you want to relax, and especially if you are breastfeeding more than one baby or if your baby is fussy or unwell.

The cross-cradle hold

The cross-cradle position can be useful in the early days because it gives you more control in guiding your baby to the breast. It can be uncomfortable to maintain without good support under your arms, especially with larger babies, so once your baby is attached, switch arms as shown in the picture below. After the first few weeks and as your baby grows longer and heavier, you may prefer to use other comfortable holds. Avoid touching the top or back of your baby's head because it often causes a baby to pull back from the breast. Forcing a baby onto the breast by firmly holding the back of the head usually has the opposite effect and can put a baby off breastfeeding.

Cross cradle

Tuck their whole front against your tummy, their hip near or resting on your thigh.

Your hand supports their neck (not the back of the head) with your palm between their shoulder blades.

Your other hand is free to shape or stabilise your breast if needed.

Make sure your baby isn't too far round the front-line them up so their eyes and nose are near the nipple.

As your baby opens their mouth, give a little push with the palm of your hand to bring their chest in close against you.

This will help their head tip back and let them plant their chin deeply against your breast.

Once your baby is attached you can bring your other arm round to support your baby's body and settle back a little for your own comfort and so that more of his weight is taken by your body. Hold your baby with the arm opposite to the breast he's going to latch onto.

The underarm (clutch or rugby) hold

The underarm hold is useful if you have had a caesarean birth. It helps keep the weight of your baby off your incision. It is also a good position for mothers with flat or inverted nipples and for babies with latch-on or sucking problems because it offers you a good view of baby and breast and control of your baby's head. You can also feed two babies at once in this position. For larger, longer babies you may need extra cushions behind your back to bring you further forward and allow space for your baby's length.

Your baby's front is close against your side, with your hand under their shoulders and neck.

Your elbow keeps them tucked closely against your body.

Your baby approaches your breast from below. This can work well if you have large breasts. If you have smaller breasts you may need to bring your baby into a semi-sitting position.

Make sure your baby isn't too far round the front. You may need a cushion between your back and the chair back to allow room for your baby's length and prevent them pushing themselves forward with his feet.

Side lying

This side-lying position is helpful if you are recovering from a caesarean birth or an episiotomy and invaluable for nursing in bed during the night.
It can take a while to get the knack but it's well worth persisting because it can make night feeds so much easier.
Some mothers decide to sleep with their baby alongside them. Others choose to move their baby back onto a separate sleep surface.
Safe Sleep and the Breastfed Baby will help you decide on the safest sleep arrangements for your family, based on your own individual circumstances.

* Lie on your side, with your knees bent up and a pillow under your head.
* Place your baby on their side facing you so that their body and your body form a V-shape, meeting at your hips, with your nipple level with their nose or eyes.
* You can put your arm under your baby's head as shown, or up by the pillow with your baby lying on the bed.
* As your baby latches, give a little push between their shoulder blades to bring their chest in closer and help their head to tip back and their mouth to
open wide.
* You may find it helpful to tuck a small pillow or rolled blanket behind the small of your back and/or between your knees.

Standing up

At some feeds babies just do better if you stand up. You can sway or bounce gently to help calm your baby, and the lack of a lap can be helpful. As always keep your baby nice and stable and let them lead the way. Try angling their legs down instead of holding them horizontal, and see what happens. Or try starting with them against your shoulder, supporting them as he moves down to the breast. Even when using other positions, sometimes just standing up and sitting down again straight away helps everything settle into a comfortable position.

As time goes by

Whether you choose to breastfeed sitting up, reclining or lying on your side, you will need to adjust how you support your baby as he grows in length and weight. Use the principles shown here as you experiment with different positions. Sometimes there are physical or medical causes for pain or discomfort such as tongue tie or a thrush infection. If you are still finding it difficult to get comfortable, do persist with seeking further and continued support. There is almost always a breastfeeding solution to breastfeeding problems. You can contact an LLL Leader by calling our Helpline. You can also find support and encouragement from breastfeeding mothers in your local LLL group.

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

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

Mastitis
Beginning Breastfeeding
Breastfeeding Your Baby - easy read
Caesarean Birth & Breastfeeding
Comfortable Breastfeeding - easy read
Skin-to-Skin
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
Inverted Nipples
My Baby Needs More Milk
My Baby Won't Breastfeed
Nipple Confusion?
Nipple Pain
Nipple Shields
Nursing Supplementers
Safe Sleep & the Breastfed Baby
Sleepy Baby - Why & What To Do
Tongue Tie
Too Much Milk & Oversupply

LLLI Resources
Position to breastfeed

Other resources
How to do Biological Nurturing: www.biologicalnurturing.com/video/bn3clip.html
Best Beginnings videos to watch online: www.bestbeginnings.org.uk/watch-fbtb

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
Biological Nurturing: Laid-back breastfeeding for mothers (DVD). Colson, S. et al. 2012.
An Introduction to Biological Nurturing; New angles on breastfeeding, Colson S. Amarillo, TX: Hale Publishing, 2010.
Supporting Sucking Skills, Watson Genna, C. Burlington, MA: Jones & Bartlett, 2012.

This information is available to buy in printed form form the LLLGB Shop.
It is also available in kindle edition.

Information, references and links on this page are taken from La Leche League resources, unless stated otherwise. Please note that LLLGB does not endorse information from outside sources, extra information is provided for you to consider. Information supplied is not intended as advice, and you are in the best position to make a decision as to how the information offered will affect you and your baby.

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively.

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Newborn baby poo in nappies: what to expect | Baby & toddler articles & support | NCT

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Your baby’s nappy can tell you a lot - find out more here.

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Find out how to make sure your baby is attaching well at the breast.

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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5. Graphic of a baby attaching on the breast

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Find out how to make sure your baby is attaching well at the breast. Vimeo Video http://www.vimeo.com/11692547 The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole: From Bump to Breastfeeding 1.

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Can I see Natural Breastfeeding positions in action?

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Updated in 2022 with important new messaging on sleep safety, this leaflet offers helpful, practical advice to parents on looking after their sleeping baby both during the day and at night.

Caring for Your Baby at Night and When Sleeping covers a range of topics, including getting some rest, night feeding, safe sleeping environments and helping baby to settle. It is endorsed by the Lullaby Trust, the Baby Sleep Info Source (BASIS), the Royal College of Midwives (RCM) and the Institute of Health Visiting (iHV).

Printed copies are available for £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK. Order using the Baby Friendly Resources order form, which you can download from our Resources page.
Please note: Orders for UK delivery only, and include postage and packaging costs. Orders may take up to 7 working days to process. The Baby Friendly Initiative reserve the right to re-print items at any time. If you are looking to order audit tools or e-learning please use our digital resources order form.

Caring for your Baby at Night and when Sleeping

A Guide for Parents

Download now

Caring For Your Baby at Night and When Sleeping: A guide for health professionals

Our accompanying guide supports health professionals who will be using Caring for Your Baby at Night and When Sleeping with new parents. It looks at the evidence underpinning the recommendations in the leaflet and offers guidance on discussing these issues.
An updated version of the health professional's guide will be made available soon.

Further resources

The Baby Sleep Information Source (Basis) is an informational source for parents who wish to make informed choices about their infant's sleep and night time care, and is the result of a collaboration between the Durham University Parent-Infant Sleep Lab, La Leche League, NCT, and the UNICEF UK Baby Friendly Initiative.

We have also collaborated with The Lullaby Trust, Public Health England, and Basis to create a range of resources for parents and health professionals, with accessible guidance on safer sleep practices. The following are available to download and buy on The Lullaby Trust website.

Safer Sleep for Babies: A Guide for Parents

Safer Sleep for Babies: Saving Babies' Lives - A Guide for Professionals

Safer Sleep for Babies: Quick Reference Card

Public Health Wales have produced a version of the Caring for your baby at night leaflet in Welsh, which is free to download.

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Caring for your baby at night leaflet - Baby Friendly Initiative

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This leaflet, endorsed by BASIS, the RCM and The Lullaby Trust, offers practical advice for parents on caring for their sleeping baby.

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Unicef UK Baby Friendly Initiative | Importance of relationship building

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How much formula does my baby need?

Newborn babies need quite small amounts of formula to start with. The amount will vary from baby to baby.

Although most babies settle into a feeding pattern eventually, they vary in how often they want to feed and how much they want to drink.

Feed your baby when they show signs that they want it. Babies tend to feed little and often, so they may not finish their bottle. Having a big feed does not mean your baby will go longer between feeds.

How do I know if my baby is getting enough formula?

Your baby's weight gain and the number of wet and dirty nappies will tell you whether your baby is getting enough formula.

Your baby should have around 6 wet nappies a day from a few days after the birth. Nappies should be wet with clear or pale yellow urine, or feel heavy.

For the first day or two after birth, your baby will pass a dark, sticky substance known as meconium. Within the first week your baby should start to pass pale yellow or yellowish brown poo. They should be having at least 1 poo a day.

Your baby will usually be weighed at birth and again in the first week. After that, healthy babies only need to be weighed at 8, 12 and 16 weeks, and again at 1 year.

This information should be entered on a chart in your personal child health record (PCHR) or "red book".

Read more about the personal child health record (red book) in Your baby's health and development reviews.

If you have any questions or concerns about your baby's weight gain, speak to a midwife or health visitor.

How will I know if my formula-fed baby is hungry?

After a while, you'll get to know the signs that show your baby is ready to feed.

For example, your baby may:

start to get restless

begin to turn their head and open their mouth (rooting)

find something to suck - usually their fist or fingers

Try to feed your baby before they cry, as this is a late sign of hunger.

What do I need if I'm formula feeding away from home?

If you need to feed your baby away from home, take with you:

a measured amount of formula powder in a small, clean and dry container

a vacuum flask of hot water that's just been boiled

an empty sterilised feeding bottle with cap and retaining ring in place

The vacuum flask does not need to be sterilised, but it should be clean, and only used for your baby. The boiling water should kill any bacteria present in the flask. If the flask is full and sealed, the water will stay above 70C for several hours.

Make up a fresh feed only when your baby needs it. The water must still be hot when you use it, to destroy any bacteria in the formula powder.

Remember to cool the bottle (with the lid on) under cold running water before you feed it to your baby.
Read more about how to make up baby formula
Alternatively, you could use a carton of ready-to-feed liquid formula when you're away from home.

What if I need to transport a made-up feed?

If it's not possible to follow the advice for formula feeding away from home, you should use a carton of ready-to-feed liquid formula.

But if you still need to transport a feed (for example, to a nursery), prepare the feed at home, cool under a running tap or in a bowl of cold water, and put it in the fridge to cool.

Make sure the feed is cold. Take it out of the fridge just before you leave and carry it in a cool bag with an ice pack, and use it within 4 hours. If you do not have an ice pack, or access to a fridge, the made-up infant formula must be used within 2 hours.

