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Find your local breastfeeding group - Kent

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Find your local breastfeeding group - Kent

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Looking for support? Find your nearest support. We’re right #BesideYou - if you’re struggling, have questions or want to meet other women breastfeeding.

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Attaching your baby at the breast step-by-step

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Attaching your baby at the breast step-by-step

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

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

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding

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Great answers to most most breastfeeding challenges

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Great answers to most most breastfeeding challenges

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Everyone faces breastfeeding challenges. From low milk supply to growth spurts, we have solutions to help get you through. Expressing There may be times when you need to express your milk including in the early … Read more → Tongue tie Babies who have a tongue-tie can find it harder to feed effectively. A tongue-tie […]

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Basic ingredients for a good milk supply

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Basic ingredients for a good milk supply

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Increasing Your Milk Supply – Breastfeeding Series

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Unicef UK Baby Friendly Initiative | Hand expression

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Breast compressions: help your baby get more milk with each suction

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Breast compressions: help your baby get more milk with each suction

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South Warwickshire University NHS Foundation Trust

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Find out about main causes of pain associated with breastfeeding

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Pain in your nipples or breasts whilst breastfeeding is most often linked to how you are holding your baby and bringing them to your breast (often referred to as positioning and attachment). Before considering any alternative reasons for experiencing pain whilst breastfeeding please use our guide to positioning and attachment to rule this out as a cause of pain. Even if there is another medical basis for the pain, getting positioning and attachment as comfortable as possible will still help.

When you first start breastfeeding, it is common to experience a strong and sometimes uncomfortable sensation for the first few seconds of your baby latching on. However, this should pass quickly, and feeding should become comfortable. If this is not the case, trying some small changes to your positioning and attachment could help make feeding more comfortable for you.

Signs that attachment is not as effective as it could be include:

If the pain is worst at the start of a feed, and continues for more than a few seconds.

If your nipple changes shape after breastfeeding - either lipstick shaped or flattened

If your baby slurps onto nipple rather than attaching with open gape

If your nipple changes colour after the breastfeed - classically a white tip to the nipple, although this may not be visible on all skin tones

If your nipple is damaged, with cracks or bleeding

If the pain is not improved after trying some of the ideas in our guide on positioning and attachment, please seek support from a breastfeeding supporter. They can observe and assess a full feed. You can also find a local support group here or contact the National Breastfeeding Helpline.

If your nipple is damaged, use moist wound healing within the wound (avoid applying cream to whole nipple) to stop a scab forming, which will deepen the wound. You can continue to breastfeed on a damaged nipple as it will still be able to heal, but it is very important to get support with positioning and attachment to prevent further damage occurring.

If a breastfeeding practitioner has helped you adjust your positioning and attachment and you still have pain or nipple damage, your baby may need to be assessed for a tongue tie or other issues that might be making breastfeeding harder.

Other causes of pain in breastfeeding:

Allergy

If your nipples are itchy (which may be triggered by warmth) or changed in colour (which may show as redness on lighter skin tones) but you do not see any change in the shape of your nipples and are not experiencing pain, the problem may be an allergy to something in contact with your nipples, such as nipple cream or breast pads. Try eliminating these to identify the cause. If disposable breast pads are causing irritation, you could try washable ones instead.

The symptoms may be relieved by a non-sedating antihistamine and hydrocortisone 1% cream applied sparingly. See our factsheet on antihistamines for more information on taking these whilst breastfeeding.

Vasospasm

If your nipple turns white at tip after breastfeeds and pain or itchiness, and redness on some skin tones, occurs immediately at end of feed when blood returns, vasospasm could be the cause.

This is due to restricted circulation from compression of the nipple by the baby squashing it between their tongue and the roof of their mouth during a feed. It can be relieved by help with attachment from a specialist breastfeeding practitioner. Vasospasm can occur in one or both breasts. It does not respond to medication which is unnecessary, but can be improved by adjusting positioning and attachment.

Raynaud's Phenomenon

If the pain is worst at the end of or after a feed and your nipples change colour rapidly after breastfeeds from white to purple then red (this might not be visible on all skin tones), you may be experiencing Raynaud's Phenomenon.

If you have a history of circulation problems or migraine and pain is triggered or made worse by cold, Raynaud's Phenomenon is more likely. Pain can be immediately after a feed but may also be delayed or can be triggered by cold even when not feeding.

You may be able to improve your symptoms by avoiding breastfeeding in cold places, covering your nipple as soon as a feed is finished and applying warmth after feeds. If this is not effective, consider asking GP to prescribe nifedipine 10mg three times a day or nifedipine LA 30mg daily. Treatment for two weeks may be sufficient or may be needed long term. You can find more detail in our Raynaud's phenomenon factsheet.

A white spot, bleb or blocked nipple pore.

If pain is worst at the end of or after a feed and you can point to a discrete spot (which may be white, yellow or pale pink) on your nipple as the origin of the pain, this is likely to be due to a white spot, also called a bleb, blocked nipple pore or milk blister. Symptoms may return periodically.

A white spot is thought to be caused by a thin bit of skin growing over a milk duct opening, and milk backing up behind it.

You can continue to feed with a white spot, and feeding may cause it to clear spontaneously. If it does not clear, the skin overgrowth can sometimes be removed by soaking the nipple in warm water and rubbing gently with a clean, moist washcloth. You can also try softening the skin with an oil such as olive oil. If this doesn't work, the skin may require removal by a healthcare professional using a sterile needle. Antibiotic cream may be required if a significant wound results. If you squeeze just behind the blister some toothpaste-like thickened milk may come out through the now opened blister.

Expressing milk

If your nipple is sore or damaged and you are using a breast pump rather than feeding directly, you may need to reduce the strength of the suction on your pump or you may be using a flange that is the wrong size. Speak to your health visitor, midwife or peer supporter to get support with expressing your milk if needed.

Strong let-down

If the pain is strongest at start of feed or just before a feed and there is a sharp intense pain in your breast(s), often described as squeezing pain, this can be due to the let down or milk ejection reflex. Pain can be worse on fuller breast.

If it is associated with leaking milk, you can reduce this by applying firm hand pressure to your breast at the time of leaking.

If your baby also makes a clicking noise during feeds or pulls away choking once the feed has started, the fast flow of milk may mean your baby is struggling to attach well. Further support from a skilled breastfeeding practitioner to improve attachment may be useful.

