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What is a nursing strike?

If a baby who has been quite happily breastfeeding suddenly starts to refuse the breast it could be a "nursing strike". Sometimes this can be mistaken for the baby wanting to stop breastfeeding, but a baby who is ready to wean usually does so over a period of time. In nursing strikes the baby seems unwilling to feed even though he appears really unhappy about it.

Something happens which makes your baby not want to feed and it can take time and patience to help them return to the breast. Nursing strikes are nearly always a temporary reaction to something which has happened and the cause may never be discovered. ¹

What might cause a nursing strike?

The term nursing strike relates to an older baby who suddenly refuses to feed. If you have a newborn baby who is not feeding, please refer to our article about When my baby won't breastfeed for more information.
Sometimes the cause is physical:

The baby might have a stuffy nose or earache which is making feeding uncomfortable.

They might have a sore throat or mouth. Some mothers have found a little injury such as a cut in their baby's mouth or an ulcer which hadn't been noticed.

Hand, foot and mouth disease or chickenpox can cause a nursing strike as it is so uncomfortable to feed.

They could have sore gums from teething, a thrush infection or even a urinary tract infection.

They may be uncomfortable from a vaccination.

They might be frustrated at a low milk supply or a change in milk taste due to something the mother has ingested. An oversupply of milk could also sometimes scare a baby who finds the flow overwhelming.

Sometimes the cause is emotional:

A common cause of a sudden nursing strike is the baby being startled in some way while nursing, perhaps by a loud noise or by a mother involuntarily exclaiming when the baby bites.

A mother may have been feeling stressed because of moving house, having visitors, travelling or dealing with a family crisis and put off nursing and the baby senses her distraction.

A mother has changed her deodorant, soap, body lotion or perfume and so smells "different" to her baby.

A new job may have meant a change in nursing habits or the baby being left with another carer for longer periods of time. Attempts to regulate nursing or offering too many bottles or dummies could also contribute to a baby refusing to breastfeed.

What can help end a nursing strike?

If illness or injury might be the cause, then consulting a doctor about medication could be useful.

Some babies will nurse, sometimes reluctantly, at night. Trying to nurse the baby in their sleep or when they are sleepy can work: it keeps them fed and helps with your milk supply.

Trying to force your baby to feed won't work and a baby will often get upset if a mother tries. Although it's hard, being relaxed and offering cuddles and skin-to-skin contact helps keep you feeling close.

Sing or rock the baby with your shirt open so perhaps they will relax and instinctively latch on.

Sitting in a quiet room with dimmed lights and no distractions may help.

Try taking a bath together.

If you can get help around the house and with other children it means you can spend more time just relaxing with the baby.

Try nursing somewhere different, while walking around, using a baby sling, sitting in the car, outside or at a friend's house. You can also try a completely different position such as facing you or vertical. Some mothers have tried facing away from a room so that the baby can see what is happening while nursing.

Rocking, dancing or doing the "baby bounce" (starting small but getting bouncier and bouncier) while holding him in a nursing position might help. Some babies love this, others don't.

Stimulate your let-down and get your milk flowing before offering the breast so the baby gets an immediate reward. You can also offer the baby something else to suck before offering to nurse so he is in "sucking" mode!

If the baby continues to get upset when offered the breast it is sometimes necessary to stop offering for a day or two and let things settle down. You can then make it clear that your breast is available without forcing the issue. See the section below on milk supply for suggestions on preventing a drop in your milk production.

If a baby has a sore mouth, some mothers have found offering breastmilk ice lollies before a feed can help to numb the mouth and make nursing more comfortable. Expressed breastmilk can also be frozen in cubes and offered in a clean cloth/muslin to suck on. This can be useful for a teething baby. Other mothers have offered a child analgesic as appropriate before trying to nurse.

Sometimes these ideas will need to be repeated for a few days before things get back to normal.

Here are a couple of unusual ideas to try

One solution that has worked for some mothers is to sit on an office chair, holding the baby in your lap but not at your breast. Ask someone to spin the chair around; not too fast but until you feel a little dizzy, and then offer the breast. It seems that being a little disorientated stimulates a natural instinct to go to the breast.

Something which has also worked is for the mother to pretend to nurse a doll or cuddly toy, causing the baby to want his comfort back from the intruder!

What about my milk supply during a strike?

It's natural to want to give the baby lots of other food and drink while they aren't nursing. As as long as they are healthy, continue to offer their usual food and water but don't rush to replace all their nursing needs with extra food immediately. Pumping or hand expressing will maintain your milk supply and help prevent you from getting uncomfortably full, which might lead to plugged ducts or mastitis.

If the nursing strike continues for more than a day you can offer expressed milk in a cup, eye-dropper, feeding syringe or spoon. It is best to avoid bottles as they can cause nipple confusion.

Nursing strikes are distressing for mother and baby

It can be really upsetting and frightening to have a baby who has suddenly lost their main food source, their biggest comfort and a lovely way to fall asleep. You want to comfort your baby but they turn away. It can help to remember that your baby isn't rejecting you. They don't understand why breastfeeding is uncomfortable, they just think it is causing discomfort and they are scared to try it again, even if the original problem is sorted out.

Almost all nursing strikes are temporary and end happily, although not necessarily quickly. Some mothers have reported nursing strikes that lasted almost three weeks, but more often the baby goes back to breastfeeding in a few days.

Even if your baby doesn't immediately return to the breast you can continue to offer for as long as you want to. If it really does turn out to be the end of breastfeeding, allow yourself to be sad and grieve for its sudden ending. Breastfeeding ideally continues until both the mother and baby are ready to stop, but sometimes the baby makes the decision for you both in spite of a mother's efforts. (For more on how it feels after your baby weans, you may find this article helpful: After weaning - what next?)

Note: If you have a newborn baby who is refusing to feed this is not a nursing strike.
See these posts for help or get support from an LLL Leader:

My Baby Won't Breastfeed
Sleepy Baby: Why and What To Do
Jaundice
Beginning Breastfeeding
Is My Baby Getting Enough Milk?

Written by Anna Burbidge for LLLGB, 2017

1 The Womanly Art of Breastfeeding 8 th Edition, pages 407-409.

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What is a nursing strike? If a baby who has been quite happily breastfeeding suddenly starts to refuse the breast it could be a "nursing strike". Sometimes this can be mistaken for the baby wanting to stop breastfeeding, but a baby who is ready to wean usually does so over a period of time.

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Your body has created and grown your baby.    Now how your body continues to grow your baby after they are born

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Your body has created and grown your baby.    Now how your body continues to grow your baby after they are born

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There is a vast selection of bottles and teats available online or in the High Street. Many of them claim to be closer

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There is no need to buy these in anticipation 

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- These are NOT to be used for the prevention of nipple damage

Their miss use can lead to:-

Continued nipple pain

Nipple tissue damage

Blocked ducts

Mastitis

As with any breastfeeding aid they are not required by all and if used, appropriate use is important

https://breastfeeding.support/treatments-sore-nipples/

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There is a lot of confusion and poor breastfeeding advice arising from the idea that there are two sorts of breast milk-namely foremilk (watery, low calorie) and hindmilk (high fat, high calorie). And, depending where you live, the confusion may go one step further, you may hear about three kinds of milk; watery soup, dinner and pudding.

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All breast milk is good

As a result of not understanding that all breast milk is good, and not really understanding how breastfeeding works, mothers are being told to stay on one breast per feed or feed from one breast for random blocks of time to "get to the hindmilk". After all, the watery soup is no more than water and without that fatty pudding a baby can't gain weight, right? Wrong. Even if that was right, why stop short of offering the "three course meal" from the second breast? Especially if a baby is having trouble gaining weight.

This article

This article looks at how babies grow, how breastfeeding works, the facts about foremilk and hindmilk, and how staying on one breast to get to the hindmilk can sabotage a breast milk supply.

How babies grow

Babies grow and gain weight from drinking lots of breast milk. All breast milk is good, it is a nutritious and complete diet and babies need plenty of it. As a rough guide babies need about 800ml or 27 fluid ounces per day in the first six months. Whether it is foremilk or hindmilk or in-the-middle-upside-down-milk, babies need lots of milk to grow.

Quantity not quality

It is the volume of breast milk that is the important factor determining a baby's weight gain not the fat content in a particular feed. Kelly Bonyata explains:

The research tells us that baby's milk intake (the volume of milk - not the amount of fat in that milk) is the only thing that has been correlated with infant growth in exclusively breastfed babies. [...] average fat content of human milk is highly variable, but has not proven to be significant when calculating baby's total energy intake or weight gain.

Whether it is foremilk or hindmilk or in-the-middle-upside-down-milk, babies need lots of milk to grow. Click To Tweet

How breastfeeding works

Your breasts make milk on demand; so that the faster your baby drinks the available milk, the faster your breasts will make more milk to replace it, indefinitely. Breasts gauge demand by their degree of fullness:

Whenever a breast is full, milk production slows down

Whenever a breast is emptied regularly, milk production increases

Storage capacity

The ideal way to make plenty of breast milk in the volumes your baby needs, is to feed your baby as often as he wants-letting him finish the first breast before offering the second side. Only your baby knows when one side is empty and whether he needs one breast or two, because breasts vary in how much milk they can hold (storage capacity). Storage capacity is explained more fully in One Breast or Two per Feed:

Breasts vary in their breast milk storage capacities. Where one mother's baby might only want one breast per feed and not be hungry for two hours, another may need both breasts per feed and be hungry again in an hour. Let your baby decide how many breasts he wants at a particular feed by looking for his feeding cues and offering him plenty of opportunities to breastfeed.

Ignoring your baby's cues and keeping to one breast to reach the hindmilk i.e. keeping your baby on one breast after he has emptied it, means the opposite breast gets little drainage, and slows down milk production. It's like trying to build a milk supply by only pumping from one breast instead of pumping from both breasts.

If you have a low storage capacity then keeping to one breast is potentially denying your baby half his milk or more. Your baby may need the "hindmilk" from both breasts.

Increasing milk supply

If your baby falls asleep after less than ten or twenty minutes into a feed, breast compressions (gently compressing and releasing the breast during a feed) can get him to start sucking again by simulating another let-down of milk. By offering the other breast when the first is finished, and repeating breast compressions if needed, your baby will get the correct balance of foremilk and hindmilk automatically. Using both breasts when needed (and sometimes three or four!) will drive up and maintain your supply.

But what about foremilk and hindmilk?

Foremilk and hindmilk are the names given to subtle differences between breast milk at the start and at the end of a breastfeed.

Foremilk describes the breast milk at the start of a breastfeed, it has a lower fat content, but has plenty of lactose the principal sugar in breast milk, not to mention all the other great ingredients in breast milk. Lactose is important for developing the brain and central nervous system, and provides 40% of a baby's energy needs. Lactose helps with calcium and iron absorption and, along with other oligosaccharides (short chain carbohydrates) promotes the growth of friendly bacteria such as Lactobacillus bifidus to fight pathogens. As the breastfeed progresses, the fat content of "foremilk" steadily increases.

Hindmilk is the name coined for the breast milk towards the end of a feed as the breast empties. There is less of it but it has a higher fat content and all the other nutritious ingredients found in milk.