If the formula that you made up at home is stored:

in a fridge - use within 24 hours

in a cool bag with an ice pack - use within 4 hours

at room temperature - use within 2 hours

Can I use bottled water to make up infant formula?

Bottled water is not recommended for making up infant formula feeds for your baby. This is because it's not usually sterile and may contain too much salt (sodium) or sulphate.

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Information and advice on formula feeding, including how much formula to give your baby, how many wet nappies they should have and how to handle feeds away from home.

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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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Good hygiene is really important when preparing a bottle of formula for your baby (NHS Choices, 2016a, 2018). A baby's immune system isn't as well developed as an adult's. This makes them more vulnerable to illness and infection, particularly diarrhoea and vomiting.

Watch our simple step-by-step guide on how to make up a bottle of formula milk for your baby.

Follow our step-by-step guide to making up a bottle of formula.

Step 1: Fill up the kettle with fresh water

Use at least 1 litre of fresh tap water. Don't boil and use water that has already been boiled, or use artificially-softened water. Bottled water is also not recommended for making up a feed as it's not sterile and may contain too much salt (sodium) or sulphate (NICE, 2105; NHS Choices, 2015, 2016a, 2017, 2018).

Step 2: Boil the water

Then leave it to cool for up to 30 minutes, so that it has cooled but is still at least 70°C.

Step 3: Clean area and wash your hands

It's important to disinfect the surface you are going to use and wash your hands thoroughly.

Step 4: Rinse and shake excess water

If you're using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse them with cooled boiled water from the kettle (not tap water). Then put your sterilised baby bottle on the cleaned, disinfected surface.

Step 5: Pour the water in

Use the amount of water you need and double check the water level is correct. Always put water in the bottle first, while it's still hot, before adding any powdered formula.

Step 6: Loosely fill the scoop with formula powder

Do this according to the manufacturer's instructions. Level it off using either the flat edge of a clean, dry knife or the leveller provided. Different tins of formula come with different scoops. Make sure you only use the scoop that comes with the formula.

Step 7: Put the teat back on the bottle

Holding the edge of the teat, put it on the bottle. Then screw the retaining ring onto the bottle. Cover the teat with the cap and shake the bottle until all of the formula powder dissolves.

Step 8: Cool the bottle for your baby

It's important to cool the formula so it's not too hot to drink. You can do this by holding the bottle (with the lid on) under cold running water.

Step 9: Test the temperature

Always test the temperature of the formula on the inside of your wrist before feeding it to your baby. It should be body temperature, which means it feels warm or cool, but not hot.

(NHS Choices, 2016a)

Step 10: Throw away un-used feed

If there is any made-up formula left after your baby has finished feeding, always throw it away.

Tips for preparing formula feeds

Always follow manufacturers' instructions carefully as they vary on how much water and powder to use.

Never add extra formula powder because this can make your baby constipated or dehydrated. Too little powder may mean your baby doesn't get the nourishment they need.

You shouldn't add anything else to the bottle like sugar or cereals either.

Never warm up formula in a microwave, as it may heat the feed unevenly and scald your baby's mouth.

You should make up each feed as your baby needs it because bacteria multiply very quickly at room temperature. You might be surprised that even sealed formula packets can sometimes contain bacteria.

Very young babies and babies with poorer immune systems, like premature babies, are more vulnerable to bacteria. It's particularly important to follow these guidelines or consider using sterile ready-made liquid feeds if your baby was born prematurely (NHS Choices, 2015).

Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, call our support line on 0300 330 0700, whether you are using formula milk, breastfeeding or mixed feeding. If you're concerned about your baby's health talk to your health visitor or GP.

NHS. (2015) Start4Life guide to bottle-feeding. Available from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf [Accessed 21st November 2017]

NHS Choices (2016a) How to make up baby formula. Available from: https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/making-up-infant-formula.aspx [Accessed 21 November 2017]

NHS Choices (2016b) Sterilising baby bottles. Available from: https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/sterilising-bottles.aspx [Accessed 21st November 2017]

NHS Choices (2016c) Types of formula milk. Available from: https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/types-of-infant-formula.aspx [Accessed 21st November 2017]

NHS Choices (2017) Formula milk: common questions. Available from: https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/infant-formula-questions.aspx [Accessed 21st November 2017]

NHS Choices (2018) Bottle-feeding advice. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/bottle-feeding-advice/ [Accessed 21st November 2017]

NICE (2015) Clinical Guidance CG37. Postnatal care up to 8 weeks after birth. Available from: https://www.nice.org.uk/guidance/cg37/chapter/1-Recommendations [Accessed 21st November 2017]

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Step-by-step guide to preparing a formula feed | Baby & toddler, Feeding articles & support | NCT

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Good hygiene is really important when preparing a bottle of formula for your baby (NHS Choices, 2016a, 2018). A baby's immune system isn't as well developed as an adult's. This makes them more vulnerable to illness and infection, particularly diarrhoea and vomiting. Follow our step-by-step guide to making up a bottle of formula.

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Unicef UK Baby Friendly Initiative | Hand expression

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Scroll across to 'Feeding Concerns' for information about pain relief you can take whilst breastfeeding.

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KellyMom.com - Breastfeeding and Parenting

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Breastfeeding after a Cesarean Birth - KellyMom.com

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Educate yourself and arrange for breastfeeding help Find a La Leche League group near you! Try to attend at least one meeting before your baby is born. Ask questions! Talk to the lactation consultant (LC)--assuming your hospital has one on staff--and ask that she meet with you as soon as you get out…

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How often should I feed by breastfed baby?

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How often should I feed by breastfed 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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This leaflet offers advice and information for parents on getting to know their baby and setting up the foundations for a close and loving relationship.

We now know that building a strong relationship between parents and their new baby will give them the best possible start in life and will help them to grow up happy and confident. This leaflet is free to download and helps parents to develop that strong relationship, starting in pregnancy and continuing into the early days, weeks and months of a baby's life.

Health professionals may want to use this leaflet in conjunction with the Baby Friendly guide to antenatal and postnatal conversations and accompanying signature sheets.

Printed copies cost £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK. Order using the Baby Friendly Resources order form, which you can download from our Resources page.
Please note: Orders for UK delivery only, and include postage and packaging costs. Orders may take up to 7 working days to process. The Baby Friendly Initiative reserve the right to re-print items at any time. If you are looking to order audit tools or e-learning please use our digital resources order form. Our myth buster posters show the key Happy Baby messages in bright and colourful poster form - find out more.

Building a Happy Baby: A Guide for Parents

Baby Friendly standards

Support to build a close and loving relationship is a key element of the Baby Friendly standards. Find out more about embedding our standards in your service.

Find more relationship building resources

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Building a happy baby: A Guide for Parents Leaflet - Baby Friendly Initiative

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This leaflet helps parents to get to know their baby and to set up the foundations for a close and loving relationship.

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Feeding your baby on the neonatal unit can be different to what you had planned, but you can still find the best way of feeding for you and your baby. Find out more here.

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First-time parents are often unprepared for the frequency with which their breastfed newborns need to feed, or how long night-time breastfeeding is likely to continue.

Breastfed babies are generally still feeding as frequently throughout the night at 3 months of age as they were at 1 month (Elias et al 1986; Ball 2003).It has been suggested by various researchers that frequent night waking is a factor contributing to the introduction of formula milk to babies, thereby undermining breastfeeding (Pinilla & Birch 1993; Marchand & Morrow 1994; Greenslade 1995; Ball 2003) given the common (but possibly no longer valid - see Doan et al 2007) perception that formula use promotes infant sleep.

A study of 253 families in the North-East of England reported that mothers who started bed-sharing in their babies' first month of life were twice as likely to still be breastfeeding when their baby was 4 months of age, in comparison with women who breastfed their baby in the absence of early bed-sharing (Ball 2003). Similar results have been seen in other studies (Blair and Ball 2004; Clements et al 1997; Elias et al 1986; Ford et al 1994; McCoy et al 2004; Mitchell & Scragg 1994; Rigda et al 2000; Quillin and Glen 2004; Baddock et al 2007, Santos et al 2009) indicating that bed-sharing is an important night-time care strategy in the context of breastfeeding. Results from the NECOT trial showed that participants who had reported bed-sharing in the first 13 weeks postnatally were half as likely as those who had reported no bed-sharing to have ceased breastfeeding at any given point (Ball et al 2011). A recent study using data from US mothers (Huang et al 2013) showed that, after adjusting for covariates, longer bed-sharing duration was associated with longer duration of any (but not exclusive) breastfeeding.

Although it is not possible to say that bed-sharing causes women to continue breastfeeding it seems likely that a positive feedback loop exists, and the two behaviours are mutually reinforcing: bed-sharing facilitates frequent feeding which supports milk supply, while breastfeeding introduces oxytocin into the mother's blood and milk, reducing mothers' blood pressure (Jonas et al 2008) and inducing sleep for both mother and infant (Stuart-Macadam & Dettwyler 1995; Hrdy 1999). Bed-sharing breastfeeding mothers cope more easily with frequent night time feeds, getting more sleep and continuing to breastfeed for longer. McKenna and Gettler (2014) have termed the combination of bed-sharing and night-time feeding 'Breast-sleeping'.

Bed-sharing inherently puts mothers and babies in close body contact; a condition which anthropologists and others consider to be the evolutionary 'norm' for human infants - click here for more information. Bed-sharing has a number of benefits, as identified by researchers, or as perceived by parents who choose to bed-share. The flip-side of these factors can be viewed as the risks or drawbacks associated with cot sleeping.

It is important that parents are made aware of how their individual circumstances affect risk; the magnitude of their personal risk-related behaviours, and how these may change from night-to-night . Parents should also know about the risks and consequences of alternate infant sleep locations, some of which can be more hazardous than bed-sharing, and are given the tools to arrive at an informed decision about whether or not to bed-share with their infant at any given time.

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Breastfed babies are generally still feeding as frequently throughout the night at 3 months of age as they were at 1 month (Elias et al 1986; Ball 2003).It has been suggested by various researchers that frequent night waking is a factor contributing to the introduction of formula milk to babies, thereby undermining breastfeeding (Pinilla & Birch 1993; Marchand & Morrow 1994; Greenslade 1995; Ball 2003) given the common (but possibly no longer valid - see Doan et al 2007) perception that formula use promotes infant sleep.

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"In a world where the majority of breasts and nipples are some shade of brown, we cannot afford to treat white skin as the default in our practice."

- Nekisha Killings, MPH, IBCLC

Founder of The Melanated Mammary Atlas®

Partners helping us #normalizebrownbreasts

The Melanated Mammary Atlas® improves care for the underserved by broadening the health professional knowledge base in real-time, one image at a time.

Re-envisioning diagnostics. Transforming support. Normalizing brown breasts.

We aim to normalize how breast conditions manifest on patients of color. The more you see, the better you can support.