You may find it helpful to express a small amount of milk just before a feed if your breasts are full, to get past the powerful let-down before starting the feed, or to use a laid-back breastfeeding position, so that the milk flow is less overwhelming for your baby.

Engorgement

If your breasts are painfully hard and full, and feeding or expressing milk relieves this sensation, your breasts may be engorged. This may be worst first thing in the morning, especially if you have not fed frequently through the night. You can avoid engorgement by feeding frequently and responsively, including at night time. Consider offering your baby a feed whenever your breasts start to feel full or uncomfortable. If you are unable to feed at that time, or if your baby refuses a feed, you can express just enough milk to relieve the discomfort. Avoid expressing more milk than necessary, as this could trigger an increase in your milk supply and make the engorgement worse. Allowing your breasts to remain engorged could lead to your breasts becoming inflamed (mastitis), or a reduction in your milk supply, so it is best to avoid this whenever possible.

If you find it hard to latch your baby on when your breasts become very full, you may like to try reverse pressure softening. Reverse pressure softening is a way to soften your areola. It can help make latching and removing milk easier when your areola is very swollen and engorged by temporarily relieving firmness and swelling.

It can be particularly helpful if you have some oedema or swelling due to IV fluids or drugs given during labour and birth, especially if you had a caesarean section. Breast engorgement in the early days can be caused by your milk coming in or by a combination of fluid held in the breast tissue around the milk ducts as well as by milk within the breast.

Reverse pressure softening briefly moves mild or firmer swelling away from under your areola, slightly backward into your breast for a short period of 5-10 minutes. This allows your areola to change shape and makes latching easier as your baby is able to get more of your areola and breast tissue into their mouth.

Reverse pressure softening also causes a 'let-down' reflex, making it easier for your baby to get milk or for you to remove milk by hand expressing or expressing with a breast pump.

Reverse pressure softening should not be used if you have mastitis, plugged ducts or a breast abscess.
How to do reverse pressure softening:
The key is to make your areola very soft right around the base of the nipple. This can make it easier for your baby to get a better latch.

Press gently on the edge of your areola, inward towards your chest wall, counting slowly to 50

Once the areola has softened, you can start to feed your baby or express (by hand or using a breast pump on low to medium pressure)

If you have very swollen breasts, doing reverse pressure softening lying on your back (taking advantage of gravity) will give more relief

Soften your areola right before each feeding (or expressing) until the swelling goes away. This takes two to four days or more

Blocked ducts and Mastitis

If there is a sore, lumpy area on your breast that may also feel hot and can appear red on lighter skin tones, you may have a blocked duct or mastitis. Mastitis is an inflammation of the breast. It may be accompanied by flu-like symptoms. Continue to feed responsively and seek support from a specialist breastfeeding practitioner as soon as possible. Blocked ducts or mastitis may be triggered by feeding infrequently, allowing your breasts to become overfull or other situations that increase pressure on your breast, for example, wearing a bra that is too tight or wearing your baby in a sling for longer than usual. Adjusting the way you hold your baby and bring them to your breast when feeding ( positioning and attachment) may also help.

You can take ibuprofen 400mg as anti-inflammatory if appropriate (i.e. if you have no contra-indications such as asthma or stomach ulcer), and also paracetamol for pain or fever. Antibiotics are not usually required if self-help measures are started quickly, but you should see a doctor if your symptoms persist. You can read our factsheets on pain relief medicines and breastfeeding and our mastitis page for more detailed information.

Abscess

An abscess is a rare complication of mastitis. You might want to consider whether you have an abscess if mastitis has not resolved following frequent, effective feeding and a course of antibiotics and if the skin on your breast looks like orange peel. A milk sample should be taken to ascertain the micro-organism involved in the infection to help decide which antibiotic might be most appropriate. An ultra sound investigation may be required to diagnose an abscess. Drainage of pus by needle aspiration or surgical drainage together with appropriate antibiotic might be offered. Abscess formation is a rare complication of infectious mastitis and may involve MRSA. You may benefit from emotional support from a breastfeeding supporter alongside specialist support from medical staff.

Thrush

Signs of thrush in you

Thrush (Candida albicans) infection can affect your breast while you are breastfeeding. Symptoms of thrush are a sudden start of breast and/or nipple pain in BOTH breasts after some weeks of pain free breastfeeding - pain is severe and can last for an hour after EVERY breastfeed. It should be confirmed by a swab of your nipples.

Thrush should not be diagnosed if:

You have pain in only one breast/nipple (thrush spreads quickly from one breast to the other)

You have never had pain free breastfeeding

If your nipples are shaped oddly after breastfeeds

If your nipple is white at the tip after breastfeeds

If the pain is different at different times of the day

If your baby has a tongue tie which you are waiting to have snipped.

Thrush in the first few weeks of feeding is rare unless the mother had vaginal thrush at delivery or had deep breast thrush at the end of a previous lactation. Less than perfect positioning and attachment with consequent damage are more likely to cause the pain at this stage.

Signs of thrush in your baby

Creamy white patches in your baby's mouth, on the tongue and may be far back or in the cheeks. Patches do not rub off.

Baby's tongue/lips may have a white gloss

It should be confirmed by a swab of the baby's mouth.

If you think you have thrush:

Before treating either you or your baby you should ask the person supporting you with breastfeeding to watch a full breastfeed from the moment the baby goes to the breast to the moment he/she comes away from the breast at the end of the feed. They need to look at your nipples at the end of the feed to look for change in colour and shape

If your baby has a white tongue but you are not experiencing pain, be aware of the risk of thrush but do not treat either of you immediately. Some babies have white tongues in the first few weeks after birth or this may be associated with tongue tie where the milk is not thrown to the back of the mouth.

Diagnosis should be confirmed by nipple swabs cultured for fungal and bacterial infection.

Breastfeeding should be pain free from the point of attachment (the moment the baby goes to the breast) onwards. Pain from thrush begins after a feed. There should be no change in the shape or colour of the nipple after a feed. Even good attachment can often be improved and help to relieve symptoms of pain. Be aware of the other causes of nipple and breast pain described on this page, and exclude them first.

Self-help measures

Thrush can be passed between you and your baby - and also between you, your partner and other children

Anecdotally, some mothers find acidophilus capsules can help to restore bacteria which can keep thrush under control (available from health food stores or chemists)

It is necessary to be very careful with hygiene in order to get rid of thrush completely - be sure to wash your hands well after each nappy change

Use a separate towel for each person in the family

Anecdotally, some mothers find reducing the level of sugar and yeast in their diet helps

If a thrush infection is confirmed, to make sure that you get rid of it, both you and your baby need treatment, prescribed by a doctor. Usually, once treatment begins the pain and other symptoms will begin to improve within 2 or 3 days. It may take longer for full recovery.