All milk is good

There aren't two distinct types of breast milk with one being inferior to the other, it is a continuum of subtle changes. Hindmilk is released with every milk ejection (let-down). By the time feeding finishes on the first breast, the first milk from the second breast will contain more fat compared to the start of the feed on the first breast. The more frequently you breastfeed, and the emptier the breasts become; the higher the fat concentration in all the breast milk.

Quantity not quality

Remember, weight gain depends on the quantity of milk not just the fat content in the last few drops. Kelly Bonyata's analogy with a hot water tap is useful. When you turn on the tap (start feeding) the water starts cold (low fat milk) but as it continues to run (as the feed progresses) the water gets warmer and warmer (higher fat). If you turn the tap off and on again quite soon, the water will still be warm (high fat milk will still be present at the start of the next feed). And you don't need to run your tap for 30 minutes or an hour to get to the warmer water (if you do, call an engineer!)

What is foremilk hindmilk imbalance?

If a mother has lots of milk, more than her baby can comfortably handle, her supply will usually adjust downwards over time to meet her baby's actual needs. In the mean time some babies may get an excess of lactose rich foremilk. This is sometimes referred to as foremilk hindmilk imbalance. Babies may also get foremilk hindmilk imbalance if a mother has a robust supply and continually takes her baby off the breast before he has finished feeding i.e. switches sides too soon.

Temporary lactose intolerance

In these situations the baby can find it difficult to digest all the abundant lactose in the plentiful foremilk causing temporary lactose intolerance or lactose overload. They may be fussy and uncomfortable with copious green, frothy and foamy nappies. The sheer volume of milk and high sugar content often means babies gain weight very well with foremilk hindmilk imbalance-even though they aren't getting their "pudding". However occasionally some babies may not gain enough weight in this situation. Advice to stay on one breast per feed or for a block of time can be very helpful with true foremilk hindmilk imbalance to ensure babies get a good proportion of higher fat milk. See Lactose Intolerance in Babies for further information and consult your breastfeeding specialist.

Confusion about green nappies

Health visitors who are already hooked on the idea of staying on one breast to get to the hindmilk may think this is an absolute certainty if you mention your baby has lots of green nappies. However the frequent scant green nappy of a baby not gaining weight is NOT the same as the copious frothy green nappy of a baby with lactose overload. Staying on one breast is not the answer for a baby with green "starvation stools". See your IBCLC lactation consultant for further information if you are not sure what your baby's nappies mean or whether block feeding is a good idea for your baby.

I kept to one breast per feed and my baby gained weight just fine!

Keeping to one breast may work perfectly if your storage capacity suits this regime. But be guided by your baby and his weight chart, not by any pre-set rules or clock-watching instructions to reach that elusive hindmilk at the bottom of the barrel.

My baby isn't gaining weight

When a baby isn't gaining weight they most likely need more milk, not more time on an already empty breast which will further reduce a mother's supply. An extra 7-8 ml of high fat milk from the same breast is no substitute for the extra 70-80 ml of fore-hind-and-in-the-middle-milk they might need from the other breast. Check with your IBCLC lactation consultant for the reasons for low weight gain for your baby and see Baby Not Gaining Weight. For increasing milk supply see How to Make More Breast Milk.

Supplements are sometimes needed

If you have been following the advice to "stay on one breast to get to the hindmilk" for quite some time, your milk supply may be quite low. If your baby has not been gaining weight properly, or has been losing weight, he won't be able to wait while you build your supply. He may need supplements ( donor milk or formula) to build back his body weight so that he is strong enough to drive your milk supply all by himself.

Summary

Confusion about how breastfeeding works is causing some health professionals to unwittingly sabotage breastfeeding by recommending staying on one breast to get to the hindmilk: either as a general rule or as specific advice when a baby is not gaining weight. It is not helpful to think of breast milk as two or three different kinds of milk. All breast milk is good and babies need lots of it to grow. Breasts have different storage capacities and what works for one mother and baby may not work for another. Contact your breastfeeding specialist for tailor made recommendations for your unique situation. And forget about foremilk and hindmilk.

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There is a lot of confusion and poor breastfeeding advice arising from the idea that there are two sorts of breast milk-namely foremilk (watery, low calorie) and hindmilk (high fat, high calorie). And, depending where you live, the confusion may go one step further, you may hear about three kinds of milk; watery soup, dinner and pudding.

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Sliced Bread - Baby Sleep Products - BBC Sounds

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Can any nests or docks, gadgets or blinds, really help babies sleep better?

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Stopping the milk coming in or stopping breastfeeding 

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Stopping the milk coming in or stopping breastfeeding 

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5.4K views · 11 reactions | How to stop the milk supply ‘coming in’ #formulafeeding #infantfeeding #pregnant #pregnancy #breastfeeding | The Eco Midwife

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How to stop the milk supply ‘coming in’ #formulafeeding #infantfeeding #pregnant #pregnancy #breastfeeding

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Olivia Hinge on Instagram: "How to do lymphatic massage to reduce the swelling in your breast tissue that can stop your milk flowing out freely. For use when you're engorged/have mastitis/blocked duct

Step away from heavy massage and heat

#mastitis #blockedducts #soreboob #milkbleb #pluggedducts #ibclc #breastfeedingproblems #breastfeeding #lactationconsultant #breastfeedingmom"

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703 likes, 56 comments - olivia_lactation_consultant on May 25, 2022: "How to do lymphatic massage to reduce the swelling in your breast tissue that can stop your milk flowing out freely. For use when you're engorged/have mastitis/blocked duct

Step away from heavy massage and heat

#mastitis #blockedducts #soreboob #milkbleb #pluggedducts #ibclc #breastfeedingproblems #breastfeeding #lactationconsultant #breastfeedingmom". 

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View this post on Instagram

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The starting point for knowing feeding is going ok

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Research has shown babies both weight can be elicited but the maternal IV fluids in labour.

(As a record take a picture of the numbers on the scales)

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Everyone is different but wearable pumps have not been found to be the most efficient 

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Everyone is different but wearable pumps have not been found to be the most efficient 

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two photos

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DIY Supplemental nursing system | My Site

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Kaya Thorpe IBCLC (2022) - revised December 2025 by Lucy Lowe IBCLC

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Why are Babies So Gassy? How much is normal and how much is a problem? | Carol Smyth IBCLC & CBT

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Sometimes there is just a straight up mis-interpretation of a baby behaviour. Newborn babies can really only do 2 core trunk movements - they can scrunch themselves inwards (flexing) or they can straighten /arch (extend), and they will do these movements for lots of reasons - to move position, to communicate they want to move, to say they want to swap sides, they want to feed, they want a nappy change, and on and on it goes. Several times I’ve seen a baby pulling knees up to start a breast crawl from the position they are in (they will then cry if they don’t get to the breast), which was misinterpreted as wind.

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Vikki Kidd - Workshop Undertaken 25/10/2025

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Vikki Kidd - Workshop Undertaken 25/10/2025

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BIC_Badge_Flange Fitting for Clinical Practice (1)

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Setting yourself up with the coffect flange size

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Setting yourself up with the coffect flange size

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Expressing Breastmilk - Patient Information Video

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This video was produced in collaboration with University Hospital Southampton as part of a project funded by NHSE South West. The project focuses on equity of access to appropriate equipment for expressing maternal breastmilk.

This video is designed to help breastfeeding parents to express breastmilk. The topics covered include:

The importance of correctly fitted equipment.
How to measure your nipple for flange sizing.
How to tell if you have the correct or incorrect fit. 
Variations in sizing depending on type or brand of breast pump.
How to prepare for expressing breastmilk.
How to assemble and use a breast pump.
Troubleshooting common issues in expressing breastmilk.

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Weaning from feeding with nipple shields 

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Weaning from feeding with nipple shields 

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Nipple shields can be a useful gadget to help a baby breastfeed in some situations. But what if a mother is ready to stop using them but her baby isn't? While simply removing the nipple shields might work for some babies, other babies refuse to close their mouths properly ( latch) on a naked breast and get very upset if they can't feel the shield that they are used to. This article shares tips and ideas for weaning from a nipple shield and is a companion article to Nipple Shields Good or Bad? and How to Get Baby Back to Breast.

Top tips

Ensure your baby is not too hungry when he practices breastfeeding without nipple shields so he is calm.

Avoid your baby becoming too frustrated or upset. If a baby is getting very upset with the idea of latching without the shield, continue the feed as normal with the shield in place and try again at another feed or on a different day. It is important that breastfeeding doesn't become a source of conflict and stress.

Try to stay relaxed. Babies are very in tune with their mothers and if mum feels anxious about latching, baby may also feel anxious. Help your baby stay calm with eye contact, smiling at him, and talking to him.

A note on flat or inverted nipples

If the reason you have been using nipple shields is due to having flat or inverted nipples, it can help to evert your nipples and shape the breast before your baby latches without the shield. Everting your nipples-coaxing out an inverted nipple or making a soft, flat nipple erect-helps your baby feel the nipple on his palate to stimulate the suckling reflex. And shaping the breast or flattening it slightly-just as you would flatten a big sandwich full of salad before you take a bite-helps your baby get a big mouthful of breast and nipple (a good latch). Pumping just before latching can be useful to bring out the nipple with the bonus that milk will be flowing ready to reward your baby if he latches. See more tips in Breastfeeding With Inverted Nipples and Flat Nipples and see Latching Tips for more information about getting a good latch and shaping the breast to help with this.

Ideas for weaning from a nipple shield

#1 Try breastfeeding without the shield (it may work!)

Some babies will be able to make the change from shield to naked breast without too much difficulty. Try our step by step guide.

Step by step

Evert your nipples if you have soft, flattish nipples by rolling your nipples between your fingers, by holding a cold cloth against them or using a breast pump for a few minutes.

Get your milk flowing prior to latching so your baby can get an instant reward of milk (use a breast pump or hand express to trigger the let-down).

Shape the breast as needed with your fingers to help your baby get a bigger mouthful of breast tissue. See Latching Tips for more information.

Try to relax. Babies can pick up on any tension so try to relax your shoulders, smile, hum a tune or even stand and sway gently from side to side for the latch.

Bring your baby to the breast just as you would with the nipple shield in place. Some mothers find the cross cradle hold can give more control for the latch-one hand supports baby's back and shoulders and one hand shapes the breast if needed. But use any position that feels comfortable, see Breastfeeding Positions for Newborns.

Wait for the moment baby opens his mouth wide then bring him quickly and confidently towards the breast. If he hesitates at the moment he feels skin, try rocking him gently and singing or talking to distract him. Maintaining eye contact, smiling and praising him may also help.

Using breast compressions will keep the milk flowing so your baby gets the idea that milk can come from skin as well as silicone. See What is Breast Compression? for more information about this technique.

Repeat. Once you have had one successful latch for part or a whole feed you can build on this by repeating the steps each time you breastfeed.

If your baby cries and refuses to latch, feed as usual with the nipple shield and try one of the other steps below at the next feed or the next day.

#2 Start the feed with the shield as normal... then remove it

A variation of #1 is to start a breastfeed with the shield in place, then remove it part way through the feed.

Step by step

Start breastfeeding with the nipple shield in place.