The Atlas

The Melanated Mammary Atlas® is your portal to a world of images displaying mammary related conditions on Asian, Indigenous, Black and Brown folks. We feature the first and only cache of images of this type available for viewing and constantly updated by health professionals and the public.

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- Any Provider who works with breasts/chests

"Indeed, if we are to truly develop an inclusive curriculum, appropriate representation must be given to all racial groups. The shortfall in representation in medical curricula is an important contributor to racial inequality in health-care experience, treatment, and patient outcomes."

Contribute an Image to The Melanated Mammary Atlas®

Our image upload tool is available to anyone who has relevant images to share. Images are input using key descriptors that will ensure accurate and robust search results. Each image is also accompanied by a case brief further detailing how the condition was recognized and treated.

We seek an equitable future of healthcare that normalizes a diverse representation of brown skin.

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Our "pay what you want" pricing model allows for members to commit to monthly contributions above the base subscription rate. A portion of additional contributions will go back into communities whose families are most impacted by health inequities.

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Join the movement to normalize brown breasts® today.

Breast conditions are not shown on dark skin in most textbooks, and as a result, many health professionals are unaware of how differently some conditions present on more deeply melanated skin.

The Melanated Mammary Atlas® was born out of a need. The sad truth is a dearth of images exists in representation of breast conditions on melanated skin in health education. By and large, the images that aspiring medical professionals see during their training are of fair skinned breasts with pink nipples. Not only is this inconsistent with the pigmentation of most of the people on this planet, it creates a gap in acumen that shows up in the care and assessment of patients of color.

Necessity is the mother of invention.

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The Melanated Mammary Atlas | Health Movement

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Health movement to normalize diversity in breast healthcare and education. The Melanated Mammary Atlas™ improves care for the underserved by broadening the health professional knowledge base in real-time, one image at a time.

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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Many mothers of twins or more breastfeed their babies successfully and we're here to support you.

Multiples are more likely to be born early and we know that very small or premature babies can find it difficult to breastfeed at the beginning. If you are unable to feed your babies straight away it doesn't mean that you won't be able to breastfeed.

Spending time with your babies, giving them skin-to-skin time with you or your partner and expressing breastmilk regularly, can all help babies to get going with breastfeeding. Talk to the hospital staff and your midwife about how they can support you to feed your babies in the way you want to.

To help you prepare for breastfeeding Twins Trust suggest that you:

Personal stories

Our work with peer-to-peer breastfeeding supporters has been made possible thanks to the National Lottery Community Fund.

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Many mothers breastfeed their twins, triplets or more. Twins Trust is here to support you with whichever feeding choice is best for your family.

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Babies can have allergies and intolerances to food just as children and adults can. The most common culprit causing a reaction for babies is cows' milk protein and a reaction to soy protein is also very common. There are various names for this including cows' milk protein allergy (CMPA), cows' milk protein intolerance (CMPI), food sensitivity and related conditions such as allergic proctocolitis or food protein-induced enterocolitis syndrome (FPIES). This article discusses infant food allergy with a particular focus on milk allergy in babies including common symptoms, causes, diagnosis and treatments.

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Can breastfed babies have milk allergies?

Although it is much more likely that a baby would react to a food he was given directly such as infant formula or dairy produce; an exclusively breastfed baby can have an allergy or intolerance to tiny traces of proteins from his mother's diet passing into breast milk. The most common food to trigger an allergic reaction through human milk is cows' milk protein. Less than 1% of exclusively breastfed babies are said to develop allergic reactions to cows' milk proteins in their mother's milk compared to 1.9-4.9% infants who have CMPA generally.

What other foods can cause allergies?

In addition to cows' milk products, other common allergenic foods include peanut, tree nuts, egg, wheat, soy, sesame, fish and shellfish but any food might cause a sensitivity in an individual mother or baby.

What about lactose intolerance?

Lactose intolerance is not the same as CMPA, but a food allergy may cause symptoms of lactose intolerance due to damage to the baby's gut affecting the digestion of lactose See Lactose Intolerance in Babies for more explanation.

Allergy or intolerance? What is the difference?

A food intolerance is an inability to digest a certain food or substance in the food. Symptoms might include tummy ache, bloating, diarrhoea or headache. Symptoms may be similar to food allergy but are not life threatening.

A food allergy is more serious than an intolerance but less common. The body makes an immune system reaction to a food, even tiny traces of the food, and occasionally this can be life threatening e.g. anaphylaxis. Allergic responses tend to be either:

Immediate (IgE-mediated). Symptoms such as swollen eyes and lips, hives, rashes, or difficulty breathing could be seen within minutes to two hours.

Delayed (non-IgE-mediated). Symptoms such as eczema, diarrhoea/constipation, blood in the stool, respiratory symptoms, or reflux might appear within hours to several days.

It's possible to have a combination of types.

How quickly can allergies be triggered through breast milk?

An allergic individual can react to trigger foods eaten directly almost immediately. But how long does it take for cows' milk and other allergens in a mother's diet to affect her breastfed baby? Kelly Bonyata IBCLC says:

Food reactions may occur within minutes, but symptoms in breastfed babies more commonly show up 4-24 hours after exposure. If baby has an acute reaction to a new food, or to a food that mom ate a large amount of, then he will probably be back to normal within a couple of hours. If baby is sensitive to a food that mom eats frequently, symptoms may be ongoing.

Symptoms of milk allergy

The most common symptoms of food allergy in the breastfed baby include:

Stomach or intestinal problems such as vomiting or reflux, signs of tummy ache/colic or diarrhoea (runny, frequent poops), green poos, poop with blood in it (allergic proctocolitis), poop with a lot of mucus, sore bottom, flatulence (often unpleasant smelling), constipation, an inflamed oesophagus (eosinophilic oesophagitis) or FPIES-a rare food allergy with severe vomiting and diarrhoea.

Skin problems such as eczema, patches of dry skin, cradle cap, nappy rash/sore bottom, rashes, hives, swelling of the eyelids or lips, flushed cheeks, skin may be unusually pale.

Breathing problems for example snuffles or cold-like symptoms, frequent ear infections, a persistent cough, wheezing or asthma.

Fussing during breastfeeding, biting at the breast or sore nipples can be associated with pain from allergies as babies can be very tense and clamp down at the breast. Sometimes there can be pronounced creasing or ridging of the nipple/areola. Babies with allergies may resist traditional positions and may push at the breast with their hands or keep coming off the breast or wriggling. Babies may want to feed all day and all night or conversely refuse to feed. Babies can seem incompetent at the breast.

Unhappy baby, unexplained crying, grunting, general fussing, baby difficult to settle and comfort, difficulty gaining weight despite copious poops, hiccups, frequent or persistent startle reflex or trouble sleeping (Noble, 2015). Allergy author Maureen Minchin describes allergy related behaviours as follows:

[Babies] who are either hyperactive before [in the womb], and persistently miserable after birth, or

[Babies] who start screaming in the second or third week of life, and

[Babies] who give many indications of gut discomfort

[Babies] who progressively develop other minor symptoms, like night sweats, cradle cap, or patches of rough skin

[Babies] who do not respond more than briefly to mothercraft skills

Is it really allergy?

There can be other reasons for symptoms of reflux, waking at night, green poop or fussy behaviour that may not necessarily be to do with the mother's diet or allergy. They are more likely to be due to food allergy if there is a family history of allergies. Discussing symptoms with your health professional and IBCLC lactation consultant will help you determine the most likely causes for your baby's symptoms.

What can cause milk allergy in babies?

There are several theories to explain the rise in childhood allergies. Some researchers are making connections between foods now thought allergenic (cows' milk, nuts, egg, wheat, soy) and their use in early infant formulas and vaccines past and present . Theories include:

A family history of allergy including hay fever, asthma, or eczema, can mean a baby has a higher risk of having allergies.

Giving a breastfed baby an early supplement of industrially made formula (including soy formula) may predispose or "sensitise" some babies to allergy. The younger the baby is when he has some formula, the more likely this is thought to happen. Although symptoms of allergy may not be seen with the first exposure, when they next encounter that protein either directly or via mothers' milk, a reaction can be triggered . Sensitisation could even occur during pregnancy . Note: Sometimes supplements may be medically necessary if your baby is not gaining weight or has high levels of jaundice and donor breast milk is unavailable. Your health professional will help you weigh up the best decision for your baby, and your IBCLC lactation consultant can help you increase your milk supply.

Vaccines contain potential allergens including milk proteins, gelatine, egg, and soy that could sensitise a baby and cause allergies with repeat exposure .

Factors such as mode of birth, nutrition, antibiotics, toxins, pollutants, and changes to the microbiome (friendly bacteria living in our bodies) may influence our gut health, how our immune systems work and hence our responses to allergens.

Diagnosis of milk allergy

Full history

Your medical professional or lactation consultant can help assess whether your baby could have a food allergy by taking a full medical history including a family allergy history. A sample questionnaire and discussion around interpreting it can be found in Maureen Minchin's book Crying Babies and Food: In the early years, 2015

Allergy tests?

According to CMPA Support-a small UK charity run by parents for parents of babies and children with food allergies and intolerances-an elimination diet (a diet for the mother that avoids trigger foods) is said to be a more accurate form of diagnosis than allergy tests:

Although there are medical tests available, they are not conclusive. Allergy Tests often return false positive and false negative results. Allergy testing only tests for IgE antibodies meaning that a non-IgE allergy will produce a negative result. The most common and accurate way to diagnose CMPA is by eliminating Cows' Milk Protein (CMP) from the diet (aka an elimination diet) for a period of time to see if the symptoms improve, and then re-introduce CMP to see if a reaction re-occurs.

CMPA Support also provide the MAP (milk allergy in primary care) guidelines to help GP's to diagnose and manage CMPA in primary care.

Treatment for milk allergy

Elimination diet

The first line of treatment recommended for suspected milk allergy in babies is to trial an elimination diet to eliminate trigger foods ( infantproctocolitis.org, Wambach & Riordan 2015, ABM, 2011). In addition to the offending allergen(s) in the mother's diet, low levels of essential fatty acids (omega-3s rather than omega-6s) and vitamin D can also be associated with infant allergies (Noble, 2015). A dietitian can be an important partner in the process to ensure you are still getting a healthy diet while excluding certain food. See the separate article Elimination Diet for more information on possible diets to follow.

Heal the mother?

A food allergy can cause damage to the lining of the gut (intestines). Repeated exposure to food allergens is sometimes said to cause "leaky gut syndrome". Author Robyn Noble explains that repeated gut damage allows more undigested food components to enter the blood stream from the intestine than normal leading to symptoms of food intolerance. Symptoms may also appear without gut damage due to enzyme or other biochemical deficiencies. Healing the mother's gut with the right diet may help her breastfed baby with food intolerances and allergies by making her breast milk less inflammatory. In extreme cases, Noble notes that when mothers consume only cooked foods or take pancreatic digestive enzymes* it seems to help food breakdown to reduce food allergy severity (Noble, 2015, p50-53).

Are probiotics helpful?