If there is no improvement at all after 7 days, consult your breastfeeding helper again as the cause of the pain may not be thrush.

Treatment

Ongoing attention to positioning and attachment is important because even the best latch can slip a little sometimes.

Miconazole cream applied to your nipples after every feed - sparingly and without washing off before the next feed

Miconazole oral gel applied gently to your baby's mouth 4 times a day a small amount at a time

If symptoms persist you may need fluconazole 150-400mg as a loading dose followed by 100-200mg daily for at least ten days. This is rarely necessary if your baby is less than 6 weeks old and could cause vomiting and stomach pains.

For more information, see our detailed factsheet on thrush and our factsheet on miconazole oral gel and the breastfed baby with oral thrush.

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Pain: if breastfeeding hurts - The Breastfeeding Network

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Pain in your nipples or breasts whilst breastfeeding is most often linked to how you are holding your baby and bringing them to your breast (often referred to as positioning and attachment). Before considering any alternative reasons for experiencing pain whilst breastfeeding please use our guide to positioning and attachment to rule this out as [...]

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You may be eligible to borrow a breast pump to help you increase your breastmilk supply. Pumps are available at The Family Hubs. You can find more information here.

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This video has no sound, but it's great in showing good positioning and how to offer baby the breast

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How to latch a baby using the exaggerated latch technique.

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Great way to allow baby and mum to adjust to each other

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To help baby get enough breast tissue in their mouth

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Uploaded by Breastfeeding Center of Ann Arbor on 2015-04-02.

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Useful for babies with smaller mouths or mothers with larger breasts

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How to express breastmilk to maintain or increase

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How to tell if feeding is going well poster

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What your baby's poo looks like when they are feeding well

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What your baby's poo looks like when they are feeding well

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Session 3 INFANT FEEDING AND BONDING 2023

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Simple ways to help alleviate and prevent engorgement

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Breast Engorgement - Breastfeeding Series

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Reverse pressure softening to relief engorgement

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Reverse pressure softening to relief engorgement

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How To Relieve Engorgement - RPS By Mother

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Breastfeeding Fixers and Leilanis Wellness Center

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Learn how do I stop having sore painful breastfeeding sessions

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Arabic, Bahasa Indonesia, Chinese, French, German, Gujarati, Hindi, Italian, Japanese, Malay, Nepali, Rohyngia, Russian, Slovak, Somali, Spanish, Swahili, Tamil, Turkish, Ukrainian, Urdu, Vietnamese, and others

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Breastfeeding Videos - Global Health Media Project

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© 2023 Global Health Media Project | a 501(c)(3) nonprofit

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Breast and bottle feeding info sheets in other languages

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Breast and bottle feeding info sheets in other languages

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Arabic, Bengali, Hindi, Lithuanian, Mandarin, Polish, Romanian, Slovak, Turkish, Ukrainian, Urdu

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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DVH's guide to Expressing breastmilk in pregnancy and after birth

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DVH's guide to Expressing breastmilk in pregnancy and after birth

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Our guide, whether you need to express for medical reasons, or to get breastfeeding off to a good start.

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This information was updated in December 2022. A PDF version is available here.

"I was surprised by how suddenly I felt ill. We went to a wedding and I only missed one feed.
Within a couple of hours I felt fluey and achey. My GP was reluctant to prescribe antibiotics,
saying they were often not needed if I kept feeding. I also took ibuprofen tablets which helped
me cope. I was surprised how well the self-help worked and that I never needed a prescription.
I felt very miserable and depressed when I had the symptoms, wondering whether
breastfeeding was worth all this - but once I felt better I remembered how good it feels."

Mastitis means inflammation of the breast.

The first sign of mastitis is a swollen usually painful area on the breast. On darker skin tones
there might be a darkening of the skin and on lighter skin tones this might be visible as a red
area on the breast. However, it is important to note that there could be no visible change in
skin colour at all. The inflammation and swelling is not always a sign of infection (WHO, 2000).
Harmful bacteria are not always present: antibiotics may not be needed if self-help measures
are started promptly. Very rarely mastitis can develop into a more serious condition which
needs urgent hospital admission and IV antibiotics (RCOG, 2012).

You may get mastitis when milk leaks into breast tissue from a blocked duct. The body reacts
in the same way as it does to an infection - by increasing blood supply. This produces the
inflammation.
NB You may not have all of the above signs during mastitis.
Prevention of Mastitis

A localised area in the breast which is painful to the touch, often in the outer upper
area. Some mums might notice a change of colour or a red area on their breast.

A lumpy breast which feels hot to touch.

The whole breast aches and may appear swollen and skin may be reddened or darker,
depending on skin tone.

Flu like symptoms - aching, increased temperature, shivering, feeling tearful and tired
(Jahanfar et al., 2013). This feeling can sometimes start very suddenly and get worse very quickly.

Signs that the Baby is Well Attached

Try to avoid suddenly going longer between feeds. If you are intending to reduce breastfeeding, cutting down gradually reduces the risk of mastitis.

Make sure your breasts don't become overfull

Avoid pressure on your breast from clothing and fingers

Start self-help measures at the first sign of any lumpy or swollen areas on your breast

Factors which make mastitis more likely:

Difficulty with attaching your baby to the breast - this may mean that the milk is not

being removed effectively and milk may leak into the breast tissue

Pressure from tight fitting clothing, particularly your bra, or a finger pressing into the

breast during feeds

Engorgement or a blocked duct

Sudden changes in how often the baby is feeding, leaving the breasts feeling full

Injuries, such as bumps or knocks from toddlers

Self-Help Measures
Mastitis starts with poor milk drainage. If your baby is not effectively attached to your breast,
or has difficulty feeding, it may be hard for the baby to remove the milk and some parts of
your breast may not be drained during a feed. Improving the way your baby is attached at
the breast will reduce the chance of you getting mastitis again. If in doubt, contact your
midwife, health visitor or breastfeeding peer supporter for help with attaching your baby for
feeding. You can also contact the National Breastfeeding Helpline.

Your baby's chin is firmly touching your breast.

Your baby's mouth is wide open

Your baby has a large mouthful of breast.

If you can see the darker skin around your nipple, you should see more dark skin above your baby's top lip than below your baby's bottom lip.