Once milk is flowing well, and your baby has had a little breast milk to take the edge off his appetite, break your baby's latch from the breast by slipping a finger between his gums.

Remove the shield and quickly bring baby back to the breast. Shape the breast if needed to help your baby get a bigger mouthful (see Latching Tips).

Some swaying and gentle humming or singing may distract your baby enough that they do not notice that the shield has gone. Try to keep your own body relaxed rather than tense so your baby also stays relaxed.

Use breast compressions if needed to keep milk flowing at a faster pace.

If your baby refuses to latch back on finish the feed with the shield and try again another time or try one of the other steps below.

#3 Try skin-to-skin time

If simply offering your baby a breast to latch instead of a nipple shield, or slipping off the shield mid-feed doesn't go well, help your baby associate the naked breast as a safe and comforting place to be without pressure to latch. Familiarise your baby with the feeling of skin by holding your baby in skin-to-skin contact between your breasts or in a laid back position where your baby is on his tummy, lying on your tummy. See our article Why Skin-to-Skin? for an explanation and videos of how reclining breastfeeding positions and skin-to-skin contact (take off those scratch mittens!) are more likely to help a baby's latching instincts. Given the right opportunity your baby may latch on his own.

Step by step

Relax together skin-to-skin or lightly dressed, or try taking a warm bath together with low lighting.

Don't worry too much if baby doesn't latch, the goal is for him to feel happy, safe and loved while he explores the smell, taste and feel of your skin.

A fairly full breast will reward baby if he latches but ideally your baby will not be too hungry during skin-to-skin time to avoid him getting frustrated.

A little finger feeding prior to latching can help some babies-the skin of the finger is closer to the feeling of a breast than silicone. And finger feeding promotes the same tongue function needed for breastfeeding. See our article on finger feeding if this is something you are interested in learning more about.

If baby does attempt to latch, shape the breast to help them as needed, smile and praise them gently.

If your baby gets hungry but will not latch, feed him as usual with the shield in place to avoid him getting upset with the breast.

#4 Try latching when your baby is sleepy or in light sleep

Many babies will breastfeed in light sleep so this can be a good time to try a feed without the nipple shield because they will be less aware of the different sensation in their mouth.

Step by step

Pick a moment when your baby is in light sleep and cradle him in a breastfeeding hold with his cheek in contact with the breast.

When he opens his mouth to search for the breast, bring him in close and try the breast shaping, swaying, humming techniques described in #1 and #2 above if needed.

If your baby latches, breast compressions can keep milk flowing.

Alternatively start the feed with the shield and when baby becomes sleepy, slip off the shield and see if he will latch again to the naked breast. Avoid waiting too long or your baby may drift into a deep sleep and may not latch again, with or without a shield.

If your baby wakes fully and refuses to latch, pop the shield back on, and try removing it part way through a feed (#3 ) or continue the feed as usual this time.

#5 Try different positions

Sometimes trying a different breastfeeding position to the usual one can help to break the expectation of the silicone nipple and your baby might be more open to try something new. He might think it is a game or a new toy instead of a feed. For example with an older baby:

For a slightly older baby, using new positions in a playful way may help turn breastfeeding into more of a casual fun thing, rather than an activity that creates tension and anxiety. Trying different positions and places for latching on-in the bath, the garden, kitchen, while walking about, in a dark room, even dangling a breast over him when he is on the floor (while you both giggle)-may all help make it more of a fun thing to do.

Try to keep this playful and pick a time when baby is not going to be overly hungry.

#6 Try different shapes of shield

Shields come in different shapes and sizes. Some are shaped so that your baby's nose has contact with your breast. Others are butterfly shaped allowing even more skin contact above and below the nipple. More skin contact below the breast will allow your baby to taste your skin and get used to the new sensation on his tongue. Trying a different shape may help some babies move towards weaning from a nipple shield-if the style suits you as a nipple protector.

#7 Stop trying for a while

If your baby gets frustrated with your attempts to get rid of the nipple shield, calm him back down and resume the feed with the nipple shield for that feeding. If he seems to be getting fussy at every feed because he is anticipating interruptions, it may be helpful to stop trying for a couple of days or a week and resume pleasant skin-to-skin time instead (#3).

Let your baby decide

Each day your baby gets older and more skilled and many mothers have found their babies leave the shield behind when the time is right for them. Many babies have suddenly stopped using them at two, four or six months of age or older. And some mothers have just carried on using the nipple shields. Nipple shields are not the end of the world if your baby is able to transfer milk and is gaining weight well. If your baby is not gaining weight well or your milk supply is low, an IBCLC lactation consultant can help you increase your milk supply and see How to Make More Milk.

# 8 Find support

Finding support from other mothers at a breastfeeding support group such as La Leche League meetings can be very helpful. Experienced breastfeeding mothers may have their own tips that worked for them and it will be reassuring to hear their success stories. Older babies may even benefit from watching other babies latch on without shields. It may also be useful to see an experienced breastfeeding specialist such as an IBCLC lactation consultant for one-to-one help and support.

What not to do

Don't force baby to the breast

Don't let your baby get constantly frustrated and upset at each feed or they might begin to associate feeling unsafe with breastfeeding. If your baby is getting upset at the breast even with nipple shields in place it is time to take a step back or take a break. See the section "Baby crying, arching and pulling away?" in How to Get Baby Back to the Breast.

Don't cut away the shield

Some mothers may have heard friends or family suggest gradually cutting away the shield to make it smaller and smaller so your baby gradually gets used to less shield and more breast. Nipple shield manufacturers do not recommend this at it could leave sharp edges to damage your baby's mouth or loose fragments could be a choking hazard. See #6 for information about different shaped shields that allow more skin contact.

When baby latches but breastfeeding hurts

Depending on the reason you started using nipple shields in the first place, there may still be an underlying issue with your baby's latch. If your baby starts latching to the naked breast but you find breastfeeding is painful, check out Why Does Breastfeeding Hurt? and check in with your IBCLC lactation consultant. Your lactation consultant will be able to make suggestions to improve latch, positioning and tongue function, the most common causes of painful feeding.

Summary

There are several tips to help with weaning from a nipple shield. Some babies will move on from them quicker than others. If milk transfer and weight gain are good, but weaning from a nipple shield is taking longer than expected, remember you're still breastfeeding even if you would prefer it to be without the shield. For advantages and disadvantages of nipple shields see Nipple Shields Good or Bad?

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Weaning From a Nipple Shield - Breastfeeding Support

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Nipple shields can be a useful gadget to help a baby breastfeed in some situations. But what if a mother is ready to stop using them but her baby isn't? While simply removing the nipple shields might work for some babies, other babies refuse to close their mouths properly ( latch) on a naked breast and get very upset if they can't feel the shield that they are used to.

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Baby's behaviour and developmental changes at 4 months

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Baby's behaviour and developmental changes at 4 months

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What to do when your baby won't take a bottle | Rachel O'Brien, IBCLC

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Bottle refusal is incredibly hard for breastfeeding parents. Learn exactly what to do when your breastfed baby won't take a bottle.

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FAQ about using infant formuls

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Questions about infant milk safety Are powdered infant milks sterile? Powdered infant milks are not sterile and they may contain harmful bacteria. However, if milks are made up appropriately for infants, they should be safe. Salmonellaand Cronobacter sakazakii(previously known as Enterobacter sakazakii)are the organisms of greatest concern in infant formula and a range of Cronobacterspecies ...

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When pumping the flange fit is important for both the users comfort and effectiveness of collecting the milk.

Be aware of a few things:-

Recent research has identified that often the wrong size has been used

Each breast could require a different sized flange.

With continued pumping the size may well need to change.

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BALIME Flange Inserts 10PCS 13/15/17/19/21mm for 24mm Flange/Shields of All Breast Pump, Nipple Measurement Card, Compatible with Medela Elvie Momcozy Spectra Jheppbay Bellababy

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This blog explores the myth that lip ties impact feeding and explains how a lip tie is normal anatomy. It examines the research on the role of the upper lip in feeding and what advice to seek if you are concerned.

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Bottle-fed babies swallow millions of microplastics a day, study finds

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Exposure is far higher than previously thought and also affects plastic food containers

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Article

Published:

Dunzhu Li 1,2 na1,

Yunhong Shi 2 na1,

Luming Yang 1,2,

Liwen Xiao orcid.org/0000-0003-3621-9568 2,3,

Daniel K. Kehoe 1,

Yurii K. Gun'ko 4,5,

John J. Boland orcid.org/0000-0002-3229-8038 1,4 &

...

Jing Jing Wang orcid.org/0000-0001-5721-7989 1

Show authors
Nature Food 1, 746-754 (2020) Cite this article

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Abstract

Polypropylene-based products are commonly used for food preparation and storage, but their capacity to release microplastics is poorly understood. We investigated the potential exposure of infants to microplastics from consuming formula prepared in polypropylene (PP) infant feeding bottles (IFBs). Here, we show that PP IFBs release microplastics with values as high as 16,200,000 particles per litre. Scenario studies showed that PP IFB sterilization and exposure to high-temperature water significantly increase microplastic release. A 21-d test of PP IFBs showed periodic fluctuations in microplastic release. To estimate the potential global exposure to infants up to 12 months old, we surveyed 48 regions, finding values ranging from 14,600-4,550,000 particles per capita per day, depending on the region. We demonstrate that infant exposure to microplastics is higher than was previously recognized due to the prevalence of PP-based products used in formula preparation and highlight an urgent need to assess whether exposure to microplastics at these levels poses a risk to infant health.

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Data availability

All data analysed in this study are contained within the Supplementary Information. The raw data that support the findings of this study are available from the corresponding author upon request to J.J.W. or from the Figshare repository at https://figshare.com/account/home#/projects/88406. Source data are provided with this paper.

Code availability

The mathematical algorithm used for MP exposure assessment has been included in the Methods. The sales data mining software Jungle Scout is available at https://www.junglescout.com/.

References

1. Microplastics in Drinking-Water (World Health Organization, 2019).

2. Tripathi, D. Practical Guide to Polypropylene (Rapra Technology, 2002).

3. Efimova, I., Bagaeva, M., Bagaev, A., Kileso, A. & Chubarenko, I. P. Secondary microplastics generation in the sea swash zone with coarse bottom sediments: laboratory experiments. Front. Mar. Sci. 5, 313 (2018).

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4. Klein, S., Dimzon, I. K., Eubeler, J. & Knepper, T. P. in Freshwater Microplastics-Emerging Environmental Contaminants? 51-67 (Springer, 2018).

5. How to Prepare Formula for Bottle-Feeding at Home (World Health Organization, 2007).

6. Simpson, R. J. & Selke, S. E. in Emerging Technologies in Plastics Recycling (ed. Andrews, G. D.) Ch. 18, 232-240 (ACS Publications, 1992).

7. Sturm, M. T., Kluczka, S., Wilde, A. & Schuhen, K. Determination of particles produced during boiling in differenz plastic and glass kettles via comparative dynamic image analysis using FlowCam ®. Analytik NEWS (14 February 2019).

8. Safe Preparation, Storage and Handling of Powdered Infant Formula: Guidelines (World Health Organization, 2007).

9. Guidance for Health Professionals on Safe Preparation, Storage and Handling of Powdered Infant Formula (Food Standards Agency & Department of Health, 2005).