Probiotics ("friendly" bacteria and yeasts) are commonly promoted as having health benefits when taken as a food supplement. Internet searches may claim that probiotics for mother and baby can be helpful for food allergies but more research is needed. UK's National Health Service says there is no evidence to confirm that probiotics can help treat eczema . Probiotic products themselves could contain allergens and author Maureen Minchin discusses the pros and cons and recommends caution in Are Baby Biotics Bugging You?

Allergic proctocolitis

Allergic proctocolitis is an inflammatory response in the large intestine to certain proteins in the diet. The main symptoms are seen in the baby's dirty nappy; loose, mucousy stools with streaks of bright red blood . Babies generally appear well but may occasionally have anaemia or low albumin levels in the blood or, rarely, may fail to thrive. For further information see;

Treatment

The Academy of Breastfeeding Medicine suggest the following protocol for mild to moderate symptoms if an elimination diet doesn't seem to help:

Consider eliminating other allergens.

Breastfeeding may continue with monitoring of weight gain and growth.

Consider following hemoglobin and albumin levels if continued moderate degree of blood loss (blood is visible) in stools.

Consider use of pancreatic enzymes* for the mother. Dosage is generally one or two capsules with snacks and two to four with meals as needed dependent on the baby's symptoms.

In severe cases with impaired growth, decreasing hemoglobin level, or decreasing serum albumin level, the use of a hypoallergenic formula may be considered; however, one should consider referral to a specialist.

*The protocol recommends further research to establish the safety and efficiency of mothers' taking pancreatic enzymes as a treatment option. The theory behind it is that the enzymes break down potential allergens before they can get into the breast milk.
FAQs on cows' milk protein allergy

How quickly will my baby improve on an elimination diet?

Our sister article Elimination Diet explains:

Once a mother has excluded the trigger food from her diet, her baby's symptoms may start to improve within three to four days however it may take two to four weeks to see full improvement. This is likely to be associated with the time taken for any existing inflammatory reactions to settle down in the baby rather than the time taken for allergens to leave breast milk.

I've tried an elimination diet but my baby is no better, what next?

If you have tried an elimination diet for dairy with no improvement see Elimination Diet for more ideas such as how to spot hidden dairy in processed food, trying a total exclusion diet and more. In the event that a food allergy is not the culprit, stay in close contact with your health professionals and IBCLC lactation consultant to help find other causes for your baby's symptoms.

What if my doctor says I should stop breastfeeding?

Some doctors are concerned that an exclusion diet isn't healthy for mother or baby and advise that weaning baby to a specially modified formula would be better for both. However there's no evidence that industrially made hydrolysed or elemental (enzyme pre-digested) prescription formulas are "better" for the prevention of allergy in preference to exclusive breastfeeding-and poor bone health has been reported with exclusive use of certain specialist formulas While it can be challenging to follow an elimination diet, with careful supervision and help from a dietitian it can still be a healthy diet. Breast milk will be easier for your baby to digest and contains all the other benefits of breast milk.

Absolutely! Your body makes sure that your breast milk contains all of the essential nutrients, antibodies and other factors your baby needs to grow and develop. Even though you may feel your diet is missing something, chances are that you are getting all the nutrients you need from the foods you are still able to eat. Even in mothers who do not have enough food to eat, levels of micronutrients such as folate, calcium, iron, copper and zinc in their breast milk remain relatively high. A multi-vitamin is a good idea for all breastfeeding mothers, and taking 500 mg of Calcium twice a day with meals plus 1,000 to 2,000 IUs of vitamin D3 will help protect your bone health while you are avoiding dairy.

What can I share with my doctor?

Some doctors may be unaware of the latest recommendations and excellent resources available on this topic:

The ABM Protocol on Allergic Proctocolitis

The Infant Proctocolitis website designed to educate healthcare professionals as well as families. It has a special medical section for your doctors. The recommendation that mothers work with a registered dietitian will reassure your health professionals that your health is being looked after. The section for "Frequently Asked Questions" (FAQ) on infantproctocolitis.org is very useful. Should I Switch to Formula?explains Allergic Proctocolitis doesn't require switching to special formulas which are often expensive and don't always suit the baby and that breastfeeding with an elimination diet is the healthiest choice.

The GP Infant Feeding Network website has comprehensive information for GPs on CMPA, explaining it is rarely necessary to stop breastfeeding, how breastfeeding is important for allergic children and when to refer to a paediatric allergy clinic.

Breastfeeding Works! Even With Allergies by Robyn Noble contains over 500 references to support its information.

If I need to supplement, what sort of formula can I use?

There may be situations where a breastfeeding mother needs to supplement her allergic baby. Or situations where a baby's allergic symptoms are very severe and a special formula may need to be considered ( ABM, 2011). Extensively hydrolysed formulas are often recommended and in some cases, elemental amino acid based formulas may be indicated ( infantproctocolitis.org). Nutritional information for alternative milks is discussed in Specialised Infant Milks in the UK: 0-6 Months, April 2020 by First Steps Nutrition Trust. Allergy author Robyn Noble cautions that although some clinicians believe it is not possible for babies to react to elemental formulas she has seen many babies react as not all ingredients are enzyme reduced to amino acids. (Noble, 2015)

What about soya based formulas, or goat's milk?

Soya based formulas, or goat's milk formulas are not recommended as many infants will have similar allergic reactions to the proteins they contain. Soy is itself a highly allergenic protein often causing reactions . UK Department of Health Government advice 2014 states:

goats' milk-based formula is not suitable for infants diagnosed as being allergic to cow's milk. GPs will prescribe an appropriate infant formula with fully hydrolysed proteins

Will my baby grow out of allergies?

A high proportion of children (90%) can grow out of their allergies by three years of age .

How can I protect my next baby from allergies?

Allergy prevention is a concern in high risk babies with a family history of allergies. Current recommendations include:

The breastfeeding mother can continue to eat allergenic food such as milk products, fish, cooked eggs and nuts during pregnancy and lactation if she can tolerate them safely. See Elimination Diet for more information.

Introduce solids while continuing to breastfeed.

UK's NHS recommends introducing potentially allergenic food gradually into a baby's diet after six months of age . See Starting Solid Foods for a full discussion of the guidance in UK and USA.

There is no evidence that using hydrolysed formula can prevent allergies and health concerns such as poor bone health have been associated with exclusive use of certain specialist formulas.

Summary

One of the most common proteins likely to trigger an allergic reaction in breastfed babies through mother's milk is cows' milk protein from cows' milk and dairy produce in a mother's diet. Known as cows' milk protein allergy there are a number of related symptoms and conditions such as allergic proctocolitis. Lactose intolerance is not the same as milk allergy, see Lactose Intolerance in Babies. Once identified, an elimination diet for mother can remove the allergens from breast milk. Many babies will grow out of allergy over time.
Information in this article is not tailored for you and your baby. Always consult with your health professionals for advice that takes yours and your baby's medical history into account.

Footnotes & References

1. Minchin, Milk Matters Infant feeding & Immune Disorder, 2015

2. Milk Matters: Infant Feeding & Immune Disorder, Maureen Minchin, 2015 p 715

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This article discusses infant food allergy with a particular focus on milk allergy in babies including causes, common symptoms, diagnosis and treatments.

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Take anti-inflammatory tablets and apply a warm compress before feeding to soothe the pain, but the most important thing is to get someone to help you position and attach your baby correctly. Speak to your doctor if after 2 feeds (6-8 hours) you are still feeling hot and shivery or the inflammation or lump is worsening. They may prescribe stronger anti-inflammatory tablets or antibiotics. Anything you're given will be safe for breastfeeding, but using antibiotics can make thrush more likely so try correcting positioning and attachment and anti-inflammatory medication urgently in the first instance to see if you can clear it yourself.

Call your Midwife or Health Visitor right away and, if you are still feeling shivery after a few hours and have a high temperature (feeling very hot and then very cold) then ring your GP immediately, or if they aren't open call NHS24 on 111.

It's probably the last thing you want to do, but try to carry on frequent breastfeeding during a bout of mastitis - emptying the breast is the only solution. Watch the video to hear a mum's story on how she overcame mastitis.

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Mastitis | Breastfeeding Support & Tips | Parent Club

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Take anti-inflammatory tablets and apply a warm compress before feeding to soothe the pain, but the most important thing is to get someone to help you position and attach your baby correctly. Speak to your doctor if after 2 feeds (6-8 hours) you are still feeling hot and shivery or the inflammation or lump is worsening.

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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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Breastfeeding after Breast & Nipple Surgery

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Breastfeeding after Breast & Nipple Surgery

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BFAR - Breastfeeding After Breast and Nipple Surgeries

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The BFAR website provides information and support to mothers who wish to breastfeed after breast or nipple surgery, and their friends and family. It is also an online resource for healthcare providers who help mothers breastfeed.

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Skin-to-skin contact - Baby Friendly Initiative

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Skin-to-skin contact is important for babies and mothers to develop close, loving parent-infant relationships and to initiate breastfeeding.

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Infant milks for parents & carers — First Steps Nutrition Trust

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

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Should I give water to my baby_portrait_pdf.pdf

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Essential Guide to Feeding & Caring for your baby

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Essential Guide to Feeding & Caring for your baby

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Infant Feeding Line 0300 330 0700. The line is open every day from 8am to midnight, including bank holidays.

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Many mums struggle with breastfeeding in the early weeks, but support can make all the difference. Watch this video as two mums share their experiences.

Feeding support from NCT

Our breastfeeding counsellors are here to help you on your feeding journey. They'll offer relevant information and suggestions - whether you're breastfeeding, formula feeding or mixed feeding. You can access their support in the following ways:

Call the NCT Infant Feeding Line

If you have any questions, concerns or need support - however you're feeding your baby - you can speak to our friendly breastfeeding counsellors free of charge by calling our support line on 0300 330 0700. The line is open every day from 8am to midnight, including bank holidays.

Online breastfeeding support - chat/social media

It's always helpful to talk to other women who are breastfeeding for support, tips and company. Peer support can be found on most social media platforms online, like this one.

As well as support from our breastfeeding counsellors and your health care providers, our breastfeeding commissioned services are offering virtual breastfeeding support via zoom groups, text messaging and one- to-one calls.

If you live in any of these areas and would like some support from a breastfeeding peer supporter, please get in touch:

Many of our local NCT branches are also providing online breastfeeding peer support via closed Facebook groups. Get in touch to find out more - search on your postcode and message your closest branch to see if they have any online peer support.

Visit a local NCT Baby Cafe - supporting you to feed your baby

Put your postcode in our local activity finder to see if there's an NCT Baby Cafe near you. You can expect support, encouragement and reliable information - whether getting ready to breastfeed, establishing breastfeeding, continuing breastfeeding, expressing, mixed feeding, formula feeding, introducing solids or stopping breastfeeding.