It doesn't hurt you when your baby feeds (although the first few sucks may feel strong).

No change in shape or colour of the nipple after feeds e.g. it should not be lipstick shaped or have a pressure line across the nipple

Your baby's cheeks stay rounded during sucking.

Your baby rhythmically takes sucks and swallows (it is normal for your baby to pause from time to time).

Your baby finishes the feed and comes off the breast on his or her own.

Your baby produces 6 or more heavy wet nappies every 24 hours (from 7 days old)

Your baby produces at least two yellow poos at least the size of a £2 coin every 24 hours (from 7-28 days old). See UNICEF's breastfeeding checklist for more details.

If your mastitis comes back after you have taken a full course of antibiotics, or is unusually severe, it is good practice to send a sample of milk for bacteria tests. This will help the GP chose the correct antibiotic for your symptoms (Jahanfar et al., 2013). For public health reasons doctors try to avoid antibiotics that are not essential or are unlikely to be effective. It is important that you finish the whole course of antibiotics to make sure that you recover fully and to help prevent the mastitis coming back with resistant bacteria (NICE NG15).
When should I contact my GP or health visitor? If you do not begin to feel better after 24 hours despite using self-help measures, or especially if you start to feel worse, you should speak to your GP or health visitor. You may need to take antibiotics.
These will also help to clear blocked ducts and engorgement. Most cases of mastitis can be improved or resolved with self-help measures.
When should I seek help urgently?

Keep on breastfeeding - you may feel ill, in pain, tearful or discouraged but continuing to breastfeed will help you to get better, and your breastmilk is still the best food for your baby

Feed your baby frequently and responsively (whenever your baby seems like they want to feed), and/or pump to your normal routine (Mitchell et al., 2022; Douglas 2022)

Don't attempt to "empty the breast" by prolonging feeds or expressing extra milk between feeds. You may see this suggested in some places, but the current research suggests you should aim to meet your baby's needs, but avoid increasing your supply beyond that as it could make the inflammation worse. (Mitchell et al., 2022; Douglas 2022)

Try to rest as much as you can, as this will help you recover

Check that your baby is effectively positioned and attached to your breast - if in doubt seek help from your midwife, health visitor or breastfeeding supporter, as even a minor tweak can make a difference.

Try feeding with your baby in different positions.

If necessary, soften your breast, by expressing a little milk or running warm water over it, so that the baby finds it easier to feed well.

Some mothers find warm compresses are soothing, and warmth on the nipple can aid let-down. However, take care using these as compresses that are too hot or used frequently could increase swelling and inflammation. Cool compresses may ease symptoms in between feeds. (Mitchell et al., 2022; Douglas 2022)

Avoid any firm pressure or massage to the breast, or use of items such as an electric toothbrush to massage lumps or sore areas. This could cause tissue damage and increase inflammation (Mitchell et al., 2022; Douglas 2022). Any pressure you apply to your breast should be no firmer than stroking a cat.

Check for clothing or anything else which is pressing into your breast. This includes a bra - some women find it helpful to go without.

Medical Treatment for Mastitis
If you feel these symptoms beginning again, start self-help measures right away.

You should contact your GP if the area becomes round and swollen or, if you can see redness or a change of colour on your skin and the pattern of the colour change/redness changes. Redness may be less visible on darker skin tones. Mastitis can develop into an abscess (a painful collection of pus). There is more information about this here: https://www.nhs.uk/conditions/breast-abscess/.
The World Health Organisation (WHO) recommend Flucloxacillin 500 milligrams four times a day as first line treatment with erythromycin 250-500 milligrams four times a day or cefalexin 250-500 milligrams four times a day if the mother is penicillin allergic. Other options have been suggested by Jahanfar et al., (2013).
If you feel seriously unwell, dizzy, confused, develop nausea, vomiting or diarrhoea or slurred speech along with the symptoms of mastitis you need to seek urgent medical attention. These can be signs that mastitis is developing into sepsis. If severe, this is a medical emergency which needs urgent hospital admission and IV antibiotics. (NHS Choices: Sepsis, RCOG, 2012:6.1)

This information comes from the Drugs in Breastmilk Service.
References

Ibuprofen reduces the inflammation, relieves pain and reduces temperature. Take 400mg three times a day after food. Ibuprofen should not be taken by women who have asthma, stomach ulcers or are allergic to aspirin. The levels of ibuprofen which pass to the baby are small. Ibuprofen is safe to take whilst breastfeeding. See https://www.breastfeedingnetwork.org.uk/analgesics/ for more information.

Paracetamol relieves pain and reduces temperature but has no anti-inflammatory action. Take two 500mg tablets four times a day.

Aspirin should not be taken by breastfeeding mothers.

Antibiotics may be needed if no improvement is seen with self-help measures. Mostantibiotics can be safely taken whilst breastfeeding.

It is essential that breastfeeding is not interrupted during mastitis.

Note: Antibiotics can make the baby produce loose, runny motions and become irritable, colicky and restless. This lasts for a short time and will get better when you finish the antibiotics.

Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD005458. DOI:10.1002/14651858.CD005458.pub3 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005458.pub3/abstract (accessed 19 November 2020)

Crepinsek MA, Crowe L, Michener K, Smart NA. Interventions for preventing mastitis after childbirth. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD007239. DOI:10.1002/14651858.CD007239.pub3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007239.pub3/full (December 2022)

Hale T., Medications and Mothers' Milk 2014 (16th Ed),

NICE guideline [NG194] Published: 20 April 2021 https://www.nice.org.uk/guidance/ng194/chapter/Recommendations (accessed December 2022)

World Health Organization. 2000, Mastitis: causes and management, WHO: Geneva http://apps.who.int/iris/bitstream/10665/66230/1/WHO_FCH_CAH_00.13_eng.pdf?ua=1.(accessed December 2022)

NICE guidelines [NG15] Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use www.nice.org.uk/guidance/ng15 (accessed December 2022)

NHS Choices: Sepsis www.nhs.uk/conditions/Bloodpoisoning/Pages/Introduction.aspx (accessed December 2022)

Royal College of Obstetricians and Gynaecologists (RCOG) (2012) Green-top Guideline No. 64b. Bacterial Sepsis following Pregnancy: 6.1. www.rcog.org.uk/globalassets/documents/guidelines/gtg_64b.pdf (accessed December 2022)

Unicef: https://www.unicef.org.uk/babyfriendly/wpcontent/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf (Accessed December 2022)

Mitchell, K. B., Johnson, H. M., Rodríguez, J. M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Cash, K. W., Berens, P., Miller, B., & Academy of Breastfeeding Medicine (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022 Breastfeeding medicine : the official journal of the Academy of Breastfeeding
Medicine, 17(5), 360-376. https://doi.org/10.1089/bfm.2022.29207.kbm
Please note this information is not yet available in print. The previous print version has now been withdrawn and should no longer be used. A new print version is planned for 2023.
Douglas P. (2022). Re-thinking benign inflammation of the lactating breast: Classification,
prevention, and management. Women's health (London, England), 18, 17455057221091349.
https://doi.org/10.1177/17455057221091349

Original leaflet compiled by Wendy Jones MBE Pharmacist and Phyll Buchanan
Breastfeeding Network Supporter and Tutor, in 2015. With thanks to Magda Sachs who
developed earlier versions

This version revised 22 December 2022.