10. Angulo, F. J., Cahill, S. M., Wachsmuth, I. K., de Lourdes Costarrica, M. & Embarek, P. K. B. Powdered infant formula as a source of Salmonella infection in infants. Clin. Infect. Dis. 46, 268-273 (2008).

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11. National Health Service, UK. Infant Feeding Survey-UK, 2010 (NHS Digital, 2012).

12. Breastfeeding and Infant Feeding Practices, Infant Feeding Practices Study II (Centers for Disease Control and Prevention, 2014).

13. Gao, X. et al. Effects of developmental exposure to TiO ₂ nanoparticles on synaptic plasticity in hippocampal dentate gyrus area: an in vivo study in anesthetized rats. Biol. Trace Elem. Res. 143, 1616-1628 (2011).

14. Zhang, C. et al. Induction of size-dependent breakdown of blood-milk barrier in lactating mice by TiO ₂ nanoparticles. PLoS ONE 10, e0122591 (2015).

Download references

Acknowledgements

This work was supported by Enterprise Ireland (grant number CF20180870), Science Foundation Ireland (grants numbers 12/RC/2278, 16/IA/4462 and 16/RC/3889), the School of Engineering Scholarship at Trinity College Dublin, and the China Scholarship Council (201506210089 and 201608300005). We also thank Keyence for help. The presentation of the material in this publication does not imply the expression of any opinion whatsoever on the part of Trinity College Dublin about specific companies or of certain manufacturers' products and does not imply that they are endorsed, recommended, criticised or otherwise by Trinity College Dublin in preference to others of a similar nature. Errors and omissions excepted. All reasonable precautions have been taken to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall Trinity College Dublin be liable for damages arising from its use.

Author information

Author notes

These authors contributed equally: Dunzhu Li, Yunhong Shi.

Authors and Affiliations

1. AMBER Research Centre and Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin, Ireland

Dunzhu Li, Luming Yang, Daniel K. Kehoe, John J. Boland & Jing Jing Wang

2. Department of Civil, Structural and Environmental Engineering, Trinity College Dublin, Dublin, Ireland

Dunzhu Li, Yunhong Shi, Luming Yang & Liwen Xiao

3. TrinityHaus, Trinity College Dublin, Dublin, Ireland

Liwen Xiao

4. School of Chemistry, Trinity College Dublin, Dublin, Ireland

Yurii K. Gun'ko & John J. Boland

5. BiOrbic Bioeconomy SFI Research Centre, University College Dublin, Dublin, Ireland

Yurii K. Gun'ko

Contributions

J.J.W. and L.X. supervised the project and led the overall effort. D.L., J.J.W., J.J.B. and L.X. wrote the manuscript. J.J.B. contributed to the experimental design and validation. Y.S. and D.L. performed online data mining and analysing. D.L., Y.S. and L.Y. carried out the sample preparation. D.L. and J.J.W. carried out the Raman measurements. D.L., D.K.K. and J.J.W. carried out the AFM and scanning electron microscopy characterization. All authors discussed the results and commented on the manuscript.

Corresponding authors

Correspondence to Liwen Xiao, John J. Boland or Jing Jing Wang.

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Competing interests

The authors declare no competing interests.

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Li, D., Shi, Y., Yang, L. et al. Microplastic release from the degradation of polypropylene feeding bottles during infant formula preparation. Nat Food 1, 746-754 (2020). https://doi.org/10.1038/s43016-020-00171-y
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Microplastic release from the degradation of polypropylene feeding bottles during infant formula preparation - Nature Food

# data[].attributes.attachment_link.description
Polypropylene-based products are commonly used for food preparation and storage, but their capacity to release microplastics is poorly understood. We investigated the potential exposure of infants to microplastics from consuming formula prepared in polypropylene (PP) infant feeding bottles (IFBs). Here, we show that PP IFBs release microplastics with values as high as 16,200,000 particles per litre.

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Avoid Mixing Breastmilk & Infant Formula - information shared by LLL Canada 

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Avoid Mixing Breastmilk & Infant Formula - information shared by LLL Canada 

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Mixing formula and human milk in the same bottle is not recommended, here’s why:

🧪 Different storage rules:

Formula must be discarded right after a feed, but human milk can be safely stored for 1–2 hours. Mixing the two could lead to wasting your milk if the bottle isn’t finished.

🛡️ Loss of protective properties:

Mixing formula with human milk can reduce lysozyme activity, an enzyme that helps protect against harmful bacteria like E. coli.

⚖️ Nutrient interference:

Added components in formula, like iron, may bind to the nutrients in your milk, reducing their absorbability.

💡 Best practice?

Offer human milk and formula separately to preserve the unique benefits of your milk.

La Leche League Canada, to learn more: lllc.ca/should-you-mix-human-milk-formula

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

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This research has found that doing skin to skin immediately after a caesarean birth has improved the breastfeeding outcomes

https://www.sciencedirect.com/science/article/pii/S0020748925000471?ref=pdf_download&fr=RR-9&rr=9408dfdf9db17068

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Thrush - Physician Guide to Breastfeeding

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Thrush Thrush (or yeast infection of the mouth) is uncommon in full term, healthy infants who are exclusively breastfed. It is more common in immunosuppressed infants (for example, very early babies in the NICU). Even if your pediatrician diagnoses or suspects thrush in your infant’s mouth, it is not contagious (the way vaginal yeast infections […]

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We are delighted to announce that PANDAS have collaborated with Neurodivergent Birth CIC to provide a new FREE online resource for neurodivergent people (including professionals and their networks) to help better understand how to access and advocate for support, including knowing your rights and what "reasonable adjustments" are and how they can help.

As Victoria White, Founder and Director of ND Birth says

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Annie Belasco, CEO of The PANDAS Foundation adds

"PANDAS Foundation have noticed an increase in people who may be neurodivergent struggling with their pregnancy and beyond journeys because of a 'one size fits all' model, for their healthcare. Most noticeably, communication styles, and a lack of adjustments made to make the processes easy to understand and process. I am delighted we are able to start to acknowledging the support that parents should have to meet their needs."

You can download the free resource here.

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Neurodivergent Resource - PANDAS Foundation UK

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We are delighted to announce that PANDAS have collaborated with Neurodivergent Birth CIC to provide a new FREE online resource for neurodivergent people (including professionals and their networks) to help better understand how to access and advocate for support, including knowing your rights and what "reasonable adjustments" are and how they can help.

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08451 202 918 Helpline Call Back Service

Leave a message anytime and a LLL Leader (breastfeeding counsellor) will contact you in daylight hours

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ABM - Association of Breastfeeding Mothers

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ABM - Association of Breastfeeding Mothers

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08444 122949

Available 7 Days/week - 9.30am-10.30pm

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08444 124 6647

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Available 7 Days a week - 9.30am-9.30pm

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'Find an IBCLC' A map of IBCLC often in independedint practice (generally not a free service)

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Find an IBCLC Lactation Consultant - Private Practice IBCLCs (generally not a free service)

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Find an IBCLC Lactation Consultant - Private Practice IBCLCs (generally not a free service)

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https://lcgb.org/find-an-ibclc/

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Drip Drop Feeding to encourage baby's suckling

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Drip Drop Feeding to encourage baby's suckling

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35K views · 386 reactions | Drip-drop Feeding Method | Breastfeeding saves lives, especially during emergencies.
Drip-drop feeding is as easy as 1-2-3! We are delighted to co-publish this video about the... | By La Leche League International | Facebook

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Breastfeeding saves lives, especially during emergencies.
Drip-drop feeding is as easy as 1-2-3! We are delighted to co-publish this video about the…

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What training do those that support one's baby feeding journey actually have?

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What training do those that support one's baby feeding journey actually have?

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Baby-Led Breastfeeding                 When the baby feeds from the mother                      

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Baby-Led Breastfeeding                 When the baby feeds from the mother                      

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When the baby feeds from the mother rather than the mother placing her breast into the baby's mouth

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Baby-led attachment is letting baby follow their instincts to find the breast and attach. It can help you get started and overcome breastfeeding challenges.

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6 Don't force your baby to finish the bottle. It's so hard when you know how much work went into making that milk, but one of the great things about breastfeeding is that babies learn to eat when they're hungry and stop when they're done. We have to trust them to do the same thing with the bottle, if their feeding is paced.

My favorite sweet spot for bottle feeds is that baby should take about 5 minutes to eat once ounce/30 mL. So for example, a 3 oz bottle should take a baby about 15 minutes to eat.

If they gulp the feeding down faster than 5 minutes per ounce you want to pace the feed more frequently OR go down one nipple speed.

And more importantly- if it is taking baby much MORE than 5 minutes per ounce, they need less pacing and possibly also need a faster flow nipple.

WARNING! If you are using the Avent Natural Response bottles- which I do NOT recommend for lots of reasons- their nipples have almost no flow. Levels 1-3 of the Avent Natural bottle with the Natural Response nipple have been independently lab tested and all have a flow rate of less than 1 mL/minute, which would mean it would take a baby 30 minutes to eat ONE OUNCE.

This is dangerously slow, especially for newborns who will get exhausted and fall asleep long before they eat a full feeding.

If you have the Avent Naturals bottles and are experiencing problems, as so many other parents are, please contact the company and make your concerns known.

You can learn more and hear other parents' experiences with these bottles here (Instagram post) or here (Facebook post).

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how to give a bottle to a breastfed baby

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Introducing bottles to breastfed babies doesn't have to be complicated or stressful. Here are the simple steps, with examples of good and bad bottle latches.

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What feeding positions work if I'm large breasted?

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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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Navigating parenting as an autistic mother

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Navigating parenting as an autistic mother

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Navigating pregnancy, birth and early parenthood as an autistic mum - Sarah Fisher

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I'm a mum of three but it's only since having my children that I've learnt I'm autistic. Here I share a little about my perinatal journeys.

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Breastfed babies take an average of 570ml to 900ml per day, depending on age. Get advice on how to work out how much breast milk to express for your baby.

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Does this mean the baby has wind?

There is no strong scientific evidence to support the idea that a blue top lip in a baby is directly linked to being windy or gassy.

However, here’s what we do know:

Common Causes of a Blue Top Lip in Babies

1. Circulation Changes:

Many newborns and young infants experience acrocyanosis = a bluish tint to their lips, hands, or feet due to immature circulation.

This is generally harmless and resolves as they grow.

2. Feeding Effort:

Some babies may have a mild temporary blue tint around their lips after vigorous sucking, especially if they are slightly breathless from feeding.

3. Cold Exposure:

If a baby is cold, their extremities and lips may appear slightly blue as their circulation prioritises their major organs.

4. Mild Transient Cyanosis/blueness:

Some babies have temporary blue lips after crying, which resolves quickly once they calm down.

Does Wind/Gas Cause a Blue Top Lip?

There is no direct evidence that trapped wind or gas causes a blue top lip.

• However, if gas causes significant discomfort leading to crying or breath-holding spells, a temporary blue tinge may appear around the lips.