These groups are run by qualified NCT Breastfeeding Counsellors but you may also receive support from a trained peer supporter or volunteer. They are free of charge and you are welcome to drop-in - there's no need to be an NCT member or have done an NCT antenatal course in order to attend.
Free one-to-one support from a volunteer
Some NCT Breastfeeding Counsellors are able to provide one-to-one support on a voluntary basis. This could be over the phone, online or in-person. Call the Infant Feeding Line on 0300 330 0700 to find out if this support is available in your area. We can put you in touch with your friendly local breastfeeding counsellor if there is one offering voluntary support near you.

We would be interested to hear any feedback that you have following support from one of our breastfeeding counsellors. Please fill in our survey.

Our courses

All of our courses are led by specially trained and experienced practitioners who understand what matters to you. Choose from our range of classes whether you're preparing for birth or need support postnatally.

What can you expect from NCT support?

Breastfeeding Counsellor

Our Breastfeeding Counsellors are here to support you on your feeding journey. They have undertaken an extensive two-year university accredited training course in counselling, listening skills and research-based breastfeeding knowledge.

You will be offered the opportunity to be listened to without judgement and without being pushed in any one direction. Our Breastfeeding Counsellors will discuss your options and explore what would work for you, alongside offering relevant information for you to achieve your feeding goals.

They will continue to support you however you feed your baby. Breastfeeding Counsellors attend regular continuous professional development days to update knowledge and skills. They are also supported by receiving supervision to explore and reflect upon their counselling practice.

Breastfeeding Peer Supporter

Our Breastfeeding Peer Supporters are mothers who are trained to support other mothers in their feeding journeys. Their six-week training course includes listening skills and straightforward breastfeeding knowledge.

They support mothers in the community both in breastfeeding support groups and by phone or social media contact. They will also signpost mothers to information and specialist support if this exceeds the limit of their knowledge or skills.

All NCT Breastfeeding Peer Supporters receive ongoing training and support from specialist breastfeeding counsellors, helping them to reflect and learn from their experiences and maintain the boundaries of their role.

All of our Breastfeeding Counsellors and Breastfeeding Peer Supporters are mothers who have the lived experience of breastfeeding their own babies.

Practical and emotional support

Your breastfeeding counsellor will make use of person-centred counselling skills, bringing thoughtful and empathetic support to you and your family. This includes listening to you without judging or criticising and offering information and suggestions. She will provide relevant information to help you make informed decisions about feeding your baby.

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Breastfeeding support from NCT | Baby & toddler, Feeding articles & support | NCT

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Breastfeeding isn't always straightforward, but there is lots of information and help to support you - wherever you are in your feeding journey.

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Helpline 0300 330 5453 (9.30am til 10.30pm run by breastfeeding volunteers)

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Trained breastfeeding counsellors are available at:National Breastfeeding Helpline, Find a local support group, Access web chat or email us.

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Donor Milk - How to donate breastmilk and access a milk bank

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Donor Milk - How to donate breastmilk and access a milk bank

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The Southwest Neonatal Network Donor Milk Bank was established in November 2011 at Southmead Hospital in Bristol. We are one of 15 UK milk banks and the only one in the South West.

Our aim is to provide safe, screened donor breast milk for all babies who need it within the South West Neonatal Network. The Southwest Neonatal Network Donor Milk Bank provides about 100 bottles of milk to 10 units around the South West and beyond each month.
Why do we need a milk bank?
For premature and vulnerable babies donor breast milk is the next best nutrition if a mother's own milk is unavailable. It offers specific benefits for these babies:

Protection from infection

Protection from necrotising enterocolitis

Easier to digest

How does it work?
Frozen breast milk is collected from a donor's home regularly and is delivered to the milk bank to be processed. After pasteurization, donor breast milk is distributed to neonatal units around the south west to be given to babies who may need it.
Being a milk donor
Breast milk donors exclusively breastfeed their own babies. We can accept donations of their excess milk from when their own baby is at least 6 weeks old and until they are about 6 months of age.

Mothers who are interested in donating are screened (in a similar way to blood donation screening) to ensure their milk is safe to be given to premature and sick babies. This process involves a blood test, a visit to the hospital with their baby to meet a member of the milk bank team and the completion of a short lifestyle and medical history questionnaire. If you are interested please contact the Milk Bank on milk.bank@nbt.nhs.uk
For further information on donor milk please visit the UKAMB website www.ukamb.org

O ur daughter, Abigail, was born at 25 weeks gestation weighing just 550g. After the initial shock of giving birth so early, feeding Abigail my expressed breast milk became a way that I could still contribute to my daughter's well-being despite her being inside a plastic box and not being able to hold her. It was amazing to hear that I could still produce breast milk and feed it to her through a tube despite such an early birth.
Yet at 550g, the amounts of feed she could take were only a very small portion of what I was able to produce. After filling up my home freezer with breast milk one of the NICU nurses suggested I consider donating milk to the milk bank. The process of becoming a donor was easy - just a bit of paperwork and a blood test. I then arranged for collection of the milk by Mike on behalf of the milk bank. Mike came to the house and even gave me a few lifts into the hospital as well at the same time - a very practical solution to an oversupply of milk. But the best thing was the feeling I got when I first saw someone's baby being fed donor breast milk (the milk had a different coloured lid indicating donor milk). I obviously didn't know if it was mine or not, but seeing another baby benefit made me feel that some good had come from my own situation. Our daughter is now doing well and I like to think that the benefits of having fed her breast milk for the first eight months of her life have put her in good stead for the future. I hope that the donor milk has done the same for other babies.

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The Southwest Neonatal Network Donor Milk Bank

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The Southwest Neonatal Network Donor Milk Bank was established in November 2011 at Southmead Hospital in Bristol.

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Sure, nappy changes are sometimes a dirty job but they can also be magical moments of one-to-one time with your child.

Find ways to make the most of the eye contact you have.

You could softly sing to newborn babies, whether it's a traditional nursery rhyme, our 'Wee, Wee, Poo' song written specifically for this moment, or your favourite new track on the radio. "It doesn't have to be a nursery rhyme," says Kerry, "you could put on some tunes and have a little dance in front of baby. If it raises a giggle, it'll help your stress too."

As well as singing, hands-on play with your baby is ideal for nappy-changing time as it allows babies to feel your touch. "'Along Came a Spider', tickle time and blowing raspberries on their tummy - all of those things can be fun and unlimited in their appeal."

As children get older, they also get wrigglier, which can pose problems in getting things done. But it can just mean a change of approach to distract children and focus their attention. You could try using their senses for example, asking them to listen out for the things they can hear or look out for what things they can see. Kerry suggests involving toddlers in their own nappy changes, getting them to fetch nappies and hold the things you need as you change them.

She has an ingenious suggestion for a game to play with them too. "Sleeping Lions - toddlers love that. 'Can you keep as still as you can while I get this nappy changed?'"

No matter the age, there's no pressure to make nappy time magical, but it's worth trying to make the most of it where possible. "We're not saying you have to make every nappy change this meaningful interaction by any means, but I think it's just an opportunity, just to sort of pause in the day with your baby," says Kerry. Taking a moment to distract your baby from what's going on can stop them from wriggling and generally make it a more enjoyable experience for you too. "We know all the baby brain development that comes from interaction, but equally it makes it less stressful for you."

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Changing baby's nappies: How to make nappy changes fun

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How to change a nappy and make it more fun for baby and less stressful experience for you while you're at it.

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A Light on the High Street

The branch is simply our church on the high street!

We rented a shop in April 2019 with a vision of serving the needs of Fordingbridge town and surrounding villages through events and programmes that meet practical & emotional needs of the community.

We are working with a group of founders and creatives to offer an exciting range of books, bible journaling stationary & cards.

Whether it is a book or a gift we have it covered... you're welcome to come and browse!

New Life Community Church (NLCC) meet at Burgate School every Sunday 10:15am.
After careful consideration and prayer we felt encouraged to rent a premises on the high street we opened the branch April 2019.

We love Fordingbridge town and the community and we want to be a beacon of light on the high street, a place where anyone can come and take shelter and chat and take part in any of our activities and programmes.

The branch is both a retail space where you will find Christian resources and gifts but also a Community Hub where we run everything from youth work & parent/carer support groups to Coffee mornings.

Our pastoral team Paul Williams and Dale Kratzke are based in the offices at the branch and the Retail side of the shop is run by a group of brilliant volunteers.

Little Buds is currently running Friday mornings & we are excited to kick off our new Support group Grow this September.

CAP Money will also be back in September and February

If you are interested in attending any of the above click here to book yourself in https://newlifecommunitychurch.co.uk/connect/events/

Coffee mornings at the Branch is every Wednesday morning, so grab a friend & get yourselves a slice of cake & a cuppa for a bargain £1.50.

NLCC and The Branch are here to serve our community- whether it's someone to talk to, one of our courses or events or access to foodbank vouchers please feel free to pop in.

We also work alongside some brilliant people who make a huge difference to The community of Fordingbridge.

Fordingbridge Foodbank is part of the Trussell Trust and is open 3 days a week and led by David and a group of volunteers. We can issue Foodbank vouchers from the branch after a few questions regarding your personal circumstances.

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The branch is simply our church on the high street! We rented a shop in April 2019 with a vision of serving the needs of Fordingbridge town and surrounding villages through events and programmes that meet practical & emotional needs of the community.

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The World Health Organisation recommends exclusive breastfeeding for the first six months and continued breastfeeding alongside other foods for at the least the first two years years and beyond.

The first few weeks can be the most difficult when you are establishing breastfeeding. Please use the tabs below for further help, tips and support. You might find it helpful to sign up to the fast, friendly, anytime, trusted NHS advice on breastfeeding.

Breastfeeding will give your baby the best start in life. However, any amount of your breastmilk will always be good for your baby's health and wellbeing.

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Feeding your baby Menu Feeding your baby Breastfeeding Baby wearing (slings) Bottle feeding Skin to skin Breastfeeding is the healthiest way to feed your baby, with important benefits for both mother and baby. We therefore encourage and support you to breastfeed your baby. We also support the right of parents to make...

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When I had my second baby, I knew I was doing it alone. Having successfully breastfed my first child through a crumbling relationship, I thought that doing it again would be a breeze. I hadn't realised how hard it could be. Breastfeeding my daughter had many challenges. Finding my feet as a mother of two was harder than I thought, especially as she would not feed in my arms for months. We could only feed lying down or if we used a sling.

As I was working it all out, I could have done with another adult around, especially with my son needing help to adjust to our bigger family. There were many times when I wanted to throw the towel in. There were many tears and I wondered if I had been utterly foolish for wanting this second child as a single mother. The support from my LLL Leader and from my local friends proved invaluable.

In hindsight, I wish I had made more plans to get the postpartum support I needed. I wish I had seen a chiropractor to fix my daughter's neck much earlier than I did. I wish I had asked my mum to move in with me for more than 10 days. I wish I had accepted more support from friends. Being a single mum who is used to doing everything alone, mostly successfully, means that I find it hard to accept help.