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Information on mastitis and breastfeeding, updated December 2022 and provided by the Breastfeeding Network

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Breast massage to help very full breasts

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Breast massage to help very full breasts

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The Basics of Breast Massage and Hand Expression

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"The Basics of Breast massage and Hand Expression" video by Maya Bolman, IBCLC and Ann Witt, MD, FABM, IBCLC

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Breasts that are over full or engorged with milk can feel uncomfortably full, swollen, hot, lumpy and painful. If the milk is not removed by your baby or by hand expression or a breast pump, engorged breasts can lead to mastitis (painful breast inflammation). It's normal to have some engorgement when your milk first comes in but it can also happen unexpectedly at other times. This article describes ways to help with engorgement.

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Reasons for engorgement

When milk first comes in

Many mothers will have some engorgement in the early days or weeks after birth. As the milk "comes in", extra blood and tissue fluids will also be present in the breasts to help with milk production which may add to the feeling of fullness and congestion, especially if your baby is not feeding well. Engorgement in the breasts may be worsened if you had an intravenous (IV) drip during the birth and could take some time to clear. Since breast tissue can extend into the armpit, some mothers may notice they have some engorgement/a lump in their armpit as their milk comes in (see below).

Engorged breasts after the first few weeks

Although engorgement is very common in the first few weeks of your baby's life, it can happen at any time, even during weaning. Possible causes include;

your baby sleeping longer than expected (a missed feed)

feeding a baby on a schedule instead of on demand

poor position and attachment affecting how baby breastfeeds

using a poorly fitted nipple shield

weaning too quickly

tight clothing or a tight bra or bag strap or even a finger pressing on the breast during a breastfeed

having too much breast milk (oversupply)

pumping more milk than your baby needs

breast trauma including vigorous massage or previous breast surgery

Anything that interferes with breastfeeding on demand can increase a mother's risk of engorgement. If painfully engorged breasts are neglected, this puts a mother at risk of breast inflammation which includes blocked ducts or mastitis. If you regularly have a lot more milk than your baby needs it may be helpful to discuss breastfeeding management with an IBCLC lactation consultant and see our article on oversupply of breast milk.

Relieving engorgement

Whatever the reason for your overly full breasts, and you may not always be sure why, softening engorged breasts with our tips below can help you feel comfortable again.

#1 Breastfeed often

Frequent breastfeeds will help relieve engorgement. Breastfeeding every couple of hours or at least 12 times in 24 hours gives your baby lots of opportunity to remove the milk that is building up. Conversely, going long periods without removing any milk can increase the discomfort. If your baby can breastfeed well, this will usually be more effective than using a breast pump. Other helpful strategies include holding your baby in as much skin-to-skin contact in the early weeks as possible, and letting baby suckle for comfort as well as nutrition.

#2 Check positioning and attachment

The way a baby attaches to the breast (latch) and the way they are held to breastfeed (positioning) can help or hinder milk removal. When a baby has a big mouthful of breast tissue as well as the nipple in their mouth (a deep latch) it helps them remove milk efficiently and comfortably from all areas of the breast. Pamela Douglas, lactation consultant and doctor writes that certain pressures on the breast can cause inflammation, these might include pressing a finger into the breast through a feed, a deep vigorous breast massage or a poor latch. If breastfeeding is not comfortable ask a breastfeeding specialist to check your positioning and attachment and see Latching Tips, Breastfeeding Positions for Newborns and Why Does Breastfeeding Hurt?

Some mothers find trying different breastfeeding positions to usual can help to relieve areas of the breast that are unexpectedly engorged.
If the engorgement has changed the shape of the breast and nipple making it difficult for your baby to latch, see #3 below.

#3 Help baby to latch

If your breasts are extremely full and engorged they may feel very tight and sometimes your nipples may seem to flatten out and almost disappear. If this happens it can be difficult for a baby to latch on. When engorgement is preventing a baby from latching on, it can help to move some of the milk away from directly behind the nipple either by hand expressing or a technique known as reverse pressure softening.

Hand expression

Gently hand expressing a little milk before feeding can help soften the breast around the nipple so that baby can latch. See Hand Expressing Breast Milk for videos and further information

Reverse pressure softening

If your breasts are so full and engorged that your baby can't latch on, a technique called reverse pressure softening can help. Reverse pressure softening can bring out a nipple flattened by severe engorgement by temporarily redistributing the extra fluid away from the nipple area back into the breast. Jean Cotterman explains more about the technique in the article below:

#4 Hand express or pump to comfort if needed

If your baby can't breastfeed, isn't feeding well yet, or can't keep up with the volume of milk, you will need to remove enough milk to stay comfortable by other means than breastfeeding.

Hand expression. Frequent hand expressing is a good way to remove excess breast milk in the early days after birth, see Hand Expressing Breast Milk for videos and further information. A pump may attract more swelling to the area before your milk is in properly by pulling more blood or tissue fluid towards the nipple. If you do use a pump at this time, keep the suction at its lowest setting and make sure the pump flange is the correct size.

Pumping. Pumping with a good quality breast pump can help to keep the breasts comfortable if they are engorged after your milk has "come-in". If you still feel painfully engorged after a breastfeed, a breast pump can remove enough milk until you feel comfortable again. Do not over pump as this could make the engorgement worse and check the pump flange is a good fit and the pump is working correctly.

When milk won't flow. See Engorgement Relief When Milk Won't Flow for more ideas if you are unable to get milk flowing.

Keep baby well fed. If your baby is not latching, any expressed milk can be given to your baby to keep him well fed until you can find some good breastfeeding help.