Serious Causes to Rule Out

If a baby has a persistent or deep blue lip colour, this may indicate low oxygen levels, which could be caused by:

• Heart problems (e.g., congenital heart defects)

• Breathing difficulties (e.g., respiratory infections, asthma, or reflux aspiration)

• Oxygen deprivation (e.g., sleep apnea, severe anemia)

When to Seek Medical Advice

• If the blue colour does not go away quickly (e.g., within a few minutes).

• If the baby is lethargic, struggling to breathe, or turning blue elsewhere.

• If there are other symptoms like poor feeding, weight loss, or frequent breath-holding spells.

If you notice a persistent blue top lip, it’s best to get it checked by a doctor to rule out any underlying concerns.

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Guest blog: “Is this normal?” The first week with a breastfeeding newborn - Baby Friendly Initiative

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In this guest blog, lactation consultant Emma Pickett explores what’s “normal” in the first week with a newborn, and encourages mums to trust their baby and their own instincts.

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Learning something new - the first 20hrs

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Learning something new - the first 20hrs

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The first 20 hours -- how to learn anything | Josh Kaufman | TEDxCSU

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This guest blog from breastfeeding counsellor Emma Pickett discusses the dangers of promoting a strict feeding schedule at the expense of responsive, flexible infant feeding.
Add your voice to Unicef UK's Change the Conversation campaign, calling on UK governments to take urgent action to protect, promote and support breastfeeding.
Somehow, somewhere, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day.

It seems to matter beyond all logic and reason. They see this magic number - 90 minutes, 2 hours, 3 hours - as a measure of something sacred.

And it's crap.

There are mums sitting at home, relaxing and nesting with their gorgeous new baby. There's a disk from a box set in the DVD player, a cup of tea on the go, a recent chat with a friend. Breastfeeding is going well. Weight gain is fine. Baby is content. But when baby shows hunger cues after only 40 minutes instead of the hoped for 1 hr 30 minutes, their heart sinks and they feel a sense something is fundamentally wrong. They aren't 'doing it right'. Their friend's baby 'goes longer'. Doubts creep in.

As adults, we grab a cup of tea, a glass of water, a sweet, a snack. We respond to our personal cues and we're flexible depending on time of day, the temperature, our mood, our energy levels. Many go to bed with a glass of water or sip from a bottle throughout the day. I don't know any adults that look at their watch and say, "Only 30 minutes till my next sip of water or mint! Not long now". But yet we expect teeny growing babies to be governed by this artificial notion of time.

Basic misconceptions

I spoke to a new mother last week who was perfectly happy with her feeding routine but wondered if she should start to stretch her baby's intervals because 'that's what you do'. When I explained that it wasn't necessarily, she said she was more than happy to go on as she was.

Where do these ideas come from? They don't come from anyone with any breastfeeding education, nor antenatal classes with breastfeeding professionals, nor books written by those trained to support breastfeeding.

They come from popular baby care books and relatives and peers.

They seem to come from a fundamental misunderstanding of the science of breastfeeding and breastmilk production. Often they come from mid-20th century ideas based around the norms of formula-feeding and pseudo-science. And that's all incredibly dangerous.

There are still people out there, surrounded by breastfeeding, who believe that a baby who feeds after 4 hours rather than 3 hours will 'take more milk'. There are people who believe that you need to wait and hold a baby off to let your breasts 'refill'. There are people who believe that when a baby does want to return to the breast after only an hour that must reflect a 'problem' and perhaps the mother even has a supply issue.

It's scary and extremely frustrating that basic messages about how milk production works don't reach the people who need them.

Searching for "normal"

So what is normal? Well, how long have you got? Because there's a lot of normal. A newborn should feed a minimum of 8-12 times in 24 hours. That means some might be going every 3 hours and others will be feeding more frequently than 2 hourly. Some babies may feed every 10 minutes every hour. Some may feed for 10 minutes every 2 hours. Some may feed for 40 minutes every 2 hours. For periods in the day, a younger baby will often cluster feed and not be happy away from the breast for any longer than a few minutes at a time. This natural cluster feeding may dominate an evening.

A very common call to the National Breastfeeding Helpline goes like this: "My baby used to sleep in the evenings and now he's awake for 3-4 hours. The only thing that seems to settle him is the breast. I feel like I must not have enough milk as he's on there for ages. Surely there can't be anything there." As the baby swaps from breast to breast, getting small quantities of very high fat content milk and decompressing at the end of a long day, they know exactly what they are doing.

And soon their patterns will change again. Some babies will start to longer intervals in the day as the months go by. But not all will.

One of the most popular babycare books (which I better not name) gives a strong direction that while frequent feeding might be occasionally acceptable during growth spurts, this holy cow of the interval between feeds matters greatly. A 3 month old baby might be going 3 hourly intervals but if this isn't increasing at 4 months, then oh dear. This same writer believes a woman can measure her milk supply by doing a yield test and using a pump to extract milk which apparently will be the equivalent amount to what her baby extracts during a feed using an entirely different process. What this woman doesn't know about breastfeeding could fill an encyclopaedia.

What I find particularly dangerous about her message that longer intervals are 'better' and 'correct', is that is means new mothers doubt their milk supply with absolutely no justification. And I know from having spent time on the message boards associated with this writer, many mothers will end up supplementing with formula to try and reach these magic numbers of minutes.

Why?

Babies are no longer being exclusively breastfed and parents are not following Department of Health recommendations because of incorrect information in a baby care book.

There are parents who choose to use formula for a whole host of complex reasons. Some do so happily and some do so miserably. But to do so, merely because you have read a lie in a book, seems tragic to me.

Our knowledge about breasts has been transformed over the last 20 years. Much of the pioneering work has been done in Australia by scientists like Professor Peter Hartmann and Dr Donna Geddes, Steven Daly and their teams.

We used to think most women had a pretty similar number of milk ducts but the ultrasound research revealed there were less than previously thought and the range was big. One woman had 4 ducts at the nipple. One had 18.

But it's the findings about breast storage capacity that we need to talk about here. When a baby feeds, some milk is manufactured during the feed itself and some is taken from milk that has been stored in the breasts between feeds.

Ultrasound revealed that a mother's storage capacity cannot be guessed from breast size. Breast size is obviously not just about glandular tissue. The range in breast storage capacity was huge.

One mother was able to store about 2.6oz per breast. Another woman stored more than 20oz. That's not a typo.

Women with a smaller breast storage capacity had a healthy milk production over a 24 hr period and their babies had good weight gain. But their babies might need to feed more frequently to access this healthy milk production.

Is this a mother with a supply problem?

No, it is not.

Her baby may continue to feed 2 hourly or even more frequently for a few months during the day, cluster feed at certain points and perhaps continue to wake a couple of times hungry at night. Her friend's baby may settle into a pattern of feeding less frequently over a 24 hour period. This friend's baby may not be receiving more milk overall.

When breasts are fuller, milk production slows. When breasts are emptier, we make more milk. When babies feed more frequently and from emptier breasts, they receive milk with a higher fat content. Frequent feeding has value. And as human milk has a fat content of around 3-5% compared to some mammals who have a fat content of 40% +, it seems pretty clear we're designed as a species to need feeding more frequently.

But let's imagine the mother with the smaller breast storage capacity has read this baby care book. She might become distressed that her baby still wants to feed 2 hourly. She might even try and stretch the interval between feeds in the mistaken belief this will increase her baby's intake. And in doing so, her breasts spend longer at full storage capacity and their milk production slows and her breasts receive the signal to decrease milk supply.

So in her attempt to stretch between feeds as the advice she is reading suggests she does, she may actually be decreasing her overall milk production in 24 hours and be doing some actual harm.

So what should we suggest to this mum who never seems to be able to stretch her baby to longer intervals in the ways that her friends seem able?

First off, we should congratulate her for responding to her baby's cues. Thankfully she knew not to try and impose some routine early on and therefore her milk supply is at its maximum capacity. Let's check breastfeeding is otherwise going well: that feeds are comfortable for her, baby does settle for periods of contentment after a feed (though it may only be an hour or even less, rather than 3), weight gain and nappies are fine and latching and positioning is at maximum efficiency. If all this is true, and never reaching a magic 'interval' is her only concern, then we need to make sure she knows as much as possible about how milk production works. It is possible she is one of the mothers who has a minimal breast storage capacity and she will need to feed more in 24 hours to maximise the volume of milk her baby receives. And there might be nothing she can do about that. What happens next is about acceptance and support and attitude.

She has to keep that up for ideally around 6 months if her baby is going to get the full benefits of exclusive breastfeeding. She might need greater support with feeding outside the home - perhaps learning how to feed in a sling or experiment with different positions for different environments. It's possible she may be woken at night more than her friend with the longer intervals - though we would expect night time intervals to be longer and for her to get a block of longer rest. She may benefit from support on safe bed-sharing practices.

And it is just a matter of months. After solids have been established, patterns will change. It's surprising what we can cope with for just a few months. We have jars of pickle in our fridge significantly older than that. We may even have toothbrushes that are around that long. In terms of an adult lifetime, it's a blink of an eye.

What won't help these mothers is the relentless message that they just need to stretch their baby a little more. That if they leave him to cry for 15 minutes, magically he will take more milk and life will change. That just isn't what science tells us is true for all women.

Responsive feeding: So much more than milk

Of course breastfeeding isn't just about milk anyway. Apparently there are people who think that a baby comes to a breast primarily to get milk but I've not met a parent of a baby who thinks that's true. Just as we don't measure our sips of water, sweets and snacks, we also don't measure every time our family smiles warmly at us, communicates with us, looks for comfort, hugs us, checks in, helps us to feel safe. No smart phone app can measure all the complexities of our relationship with our baby and all the things that responsive feeding can do. You are trying to count and measure love.

And I'm talking about myself here, by the way. My children under 6 months never went longer than 2 hours between feeds in the day and not much longer at night. My red record book records me feeding at 3 months every 90 minutes or so. So I learnt to feed while babywearing. I went to friendly groups and friendly places and met up with people at home. I read about safe co-sleeping practices which I know beyond a shadow of a doubt saved my bacon. And thankfully, I never felt anything was 'wrong'. I just trusted my body. I trusted my baby and we worked as a beautiful team. I sat at home on the sofa and fed relatively frequently, enjoyed my box sets and my healthy and not-so-healthy snacks and that was OK.

It really wasn't for long. But the benefits of exclusive breastfeeding will be.

Why should a watch or clock tell me how to be a mother? I'd rather pay attention to my baby.
Sources

Anatomy of the lactating human breast redefined with ultrasound imaging. DT Ramsay, JC Kent, RA Hartmann, and PE Hartman. 2005.

The magic number and long-term milk production. Nancy Mohrbacher IBCLC

Studies on Human Lactation: Development of the computerized breast measurement system. D.B Cox, R.A Owens, Peter E. Hartmann

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Guest blog: Breastfeeding: The dangerous obsession with the infant feeding interval - Baby Friendly Initiative

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Advice that babies must follow a strict three-hourly breastfeeding routine is causing mothers distress and guilt,and reducing breastfeeding rates.

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In this video, we look at the importance of developing close and loving relationships with babies in their early days and weeks.

Responding to babies' needs for comfort and food is hugely beneficial for brain development and makes for more confident toddlers. Parents should be supported in breastfeeding responsively and keeping their babies close to help them become happy, healthy and secure children and adults.