Now that we are on the other side of it, we seem to have found our groove. My toddler's latch is still dreadful, but her personality brings a lot of joy to our home and I wouldn't change it for the world! Although things were very hard at the beginning, breastfeeding my second child as a single mum has meant that I haven't had to convince anybody about the importance of breastfeeding till my daughter is ready to stop, which was a challenge the first time around.

I would definitely prefer having a third child whilst being in a loving relationship, and I hope that one day I will find a supportive partner who helps make the next experience a wonderful one, but I would never tell anyone not to do it alone. As relentless as it is, having my family is the most amazing part of my life.
Written by Lorette Michallon, LLL Milton Keynes, and first published in Breastfeeding Matters issue 225 (May/June 2018)

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Single mum and breastfeeding - La Leche League GB

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When I had my second baby, I knew I was doing it alone. Having successfully breastfed my first child through a crumbling relationship, I thought that doing it again would be a breeze. I hadn't realised how hard it could be. Breastfeeding my daughter had many challenges.

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The risks of not breastfeeding
A lot that you and you partner have about breastfeeding, will give you this information, but they will emphasis the benefits for breastfeeding rather than talk about the risks of not doing so. I say that breastfeeding is the way we have evolved over millions of years to feed our babies, and that anything else is a risk. Some people find this way of looking at it uncomfortable, but if you read around it I think you'll see it makes sense. Remember we are mammals, and have been for millions of years. All mammals feed their young milk from breasts or teats. The word mammal actually means that the animal has a mammary gland to produce milk.
The use of artificial formula is a very very recent phenomenon, and is not as safe as you might think. For one thing, babies fed on 'modern' formula (since, say, the 1970s) are not even in middle age yet.

No long- term studies have been done. What we do know is that artificial formula changes the body: it alters a baby's gut (breastfed babies' poo is yellow and smells milky, while that of formula fed babies is browner and smellier, more like adult poo) and immune system, making babies more vulnerable to infections. The immune protection that your partners
breastmilk provides cannot be underestimated.

Breastfeeding has served us as a species for millions of years of successful evolution, and probably has many more effects on the body than we currently know about - and we know about a lot. If you read about it, or Google the benefits of breastfeeding, you will probably be overwhelmed! Artificial formula can never come close to matching the living fluid that your partners breasts will produce.

Having said all this, her choice regarding how you feed your baby is sovereign, and supporting her choices is your role, sharing your opinions but understanding that whatever conclusions you come to are the right ones for you and your family.

The risks to your baby (and partner) from not breastfeeding:

The risks of not breastfeeding for the mother:

Any breastfeeding will protect your lover and your baby from these risks, and the longer she breastfeeds for, the longer the protection will last.

Where to get breastfeeding support

In most hospitals the midwives will be able to help your partner and your baby get breastfeeding started. There are infant feeding advisors on staff if you need more help.

In some hospitals there are maternity assistants or volunteer peer supporters on post-natal wards who can also offer support. If you give birth at home, or once you come home from hospital, community midwives will visit or offer clinics in the early days.

Then you'll be allocated a health visitor, who should be able to direct you to breastfeeding groups or peer supporters in the community. Peer supporters are other mothers who've breastfed their own children, who've had additional training in supporting breastfeeding.

They can offer understanding and support and help with minor challenges, such as poor attachment/'latch', and they can signpost you to more help for other difficulties. They often run breastfeeding groups where your lover can meet other mothers with new babies, which can be very reassuring.

There's also a national breastfeeding helpline staffed by trained breastfeeding counsellors, and organisations like La Leche League, the Association of Breastfeeding Mothers and the Breastfeeding Network which run support groups, online discussion groups and Facebook pages and offer great information on their websites. Details of them all are at the back
of the book. There's bound to be something in your area. If your partner is finding breastfeeding challenging, you can help her to access the support she needs.

Copyright 2017 by Birthing4Blokes.

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Supporting your partners breastfeeding choices

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A lot that you and you partner have about breastfeeding, will give you this information, but they will emphasis the benefits for breastfeeding rather than talk about the risks of not doing so. I say that breastfeeding is the way we have evolved over millions of years to feed our babies, and that anything else is a risk.

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Breastmates

All Breastmates groups are currently suspended in response to coronavirus (COVID-19) pandemic.

Please read information about other breastfeeding support.

Breastmates is a network of free breastfeeding support groups held across Swindon.

They are informal drop-in groups, run by mums who are not only trained in breastfeeding support, but who have breastfed and in most cases are still breastfeeding.
You don't have to be having any breastfeeding problems to attend. Groups offer an opportunity to chat to other breastfeeding mums whether you are breastfeeding or pregnant. Partners, children, family and friends are welcome too, as they all play an important role in supporting breastfeeding mums.

Swindon Breastmates have a Facebook page which is a closed group for local breastfeeding mums. To join please send a request to the address below. (This is an informal Facebook page managed by Breastmates peer support volunteers and is not affiliated with Swindon Borough Council): www.facebook.com/groups/SwindonBreastmates

To find out more about the Breastmates peer supporters, please see the document below:

Swindon Breastmates groups

Day

Venue

Time

Monday

Croft Playgroup
Marlborough Road
Swindon
SN3 1RA

12.00pm to 1.30pm (excluding bank holidays)

Term time only

Tuesday

Lower Shaw Farm
Old Shaw Lane
Shaw
Swindon
SN5 5PJ

(Walk up the farm lane, we are in the last building on the left)

12.30pm to 2.30pm

Wednesday

Central @ RLK
(Formerly Robert Le Kyng Children Centre)
Westcott Street
Swindon
SN1 5HS
Tel: 01793 617484

12.30pm to 2.00pm

Term time only

Thursday

The Underground
Orbital Retail Park
Thamesdown Drive
Swindon
SN25 4AN

12.30pm to 2.30pm

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All Breastmates groups are currently suspended in response to coronavirus (COVID-19) pandemic. Please read information about other breastfeeding support. Breastmates is a network of free breastfeeding support groups held across Swindon. They are informal drop-in groups, run by mums who are not only trained in breastfeeding support, but who have breastfed and in most cases are still breastfeeding.

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This lovely group offers online and in person support.

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Bath and West Wiltshire Breastfeeding Peer Support

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This group has been set up in response to the current situation, to replace the in-person support offered to mums by breastfeeding peer supporters on the postnatal ward, in NICU and in the Mum2Mum...

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What a good breastfeed looks like (2 mins)

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What a good breastfeed looks like (2 mins)

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Salisbury Breastfeeding Support Group (UK) has 2,141 members. A support group for Mummies in the Salisbury, Wiltshire area - come and find advice, support, ask questions, help others and 'keep calm,...

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Using smart technology, we provide parents and parents-to-be with vital support on their breastfeeding and parenting journey, anytime, anywhere.

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COVID-19 vaccines, pregnancy and breastfeeding FAQs | RCOG

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COVID-19 vaccines are strongly recommended in pregnancy.

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I provide parents with infant feeding information and support both antenatally and postnatally.

I breastfed my eldest for 14 months, and allowed my youngest to self-wean, which she did so gradually that I'm not entirely sure when her last feed was. Although it was certainly well past the World Health Organisation's recommended minimum, of two years of age. I really enjoyed breastfeeding both my children, and decided I wanted to offer new parents the support they need to overcome any difficulties and enjoy what can be a very rewarding experience.
Breastfeeding Helplines
I trained as an NCT breastfeeding peer supporter, as well as undertaking some infant feeding training with Mother & Baby International, before training with the Association of Breastfeeding Mothers (ABM) to become a breastfeeding counsellor.

Over the years I have volunteered at several breastfeeding support groups, and helped to set up and run BOOBS (previously known as Swindon Extended Breastfeeding Support), which is specifically for those breastfeeding children aged 12 months and older. Currently I run with a free support group in Devizes, as well as helping run one in Swindon. I also volunteer answering calls on the National Breastfeeding Helpline.

Every few months I run a free, antenatal feeding information evening, as part of Optimum Bumps. During these sessions breastfeeding parents come along to share their experiences and allow expectant parents to see them breastfeed their babies.

A fully qualified breastfeeding counsellor or International Board Certified Lactation Consultant (IBCLC) are by far the best people to seek help from, if you are experiencing breastfeeding difficulties.

Breastfeeding counsellors are parents, who have breastfed themselves and have undergone extensive training in supporting others who wish to breastfeed. They work predominantly in a voluntary capacity, running support groups, manning telephone helplines, working on postnatal wards or doing home visits.

IBCLCs are usually health care professionals and specialise in the clinical management of breastfeeding. They may work for the NHS or they may have a private practice. Access to NHS employed IBCLCs is free but the cost for consultations with private IBCLCs varies. A few IBCLCs offer their services for free, on a voluntary basis.

There are several helplines that you can call, if you wish to speak to a breastfeeding counsellor:

Association of Breastfeeding Mothers (ABM) - 0300 330 5453

National Breastfeeding Helpline - 0300 100 0212

La Leche League - 0845 120 2918

National Childbirth Trust (NCT) - 0300 330 0771

If you feel that you need face-to-face support, there are several options, locally.

nant women are not only welcome, but positively encouraged, to come along and ask any questions they may have on the subject. And what's more, there is often cake.
Swindon Breastmates is a network of free breastfeeding support groups, run by NHS Swindon. They are informal drop-in groups, run by mums who are not only trained in breastfeeding support, but who have breastfed, or in most cases who still are breastfeeding, their own children. You don't have to be having any breastfeeding problems in order to attend. In fact you don't even need to be breastfeeding, yet. Preg

The groups were stopped, due to Covid, and are gradually re-starting. The groups are at Christ Church Community Centre, from 9:30am until 11:30am, on Tuesdays and at the Swindon Parenting Hub, by Abbeymeads Primary School from 9:15am until 11:15am, on Thursdays.

Some of the mums volunteering at the Breastmates groups have set up a closed Facebook group, called 'Swindon Breastmates (Breastfeeding Support)'. Here parents and expectant parents can ask questions and get support from each other, in the privacy of their own homes, at any time of day or night. This is an unofficial group and is not officially associated with the NHS

Wiltshire Breastfeeding Support has recently been set up by the ABM. In North Wiltshire, there are curerntly groups running in Chippenham, Devizes and Calne.

The Chippenahm group runs on Mondays from 10am until 11:30am, at Spring Rise Children's Centre in Frogwell.

Those volunteering at the Chippenham group have set up a closed Facebook group called 'Chippenham Breastfeeding Support and Chatter'. It is a place for breastfeeding mothers and pregnant mothers, who are planning to breastfeed, from Chippenham and the surrounding area, to chat about the highs and lows of breastfeeding and access support with feeding issues.

I run the Devizes group on Fridays, at Optimum Corner, from 1pm until 2:30pm.

I also help run the Calne group, in Calne Children's Centre, on Wednesdays, from 1pm until 2:30pm.