Expressing just enough milk to stay comfortable won't make the engorgement worse. It is important to remove enough milk to soften the breasts, this will protect your milk supply in the days to follow and will help avoid blocked ducts or mastitis. Expressing a little milk may also make it easier for your baby to latch deeply (see #3 above).

#5 Breast movement

Natural breast movement may help to prevent breast inflammation but bra wearing and inactive lifestyles can restrict this normal movement (Douglas, Vol 18: 1-20 2022). Solutions to this could include:

Go without a bra as much as possible (Douglas, Vol 18: 1-29 2022). For a more in depth discussion about the pros and cons of bra wearing during lactation see Nursing Bras FAQ.

Breast gymnastics. Doctor and lactation consultant Pamela Douglas says that gentle upper limb stretches or moving the breasts in gentle circular movements with the hand or palm laid over the breast may help to prevent breast inflammation. Lactation consultant Maya Bolman calls this type of movement breast gymnastics for engorgement and she demonstrates her method in a Facebook video.

Breast massage. Breast massage is sometimes mentioned as a way to prepare the breasts for breastfeeding or hand expressing to release milk from all areas of the breast. One study found that a light breast massage combined with hand expression helped to drain engorged breasts. However several authors are concerned that any kind of massage, unless professionally done, could worsen or cause breast inflammation (Douglas, Vol 18: 1-20 2022; Mitchell et al, 2022) since the ducts in the breast can be easily damaged.

If a mother is considering trying massage, it is important to do so gently so as not to bruise the breast tissue or increase inflammation (Morgensen et al, 2020). Massage techniques and therapies favoured by some lactation consultants include:

Lymphatic massage

The lymphatic system is a network of little tubes in the body that drains waste products from the cells in lymphatic fluid. Lymphatic massage is thought to help engorgement by helping to drain lymphatic fluid from the breast towards the lymph nodes in the armpits (axilla). Lactation consultant and breast surgeon Katrina Mitchell has developed a handout showing how to do this type of massage using very light touch circular movements similar to that used to stroke a cat. Douglas cautions that even gentle pressure could contribute to breast inflammation (Douglas, Vol 18: 1-20 2022).

Therapeutic Breast Massage

A technique popularised by Maya Bolman of Breastfeeding Medicine of Northeast Ohio called Therapeutic Breast Massage in Lactation (TBML) involves alternating breast massage with hand expression (see video). As above, this type of gentle massage is also said to help drain lymph/tissue fluid from the breast via the lymphatic system in the armpits.

Circular massage

Global health Media summarises six steps to take to relieve engorgement in the following video and describes a massage involving making circular hand movements at 01:40.

Other physical therapies

Mogensen et al discuss a number of other physical therapies that may help relieve engorgement including therapeutic ultrasound and cupping therapy.

Ultrasound is used by medical professionals to reduce pain and increase circulation and some mothers have found it helped improve the symptoms of engorgement. However Douglas states that there is no evidence supporting the use of therapeutic ultrasound in lactation (Douglas, Vol 18: 1-20 2022) and cites a systematic review that found no positive effect.

Cupping therapy is a traditional Chinese medicine technique performed by a physical therapist that uses suction cups to create a vacuum to improve lymphatic fluid drainage (Mogensen et al, 2019).

#6 Cold therapy and cabbage

Cold compresses (e.g. frozen peas or crushed ice in a damp cloth) placed against any sore areas of the breast for up to 20 minutes at a time, or chilled cabbage leaves in your bra can provide pain relief between feeds (Mitchell et al, 2022). The Womanly Art of Breastfeeding, a popular breastfeeding book, explains more about cabbage and cold therapy:

Use green cabbage (red can stain), which may help reduce swelling [Stop use if a skin rash or other signs of allergy appear]. Remove the outer leaves in case there are any pesticides on them. Tear off some inner leaves, tear out the hard central stem, crumple the leaves gently in your hand, and apply them to your breast (not over your nipple, so the taste isn't left behind to bother your baby). Doesn't that feel wonderful? You can wear them inside a bra or under a tight shirt to keep them in place. replace the leaves with fresh ones whenever you want to.

Inflammation responds best to cold. Wrap a bag of frozen peas (or carrots) in a small towel and use it as a cold compress, alternating about twenty minutes on and twenty minutes off, as much as you like. Refreeze as needed. If you feel like a hot shower, let the water play over your back, not your chest. Same for a heating pad.

#7 Pain relief

If engorgement is very painful, appropriate pain relief or anti-inflammatory medication can help with the pain and accompanying inflammation (Mitchell et al, 2022). Pain relief may also help the let-down reflex however Pamela Douglas cautions that over reliance on medication could interfere with the body's own systems to calm the inflammatory response (Douglas, Vol 18: 1-20 2022).

Warmth before a feed

Some authors recommend placing a warm compress or warm towels on the breast just before pumping (or breastfeeding) as a little warmth can help with the let-down reflex and also provide some pain relief (Lawrence, 2016). It's important not to go too warm as too much heat could bring more blood to the area and make the engorgement worse.

#8 Gravity

The Womanly Art of Breastfeeding suggests lying flat on your back to rest allows gravity to help drain fluids away from the breasts. Trying reverse pressure softening while lying down can be helpful to release engorgement behind the nipple.

Lumps in the armpit

Breast tissue extends into the armpit (called the Tail of Spence) and this breast tissue could become engorged in the form of a lump in the armpit. Engorgement here will respond to the same measures used for engorgement in other areas of the breast such as frequent breastfeeds and cold therapy. Occasionally the lump in the armpit will be swollen glandular tissue that does not drain into the rest of the breast; cold compresses for pain relief and a little time will help this to resolve naturally. Note: extra milk making glandular tissue can also be found in other parts of the body on the 'milk line'. Persistent lumps should always be checked with a health professional.

Summary

Breasts that are over full with milk are known as engorged. Engorgement in the early weeks may also include blood and tissue fluid in the breast as well as breast milk. If engorgement is left unchecked it could develop into painful mastitis (inflammation of the breast). Breastfeeding frequently, hand expressing or pumping to stay comfortable, and gentle breast movement can all help to reduce breast engorgement and avoid mastitis. If you are having trouble expressing any milk see Engorgement Relief When Milk Won't Flow. If you do develop symptoms of mastitis and are not starting to feel better after 12-24 hours of treatment, contact your health professional for advice. See Mastitis Symptoms and Treatment for further information.