For more information:

Find more relationship building resources

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The Importance of relationship building video - Baby Friendly Initiative

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This video looks at the importance of developing close, loving relationships with babies in their early days and weeks.

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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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Using a Responsive Baby Feeding Technique

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Using a Responsive Baby Feeding Technique

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RELAXATION - The more relaxed the mum the more relaxed the baby

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RELAXATION - The more relaxed the mum the more relaxed the baby

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Using a Suplemntary Nursing Sysytem (SNS)

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Using a Suplemntary Nursing Sysytem (SNS)

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An at-breast supplementer, nursing supplementer or ‘supply line’ allows a mother to feed her baby supplemental milk at the breast. It

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NCT Parent Hub - Pregnancy and parenting information exclusively for NCT Antenatal course attendees.

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First Steps Nutrition Trust - information on recommended good practices during pregnancy and for babies at different ages

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Breastmilk is the bespoke food for a human infant. Breastfeeding ensures all the infants' nutrient needs are met, encourages optimum infant development, facilitates mother and child bonding, and protects the infants' and mothers' health in the short and long term.
In order to protect breastfeeding and support families who use formula it is important that all those who offer advice to families have accurate and unbiased information about infant feeding, including clear information about infant formula.

We also provide information and advice on eating well for new mothers, particularly those who are breastfeeding, and information and practical advice on introducing solid foods to babies, with recipes and photos to show the sorts of foods, and amounts of foods, that will give them a good start to their eating journey. On this webpage you can also find our eating well guide for vegan infants and under 5s, a recipe book with simple, cost-effective ideas for the whole family and a poster which provides a simple guide to eating well for infants.

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Eating Well resources - First Steps Nutrition Trust

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The resources produced by First Steps Nutrition Trust provide help and support for pregnancy, infants and new mums, and young children up to five years.

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Stopping BF - some suggested stratergies 

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Stopping BF - some suggested stratergies 

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Some how, some where, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day.

It seems to matter beyond all logic and reason. They see this magic number - 90 minutes, 2 hours, 3 hours - as a measure of something sacred.

And it's crap.

There are mums sitting at home, relaxing and nesting with their gorgeous new baby. There's a disk from a box set in the DVD player, a cup of tea on the go, a recent chat with a friend. Breastfeeding is going well. Weight gain is fine. Baby is content. But when baby shows hunger cues after only 40 minutes instead of the hoped for 1hr 30 minutes, their heart sinks and they feel a sense something is fundamentally wrong. They aren't 'doing it right'. Their friend's baby 'goes longer'. Doubts creep in.

As adults, we grab a cup of tea, a glass of water, a sweet, a snack. We respond to our personal cues and we're flexible depending on time of day, the temperature, our mood, our energy levels. Many go to bed with a glass of water or sip from a bottle throughout the day. I don't know any adults that look at their watch and say, 'Only 30 minutes till my next sip of water or mint! Not long now'. But yet we expect teeny growing babies to be governed by this artificial notion of time.

I spoke to a new mother last week who was perfectly HAPPY with her feeding routine but wondered if she should start to stretch her baby's intervals because 'that's what you do'. When I explained that it wasn't necessarily, she said she was more than happy to go on as she was.

Where do these ideas come from? They don't come from anyone with any breastfeeding education, nor antenatal classes with breastfeeding professionals, nor books written by those trained to support breastfeeding.

They come from popular baby care books and relatives and peers.

They seem to come from a fundamental misunderstanding of the science of breastfeeding and breastmilk production. Often they come from mid-20th century ideas based around the norms of formula-feeding and pseudo-science. And that's all incredibly dangerous.

There are still people out there, surrounded by breastfeeding, who believe that a baby who feeds after 4 hours rather than 3 hours will 'take more milk'. There are people who believe that you need to wait and hold a baby off to let your breasts 'refill'. There are people who believe that when a baby does want to return to the breast after only an hour that must reflect a 'problem' and perhaps the mother even has a supply issue.

It's scary and extremely frustrating that basic messages about how milk production works don't reach the people who need them.

So what is normal? Well, how long have you got? Because there's a lot of normal. A newborn should feed a minimum of 8-12 times in 24 hours. That means some might be going every 3 hours and others will be feeding more frequently than 2 hourly. Some babies may feed every 10 minutes every hour. Some may feed for 10 minutes every 2 hours. Some may feed for 40 minutes every 2 hours. For periods in the day, a younger baby will often cluster feed and not be happy away from the breast for any longer than a few minutes at a time. This natural cluster feeding may dominate an evening.

A very common call to the National Helpline goes like this: "My baby used to sleep in the evenings and now he's awake for 3-4 hours. The only thing that seems to settle him is the breast. I feel like I must not have enough milk as he's on there for ages. Surely there can't be anything there." As the baby swaps from breast to breast, getting small quantities of very high fat content milk and decompressing at the end of a long day, they know exactly what they are doing.

And soon their patterns will change again. Some babies will start to longer intervals in the day as the months go by. But NOT all will.

One of the most popular baby care books (which I better not name) gives a strong direction that while frequent feeding might be occasionally acceptable during growth spurts, this holy cow of the interval between feeds matters greatly. A 3 month old baby might be going 3 hourly intervals but if this isn't increasing at 4 months, then oh dear. This same writer believes a woman can measure her milk supply by doing a yield test and using a pump to extract milk which apparently will be the equivalent amount to what her baby extracts during a feed using an entirely different process. What this woman doesn't know about breastfeeding could fill an encyclopaedia.

What I find particularly dangerous about her message that longer intervals are 'better' and 'correct', is that is means new mothers doubt their milk supply with absolutely no justification. And I know from having spent time on the message boards associated with this writer, many mothers will end up supplementing with formula to try and reach these magic numbers of minutes.

Why?

Babies are no longer being exclusively breastfed and parents are not following Department of Health recommendations because of incorrect information in a baby care book.

There are parents who choose to use formula for a whole host of complex reasons. Some do so happily and some do so miserably. But to do so, merely because you have read a lie in a book, seems tragic to me.

Our knowledge about breasts has been transformed over the last 20 years. Much of the pioneering work has been done in Australia by scientists like Professor Peter Hartmann and Dr. Donna Geddes, Steven Daly and their teams.

We used to think most women had a pretty similar number of milk ducts but the ultrasound research revealed there were less than previously thought and the range was big. One woman had 4 ducts at the nipple. One had 18.

But it's the findings about breast storage capacity that we need to talk about here. When a baby feeds, some milk is manufactured during the feed itself and some is taken from milk that has been stored in the breasts between feeds.

Ultrasound revealed that a mother's storage capacity cannot be guessed from breast size. Breast size is obviously not just about glandular tissue. The range in breast storage capacity was huge.

One mother was able to store about 2.6oz per breast. Another woman stored more than 20oz. That's not a typo.

Women with a smaller breast storage capacity had a healthy milk production over a 24 hr period and their babies had good weight gain. But their babies might need to feed more frequently to access this healthy milk production.

Is this a mother with a supply problem?

No, it is not.

Her baby may continue to feed 2 hourly or even more frequently for a few months during the day, cluster feed at certain points and perhaps continue to wake a couple of times hungry at night. Her friend's baby may settle into a pattern of feeding less frequently over a 24 hour period. This friend's baby may not be receiving more milk overall.

When breasts are fuller, milk production slows. When breasts are emptier, we make more milk. When babies feed more frequently and from emptier breasts, they receive milk with a higher fat content. Frequent feeding has value. And as human milk has a fat content of around 3-5% compared to some mammals who have a fat content of 40% +, it seems pretty clear we're designed as a species to need feeding more frequently.

But let's imagine the mother with the smaller breast storage capacity has read this baby care book. She might become distressed that her baby still wants to feed 2 hourly. She might even try and stretch the interval between feeds in the mistaken belief this will increase her baby's intake. And in doing so, her breasts spend longer at full storage capacity and their milk production slows and her breasts receive the signal to decrease milk supply.

So in her attempt to stretch between feeds as the advice she is reading suggests she does, she may actually be decreasing her overall milk production in 24 hours and be doing some actual harm.

So what should we suggest to this mum who never seems to be able to stretch her baby to longer intervals in the ways that her friends seem able?

First off, we should congratulate her for responding to her baby's cues. Thankfully she knew not to try and impose some routine early on and therefore her milk supply is at its maximum capacity. Let's check breastfeeding is otherwise going well: that feeds are comfortable for her, baby does settle for periods of contentment after a feed (though it may only be an hour or even less, rather than 3), weight gain and nappies are fine and latching and positioning is at maximum efficiency. If all this is true, and never reaching a magic 'interval' is her only concern, then we need to make sure she knows as much as possible about how milk production works. It is possible she is one of the mothers who has a minimal breast storage capacity and she will need to feed more in 24 hours to maximise the volume of milk her baby receives. And there might be nothing she can do about that. What happens next is about acceptance and support and attitude.

She has to keep that up for ideally around 6 months if her baby is going to get the full benefits of exclusive breastfeeding. She might need greater support with feeding outside the home - perhaps learning how to feed in a sling or experiment with different positions for different environments. It's possible she may be woken at night more than her friend with the longer intervals - though we would expect night time intervals to be longer and for her to get a block of longer rest. She may benefit from support on safe bed-sharing practices.

And it is just a matter of months. After solids have been established, patterns will change. It's surprising what we can cope with for just a few months. We have jars of pickle in our fridge significantly older than that. We may even have toothbrushes that are around that long. In terms of an adult lifetime, it's a blink of an eye.

What won't help these mothers is the relentless message that they just need to stretch their baby a little more. That if they leave him to cry for 15 minutes, magically he will take more milk and life will change. That just isn't what science tells us is true for all women.

Of course breastfeeding isn't just about milk anyway. Apparently there are people who think that a baby comes to a breast primarily to get milk but I've not met a parent of a baby who thinks that's true. Just as we don't measure our sips of water, sweets and snacks, we also don't measure every time our family smiles warmly at us, communicates with us, looks for comfort, hugs us, checks in, helps us to feel safe. No smart phone app can measure all the complexities of our relationship with our baby and all the things that responsive feeding can do. You are trying to count and measure love. That's not going to achieve much other than a flat phone battery. And you could miss out on some magic that you can't go back and live again.

And I'm talking about myself here, by the way. My children under 6 months never went longer than 2 hours between feeds in the day and not much longer at night. My red record books records me feeding at 3 months every 90 minutes or so. So I learnt to feed while babywearing. I went to friendly groups and friendly places and met up with people at home. I read about safe co-sleeping practices which I know beyond a shadow of a doubt saved my bacon. And thankfully, I never felt anything was 'wrong'. I just trusted my body. I trusted my baby and we worked as a beautiful team. I sat at home on the sofa and fed relatively frequently, enjoyed my box sets and my healthy and not-so-healthy snacks and that was OK. It really wasn't for long. But the benefits of exclusive breastfeeding will be.

Why should a watch or clock tell me how to be a mother? I'd rather pay attention to my baby.

Sources:

Anatomy of the lactating human breast redefined with ultrasound imaging. DT Ramsay, JC Kent, RA Hartmann, and PE Hartman. 2005.