We have plans to get a Melksham group up and running in 2023 (probably on a Thursday morning).

You do not need to be having a problem with feeding in order to attend. You can attend simply to chat with other parents. You can even attend if your baby hasn't been born yet. But of course, if you do feel the need for feeding support, that is the group's main purpose, so just ask.

We have our own Facebook page and closed Facebook group, called 'Devizes, Melksham and Calne Breastfeeding Support'. Here parents and expectant parents can ask questions and get support from each other, in the privacy of their own homes, at any time of day or night, as well as keep up-to-date with any changes to the running of the in-person support.

To request to join the group, please visit:

And for more information, please visit the Devizes, Melksham and Calne Breastfeeding Support Facebook page:

As part of the West Swindon Family Hub. myself and fellow Breastfeeding Counsellor Elena Rossi run a free, drop-in breastfeeding support session, at Toothill Church, on Mondays from 10am until 11:30am.

For more information on the Hub, please visit the West Swindon Family Hub Facebook page:

Cricklade Breastfeeding Best Friends

Cricklade Breastfeeding Best Friends is a weekly infant feeding peer-support group, running from 1pm until 3pm, on Tuesday afternoons, at the Cricklade Town Hall Annexe.

There is no website or Facebook page for the group, but if you want to get in contact with the organiser you can email her on:

This group is for anyone in the Swindon area who is breastfeeding (or is hoping to breastfeed) a child older than 12 months. BOOBS meets once a month. The meetings are held on different days of the week, including Saturdays. Having meetings on different days should ensure that those who have returned to work, even if full-time, should be able to attend a meeting at least every few months.

Or to chat with other local parents breastfeeding their children of 12 months and older, join the closed Facebook group:

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I provide parents with infant feeding information and support both antenatally and postnatally. I breastfed my eldest for 14 months, and allowed my youngest to self-wean, which she did so gradually that I'm not entirely sure when her last feed was. Although it was certainly well past the World Health Organisation's recommended minimum, of two years of age.

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Bath and North East Somerset Community Health and Care Services

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Your Health Visiting Service is accredited under the Unicef baby-friendly initiative, which means we have achieved rigorously assessed, quality standards for providing support to all parents for responsive parenting.
Health Visitors are qualified nurses or midwives with a specialist qualification in public health for children, young people and families. They work alongside families offering support and information around parenthood and early parenting, from pregnancy right through to when your child starts school. The service offers support for all parents of all children (0-5), whatever their circumstances.

Out latest Baby & Toddler Hub schedule:

BANES HV Baby & Toddler Hubs - Sept 2022

Please click here to download our 'Essential guide to feeding and caring for your baby'.

More useful links here.

Latest News

NO Baby & Toddler Hub at Paulton Hospital on 20th September

Please be aware the Baby & Toddler hub at Paulton hospital on Tuesday 20th September is cancelled. We have other hubs available in the area - Orchard Vale, MSN on Wednesdays 10.30-12.30pm or Hope House Centre, Radstock on Thursdays 9.30-11am. Sorry for any inconvenience caused. Somer Valley Health Visitors 01761 408358

NO Baby & Toddler Hub at Abbot Alphege School, Bath during school holidays

Baby & Toddler Hub at Abbott Alphege School will NOT be running on Thursday 18th August and 1st September - back on Thursday 15th September. Alternative venues are available across Bath & North East Somerset. To speak to a HV, please call us on 01225 831829. Parkside Health Visitors.
Community Hub Update
The BANES Health Visiting Service is delighted to welcome you to the Baby and Toddler drop-in Hubs from March 14th 2022.

The Hubs provide an opportunity for you to meet with a member of the Health Visiting team for advice and support.

Please bear with us as we are expecting the Hubs to be busy during the first few months and you may need to wait to be seen.

Whilst Covid restrictions have been relaxed, healthcare settings, including the Hubs, are still required to adhere to the guidance of wearing a face mask/covering; hand sanitation; and social distancing. On arrival at the Hub a member of the team will be available to greet you and run through the guidance. Please do not attend if you are showing any Covid symptoms or if you or your child are unwell.

Please remember to bring your child's red book with you.

Please also find a list of low cost BANES Baby and Toddler groups, on the Maternity Voices Partnership Padlet by clicking here
MMR
Uptake of most routine childhood vaccinations has been declining over the past 5 to 10 years. It is extremely important that all babies and children receive their routine vaccinations at the right time in order to give them the best start in life.

Diseases like smallpox and polio have been eradicated in the UK thanks to vaccines.

The MMR vaccine protects against three infections: measles, mumps and rubella. One in 10 children under the age of 5 in England haven't had one or both of their MMR vaccines which means that measles importations could lead to outbreaks.

Measles can infect around 9 out of 10 non-immune (those who are unvaccinated or have not previously been infected with the measles virus) people exposed to it and can lead to serious complications. The MMR vaccine is the safest and most effective way for parents and guardians to protect their children against measles, mumps and rubella.

Find out more here
Healthy Start Vouchers
🍏🍌🥕Have you received your letter from NHS Healthy Start? If you've been invited to apply for your new Healthy Start prepaid card, visit https://bit.ly/3dm0BIg to apply today 😊

The Institute of Health Visiting has produced some really useful advice on parenting through Coronavirus. They have also produced a guidance document regarding your baby's 6-8 week GP review during lock down.

NHS England has produced a leaflet on illness and coronavirus in newborn babies:

Take the survey here - https://www.bswmaternityvoices.org.uk/survey/

There is some useful information on this website.

More about us

We see all children (0-5 years) and their families who are residents in the Bath and North East Somerset area.

Some of these services are not available or have changed due to COVID 19. You can expect to receive support from your Health Visitor from birth through to when your child is 5 years old or enters school which includes:

An invitation to an antenatal parent course called Hello Baby! This is a free course for parents expecting a baby, which runs over 3 sessions. It is a lovely way to meet other parents and members of your health visiting team and is a really friendly and relaxed course about becoming a parent. This is currently not available.

A visit to your home while you are pregnant. This is a chance to meet your Health Visitor and discuss becoming a parent and the local support available for you. These are currently being offered virtually via video/telephone.

A new birth visit. Your Health Visitor will arrange to visit you at home before your baby is 14 days old to support you with feeding and caring for your baby and adjusting to having a new family member.

A 6-8 week visit. At 6-8 weeks your Health Visitor will arrange to see you face to face to find out how you are feeling as new parents and support you with any questions.

Next Steps Group - when your baby is 3-4 months old you will be invited to a virtual group. This is a live presentation covering topics such as home safety, oral health and introduction to solids.

Weekly baby & toddler hubs. Baby & toddler hubs are drop-in sessions which have replaced baby clinics. They offer relaxed settings for families to meet and chat with Health Visitors and other parents and Carers.

Development reviews. These are a chance to discuss the development of your child with your Health Visitor. Development reviews take place at 9-12 months and 2 - 2.5 years.

If you want to look to see how your baby is developing we have some useful websites for you to look at here.

What can I talk to my Health Visitor about?

With your Health Visitor, you are able to share thoughts, feelings and experiences about being a parent health Visitors have the professional experience to support you through any worries you may have. At the hubs, you can also chat with other parents in a relaxed play environment for your baby. The Health Visiting Team may be able to support you:

Infant feeding and introducing family foods

Understanding your baby's behaviour and how they are developing

Adjusting to becoming a parent

Family life and difficulties such as postnatal depression

Healthy choices such as lifestyle, eating or immunisations

Home safety, discussing housing concerns, domestic abuse or child abuse

We work with other professionals and practitioners to support you getting additional expert help if you need it. We can also signpost you to take full advantage of the range of resources that are available to you locally so you can gain support within your own community. We also work closely with local Children's Centre's to promote family activities which help build a strong bond with your child. Children's Centre's offer a range of services, advice and support for Parents and Carers.
How do I access this service?
By phone: You can call your Health Visiting team at any time during office hours (9am - 5pm). All teams have an answering machine where you can leave a message during times when nobody is available to take your call.

In-person: You can drop into any of the baby & toddler hubs across Bath & North East Somerset - See above.

Contact Us

If you would like any support or advice about the health and wellbeing for your child or yourself from your Health Visitor please contact your local Health Visiting Team whose details are below and also in your child's red book
Parkside Team: 01225 831829 Bath South Team : 01225 831694 Keynsham Team: 0117 9461076 Chew Valley Team: 01225 613887 Somer Valley Team: 01761 408358
Learn more about the HANDi app here - a local app providing expert advice on common childhood illnesses.

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Health Visiting - Bath and North East Somerset Community Health and Care Services

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Your Health Visiting Service is accredited under the Unicef baby-friendly initiative, which means we have achieved rigorously assessed, quality standards for providing support to all parents for responsive parenting. Health Visitors are qualified nurses or midwives with a specialist qualification in public health for children, young people and families.

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Baby Connections is a free weekly drop-in infant feeding support group.

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Bath & North East Somerset, Swindon and Wiltshire (BSW) Maternity Voices Partnership Plus

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​While we make every effort to keep these padlets up to date, we make no warranties or representations that the information will be:

As an MVP, we are not liable for any loss or damage that may come from using these padlets. We are unable to endorse the information held on third party websites, it is for information only.

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Resources - Bath North East Somerset, Swindon and Wiltshire Maternity Voices Partnership Plus

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​While we make every effort to keep these padlets up to date, we make no warranties or representations that the information will be: As an MVP, we are not liable for any loss or damage that may come from using these padlets.

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Leave Feedback - Bath North East Somerset, Swindon and Wiltshire Maternity Voices Partnership Plus

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We as your Maternity voices parternership want to hear the voices of all parents. You can find us at groups across the region and we're always keen to come somewhere new so please reach out if you would like us to come to your group / event / meet up to talk about the experiences of maternity services.

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Keeping you breastfed baby hydrated in the heat 

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Keeping you breastfed baby hydrated in the heat 

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Babies and young children can become ill during very hot weather. Their health can be seriously affected by:

Try these tips for keeping your child happy and healthy in the heat.

Sun safety

Keep your baby cool and protect them from the sun.

Babies less than 6 months old should be kept out of direct sunlight. Their skin contains too little melanin, which is the pigment that gives skin, hair and eyes their colour, and provides some protection from the sun.

Older babies should also be kept out of the sun as much as possible, particularly in the summer and between 11am and 3pm, when the sun is at its strongest. If you go out when it's hot, attach a parasol or sunshade to your baby's pushchair to keep them out of direct sunlight.

Apply a sunscreen with a sun protection factor (SPF) of at least 30 to your baby's skin. Make sure the product also protects against both UVA and UVB rays. Many brands produce sunscreen specifically for babies and young children, as these products are less likely to contain additives that might irritate the skin. Apply the suncream regularly, particularly if your child is in and out of the sea or paddling pool.

Make sure your child wears a sunhat with a wide brim or a long flap at the back to protect their head and neck from the sun.