* Extract reproduced by permission from Pinter & Martin

Footnotes & References

1. The Womanly Art of Breastfeeding*, LLLI, Pinter and Martin 2010, p387

2. Breastfeeding A Guide for the Medical Profession, Lawrence and Lawrence, 2016

3. The Womanly Art of Breastfeeding, LLLI, Pinter and Martin 2010, p387

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Breasts that are over full or engorged with milk can feel uncomfortably full, swollen, hot, lumpy and painful. If the milk is not removed by your baby or by hand expression or a breast pump, engorged breasts can lead to mastitis (painful breast inflammation).

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How to bottle feed if you need to top up breastfeeds

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How to bottle feed if you need to top up breastfeeds

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South Warwickshire University NHS Foundation Trust

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La Leche League - Click on the 'languages' tab at the top of the home page 

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La Leche League - Click on the 'languages' tab at the top of the home page 

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Afrikaans, Arabic, Bemba, British sign language, Croatian, simplified Chinese, Dutch, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Japanese, Polish, Portuguese, Russian. Spanish, Swahili, Turkish, Ukrainian and Welsh,

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Homepage - La Leche League International

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During the early days with my third baby, I felt a special connection in my heart and soul with my LLL colleagues and with all the mothers whose breastfeeding wisdom has been passed along.

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Follow this expressing plan when you need to increase or protect your milk supply 

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Follow this expressing plan when you need to increase or protect your milk supply 

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Mum's body can nourish more than one baby. Learn how.

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Hello I'm Anna Le Grange, Infant Feeding Coordinator at Darent Valley Hospital.

Alongside our team of infant feeding supporters, midwives and maternity support workers, I am here to support you to feed your baby - whatever your goals.

We can answer your questions in pregnancy and will give you support to feed your baby after the birth, and until you are transferred over to the health visiting team once your baby is 10-28 days old.

You can contact us at anytime via email: dgn-tr.infantfeedingteam@nhs.net

If you are an inpatient on our postnatal wards you can ask to see the infant feeding team Monday to Friday 8-4.

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We direct families to this Padlet board to share resources on breastfeeding and bottle feeding.

We also share where you can get further support with feeding your baby.

Take a look at the section heading and scroll down to find what you need. You can click on a link to access the resource.

Due to internet some restrictions, sometimes videos about breastfeeding are blocked. This can happen on our hospital network. You could try using a different internet connection such as your own mobile service provider to access the breastfeeding resources.

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You can use this board to share resources with the families that you are supporting with feeding.

Due to internet some restrictions, videos about breastfeeding are sometimes blocked. This can happen on our hospital network. You could try using a different internet connection such as the family's own mobile service provider to access the breastfeeding resources.

If you are supporting families where English is not their first language - click on the 3 dots at the top right of the Padlet and click language and then the language spoken. Please also see the section on information in other languages

If you see any errors or have a resource you would like to add, please email me on dgn-tr.infantfeedingteam@nhs.net

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Colostrum Collection in Pregnancy: When to start and how to do it

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Breast compressions - Help Baby get more milk each feed

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Breast compressions - Help Baby get more milk each feed

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Breast Compressions

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Breast compressions to help baby get more milk. Can be used while pumping

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Breast compressions to help baby get more milk. Can be used while pumping

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4 day old feeding with breast compressions

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Contact Health Visiting Find a healthy child clinic Feeding your baby can feel quite overwhelming at first – whether you are breastfeeding, bottle-feeding or a combination of both. Breastfeeding There is a lot of evidence to show how beneficial it is to breastfeed your baby, for both you and them. Deciding how to feed your […]

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Infant Feeding clinics :: Greenwich 0 to 4

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See below for a list of venues and times of clinics. All our clinics are closed on bank holidays.

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Baby Umbrella run groups and provide specialist support in West Kent.

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Get free specialist support with breastfeeding and early parenting in West Kent. Face to face and zoom appointments available now.

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Free breastfeeding support across the county

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LLLGB offers free breastfeeding support to anyone who is, or wants to, feed their child their milk or donor milk. You can get support: join one of the face-to-face meetings across Kent (find…

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From coffee groups to meet-ups for new dads, our local groups and activities can help you build up a supportive social network.

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You may be eligible to borrow a breast pump to help you increase your breastmilk supply. Pumps are available at The Family Hubs. You can find more information here.

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Intuitive Bottle Feeding for Breastfed Babies

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Sometimes a baby may need supplemental breast milk, donor milk or formula in addition to direct breastfeeding. There are many possible reasons for low milk supply and if a baby isn't gaining weight or not gaining enough weight more milk may be needed either temporarily or longer term.

Traditionally supplemental milk has been fed by spoon, syringe, cup-feeding or bottle. But there is another option; supplementing at the breast using a fine feeding tube or supply line. This article looks at how at-breast supplementers work, when to use one, and the pros and cons of supplementing at the breast.

How supplementing at the breast works

Supplementing at the breast requires a container of milk connected to a length of flexible feeding tube. The tube and container may be referred to as an at-breast supplementer, nursing supplementer, lactation aid or a supply line. The free end of the feeding tube is held or taped to run alongside mother's nipple so that the baby takes the tube and nipple together in his mouth when he latches. Alternatively the tube can be inserted in the corner of baby's mouth part way through a breastfeed after the breast has been drained. While the baby feeds at the breast, he also receives supplemental milk via the small tube. As long as baby breastfeeds with a good attachment (latch) and suction, with his lips sealed around the breast, milk will flow up the tube with much the same principle as sucking up a straw.

It is a good idea to stay in contact with your IBCLC lactation consultant or health professionals while supplementing at the breast.

Types of supplemental feeding system

There are currently only a few commercial systems, each using different designs and each with their own advantages and disadvantages. It is also possible to make a homemade version, see Homemade Supplemental Nursing System or use a supply line as a finger-feeder. The commercial systems include:

The Medela Supplemental Nursing System (SNS) uses a hard sided container for the supplement which hangs from your neck. Two tubes deliver the supplement from the container one to each breast. The feeding tubes can be taped to the breast with surgical tape or a sticking plaster. Slits in the cap make it possible to pinch shut one or both tubes to prevent milk flowing.

The Lact-Aid uses a soft disposable bag to hold the supplement which also has a neck strap to hang around the neck like the SNS and a clamp to stop milk flow if needed. This system only has one feeding tube which can be moved between breasts. There are ongoing costs to buy new sterile bags to hold the supplement.

Haakaa's Supplemental Feeding Combo is a new supplementer on the market currently available in New Zealand. Squeezing the container of milk controls the flow of supplement.