The magic number and long-term milk production. Nancy Mohrbacher IBCLC

Studies on Human Lactation: Development of the computerized breast measurement system. D.B Cox, R.A Owens, Peter E. Hartmann

Originally written 2011. Updated July 2016.

The article is featured also in UNICEF: https://www.unicef.org.uk/babyfriendly/breastfeeding-the-dangerous-obsession-with-the-infant-feeding-interval/

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The Dangerous Game of the Feeding Interval Obsession - Emma Pickett IBCLC

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Some how, some where, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day. It seems to matter beyond all logic and reason.

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Kathryn Stagg IBCLC on Instagram: "Nipple thrush. Is it though?

Now if you go to the doctor with sore nipples you will likely come out with a prescription for anti-fungals, antibiotics or sometimes both. This is mainly because most GPs dont really know how to help with the latch. They don't have training on this! We have known for a long time that thrush is very over diagnosed. But is thrush on the nipple even a thing? 

@dr_naomidow_ibclc summarised this thinking in an excellent talk at @lactationconsultantsgb conference

Candida (more commonly known as thrush) thrives in specific conditions: damp, folded over skin, places with friction and increased pH. It cannot invade deeper tissues unless the person is severely immunocompromised. Lactating breasts are highly resistent to infection. And human milk contains lots of "good" bacteria which helps prevent thrush from building up. Thrush is actually not contagious by touch or droplets. Couples are not told to restrain from sex when one has vaginal thrush. Babies can absolutely have thrush in their mouths (although also very over-diagnosed) but it actually will not infect the mother's breast during a feed

So we are now questioning firstly the notion of passing thrush from baby to breastfeeding parent, and whether thrush would actually thrive on the nipple and breast anyway, and if it did, does it actually cause painful feeds?

The symptoms commonly thought of as thrush are often dermatitis, vasospasm/neuropathic pain, or dysbiosis/subacute mastitis

But what if the swab was positive? Low levels of candida are common on people's skin but cause no harm. 80% people have some candida in their mouths that's not causing any issues. Both could be picked up when swabbing a nipple

Why does this matter? Firstly wrong diagnosis means wrong treatment and symptoms won't improve. If they do improve it may due to the anti-inflammatory properties of mamy antifungals. But once stopped, symptoms may return. Some candida is becoming resitent to fluconazole through overuse, just like antibiotic resistance. Candida in immunocompromised people can be life threatening so fluconazole needs to be effective

More info: https://physicianguidetobreastfeeding.org/mythbusters/"

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97 likes, 20 comments - kathrynstaggibclc on September 20, 2024: "Nipple thrush. Is it though?

Now if you go to the doctor with sore nipples you will likely come out with a prescription for anti-fungals, antibiotics or sometimes both. This is mainly because most GPs dont really know how to help with the latch. They don't have training on this! We have known for a long time that thrush is very over diagnosed. But is thrush on the nipple even a thing? 

@dr_naomidow_ibclc summarised this thinking in an excellent talk at @lactationconsultantsgb conference

Candida (more commonly known as thrush) thrives in specific conditions: damp, folded over skin, places with friction and increased pH. It cannot invade deeper tissues unless the person is severely immunocompromised. Lactating breasts are highly resistent to infection. And human milk contains lots of "good" bacteria which helps prevent thrush from building up. Thrush is actually not contagious by touch or droplets. Couples are not told to restrain from sex when one has vaginal thrush. Babies can absolutely have thrush in their mouths (although also very over-diagnosed) but it actually will not infect the mother's breast during a feed

So we are now questioning firstly the notion of passing thrush from baby to breastfeeding parent, and whether thrush would actually thrive on the nipple and breast anyway, and if it did, does it actually cause painful feeds?

The symptoms commonly thought of as thrush are often dermatitis, vasospasm/neuropathic pain, or dysbiosis/subacute mastitis

But what if the swab was positive? Low levels of candida are common on people's skin but cause no harm. 80% people have some candida in their mouths that's not causing any issues. Both could be picked up when swabbing a nipple

Why does this matter? Firstly wrong diagnosis means wrong treatment and symptoms won't improve. If they do improve it may due to the anti-inflammatory properties of mamy antifungals. But once stopped, symptoms may return. Some candida is becoming resitent to fluconazole through overuse, just like antibiotic resistance. Candida in immunocompromised people can be life threatening so fluconazole needs to be effective

More info: https://physicianguidetobreastfeeding.org/mythbusters/". 

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This information is also available in PDF format by clicking here.​
This factsheet is intended to provide access to relevant evidence-based information. The national guidelines, research, data, pharmacokinetic properties and links shared are taken from various reference sources, they were checked at the time of publication for appropriateness and were in date. These are provided where we believe the information may be useful but we do not take any responsibility for their content. The factsheet is provided to empower users to make an informed decision about their treatment; but it does not constitute medical advice and cannot replace medical assessment, diagnosis, treatment or follow up from appropriately trained healthcare professionals with relevant competence.
The Breastfeeding Network factsheets will be reviewed on an ongoing basis, usually within three years or sooner where major clinical updates or evidence are published. No responsibility can be taken by the Breastfeeding Network or contributing authors for the way in which the information is used. If you have any questions about this information, you can contact the Drugs in Breastmilk team through their Facebook page or on druginformation@breastfeedingnetwork.org.uk.
Over the counter medicines
Paracetamol
You can take paracetamol at the normal adult dose as described in the patient information leaflet. Only a very small amount passes into your breastmilk. It is important to not exceed the daily dose of paracetamol. Do not take more than 2 tablets at any one time. Do not take more than 8 tablets in 24 hours. Always read the instructions on the pack before taking.

Branded products include Panadol ® and Solpadeine Headache ®. Most pharmacies also stock own-brands. Paracetamol may also be included in cold remedies and combined pain relief medications. It is important not to take too much by accident - please check the ingredients carefully and ask a pharmacist if you are unsure. For more information on cold remedies and combined medications, see our factsheet on Cough and Cold Remedies.

Some paracetamol-containing medications also contain caffeine in varying amounts. Caffeine passes into your breastmilk. The NHS suggests that you should not have more than 200mg of caffeine per day whilst breastfeeding, including from drinks, as it could make your baby restless or keep them awake, so bear this in mind when choosing which medicine to take. See the NHS page on breastfeeding and diet for more information and to find out how much caffeine is in different foods and drinks.

If your baby needs to take paracetamol suspension (e.g. Calpol ®) whilst you are taking paracetamol, they can do so at their own full and normal dose. The amount that they would get through your breastmilk is too small to be harmful in addition.

Ibuprofen

If you are usually able to take ibuprofen, you can do so at the normal adult dose as described in the patient information leaflet. Only a very small amount passes into your breastmilk.

Branded ibuprofen products include Nurofen ®, Cuprofen ® and Anadin Ultra ®. Most pharmacies also stock own-brands.

Ibuprofen may not be suitable for people with a history of stomach ulcer, as it can cause bleeding, or who have asthma (unless your doctor says it is OK), as it can cause breathing problems. Consult your doctor or pharmacist before using it if you have either of these conditions.

You can take paracetamol and ibuprofen together during breastfeeding if needed, up to their maximum daily doses.

If your baby needs to take ibuprofen suspension (e.g. Nurofen for Children ®) whilst you are taking ibuprofen, they can do so at their own full and normal dose. The amount that they would get through your breastmilk is too small to be harmful in addition.

Aspirin

Products containing aspirin (including Anadin Original ® and Disprin ®) for pain relief are not recommended whilst you are breastfeeding because there is a possible link between aspirin and Reye's syndrome in children, especially if your child has a viral infection or fever. The risk is very low, but as other pain relief options are available, it is best avoided if possible. If you take a single dose of aspirin for pain relief by mistake, you can continue breastfeeding as the risk is very small, but you should not take any more doses. Further information is available from the site www.breastfeeding-and-medication.co.uk here and the NHS here.

If you are concerned, please speak to your doctor, pharmacist or contact our Drugs in Breastmilk Service.

Note: You may be prescribed low-dose aspirin (75-150milligrams once daily) to thin your blood if you have certain medical conditions. This is lower than a pain-relieving dose and is usually compatible with breastfeeding. For more information, see breastfeeding-and-medication.co.uk. If you are taking low dose aspirin you may be advised to be cautious if your breastfed child develops a fever. Please contact the Drugs in Breastmilk service for more support if this happens.

Codeine and dihydrocodeine

Codeine and dihydrocodeine are weak opioids that are available over the counter in combination with other medications described above. Codeine is not recommended when you are breastfeeding. Please see the section on opioids below for more information.

Prescription analgesics

The most widely prescribed analgesics are listed below. However, many combinations are used.
Non-steroidal anti-inflammatory drugs (NSAIDs)
These are generally acceptable during breastfeeding as they transfer only in small amounts into breastmilk.

Ibuprofen is the first-choice anti-inflammatory when breastfeeding as it has been used by many breastfeeding mothers without any reports of problems.

Diclofenac, (Voltarol®) is acceptable when breastfeeding, as it won't stay in your body for long. It has been used by many breastfeeding mothers without reports of problems. Diclofenac gel and eye drops are compatible with breastfeeding. Your doctor will decide if diclofenac is safe for you to take in oral form or by suppository, because diclofenac is avoided in people with some long-term conditions, including heart disease, diabetes or high cholesterol.

Naproxen and indomethacin stay in your body for longer than diclofenac. They are not first choices for NSAID pain relief when you are breastfeeding, especially if your baby is premature or newborn, due to some reports of possible side effects. Other NSAIDs should be considered first, but naproxen or indomethacin can be used with caution if alternatives are not suitable. If your baby gets an upset stomach, vomiting or diarrhoea, or you have any other concerns, speak to your doctor, health visitor or pharmacist.

Celecoxib (Celebrex®) This anti-inflammatory is called a cox 2 inhibitor and has been useful for patients who are at risk of stomach bleeding. It is prescribed less frequently now due to a small increased risk of heart attack or stroke. Your doctor will decide with you if this medicine is suitable for you. The amount of celecoxib passing into breastmilk is thought to be too small to be harmful. However, there is less information on the transfer of these drugs into breastmilk. If you would prefer to avoid them, you can take a traditional NSAID (e.g. ibuprofen or diclofenac) with a proton pump inhibitor (a medicine that reduces stomach acid) such as omeprazole. This is compatible with breastfeeding (see our factsheet on indigestion for more information).

Opioids
This introduction to opioids contains important information. Please read it before looking for your specific medicine information.
Opioids are a type of medicine that provides good relief of moderate to severe acute (short-term) pain. Opioids are effective for short periods and should be used at the lowest effective dose for the shortest time possible. There is limited evidence that they are helpful for long-term pain.

When deciding if you can take opioids whilst breastfeeding, factors to consider include:

which opioid is being considered

how well you are managing your pain

if your baby is healthy

You may prefer to try other types of pain relief first. However, it is important that you can manage your pain, and sometimes opioids will be the most effective option.

Opioids are often described as either "weak opioids" or "strong opioids." All opioids can cause side effects regardless of whether they are "weak" or "strong." The dose of the chosen opioid is important. As the dose increases, so does the likelihood of side effects. All opioids can be addictive, though it is rare for people to become addicted to opioids when taking them for acute pain. You should not take opioids for longer than 3 days without instructions from your doctor.