Avoid dehydration

Like adults, babies and young children need to drink plenty of fluids to avoid becoming dehydrated.

From 0 to 6 months

Fully breastfed babies do not need any water until they've started eating solid foods. During hot weather they may want to breastfeed more than usual.

If you're bottle feeding, as well as their usual milk feeds, you can give your baby a little cooled boiled water. If your baby wakes at night, they'll probably want milk. If they have had their usual milk feeds, try cooled boiled water as well.

Remember you can ask your health visitor or another health professional for advice about any baby care issue, advice will then be tailored to meet your baby's needs.

From around 6 months

Once you have started to introduce solid foods, you should offer your baby sips of water from a cup or beaker with meals. Remember that breastmilk or infant formula should be their main drinks during the first year. In hot weather, you may need to offer some additional water outside of mealtimes.

From 12 months

Water, breast milk or whole cows' milk should be your baby's main drinks. In hot weather, you can try giving them frozen lollies made from plain water or from very diluted fruit juice to help keep them hydrated. Lollies made from diluted fruit juice should only be given at mealtimes because they can cause tooth decay.

For older children, give them plenty of fruit and salad to help keep their fluid levels up. Remember that undiluted fruit juice or smoothies should not be given to children until they are 5 years old, as these can also cause tooth decay.

Read more about drinks and cups for babies and young children.

Keeping cool

Follow these tips to help keep your children cool and safe during hot weather.

Playing in a paddling pool is a good way of keeping babies and children cool. Keep the pool in the shade during very hot weather and supervise the children carefully at all times.

Run them a cool bath before bedtime.

Keep your child's bedroom cool during the day by closing blinds or curtains. You can also use a fan to circulate the air in the room.

Keep nightwear and bedclothes to a minimum. If your baby kicks or pushes off the covers during the night, consider putting them in just a nappy with a single well-secured sheet that will not work loose and cover their face or get entangled during the night.

A nursery thermometer will help you monitor the temperature of your baby's room. Your baby will sleep most comfortably when their room is between 16C and 20C.

Further information:

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Babies and young children can become ill during very hot weather. Their health can be seriously affected by: Try these tips for keeping your child happy and healthy in the heat. Keep your baby cool and protect them from the sun. Babies less than 6 months old should be kept out of direct sunlight.

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The Perinatal Dad is a report by the Fatherhood Institute's Head of Training, Jeszemma Howl, drawing on research she undertook - thanks to a Winston Churchill Memorial Trust Fellowship - with the aim of exploring and examining the very best offer to families, that engages the father in the perinatal period and supports women to breastfeed for as they want to.
The report is designed to be a useful tool to help commissioners, managers, staff, researchers and policy makers who are invested in increasing the continuation of breastfeeding rates consider strengthening the effectiveness of the support and information given to both mothers and fathers at this golden yet vulnerable time. The report also highlights the need to engage fathers in the perinatal period, looking at the barriers and opportunities, reflecting families' wishes and creating 'Mother-focussed, Family-inclusive' services. It includes the following elements:

The Report: Exploring and examining the evidence found during the Fellowship travels, including recommendations and key questions for the UK

The Five Point Checklist, informed by this research, the survey of fathers (2019) and conversations with staff and mangers in health and family services, is designed to support and improve family well-being by helping services assess existing services, and create a mother-focused, family inclusive approach to breast feeding support.

Tips for Fathers is a short, downloadable handout to use in breastfeeding support as a conversation starter with fathers.

Survey Results from the 2019 online survey of 95 UK fathers

Tags: Breastfeeding, Fathers and breastfeeding, Infant nutrition, Maternity, New fathers, Parenting education, Perinatal, Postnatal

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The Perinatal Dad - Engaging Fathers in the Perinatal Period to Support Breastfeeding: The Fatherhood Institute

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The Perinatal Dad is a report by the Fatherhood Institute's Head of Training, Jeszemma Howl, drawing on research she undertook - thanks to a Winston Churchill Memorial Trust Fellowship - with the aim of exploring and examining the very best offer to families, that engages the father in the perinatal period and supports women to breastfeed for as they want to.

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Inverted or Flat Nipples

The size and shape of nipples and breasts vary from person to person and can change during the breastfeeding journey. It is common for nipples to gradually change shape, become more elastic and protrude more during pregnancy and while breastfeeding. When babies suck at the breast, they stretch the nipple and surrounding breast tissue into their mouth. The more elastic or stretchy the nipple, the easier it will be for your baby to latch. However, even if the nipples don't protrude more during pregnancy, you can still breastfeed. These variations often have very little to do with the baby's ability to breastfeed, because baby latches to the nipple and surrounding breast tissue.

If you have inverted or flat nipples, your baby may need more time and patience to breastfeed. A flat nipple is smooth next to the breast tissue. Inverted nipples withdraw below the surface of the nipple. If you think your nipple may be inverted, try placing your thumb and finger on opposite sides of the areola (the darker area of skin surrounding the nipple) and squeezing gently inwards. Sometimes nipples may be partly inverted, looking dimpled or folded. Severely inverted nipples retract deeply when compressed or stimulated. A nipple that stands out when stimulated is not inverted.

After your baby is born, your nipples may appear flatter than usual but babies often lick the nipple to stimulate it before latching on. Your nipples may also appear flatter if your breasts are very full or engorged.

A deep latch and comfortable position helps your baby latch and breastfeed effectively. In the beginning, the following techniques may help you initiate breastfeeding:

Immediately after birth, place your baby in skin-to-skin contact on your chest. Continue to use skin to skin during early breastfeeding to soothe your baby and to ease frustrations during breastfeeding. Ideally, the breastfeeding dyad is kept together until both are discharged.

Being with your baby helps you to recognize your infant's hunger cues.

Before breastfeeding, express several drops of milk, so the milk is immediately available when your baby latches.

You may massage your breast while breastfeeding to assist your baby in receiving milk.

To help evert the nipple:

Pull back on breast tissue so nipple will protrude more.

Breastfeed in a laidback or side-lying position especially if you have large breasts.

Breast engorgement can contribute to the nipple being less protruded. Massage the nipple and areolar area so milk will move back into the breast or will leak out, softening the areola and everting the nipple. Also try reverse nipple softening. Reverse pressure softening involves using gentle finger pressure around the base of the nipple to temporarily move some of the swelling slightly backward and upward into the breast.

Roll the nipple between the thumb and index finger and immediately afterwards touch the nipple with a moist cold cloth. Avoid making the nipple too cold because it can result in the nipple being numb, and inhibit let down.

Use nipple and breast support to help protrude the nipple. Use both hands on each side of breast to make a "sandwich", to squeeze nipple and areola. Use hands to press in on breast like the way you hold a big sandwich to put in the mouth.

Use a breast pump for several minutes to draw out the nipple. The suction from a pump will often cause the nipple to protrude more.

If you have had assistance with latch and tried the tips in this article and your nipples are still sore, consider trying a nipple shield. The nipple shield is a thin silicone devise that goes on top of your nipple and areola while breastfeeding. It looks like a brimmed hat. The nipple shield is a commercially made product. A nipple shield can be used temporarily to help establish breastfeeding or in some cases to help ensure that breastfeeding continues. A shield provides a firm stimulus at the roof of a baby's mouth where the soft and hard palate meet. This may help your baby suckle more effectively.

Commercial products that are intended to assist in drawing out inverted nipples such as breast shells or everters are best used only with the guidance of a trained lactation consultant.

If Nipple Soreness Occurs

You may experience nipple soreness for about the first two weeks of nursing while your flat or inverted nipple is gradually drawn out by baby's suckling. This discomfort is generally the result of adhesions or skin binding to underlying breast tissue. If the soreness is severe, or continues past the initial two weeks, consult your health professional.

If your nipple retracts after feedings, that skin may remain moist, leading to chapping of the skin. After feeding, pat your nipples dry and apply a moisturizer safe for breastfeeding. You may also want to wear breast shells or other devices to keep your nipple out between feedings so the skin can dry.

When Nipple Soreness is Prolonged
Rarely, sore nipples may persist for a longer period because instead of stretching, the adhesions remain tight. This can create a stress point which may lead to cracks or blisters.

If one breast is easier for your baby to grasp and he nurses well from that breast, you can continue to feed on that side. You can pump the breast with the deeply inverted nipple until the adhesions loosen and the nipple is drawn out. Your baby will get all the milk he needs from one breast if allowed unlimited and unrestricted time at the breast.

If both nipples are deeply inverted, you can pump both breasts simultaneously for 15-20 minutes 8 or more times in 24 hours. You can feed your baby with an alternative feeding device until she is able to latch on effectively and comfortably.

How long you will need to pump in order to draw out your nipples depends upon the strength of the adhesions and the degree of inversion. One pumping may be enough to completely draw out the nipple. If the nipple continues to deeply invert, you may need to continue pumping. When your nipple stays out after pumping, you can resume breastfeeding immediately.

Once your nipple can be drawn into the baby's mouth correctly and the baby can breastfeed effectively, you should be able to discontinue pumping and breastfeed without discomfort.

On rare occasions you may continue to feel some discomfort even after your nipple has been drawn out. This could be due to the correction to the nipple.

The nipple may invert again as your baby pauses during a feeding. In this case, you may need to stop breastfeeding and pump again for a few minutes before putting baby back to the breast.

As a temporary transition to exclusive breastfeeding, breast compressions or the use of a nursing supplementer might help to encourage continuous sucking and swallowing so that the nipple won't be as likely to invert during feeding.

If you do encounter challenges during your breastfeeding journey, support from a La Leche League Leader and other participants in Group meetings may help you to overcome the challenges. ( Find a Leader or meeting.)
Additional Resources
Cotterman, Jean K., Reverse Pressure Softening, http://breastfeedingmadesimple.com/wp-content/uploads/2016/02/SimplerRPSsheet2.pdf

Cotterman, Jean K., Reverse Pressure Softening, http://www.breastfeedingonline.com/rps.shtml#sthash.2MPE4KHE.T3v63FBt.dpbs

Cotterman, Jean K., Engorgement Help: Reverse Pressure Softening
... a technique to aid latching when a mother is engorged, https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/

Cotterman, Jean K. Reverse Pressure Softening, http://www.health-e-learning.com/articles/RPS_JCotterman_ver2005.htm

Genna, Catherine Watson, Supporting Sucking Skills in Breastfeeding Infants, C. Burlington, MA: Jones & Bartlett, 2012.

La Leche League Great Britain, Nursing Supplementers, https://www.laleche.org.uk/nursing-supplementers/

Mohrbacher, N. Breastfeeding Answers: A guide to helping Families, 2nd edition

( Revised February 2022)

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Inverted and Flat Nipples - La Leche League International

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Inverted or Flat Nipples The size and shape of nipples and breasts vary from person to person and can change during the breastfeeding journey. It is common for nipples to gradually change shape, become more elastic and protrude more during pregnancy and while breastfeeding.