Controlling the rate of flow of milk

It is important to get the flow of supplement at the right speed-too fast and your baby may get too much milk to cope with. If the flow is too slow, an underweight baby may not have the stamina to keep feeding long enough or at all. Ideally with the supplementer in place, your baby will be having one swallow of milk after every suck or after every two to three sucks for most of the feed. The rate of flow of milk from the supplementer varies with:

The diameter of the tube-the wider the tube, the faster the flow of milk. The Medela SNS provides several sizes of tube to help you find the right flow rate for your baby.

The position of the container in relation to the baby-the flow is slower if the bottle is positioned below the baby and faster if the container is positioned above baby's head.

Lactation consultants Diana West and Diane Wiessinger discuss how to adjust flow rate in the Medela SNS in the following excerpt:

A baby who is seriously underweight or who has a weak suck might be fed with the larger tube, while a baby who is gaining well might use the smaller tube. Most mothers start with the medium size tubing. If milk flow is not sufficient with any one tube size, even when the bottle is as high as it can go, another option is to tape both tubes of a given size together on one breast, or to tape one tube to the side of the bottle, facing upwards and unclamp it, allowing air to enter the reservoir more quickly. Milk exits only when air enters, so the faster air flows into the reservoir, the faster milk can be removed from it.

Cleaning a supplemental nursing system

The small feeding tubes are very difficult to clean and will need replacing regularly. Follow manufacturer's cleaning recommendations very carefully for commercial feeding systems and for information about cleaning homemade versions see Homemade Supplemental Nursing System on this website.

When to use an at-breast supplementer

Supplementing at the breast can be used short term or long term and helps avoid a baby losing interest in breastfeeding prematurely in favour of a bottle. Potential uses include:

Supplementing a baby if there is a reason for low milk supply including insufficient glandular tissue.

Keeping an adopted baby fed at the breast to give mother and baby the experience of breastfeeding.

Keeping a baby interested in latching when encouraging a baby back to the breast after a period of bottle feeding or while a mother is relactating.

The tube can be used as part of a finger feeding exercise for suck training.

Pros and cons of supplementing at the breast

Advantages

Baby can get the additional milk he needs at the breast without introducing other feeding methods or techniques.

Baby gets more practice at breastfeeding well. If baby doesn't feed correctly, milk won't come up the tube.

Mother is able to enjoy the full experience of breastfeeding.

Helps avoid bottle preference or nipple confusion. There is less chance that a baby will start to prefer a bottle instead of the breast or stop breastfeeding correctly due to nipple confusion with a bottle teat.

Increases the flow of milk. Supplementing at the breast eliminates a baby's frustration with slow flow when milk supply is very low.

The breasts are stimulated to make more breast milk by additional suckling.

Baby associates feeling full with the breast and this reinforces his desire to breastfeed.

Disadvantages

It can be difficult and fiddly to use until you get the hang of it, particularly when away from home. An IBCLC lactation consultant can help you get started.

It is difficult to clean the little tubes thoroughly.

The system can leak, particularly homemade versions.

Doesn't work for all babies. Some babies can't seem to suck milk up the tube or are not able to get very much. A very underweight baby may still fall asleep at the breast without having fed well. Older babies may be aware of the tube and keep pulling it out.

Only works with good positioning. It isn't a suitable method if a baby isn't latching or is latching so badly as to make his mother's nipples painfully sore.

May affect baby's attachment at breast (latch). Some babies are aware of the tube and it can disturb their latch, tweaking it into different positions may help. Some babies try to suck on the tube like a straw rather than breastfeed correctly.

The tube could cause gagging if it reaches too far into the baby's mouth. Taping the tube to the breast with medical tape so that it aligns with the end of the nipple or behind the nipple can avoid this (see "Taping the tube" below)

Reconstituted powdered formula may clog the tubing.

What supplements can be used with a supply line?

This will depend on your individual circumstances. Supplements could be a mother's own expressed breast milk, donor milk or formula supplements if needed. Some mothers prefer to use ready made formula as powdered formula may clog the small tubes if it is not well blended. If using powdered formula, use the World Health Organization (WHO) guidelines for safe preparation or the UK's National Health Service guidelines Making up Infant Formula, NHS, 2019. And when using expressed breast milk see our storage guidelines. If your baby is underweight, your health professional or IBCLC lactation consultant can guide you with suggested volumes of milk to use in the supplementer. Generally a baby will take as much as they need at any given feeding and this could vary widely depending how much breast milk he is also getting direct from the breast. Staying in contact with your health care team for regular weights will ensure baby is getting enough and growing appropriately.

Taping the tube

The manufacturer's instructions for one of the commercial systems discuss taping the tube beyond the end of the nipple. However, this might cause a baby to gag or use the tube as a straw instead of breastfeeding correctly. The tube need not extend beyond the mother's nipple to work. Surgical sticky tape can be used horizontally across the tube or vertically along its length to prevent the tube from slipping. Some mothers use sticking plasters to guide and hold the tubes by slipping the tube under the non sticky portion of the plaster at each feed.

Video of inserting a lactation aid with Dr. Jack Newman

This clip from Dr Jack Newman's website shows a homemade supplementer being inserted during a breastfeed. Note the baby in this clip looks like he is having to turn his head slightly to reach the breast as he is on his back. Rotating a baby's body towards his mother to ensure his head and neck are all in a straight line is usually preferable to make swallowing easier for baby. See Homemade Supplemental Nursing System for further information on how to make your own at-breast supplementer.

Video using a commercial supplementation system by Natasha Batsford

Get help with breastfeeding

There are lots of ideas to increase your baby's intake of breast milk even if you can't produce a full supply. See How to Make More Breast Milk and contact your IBCLC lactation consultant for more support. Your lactation consultant can help you find the best latch and position for you and your baby, check your baby's tongue function, and help with breastfeeding management.

Summary

An at-breast supplementer or supply line allows a baby to take top ups of supplemental milk directly at the breast while breastfeeding. Supplementing this way has various pros and cons but is another option to consider alongside bottles or cup feeding. A very underweight baby who has not been gaining weight can still tend to fall asleep at the breast without having swallowed plenty of milk, even with a supplemental tube in place. It is important to monitor weight gains and dirty nappies to establish whether your baby is getting enough milk. Stay in contact with your IBCLC lactation consultant or health professionals while supplementing at the breast using a lactation aid.

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This article looks at how at-breast supplementers work, when to use one, and the pros and cons of supplementing at the breast.

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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.