Opioids may make you feel sleepy, dizzy or confused. Take extra care when looking after your baby if you experience any of these side effects. Medicines that make you drowsy can make bed-sharing less safe. Baby Sleep Info Source (BASIS) has more information on sleep and safety. They recommend that you do not share your bed with your baby after you have taken medication that makes you sleepy.

The law on drugs and driving changed in 2015. It is against the law to drive if you are impaired by your medicine. For more information on whether you can drive whilst taking opioid pain relief, see the gov.uk website or speak to your doctor or pharmacist.

Only a small amount of the drug passes into your breastmilk, but this may sometimes cause side effects in your breastfed child. Whilst you are taking any opioid, you should watch out for these possible side effects in your baby:

Breathing problems / slower breathing

Lethargy

Drowsiness

Poor Feeding

Constipation

Paleness

Take particular care if your baby is under one month old or exclusively breastfed. If you experience side effects yourself whilst taking opioids, it could be more likely that your baby will also experience side effects. Please speak to a doctor or pharmacist for more information. If you notice any side effects in your baby, please seek medical attention as soon as possible.

Opioids can sometimes cause constipation. If you experience constipation, please see our constipation factsheet for more information.

Sometimes opioids are used for chronic pain. This is long-term pain that lasts more than 3 months. There is little evidence that opioids are effective for chronic pain, although some conditions may have some limited benefit. Some people with chronic pain may have the dose of their opioids increased over time for their pain. If your pain is not helped by your opioid you should speak to your doctor. Your local NHS services should have support available for people living with long term pain including support groups, pain clinics and pain management programmes. It is worth asking your doctor for more information if you haven't recently or ever accessed these services.

If you are taking any other regular medicines when you buy an opioid medicine over the counter, let the pharmacist know. If you are being prescribed an opioid, please mention your other medications to your doctor to check if this is ok. Some medicines interact with opioids. This can make driving unsafe (and illegal) and could cause more severe side effects, make you unwell or unable to care for your baby. If you are not sure, you can speak to your local pharmacist or contact the Drugs in Breastmilk team.

If you are experiencing chronic (long-term) pain, cancer pain or are prescribed strong opioids not discussed below, please contact the Drugs in Breastmilk team to discuss this. The information below is relevant to treating short-term pain while breastfeeding otherwise healthy, full-term babies and children.

Weak opioids

Codeine

Codeine is a weak opioid. It is sold over the counter in combination with paracetamol (co-codamol, Solpadeine Plus ®) or ibuprofen (Nurofen Plus ®). It is available on prescription on its own or in higher doses. Products containing codeine are not recommended when you are breastfeeding. Small amounts of codeine can pass through to your baby in your breastmilk and may cause drowsiness or breathing problems. Codeine for pain relief is not recommended for use in children under 12 years.

If you take a single dose of codeine by mistake, you can continue breastfeeding as normal as long as your child is full term and otherwise well, as the risk is small. However, you should not take any more doses and should watch your baby for drowsiness, breathing difficulties, constipation or difficulty feeding.

For more detailed information on codeine and breastfeeding, which is also suitable for healthcare professionals, please see our codeine factsheet.

If you are concerned, please speak to your doctor, pharmacist or contact our Drugs in Breastmilk service.
Dihydrocodeine
Dihydrocodeine is a weak opioid. It is the first choice if you need stronger pain relief than paracetamol or ibuprofen whilst breastfeeding. This is because your body processes it differently to codeine. It is frequently used for pain relief after a caesarean section, and it has been used widely during breastfeeding without problems. You can buy a low dose over the counter in combination with paracetamol (Paramol ®). Higher doses are available on prescription.

Although dihydrocodeine is a safer option than codeine whilst breastfeeding, it is still possible that it could affect your child. To minimise the risk, you should take it at the lowest effective dose, for the shortest time possible. If another, non-opioid pain medication would be effective, you may prefer to use this instead. Please be aware of the information above on opioid use, including precautions and possible side effects, when taking dihydrocodeine.

You should not use dihydrocodeine (Paramol ®) for more than three days without speaking to your doctor.

For more information, see https://breastfeeding-and-medication.co.uk/thoughts/dihydrocodeine-and-breastfeeding.
Tramadol
Tramadol is another opioid that is processed differently in your body to codeine. It is only available on prescription. If you are taking a usual dose, the amount passing into your breastmilk will be much less than the dose that is sometimes given to newborn infants for pain relief and is unlikely to have a negative effect on your baby. Studies in breastfed newborn infants found tramadol did not cause any negative effects. You can use it with caution whilst breastfeeding, at the lowest effective dose, for the shortest time possible, following the precautions for opioids listed above.

Strong opioids

Strong opioids are usually used for only a short period, often after an accident or surgery. You can take some strong opioids for a short time whilst breastfeeding. If you need to use strong opioids over a longer period, please contact the Drugs in Breastmilk team to discuss this.

You can breastfeed after surgery as soon as you are awake enough to hold your baby. You can read more about medicines used during surgery in our anaesthetics factsheet. If you are in hospital your infant feeding team may be able to support you to stay with your baby. Some hospitals already have good policies in place to arrange this. UNICEF and the Association of Anaesthetists advise that women should be encouraged to breastfeed as usual after surgery and that there should be breastfeeding support available.

Opioid medicines can cause side effects, which can make looking after a baby difficult. If you are in too much pain to look after your baby, you may need some help. If you have had surgery, you will usually need someone with you to help look after your baby for at least 24 hours, or sometimes longer if your pain relief is making you sleepy. Someone helping to care for your baby could bring them to you for feeds, allowing you to rest in between.

If you are not able to breastfeed as usual or miss some feeds, you can ask for support from your hospital infant feeding team, who may be able to lend you a hospital grade breast pump. It is important to protect your milk supply and minimise the risk of mastitis. For more information you can read our webpage on expressing and storing breastmilk. You can also contact the National Breastfeeding Helpline for information and support.

Morphine (Oramorph ®, Actimorph ®) is the strong opioid of choice while breastfeeding. It can be used with caution at the lowest effective dose, for the shortest possible duration. Oral morphine is frequently given to mothers after a caesarean section. You can use it with caution when breastfeeding. Morphine does pass into breastmilk and may cause side effects in your child, so it is important that the precautions for opioids given above are followed, especially for babies that are under one month or exclusively breastfed.

Diamorphine is also sometimes used after an operation, but morphine is preferred if you are breastfeeding. You can use it with caution when breastfeeding. Diamorphine does pass into breastmilk and may cause side effects in your child, so it is important that the precautions for opioids given above are followed, especially for babies that are under one month or exclusively breastfed.

For information on any other strong opioids not covered here, please contact the Drugs in Breastmilk team.

Coughs and cold remedies
Constipation
D econgestants

F lu and breastfeeding

Herbal medications
Indigestion
Sore throats

Bibliography

British National Formulary - https://bnf.nice.org.uk/

Drugs and Lactation Database (LactMed®) - https://www.ncbi.nlm.nih.gov/books/NBK501922/

Specialist Pharmacy Service: https://www.sps.nhs.uk/

NHS medicines website: https://www.nhs.uk/medicines/

NHS website: Breastfeeding and medicines: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-and-lifestyle/medicines/

E Lactancia website: https://www.e-lactancia.org/

NICE Clinical Knowledge summaries: https://cks.nice.org.uk/topics/

Hale T. W. Medications in Mothers Milk. www.halesmeds.com

Dr Wendy Jones, Breastfeeding and Medication website: https://breastfeeding-and-medication.co.uk/

SPS: Can breastfeeding mothers take paracetamol or combination paracetamol products? https://www.sps.nhs.uk/articles/can-breastfeeding-mothers-take-paracetamol/

SPS: Using codeine, dihydrocodeine or tramadol during breastfeeding. https://www.sps.nhs.uk/articles/using-codeine-dihydrocodeine-or-tramadol-during-breastfeeding/

Datta P, Rewers-Felkins K, Kallem RR, Baker T, Hale TW. Transfer of Low Dose Aspirin Into Human Milk. J Hum Lact. 2017;33(2):296-299. doi.org/10.1177/0890334417695207

MHRA: Codeine for analgesia: restricted use in children because of reports of morphine toxicity. https://www.gov.uk/drug-safety-update/codeine-for-analgesia-restricted-use-in-children-because-of-reports-of-morphine-toxicity

SPS: Using strong opioid analgesics during breastfeeding. https://www.sps.nhs.uk/articles/using-strong-opioid-analgesics-during-breastfeeding/

NICE clinical knowledge summary: Weak opioids https://cks.nice.org.uk/topics/analgesia-mild-to-moderate-pain/management/weak-opioids/#pregnancy-breastfeeding

Mitchell J, Jones W, Winkley E, Kinsella SM. Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2020;75(11):1482-1493. doi.org/10.1111/anae.15179

Department for Transport Leaflet, New Drug Driving Rules: https://extranet.dft.gov.uk/think-downloads/wp-content/uploads/sites/29/2015/01/150213-10349-DfT-New-Drug-Driving-Rules-A5-Leaflet_DIGITAL-Amended.pdf

©The Breastfeeding Network. Last full review May 2024. Last amended June 2024. Next review due May 2027.

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Pain Relief (Analgesics) and Breastfeeding - The Breastfeeding Network

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This information is also available in PDF format by clicking here.​ This factsheet is intended to provide access to relevant evidence-based information. The national guidelines, research, data, pharmacokinetic properties and links shared are taken from various reference sources, they were checked at the time of publication for appropriateness and were in date.

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A stratergy for getting BF off to a good start

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A stratergy for getting BF off to a good start

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Amoumts of colostrum hand expressed by one mother - before and afler birth

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Amoumts of colostrum hand expressed by one mother - before and afler birth

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Cannabis and Breastfeeding | La Leche League Canada - Breastfeeding Support and Information

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A WhatsApp Group set up by an NCT Practitioner that is open to all solo parents - please join

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The West Midlands Organisations | singleparents.org.uk

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Acacia provides telephone support and a weekly befriending service for mothers and their families affected by pre or post natal depression across North Birmingham.
Acacia Dads is a free support service for dads and other family members who feel they may need some extra help and support after the birth of a child or help in finding ways to support their partner who may be experiencing Postnatal depression.
Services also include creche facilities, pamper service for mums attending post natal support sessions, baby massage classes, resource library and family fun sessions.

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Support. Understanding. Friendship.

WAY is a UK charity that offers a peer-to-peer support network for anyone who's lost a partner before their 51st birthday - married or not, with or without children, inclusive of sexual orientation, gender, race and religion.
Donate via JustGiving
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Join hundreds of others who get what you're going through.

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WAY Widowed & Young - Bereavement support UK

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WAY is the only national charity in the UK for men and women aged 50 or under when their partner died.

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Our relationships affect every aspect of our lives. To learn how to make yours work better, create a free account - share questions and stories with the community, try fun and helpful activities, or get private support from a Click listener.

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Our relationships affect every aspect of our lives. To learn how to make yours work better, create a free account - share questions and stories with the community, try fun and helpful activities, or get private support from a Click listener.

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Connect with local like-minded single parents and the wider Frolo community for friendship, support & meetups.